Incidence de l’endophtalmie après injection intravitréenne : peut-on se passer de l’antibioprophylaxie ?

Antibioprophylaxis in Prevention of Endophthalmitis in Intravitreal Injection: A Systematic Review and Meta-Analysis

“…Only two studies reported the median age within patients; specifically 72.2 [ 13 ] and 79.3 [ 20 ] years old. A third study reported an age of the population ranging from 30 to 70 years old, but did not specify a mean or median age [ 18 ].…”

“…Four studies provided details of the indications for injections which were exudative age-related macular degeneration [ 13 , 17 , 18 ], choroidal neovascular membranes secondary to myopic degeneration [ 13 , 18 ], macular edema secondary to diabetes [ 13 , 18 , 21 ], central and branch retinal vein occlusions [ 13 , 18 ], uveitis [ 13 , 18 ], birdshot chorioretinopathy [ 13 ] and other proliferative retinopathies [ 13 ]. The five other studies included all patients needing intravitreal injections but did not specify more detailed indications [ 16 , 19 , 20 , 22 , 23 ].…”

“…all studies reported injections of bevacizumab except one [ 21 ], all studies reported injections of ranibizumab except one [ 18 ], six studies used triamcinolone injections [ 13 , 16 , 20 , 21 , 22 , 23 ], three studies reported pegatnamib injections [ 13 , 20 , 23 ], one gave aflibercept [ 19 ], one reported dexamethasone injections [ 23 ] and one reported a C3F8 injection [ 22 ]. Among the studies reporting multiple products within the injection, five combined injections of bevacizumab, ranibizumab and triamcinolone [ 13 , 16 , 20 , 22 , 23 ], three combined bevacizumab, ranibizumab, triamcinolone and pegatnamib [ 13 , 20 , 23 ], one reported simultaneously ranibizumab and triamcinolone [ 21 ], and one bevacizumab and ranibizumab [ 19 ]. However, only one of these studies reported the sample size with and without antibiotics within each group of type of products injected [ 19 ].…”

“…Another study used a topical antibiotic before and after the injection (levofloxacin 5 times daily the 3 days before and the 3 days after injection) [ 23 ]. Four studies administered antibiotics during and after the injection (one drop immediately at the end of procedure and then a 4 th generation fluoroquinolone after 3 or 5 days [ 13 , 16 ] or tobramycin 4 times daily during 4 days [ 20 ] or azithromycin twice daily during 3 days [ 20 ] or others left the prescription of topical antibiotics to the discretion of individual physicians). Finally, one article reported antibiotics only after the injection (4 times daily during 4 days) [ 19 ].…”

“…Secondary outcomes were clearly defined in two studies and involved investigations of the microbial spectrum [ 13 , 17 , 19 ] and clinical outcomes including return to baseline visual acuity [ 17 , 19 ]. However, other studies also described microbial spectrum [ 16 , 18 , 20 , 21 , 22 , 23 ] and four studies reported the number of endophthalmitis for each product used [ 13 , 19 , 22 , 23 ]. However, whether it was in group with or without antibiotics was unclear.…”