OJOph  Vol.3 No.2 , May 2013
The Role of Prophylactic Antibiotic Use in Prevention of Endophthalmitis Following Intravitreal Injection of Anti-Vascular Endothelial Growth Factor Agents: A Meta-Analysis
Abstract: Purpose: To determine the role of prophylactic antibiotic use in preventing endophthalmitis following intravitreal injections of Anti-Vascular Endothelial Growth Factor Agents (anti-VEGF).Methods: A meta-analysis was conducted for studies reporting the rates of endophthalmitis following injection of anti-vascular endothelial growth factor agents for a variety of disorders. Inclusion criteria included reporting how many patients were given post-injection antibiotic drops, and how many patients were diagnosed with endophthalmitis (both with and without antibiotic drops). Results: The reported rate of endophthalmitis following intravitreal anti-VEGF agents has varied significantly based on the study, with a range between 0.009% to 0.87%. In our meta-analysis, the rate of endophthalmitis in patients receiving post-injection antibiotics was found to be 0.081%, compared to 0.072% for patients who did not receive antibiotics. This difference was not found to be statistically significant. Conclusion: Although the rate of endophthalmitis is extremely low following intravitreal anti-VEGF injections, the controversy regarding the best prevention of this dreaded complication continues. According to our meta-analysis, the answer does not seem to lie in post-injection antibiotic use.
Cite this paper: Dhoot, S. , Kunjukunju, N. and Sabates, N. (2013) The Role of Prophylactic Antibiotic Use in Prevention of Endophthalmitis Following Intravitreal Injection of Anti-Vascular Endothelial Growth Factor Agents: A Meta-Analysis. Open Journal of Ophthalmology, 3, 46-49. doi: 10.4236/ojoph.2013.32012.

[1]   C. McCannel, “Meta-Analysis of Endophthalmitis after Intravitreal Injection of Anti-Vascular Endothelial Growth Factor Agents,” Retina, Vol. 31, No. 4, 2011, pp. 654661.

[2]   C. P. Shah, S. J. Garg, J. F. Vander, et al., “Outcomes and Risk Factors Associated with Endothelial Growth Factor Agents,” Ophthalmology, Vol. 118, No. 10, 2011, pp. 2028-2034. doi:10.1016/j.ophtha.2011.02.034

[3]   D. Mezad-Koursh, M. Goldstein, G. Heilwail, et al., “Clinical Characteristics of Endophthalmitis after an Injection of Intravitreal Antivascular Endothelial Growth Factor,” Retina, Vol. 30, No. 7, 2010, pp. 1051-1057. doi:10.1097/IAE.0b013e3181cd47ed

[4]   S. S. Bhatt, K. E. Stepien and K. Joshi, “Prophylactic Antibiotic Use after Intravitreal Injection: Effect on Endophthalmitis Rate,” Retina, Vol. 31, No. 10, 2011, pp. 2032-2036. doi:10.1097/IAE.0b013e31820f4b4f

[5]   A. R. Bhavsar, C. R. Stockdale, F. L. Ferris, et al., “Update on Risk of Endophthalmitis after Intravitreal Drug Injections and Potential Impact of Elimination of Topical Antibiotics,” Archives of Ophthalmology, Vol. 130, No. 6, 2012, p. 227.

[6]   C. S. Cheung, A. W. Wong, A. Lui, et al., “Incidence of Endophthalmitis and Use of Antibiotic Prophylaxis after Intravitreal Injections,” Ophthalmology, Vol. 119, No. 8, 2012, pp. 1609-1614. doi:10.1016/j.ophtha.2012.02.014

[7]   N. M. Pharmakakis, I. K. Petropoulos, C. D. Georgakoupoulos, et al., “Apoptotic Mechanisms within the Retina in Staphylococcus epidermidis Experimental Endophthalmitis,” Graefes Archives for Clinical and Experimental Ophthalmology, Vol. 247, 2009, pp. 667-674. doi:10.1007/s00417-008-0996-z

[8]   J. M. Moss, S. R. Sanslo and C. N. Ta, “A Prospective Randomized Evaluation of Topical Gatifloxacin on Conjunctival Flora in Patients Undergoing Intravitreal Injections,” Ophthalmology, Vol. 116, No. 8, 2009, pp. 14981501. doi:10.1016/j.ophtha.2009.02.024

[9]   The Endophthalmitis Vitrectomy Study Group, “Microbiologic Factors and Visual Outcome in the Endophthalmitis Vitrectomy Study,” American Journal of Ophthalmology, Vol. 122, No. 6, 1996, pp. 830-846.

