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Meta-Analysis
. 2015 Jun;93(4):303-17.
doi: 10.1111/aos.12684. Epub 2015 Mar 16.

Antibiotic prevention of postcataract endophthalmitis: a systematic review and meta-analysis

Line Kessel  1   2 , Per Flesner  3 , Jens Andresen  4 , Ditte Erngaard  5 , Britta Tendal  2 , Jesper Hjortdal  6
Affiliations
Meta-Analysis

Antibiotic prevention of postcataract endophthalmitis: a systematic review and meta-analysis

Line Kessel et al. Acta Ophthalmol. 2015 Jun.

Abstract

Endophthalmitis is one of the most feared complications after cataract surgery. The aim of this systematic review was to evaluate the effect of intracameral and topical antibiotics on the prevention of endophthalmitis after cataract surgery. A systematic literature review in the MEDLINE, CINAHL, Cochrane Library and EMBASE databases revealed one randomized trial and 17 observational studies concerning the prophylactic effect of intracameral antibiotic administration on the rate of endophthalmitis after cataract surgery. The effect of topical antibiotics on endophthalmitis rate was reported by one randomized trial and one observational study. The quality and design of the included studies were analysed using the Cochrane risk of bias tool. The quality of the evidence was evaluated using the GRADE approach. We found high-to-moderate quality evidence for a marked reduction in the risk of endophthalmitis with the use of intracameral antibiotic administration of cefazolin, cefuroxime and moxifloxacin, whereas no effect was found with the use of topical antibiotics or intracameral vancomycin. Endophthalmitis occurred on average in one of 2855 surgeries when intracameral antibiotics were used compared to one of 485 surgeries when intracameral antibiotics were not used. The relative risk (95% CI) of endophthalmitis was reduced to 0.12 (0.08; 0.18) when intracameral antibiotics were used. The difference was highly significant (p < 0.00001). Intracameral antibiotic therapy is the best choice for preventing endophthalmitis after cataract surgery. We did not find evidence to conclude that topical antibiotic therapy prevents endophthalmitis.

Keywords: antibiotic therapy; cataract surgery; cefuroxime; endophthalmitis; prevention.

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Figures

Figure 1
Figure 1
Schematic presentation of the literature search (A) literature search profile for intracameral antibiotic prophylaxis of postoperative endophthalmitis (B) literature search profile for topical antibiotic prophylaxis of postoperative endophthalmitis Both search profiles were limited to the publications published in English or the Scandinavian languages published within the last 10 years.
Figure 2
Figure 2
Forest plot showing the effect of peri‐operative, prophylactic intracameral antibiotic treatment as reported in the randomized trial and the 17 observational studies reporting endophthalmitis rate in patients receiving intracameral antibiotic prophylaxis (cefazolin, cefuroxime, moxifloxacin or vancomycin) versus no intracameral antibiotic prophylaxis.
Figure 3
Figure 3
Forest plot showing the effect of prophylactic topical antibiotic therapy as reported in the randomized trial and in the observational study.
See this image and copyright information in PMC

Comment in

  • Can endophthalmitis be prevented?
    Stenevi U, Lundström M. Stenevi U, et al. Acta Ophthalmol. 2015 Jun;93(4):301-2. doi: 10.1111/aos.12751. Acta Ophthalmol. 2015. PMID: 25981439 No abstract available.

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