Abstract
We performed a systematic review and meta-analysis to determine whether the use of local antibiotics is a beneficial prophylactic treatment for endophthalmitis in patients treated with anti-VEGF agents. We searched the MEDLINE and EMBASE databases, and the Cochrane Library over the period January 2007 to December 2016. The search terms used included “Endophthalmitis”, “Antibiotic” and “Intravitreal injection”. Studies in which the patients were treated exclusively with intravitreal injections of anti-VEGF were selected. Eight studies fit the inclusion criteria, which included a total of 276,774 injections; 109,178 (39.45%) were associated with the use of antibiotics and 114,821 (60.55%) were not associated with the use of antibiotics. Our meta-analysis indicated a significant risk for endophthalmitis that was 1.70 times greater with the use of antibiotics than that without antibiotics, with a confidence interval of 1.08 to 2.66 (p = 0.02). A meta-regression indicated that the location (operating rooms versus outpatient clinics) of injection did not have a significant effect on the incidence of endophthalmitis. The prophylactic use of antibiotics when administering anti-VEGF intravitreal injections may contribute to a greater incidence of endophthalmitis. This finding, in addition to reducing costs, would eliminate a treatment that has been shown to be unnecessary and even harmful to patients.
Highlights
Intravitreal anti-vascular endothelial growth factor (VEGF) therapy is frequently used as one of the main treatments for many retinal pathologies, including age-related macular degeneration[1], diabetic macular edema[1,2] and retinal vein occlusion[3]
In cases of endophthalmitis with and without antibiotic prophylaxis, staphylococcus and streptococcus were the most frequent microorganisms identified in culture-proven endophthalmitis
In six of the studies, the injections were administered in an operating room, and in the two remaining studies, the injections were administered in outpatient clinics
Summary
Intravitreal anti-vascular endothelial growth factor (VEGF) therapy is frequently used as one of the main treatments for many retinal pathologies, including age-related macular degeneration (exudative)[1], diabetic macular edema[1,2] and retinal vein occlusion[3]. The only preventive measure with some consensus regarding its effectiveness is the application of povidone-iodine to the ocular surface prior to injection, which is the only effective prophylactic measure supported by clinical trials[6] Other measures, such as the use of gloves, a blepharostat or masks and the setting where injection was given (operating rooms or outpatient clinics), remain controversial[7,8]. No consensus exists regarding the benefits of antibiotic prophylaxis of endophthalmitis after anti-VEGF injections To clarify this controversy, we present a meta-analysis to evaluate the incidence of endophthalmitis after treatment with anti-VEGF agents associated with 1) use of topical antibiotics and 2) the setting where the injection is performed
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