***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Purpose In an ongoing prospect i ve multicenter r and omised placebo-controlled trial we study the adjuvant use of intravitreal dexamethasone in the treatment of patients with suspected bacterial endophthalmitis after phacoemulsification . In accordance with the study protocol , a mid- inclusion interim analysis of the safety of the study drug was performed . Patients and methods Patients with suspected endophthalmitis after phacoemulsification were asked to participate in this study . A diagnostic vitreous biopsy was taken and the patients received intravitreal injections of 400 micrograms dexamethasone or a placebo , plus 0.2 mg vancomycin and 0.05 mg gentamicin . Injections were repeated after 3 or 4 days . The safety analysis included : the number of eyes with an evisceration ; no light perception ; or a visual acuity of less than 5/200 . Treatment outcome was evaluated in terms of : the percentage of patients with a visual acuity of 20/40 or more and 20/100 or more . Results The interim analysis included 81 patients with at least 1 year follow-up . Sixty-three patients ( 65 % ) were culture-positive . Safety analysis : 7 eyes were eviscerated ( 3 dexamethasone , 4 placebo ) ; 4 eyes had no light perception ( 2 dexamethasone , 2 placebo ) ; and 4 eyes had less than 5/200 vision ( 3 dexamethasone , 1 placebo ) . Treatment outcome : 70 % of patients had a visual acuity of at least 20/40 . Conclusion The safety analysis does not warrant premature discontinuation of the study . So far , the overall outcome of our treatment regimen , consisting of merely a diagnostic biopsy instead of a vitrectomy and an optimized antibiotic dosing , compares favourably to published literature Purpose To determine the effects of intravitreal dexamethasone in patients with exogenous fungal endophthalmitis . Methods Twenty cases of culture-proven exogenous fungal endophthalmitis following cataract surgery ( 11/20 ) and trauma ( 9/20 ) were retrospectively analysed for pre- and postoperative visual acuity , anterior chamber and vitreous inflammation and media clarity . All patients were managed with pars plana vitrectomy with intravitreal amphotericin ? and oral ketoconazole with ( steroid plus group ) or without ( steroid minus group ) intravitreal dexamethasone . Results were analysed by Fisher 's exact test . Results Following vitrectomy 9 of 20 patients ( 45 % ) achieved a visual acuity better than counting fingers at 3 m. No statistically significant difference was observed in anatomical and visual outcome between the steroid plus and steroid minus groups , though the number of patients with favourable visual outcome was greater in the steroid plus group . Rate of clearance of inflammation was better in the steroid plus group ( 40 ± 15.5 vs 55 ± 8.6 days ) . All patients ( 6/20 ) with pre-operative vision better than counting fingers showed good anatomical and visual outcome in both groups . Conclusions The results of our retrospective study suggest that steroids may be beneficial in promoting faster clearance of inflammation in fungal endophthalmitis . Sensitivity of the fungi to antifungals , dose and timing of steroid and institution of effective antifungal medication prior to the use of steroids are the essential factors which need to be examined further in a prospect i ve manner AIM To evaluate the efficacy of intravitreal dexamethasone co-administered with intravitreal antibiotics along with vitrectomy in the management of exogenous bacterial endophthalmitis . METHODS In a prospect i ve r and omised clinical trial , 63 patients ( 63 eyes ) with suspected bacterial endophthalmitis ( postoperative and post-traumatic ) were treated with vitrectomy and intravitreal antibiotics and r and omised to intravitreal dexamethasone ( IOAB with = 29 eyes ) and no dexamethasone ( IOAB without = 34 eyes ) . Inflammation score ( IS ) and visual acuity were measured by two masked observers before surgery , and at 1 , 4 , and 12 weeks after surgery in both the groups . RESULTS There was significant reduction ( p < 0.0001 ) in IS at 1 , 4 , and 12 weeks after the surgery in the “ IOAB with ” group ; there was temporary but significant increase ( p < 0.01 ) in IS at 1 week in the “ IOAB without ” group , before decline ( p < 0.001 ) of IS at 4 and 12 