[10]   Endophthalmitis Vitrectomy Study Group, “Results of the Endophthalmitis Vitrectomy Study. A Randomized Trial of Immediate Vitrectomy and of Intravenous Antibiotics for the Treatment of Postoperative Bacterial Endophthalmitis,” Archives of Ophthalmology, Vol. 113, No. 12, 1995, pp. 1479-1496. doi:10.1001/archopht.1995.01100120009001

[11]   E. Veringa, A. VanBelkum and H. Schellekens, “Iatrogenic Meningitis by Streptococcus salivarius Following Lumbar Puncture,” Journal of Hospital Infection, Vol. 29, No. 4, 1995, pp. 316-318. doi:10.1016/0195-6701(95)90283-X

[12]   S. W. O’Kelly and D. Marsh, “Face Masks and Spinal Anesthesia,” British Journal of Anaesthesia, Vol. 710, 1993, p. 239. doi:10.1093/bja/70.2.239

[13]   H. A. McLure, C. A. Talboys, S. M. Yentis, et al., “Surgical Face Masks and Downward Dispersal of Bacteria,” Anesthesia, Vol. 53, 1998, pp. 624-626. doi:10.1046/j.1365-2044.1998.435-az0528.x

[14]   M. Trautmann, P. M. Lepper and F. J. Schmitz, “Three Cases of Bacterial Meningitis after Spinal and Epidural Anesthesia,” European Journal of Clinical Microbiology and Infectious Diseases, Vol. 21, No. 1, 2002, pp. 43-45. doi:10.1007/s10096-001-0643-7

[15]   A. E. Green-Simms, N. S. Ekdawi and S. J. Bakri, “Survey of Intravitreal Injection Techniques Among Retinal Specialists in the United States,” American Journal of Ophthalmology, Vol. 151, No. 2, 2011, pp. 329-332. doi:10.1016/j.ajo.2010.08.039

[16]   S. M. Hariprasad, K. J. Blinder, G. K. Shah, et al., “Penetration Pharmacokinetics of Topically Administered 0.5% Moxifloaxcin Ophthalmic Solution in Human Aqueous and Vitreous,” Archives of Ophthalmology, Vol. 123, No. 1, 2005, pp. 39-44. doi:10.1001/archopht.123.1.39

[17]   O. Cekic, C. Batman, U. Yasar, et al., “Penetration of Ofloxacin in Human Aqueous and Vitreous Humors Following Oral and Topical Administration,” Retina, Vol. 18, No. 6, 1998, pp. 521-525. doi:10.1097/00006982-199806000-00005

[18]   O. Cekic, C. Batman, U. Yasar, et al., “Human Aqueous and Vitreous Humor Levels of Ciprofloxacin Following Oral and Topical Administration,” Eye, Vol. 13, No. 4, 1999, pp. 555-558. doi:10.1038/eye.1999.137

[19]   S. Pilli, A. Kotsolis, R. F. Spaide, et al., “Endopthalmitis Associated with Intravitreal Anti-Vascular Endothelial Growth Factor Therapy Injections in an Office Setting,” American Journal of Ophthalmology, Vol. 29, 2008, pp. 153-154.

[20]   L. H. Lima, S. A. Zweifel, M. Engelbert, et al., “Evaluation of Safety for Bilateral Same-Day Intravitreal Injections of Antivascular Endothelial Growth Factor Therapy,” Retina, Vol. 29, No. 9, 2009, pp. 1213-1217. doi:10.1097/IAE.0b013e3181b32d27