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 < 0.001). In phacoemulsification cases, POE was 0.043% with IC antibiotics vs. 0.14% without (RR: 0.11, CI: [0.06, 0.20], ARR: 0.097, p < 0.001). POE risk was lower with combined IC and topical antibiotics (0.02% vs. 0.056%, RR: 0.40, p < 0.001). Gram-positive bacteria were more common in POE cases without IC antibiotics; gram-negatives were more frequent with IC use. 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.

尽管已有诸多相关研究，但目前对于前房内（intracameral, IC）抗生素用于预防白内障手术后眼内炎（postoperative endophthalmitis, POE）的临床使用方案仍未达成共识。本研究系统性检索了Ovid MEDLINE、EMBASE及Cochrane CENTRAL数据库（建库至2021年4月；PROSPERO注册号：CRD42021248702），筛选出报告了使用或未使用前房内抗生素的术眼术后眼内炎发生风险的相关研究。采用Cochrane偏倚风险工具与纽卡斯尔-渥太华量表（Newcastle-Ottawa Scale）对纳入研究的方法学质量进行评估。本研究采用随机效应模型开展荟萃分析。最终纳入23项研究（含2项随机对照试验（Randomized Controlled Trial, RCT）、21项观察性研究；共涉及5442686只术眼），结果显示使用前房内抗生素组的术后眼内炎发生率显著低于未使用组（0.038% vs. 0.096%，相对危险度RR=0.15，95%置信区间CI：[0.10, 0.23]，绝对风险降低ARR=0.058，p<0.001）。在超声乳化术病例亚组中，使用前房内抗生素组的术后眼内炎发生率为0.043%，未使用组为0.14%（RR=0.11，CI：[0.06, 0.20]，ARR=0.097，p<0.001）。联合使用前房内与局部抗生素组的术后眼内炎风险进一步降低（0.02% vs. 0.056%，RR=0.40，p<0.001）。未使用前房内抗生素的术后眼内炎病例中，革兰阳性菌检出率更高；而使用前房内抗生素组则以革兰阴性菌更为多见。综上，前房内抗生素可降低白内障术后眼内炎的发生风险，但由于存在潜在混杂因素，现有证据质量为低至极低水平。未来仍需开展更严谨的研究，充分纳入手术操作技术、消毒剂使用及辅助抗生素使用等影响因素进行分析。