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Meta-analysis finds topical antibiotic prophylaxis does not reduce endophthalmitis after intravitreal injectionStudy finds topical antibiotics do not prevent eye infections after injections

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Key Takeaway
Consider that topical antibiotic prophylaxis shows no significant reduction in endophthalmitis after intravitreal injection.

This systematic review and meta-analysis examined the association between topical antibiotic prophylaxis and endophthalmitis risk following intravitreal injections. The analysis included data from 3,138,778 injections and 1,426 endophthalmitis cases across observational studies, with quality assessed using the Newcastle-Ottawa Scale. The primary comparison was between patients receiving topical antibiotic prophylaxis and those receiving no prophylaxis.

The main results showed no significant difference in endophthalmitis incidence between groups (odds ratio 1.85, 95% confidence interval 0.72–4.76; P=0.2). Culture-positive rates also showed no significant difference (OR 1.23, 95% CI 0.53–2.84; P=0.63). Best-corrected visual acuity decreased by 4.5 ETDRS letters in the antibiotic prophylaxis group compared with the no-prophylaxis group, but this difference was not statistically significant (P=0.65).

Safety and tolerability data were not reported in the included studies. The analysis has limitations inherent to observational data, including potential confounding and the inability to establish causation. The authors note that given the lack of demonstrated benefit and potential risks, routine topical antibiotic prophylaxis is not recommended for intravitreal injections.

Researchers conducted a large review of existing studies to see if using antibiotic eye drops before or after intravitreal injections helps prevent a serious eye infection called endophthalmitis. Intravitreal injections are a common treatment for conditions like macular degeneration. The analysis combined data from studies involving over 3 million injections and more than 1,400 infection cases.

The main finding was that patients who received topical antibiotic prophylaxis did not have a lower rate of endophthalmitis compared to patients who did not receive the antibiotics. The odds of infection were not significantly different between the two groups. Furthermore, there was no significant difference in the final visual acuity (sharpness of vision) between the groups, though the antibiotic group showed a very small, non-significant decrease.

This was a meta-analysis of observational studies, which means it can show a link but cannot prove cause and effect. The study did not report on specific safety concerns or side effects from the antibiotic use. Based on this evidence and the potential risks of unnecessary antibiotic use, the authors note that routine antibiotic prophylaxis for these injections is not recommended. Readers should understand this as a large-scale analysis suggesting current practice may not need to change, but individual decisions should always be made with an eye doctor.

What this means for you:
Large review suggests antibiotic eye drops may not prevent infections after certain eye injections.

Study Details

Study typeMeta analysis
EvidenceLevel 1
PublishedApr 2026
View Original Abstract ↓
PURPOSE: To compare the incidence of endophthalmitis after intravitreal injection with versus without topical antibiotic prophylaxis. METHODS: We systematically searched PubMed, Embase, and the Cochrane Library from each database's inception through August 2024. The primary outcome measure was the endophthalmitis rates after intravitreal injection, whereas the secondary outcomes included the distribution and quantity of microorganisms and best-corrected visual acuity changes. Study quality was assessed using the Newcastle-Ottawa Scale. For the meta-analysis, pooled summary estimates were calculated using a random-effects model. RESULTS: Eighteen studies (3,138,778 intravitreal injections; 1,426 endophthalmitis cases) showed no significant difference in endophthalmitis incidence between prophylaxis and no-prophylaxis groups (odds ratio 1.85, 95% confidence interval [CI] 0.72‒4.76; P = 0.2). For microbial analysis, we selected 11 studies that demonstrated no significant difference in culture-positive rates between prophylaxis and nonprophylaxis groups (OR, 1.23; 95% CI, [0.53‒2.84]; P = 0.63). Four studies provided best-corrected visual acuity changes from baseline to final follow-up, antibiotic prophylaxis group showed a decrease by 4.5 ETDRS letters compared with the no-prophylaxis group, although this difference was not statistically significant ( P = 0.65). CONCLUSION: Topical antibiotics did not reduce endophthalmitis risk or improve visual outcomes postintravitreal injection. Given potential risks, routine prophylaxis is not recommended.
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