Efficacy of intracameral antibiotics following manual small incision cataract surgery in reducing the rates of endophthalmitis: A meta‐analysis

Abstract

Background Manual small incision cataract surgery (MSICS) is a widely used technique for cataract surgery in the developing world. Higher rates of postoperative endophthalmitis have been reported with this technique compared with phaco‐emulsification. The purpose of this study was to evaluate the efficacy of prophylactic intracameral (IC) antibiotics in reducing the rates of postoperative endophthalmitis following MSICS. Methods Systematic review and meta‐analysis of patients undergoing MSICS. A literature search in PubMed and EMBASE databases was performed to identify studies published from October 1992 to April 2020 evaluating MSICS with a minimum of 500 eyes reported. Two authors independently assessed eligibility, extracted data and assessed the risk of bias. Heterogeneity was assessed using the I2 test. Results Twelve studies enrolling 1 494 307 eyes were included. IC antibiotics were used in 725 324 (48.5%) eyes. The risk ratio of developing endophthalmitis was 2.94 (95% CI, 1.07‐8.12; P = .037) in eyes that did not receive IC antibiotics. Conclusions Routine use of IC antibiotics may help to reduce the rates of endophthalmitis following MSICS and significantly improve the safety of this effective form of cataract surgery.

Intracameral antibiotics during cataract surgery: efficacy, safety, and cost–benefit considerations

“…Clinical studies have shown the quantitative efficacy of intracameral antibiotics in the reduction of endophthalmitis incidence. A large-scale meta-analysis that included over 1.4 million eyes reported a risk ratio of 2.94 for endophthalmitis in patient cohorts that had not received intracameral antibiotics compared to cohorts that had [24]. Other meta-analyses of 6.8 million eyes and 1.1 million eyes reported odds ratios for endophthalmitis of 0.14 and 0.19, respectively, in cohorts that received intracameral antibiotics compared to cohorts that had not [25 ▪▪ ,26 ▪ ].…”

Complications of manual small-incision cataract surgery

“…There were 547 cases of endophthalmitis in MSICS cases operated without intracameral antibiotics, the risk ratio of postoperative endophthalmitis being 2.94 (95% CI, 1.07–8.12; P = .037) in these as compared to eyes where intracameral antibiotics were used. [ 47 ]…”

Fighting infection

“…Rana et al 12 addressed the issue of prophylaxis against exogenous endophthalmitis following manual small incision cataract surgery. In a systematic review and meta‐analysis that covered 12 studies and approximately 1.5 million eyes, the incidence of postoperative endophthalmitis was significantly lower when intracameral antibiotics were used.…”