June 2017
Volume 58, Issue 8
Open Access
ARVO Annual Meeting Abstract  |   June 2017
The effect of antibiotic prophylaxis on endophthalmitis rate after intravitreal injection with antiangiogenic agents: a meta-analysis
Author Affiliations & Notes
  • Raquel Mansilla Cuñarro
    Ophthalmology, University of Santiago de Compostela, Santiago de Compostela, Spain
  • Manuel F Bande
    Ophthalmology, University of Santiago de Compostela, Santiago de Compostela, Spain
  • Maribel Fernandez
    Ophthalmology, University of Santiago de Compostela, Santiago de Compostela, Spain
  • Maria Jose Blanco-Teijeiro
    Ophthalmology, University of Santiago de Compostela, Santiago de Compostela, Spain
  • Antonio Piñeiro
    Ophthalmology, University of Santiago de Compostela, Santiago de Compostela, Spain
  • Francisco Gomez-Ulla
    Ophthalmology, University of Santiago de Compostela, Santiago de Compostela, Spain
  • Footnotes
    Commercial Relationships   Raquel Mansilla Cuñarro, None; Manuel Bande, None; Maribel Fernandez, None; Maria Jose Blanco-Teijeiro, None; Antonio Piñeiro, None; Francisco Gomez-Ulla, None
  • Footnotes
    Support  None
Investigative Ophthalmology & Visual Science June 2017, Vol.58, 5507. doi:
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      Raquel Mansilla Cuñarro, Manuel F Bande, Maribel Fernandez, Maria Jose Blanco-Teijeiro, Antonio Piñeiro, Francisco Gomez-Ulla; The effect of antibiotic prophylaxis on endophthalmitis rate after intravitreal injection with antiangiogenic agents: a meta-analysis. Invest. Ophthalmol. Vis. Sci. 2017;58(8):5507.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract

Purpose : For a decade, numerous studies have been conducted on the controversial use of antibiotics as prevention of endophthalmitis in intravitreal injections with antiangiogenics (anti-VEGF). Our objective is to confirm whether the use of local antibiotics is a good prophylactic treatment for endophthalmitis in patients treated with anti-VEGF.

Methods : We have conducted a search in MEDLINE over the period from January 11, 2007 to April 1, 2016. The MeSH terms used were “Endophthalmitis”, “Vascular endothelial growth factor”, “Antibiotic”, and “Intravitreal injection”. Studies were chosen in which the patients were treated exclusively with intravitreal injections of anti-VEGF agents (Aflibercept, bevacizumab, or ranibizumab) and in which intravitreal injections with corticosteroids could be excluded. Two independent reviewers extracted data and assessed the risk of bias. To assess the methodological quality of the studies, we used the Strengthening the Reporting of Observational Studies in Epidemiology Statement (STROBE) checklist for observational studies. A priori outcomes were to evaluate the incidence of endophthalmitis after treatment with anti-VEGF agents associated with use of topical antibiotics and injection site.

Results : A total of 276,774 injections, 109,178 (39.45 %) associated with the use of antibiotics and 114,821 (60.55 %) not associated with their use, were included. Our meta-analysis showed a significant risk of suffering from endophthalmitis that was 1.70 times greater with the use of antibiotics than without it, with a credibility interval from 1.09 to 2.66. (p=0.02). A meta-regression indicated that the circumstances of injection (operating rooms verses outpatient clinics) do not have a significant effect on the incidence of endophthalmitis.

Conclusions : This study involves the largest meta-analysis on this subject to date. Our results establish that the use of antibiotics in prophylactic treatment with anti-VEGF intravitreal injection contributes to a greater incidence of endophthalmitis. This confirmation, in addition to reducing costs, would eliminate a treatment that has shown itself to be unnecessary and could even be harmful to the patient.

This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.

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