The effect of a preoperative subconjuntival injection of dexamethasone on blood-retinal barrier breakdown following scleral buckling retinal detachment surgery: a prospective randomized placebo-controlled double blind clinical trial

Graefes Arch Clin Exp Ophthalmol. 2010 Jul;248(7):957-62. doi: 10.1007/s00417-010-1319-8. Epub 2010 Feb 25.


Background: Blood-retinal barrier breakdown secondary to retinal detachment and retinal detachment repair is a factor in the pathogenesis of proliferative vitreoretinopathy (PVR). We wished to investigate whether an estimated 700 to 1000 ng/ml subretinal dexamethasone concentration at the time of surgery would decrease the blood-retinal barrier breakdown postoperatively.

Methods: Prospective, placebo-controlled, double blind clinical trial. In 34 patients with rhegmatogenous retinal detachment scheduled for conventional scleral buckling retinal detachment surgery, a subconjunctival injection of 0.5 ml dexamethasone diphosphate (10 mg) or 0.5 ml placebo was given 5-6 hours before surgery. Differences in laser flare photometry (KOWA) measurements taken 1, 3 and 6 weeks after randomisation between dexamethasone and placebo were analysed using mixed model ANOVA, while correcting for the preoperative flare measurement.

Results: Six patients did not complete the study, one because of recurrent detachment within 1 week, and five because they missed their postoperative laser flare visits. The use of dexamethasone resulted in a statistically significant decrease in laser flare measurements at the 1-week postoperative visit.

Conclusion: The use of a preoperative subconjunctival injection of dexamethasone decreased 1-week postoperative blood-retina barrier breakdown in patients undergoing conventional scleral buckling retinal detachment surgery. This steroid priming could be useful as a part of a peri-operative regime that would aim at decreasing the incidence of PVR.

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Blood-Retinal Barrier / drug effects*
  • Blood-Retinal Barrier / metabolism
  • Blood-Retinal Barrier / pathology
  • Combined Modality Therapy
  • Conjunctiva
  • Dexamethasone / administration & dosage*
  • Double-Blind Method
  • Female
  • Follow-Up Studies
  • Glucocorticoids / administration & dosage
  • Humans
  • Injections, Intraocular
  • Lasers
  • Male
  • Middle Aged
  • Photometry
  • Placebos
  • Postoperative Complications / prevention & control
  • Preoperative Care / methods
  • Retinal Degeneration* / drug therapy
  • Retinal Degeneration* / metabolism
  • Retinal Degeneration* / surgery
  • Scleral Buckling*
  • Vitreoretinopathy, Proliferative / prevention & control*
  • Young Adult


  • Glucocorticoids
  • Placebos
  • Dexamethasone

Associated data

  • ISRCTN/ISRCTN31308983