Share This Article:

The Role of Prophylactic Antibiotic Use in Prevention of Endophthalmitis Following Intravitreal Injection of Anti-Vascular Endothelial Growth Factor Agents: A Meta-Analysis

Abstract Full-Text HTML Download Download as PDF (Size:121KB) PP. 46-49
DOI: 10.4236/ojoph.2013.32012    4,053 Downloads   5,670 Views   Citations


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.

Conflicts of Interest

The authors declare no conflicts of interest.

Cite this paper

S. Dhoot, N. Kunjukunju and N. Sabates, "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, Vol. 3 No. 2, 2013, pp. 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

comments powered by Disqus

Copyright © 2019 by authors and Scientific Research Publishing Inc.

Creative Commons License

This work and the related PDF file are licensed under a Creative Commons Attribution 4.0 International License.