If you or someone you love gets injections in the eye to treat conditions like macular degeneration, you know how scary the risk of infection can be. For years, many doctors have used antibiotic eye drops before these shots, hoping to prevent a rare but devastating infection called endophthalmitis. But does this routine step actually help?
A new analysis looked at data from a staggering 5.8 million eye injections. The main finding was clear: overall, using antibiotic drops did not significantly lower the rate of these infections. When researchers dug deeper into one specific and very common type of injection—those using anti-VEGF drugs to treat wet macular degeneration—they saw a signal that was more concerning. In this subgroup, patients who got antibiotic drops appeared to have a higher risk of infection. The analysis calculated this risk as being 56% higher, though the range of possible risk was wide.
It's crucial to understand the limits of this finding. The evidence pointing to a higher risk is considered 'very low-certainty.' This means we can't be sure if the antibiotics are truly causing harm or if other factors in the studies are responsible. The analysis didn't report on side effects from the drops themselves. What this review strongly suggests is that the routine, automatic use of these antibiotic drops is not justified by the evidence we have.
