Intracameral antibiotics for endophthalmitis prophylaxis in cataract surgery: a meta-analysis

Despite numerous studies, there is no consensus on the use of intracameral (IC) antibiotics to prevent postoperative endophthalmitis (POE) after cataract surgery. A systematic search of Ovid MEDLINE, EMBASE, and Cochrane CENTRAL (inception–April 2021; PROSPERO ID: CRD42021248702) identified studies reporting POE risk in eyes treated with or without IC antibiotics. Study quality was assessed using the Cochrane risk-of-bias tool and Newcastle-Ottawa Scale. Meta-analysis was conducted using a random-effects model. Among 23 studies (2 RCTs, 21 observational; 5,442,686 eyes), POE incidence was lower with IC antibiotic use (0.038% vs. 0.096%, RR: 0.15, CI: [0.10, 0.23], ARR: 0.058, p IC antibiotics reduced POE risk, though evidence quality was low to very low due to potential confounding. More rigorous studies accounting for surgical technique, antiseptic use, and adjunctive antibiotics are needed.