title: POOLED ESTIMATES OF INCIDENCE OF ENDOPHTHALMITIS AFTER INTRAVITREAL INJECTION OF ANTI-VASCULAR ENDOTHELIAL GROWTH FACTOR AGENTS WITH AND WITHOUT TOPICAL ANTIBIOTIC PROPHYLAXIS.
abstract: OBJECTIVE
  To assess the effect of topical antibiotic prophylaxis on postoperative endophthalmitis after intravitreal injection of anti-vascular endothelial growth factor agents.
  
  
  METHODS
  A systematic literature search was performed from inception to March 2016 using PubMed, Medline, Web of Science, Embase, and the Cochrane Library, to identify articles that reported cases of endophthalmitis after intravitreal injection of anti-vascular endothelial growth factor agents. We used a pooled analysis to estimate the incidence of cases of endophthalmitis who developed after injections performed with and without topical antibiotic prophylaxis. We used regression analysis to explore the effects of study characteristics on heterogeneity.
  
  
  RESULTS
  From our search of electronic databases, we identified and screened 4,561 unique records. We judged 60 articles to have reported findings for cohorts of patients who met our inclusion criteria, (12 arms of randomized clinical trials, 11 prospective cohort studies, and 37 retrospective cohort studies), which included 244 cases of endophthalmitis and 639,391 intravitreal injections of anti-vascular endothelial growth factor agents. The final pooled estimate endophthalmitis proportions were 9/10,000 (95% confidence interval, 7/10,000-12/10,000) in the antibiotic-treated group and 3/10,000 (95% confidence interval, 2/10,000-5/10,000) in the untreated group. The estimated incidence of endophthalmitis with topical antibiotic prophylaxis was approximated three times the incidence without prophylaxis. Random effects regression showed that none of the study characteristics significantly affected the effect size in either group.
  
  
  CONCLUSIONS
  Topical antibiotic after intravitreal injection of anti-vascular endothelial growth factor agents is associated with a higher risk of endophthalmitis.
authors.affiliation: Department of Ophthalmology, University of Catania, Catania, Italy.
authors.forename: Michele
authors.initials: M
authors.lastname: Reibaldi
authors.affiliation: Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy.
authors.forename: Alfredo
authors.initials: A
authors.lastname: Pulvirenti
authors.affiliation: Department of Ophthalmology, University of Catania, Catania, Italy.
authors.forename: Teresio
authors.initials: T
authors.lastname: Avitabile
authors.affiliation: Department of Ophthalmology, University of Catania, Catania, Italy.
authors.forename: Vincenza
authors.initials: V
authors.lastname: Bonfiglio
authors.affiliation: Department of Ophthalmology, University of Catania, Catania, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Russo
authors.affiliation: Department of Ophthalmology, University of Ancona, Ancona, Italy.
authors.forename: Cesare
authors.initials: C
authors.lastname: Mariotti
authors.affiliation: Department of Clinical and Molecular Biomedicine, Section of Pharmacology and Biochemistry, University of Catania, Catania, Italy.
authors.forename: Claudio
authors.initials: C
authors.lastname: Bucolo
authors.affiliation: Ophthalmology Unit, Department of Neurological, Neuropsychological, Morphological and Movement Sciences, University of Verona, Verona, Italy.
authors.forename: Rodolfo
authors.initials: R
authors.lastname: Mastropasqua
authors.affiliation: Department of Ophthalmology, University of Catania, Catania, Italy.
authors.forename: Guglielmo
authors.initials: G
authors.lastname: Parisi
authors.affiliation: Department of Ophthalmology, University of Catania, Catania, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Longo
mesh_terms: D020533:Angiogenesis Inhibitors / Q000008:administration & dosage*; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D019072:Antibiotic Prophylaxis; D009877:Endophthalmitis / Q000453:epidemiology* / Q000209:etiology; D015818:Eye Infections, Bacterial / Q000453:epidemiology* / Q000209:etiology; D014943:Global Health; D006801:Humans; D058449:Intravitreal Injections / Q000009:adverse effects; D042461:Vascular Endothelial Growth Factor A / Q000037:antagonists & inhibitors*; D014792:Visual Acuity
chemical_list: D020533:Angiogenesis Inhibitors; D000900:Anti-Bacterial Agents; D042461:Vascular Endothelial Growth Factor A