weeks . The magnitude and relative percentage change in IS between the two groups were found to be significant at 1 ( p < 0.0001 ) , and 4 ( p < 0.01 ) weeks , and not at 12 weeks . The visual acuity at 12 weeks was comparable in both the IOAB with and IOAB without groups . CONCLUSION Intravitreal dexamethasone helps in early reduction of inflammation in exogenous bacterial endophthalmitis , but has no independent influence on the visual outcome . In selected patients with endophthalmitis where oral corticosteroids can not be given for medical reasons intravitreal corticosteroids could be beneficial ; in other situations they could be complementary to oral corticosteroid therapy OBJECTIVE To analyze the data for cultures and Gram stains prospect ively collected by protocol in the Endophthalmitis Vitrectomy Study . DESIGN Cultures of aqueous , undiluted vitreous , and ( for patients who underwent vitrectomy ) vitrectomy cassette fluid  obtained from 420 patients were prepared on chocolate agar , in thioglycolate broth , and on Sabouraud dextrose agar ; Gram stains of the aqueous and undiluted vitreous were made . Criteria were devised to distinguish true pathogens ( confirmed positive cultures ) from contaminants . SETTING Private and university-based retina-vitreous practice s and corresponding microbiology laboratories . RESULTS Compared with the aqueous , undiluted vitreous produced a higher percentage of confirmed positive cultures and higher colony counts on chocolate agar and was more frequently the only source of a positive culture from the eye . Nevertheless , the aqueous and vitrectomy cassette fluid were the only source of a positive culture from the eye in 4.2 % and 8.9 % of eyes , respectively . The overall yields of chocolate agar and thioglycolate broth were similar . A positive Gram stain from the aqueous or undiluted vitreous was highly predictive of a positive culture from the eye , but a negative Gram stain had little predictive value for the culture result . The overall rate of laboratory-confirmed infection was not statistically significantly higher in the vitrectomy group than in the tap or biopsy group . CONCLUSIONS The vitreous was a richer source of positive cultures and high colony counts than was the aqueous , either because it is more supportive of bacterial growth or because a somewhat larger inoculum of the vitreous than of aqueous could be obtained . The result of Gram stain should not determine the choice of antibiotic drugs in the treatment of endophthalmitis . Vitrectomy , with culture of the vitrectomy cassette fluid , did not produce significantly more positive cultures than tap or biopsy material , and the procedure should not be performed to improve the microbiological yield Purpose To study whether intravitreal dexamethasone as adjuvant to intravitreal antibiotics improves the outcome in patients with suspected postoperative bacterial endophthalmitis . Design Prospect i ve r and omized clinical trial . Setting Tertiary referral center . Patient population Twenty-nine consecutive patients with suspected postoperative bacterial endophthalmitis within 6 weeks of cataract surgery . Intervention Patients underwent a vitreous biopsy followed by intravitreal injection of antibiotics ( 0.2 mg vancomycin and 0.05 mg gentamicin ) and 400 μg dexamethasone or placebo . After 3–4 days the intravitreal injection of antibiotics and dexamethasone or placebo was repeated Primary outcome measureS nellen visual acuity at 3 and 12 months after treatment . Results In 20/29 patients ( 69 % ) the vitreous cultures were positive . 13/29 patients received dexamethasone . Seven patients had a functionally lost eye ( final vision of h and movements or less ) , in four due to retinal detachment . Visual acuity tended to be better in the dexamethasone treated patients than in those given placebo , at both 3 months ( P=0.055 ) and 12 months ( P=0.080 ) . Conclusion This small prospect i ve , placebo-controlled series showed a trend towards a better visual outcome in patients with suspected bacterial endophthalmitis when treatment with intravitreal antibiotics was combined with intravitreal dexamethasone . Our findings justify a larger multicenter r and omized study Aim To evaluate the use of intravitreal dexamethasone as adjunctive therapy in the treatment of presumed