Antibiotic Injection in Cataract Surgery and Risk of Endophthalmitis: A Bayesian Meta-Analysis

Cataract surgery is the most performed surgical procedure worldwide, with over 28 million cases annually. Traditional postoperative care relies on topical eye drops for infection prevention and inflammation control; however, challenges such as patient noncompliance and cost limitations persist. The dropless cataract surgery approach, involving intracameral or subconjunctival administration of antibiotics and corticosteroids during surgery, has gained attention as an alternative to improve adherence, simplify care, and potentially reduce postoperative complications, including endophthalmitis.

To evaluate the risk of postoperative endophthalmitis associated with antibiotic injection during cataract surgery in comparison to the standard eye drop regimen.

We systematically searched PubMed, Embase, and the Cochrane Library for studies evaluating the safety of antibiotic injections in cataract surgery compared with conventional postoperative regimens. Bayesian random-effects meta-analysis was used for marginal posterior distributions for the overall and between-study heterogeneity, expressed as odds ratios (OR) with 95% credible intervals (CrIs). Risk of bias was assessed with ROBINS-I or RoB-2. All statistical analyses were performed using R version 4.5.0.

54 studies were included, encompassing 6,867,422 surgeries, of which 3,501,802 received antibiotic injection therapy. Antibiotic injection was associated with a reduction in the risk of postoperative endophthalmitis (OR 0.208; 95% CrI: 0.161-0.268), with a 100% posterior probability of clinically meaningful benefit (OR < 0.80) and a 99.1% likelihood that future studies would confirm these findings. Sensitivity analyses corroborated the general findings.

The use of antibiotic injection was associated with a significant reduction in the risk of postoperative endophthalmitis.