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ANTIBIOTIC PROPHYLAXIS FOR PREVENTING ENDOPHTHALMITIS AFTER INTRAVITREAL INJECTIONS: An Updated Systematic Review and
Yuri Aleksander-Ivanov1, Lidia Cheidde2, Luiz Alberto Zago Filho3,4
1Faculty of Medicine, University of Southern Santa Catarina (UNESC), Criciuma, South Carolina, Brazil.
Retina (Philadelphia, Pa.)
|December 5, 2025
Summary
Topical antibiotic prophylaxis after intravitreal injections (IVIs) does not reduce endophthalmitis risk. In fact, it may increase risk for anti-VEGF IVIs, suggesting routine prophylaxis is unwarranted.
Area of Science:
- Ophthalmology
- Infectious Diseases
- Evidence-Based Medicine
Background:
- Endophthalmitis is a severe complication of intravitreal injections (IVIs), potentially causing vision loss.
- Clinical practices for antibiotic prophylaxis vary globally, with ongoing debate regarding its efficacy.
- Evaluating prophylactic strategies is crucial for patient outcomes and resource allocation.
Purpose of the Study:
- To systematically review and meta-analyze the efficacy of topical antibiotic prophylaxis in preventing endophthalmitis after IVIs.
- To assess the impact of antibiotic prophylaxis on endophthalmitis incidence across various IVI types.
- To provide evidence-based recommendations on the routine use of antibiotic prophylaxis.
Main Methods:
- Systematic review and meta-analysis of studies from PubMed, Embase, Cochrane, and Web of Science up to July 2025.
- Inclusion of studies comparing endophthalmitis rates in IVIs with and without antibiotic prophylaxis.
- Data synthesis using a random-effects model, with risk of bias assessed by ROBINS-I tool.
Main Results:
- Twenty-two studies involving over 5.8 million IVIs were analyzed.
- No significant overall reduction in endophthalmitis incidence was found with antibiotic prophylaxis (p=0.09).
- Subgroup analysis revealed a significantly higher risk of endophthalmitis with antibiotic prophylaxis in anti-VEGF injections (OR 1.56, 95% CI 1.03-2.36).
Conclusions:
- Topical antibiotic prophylaxis is not associated with decreased endophthalmitis risk following IVIs.
- Antibiotic prophylaxis may elevate endophthalmitis risk in patients receiving anti-VEGF injections.
- Routine use of topical antibiotic prophylaxis for IVIs is not supported by current evidence.
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