bacterial endophthalmitis . Design Prospect i ve , double masked , r and omised placebo-controlled clinical trial . Methods Patients with ‘ post cataract surgery ’ , ‘ bleb-related ’ and ‘ other ’ endophthalmitis were grouped and r and omised to receive intravitreal ceftazidime ( 2.225 mg/0.1 ml ) , vancomycin ( 1 mg/0.1 ml ) , and either dexamethasone ( 0.4 mg/0.1 ) or placebo . All underwent vitreous and aqueous sampling for microbiological analysis . Injections were repeated after 48 h if necessary . The primary outcome measure was Snellen visual acuity on presentation , within the first 14 days post injection , and at 2–4 months . Results 62 patients completed the protocol from 2001 to 2005 . Thirty patients received intravitreal dexamethasone and 32 received intravitreal placebo . There was no statistically significant difference in the visual outcomes of either group with a mean 2.79 Snellen lines improvement of the intravitreal dexamethasone group versus 1.8 lines in the placebo group . Subgroup analysis suggested a clinical trend to better visual acuity in the post cataract steroid subgroup with mean 4.1 lines improvement versus 2.7 in the placebo group ( p=0.33 ) . No adverse events attributable to the dexamethasone were reported . Conclusions Intravitreal dexamethasone appears safe and may be of benefit in post cataract surgery bacterial endophthalmitis PURPOSE To determine the microbiologic spectrum and antibiotic susceptibilities of infecting organisms in postoperative endophthalmitis and to evaluate the effects of operative factors on the microbiologic spectrum . METHODS Patients with bacterial endophthalmitis presenting within six weeks of cataract extraction or secondary intraocular lens implantation ( IOL ) were evaluated .  Cultures and Gram stains were performed on intraocular specimens and susceptibility tests on the isolates . RESULTS Confirmed microbiologic growth was demonstrated from intraocular specimens from 291 of 420 patients ( 69.3 % ) . Gram-positive bacteria were isolated from 274 patients ( 94.2 % ) with confirmed growth and gram-negative bacteria from 19 ( 6.5 % ) . Two hundred twenty-six of the 323 isolates obtained ( 70.0 % ) were gram-positive , coagulase-negative micrococci , 32 ( 9.9 % ) Staphylococcus aureus , 29 ( 9.0 % ) Streptococcus species , seven ( 2.2 % ) Enterococcus species , ten ( 3.1 % ) miscellaneous gram-positive species , and 19 ( 5.9 % ) gram-negative species . All gram-positive isolates tested were susceptible to vancomycin . Seventeen gram-negative isolates ( 89 % ) were susceptible to both amikacin and ceftazidime and two ( 11 % ) were resistant to both . Anterior chamber or secondary IOL implantations were associated with higher rates of infection with gram-positives other than coagulase-negative micrococci than were posterior chamber IOL implantations ( P = .022 ) or primary cataract extraction s ( P = .024 ) . CONCLUSIONS Gram-positive , coagulase-negative micrococci predominated in this series . Vancomycin was active against all gram-positive isolates tested . Amikacin and ceftazidime showed equivalent activity against gram-negative isolates . Secondary or anterior chamber lens implantations were associated with a possible spectrum shift toward gram-positive organisms other than the coagulase-negative micrococci Purpose To study intravitreal dexamethasone and vancomycin concentrations , when used together in patients with suspected postoperative bacterial endophthalmitis . Animal studies had suggested that dexamethasone might decrease the concentration of vancomycin . Design Prospect i ve r and omized clinical trial in a tertiary referral center . Methods Twenty-nine consecutive patients with suspected postoperative bacterial endophthalmitis underwent a vitreous biopsy  followed by intravitreal injection of antibiotics ( 0.2 mg vancomycin , 0.05 mg gentamicin ) and 400 μ 
    Output:
    
A combined analysis of two studies suggests adjunctive steroids may provide a higher probability of having a good visual outcome at three months than not using adjunctive steroids .
However , considering that most of the confidence intervals crossed the null and that this review was limited in scope and applicability to clinical practice , it is not possible to conclude whether the use adjunctive steroids is effective at this time .