Ophthalmology. Retina · 2025
Rates of Endophthalmitis in Prefilled versus Nonprefilled Syringes for Intravitreal Injections: A Systematic Review and Meta-Analysis.
СтатьяСистематический обзорМетаанализНазвание и аннотация: Перевод пока не подготовлен
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Zhang Charles, Lai Daniel A, AbouKasm Georges, Ersan Sinan, Leung Nicholas, Zhu Daniel, Patel Nimesh A, Flynn Harry W, Yannuzzi Nicolas A
Аннотация
TOPIC: This study compares rates of endophthalmitis after intravitreal injections (IVIs) using prefilled versus nonprefilled syringes (PFSs).
CLINICAL RELEVANCE: Intravitreal injections are among the most frequently performed medical procedures for retinal disease. Although generally safe, IVIs carry a small risk of endophthalmitis, leading to devastating vision loss. Given the high volume of injections performed annually, minimizing risk factors is essential.
METHODS: A systematic review and meta-analysis were conducted using PubMed, Embase, and Scopus following the Preferred Reporting Items for the Systematic Reviews and Meta-Analysis guidelines (PROSPERO ID: CRD420251030471). Studies comparing endophthalmitis risk among patients receiving IVI from manufacturer-prefilled syringes (MPFSs), pharmacy-compounded syringes, and glass vial preparations (GVPs) were included. Risk ratio meta-analyses assessed rates of all endophthalmitis and culture-positive cases.
RESULTS: A total of 11 studies were included for meta-analysis, with publication dates ranging from 2018 to 2023. A total of 1 523 597 injections in the combined PFS group and 5 907 310 injections in the glass vial group were analyzed. The pooled rate of endophthalmitis in PFSs was 1:5461 injections, whereas the rate with GVP was 1:3200 injections. The pooled rate of endophthalmitis was significantly lower with PFSs (risk ratio [RR] = 0.53; 95% confidence interval [CI], 0.44-0.64; I2 = 24%, P < 0.00001). When stratified by the preparation method, the pooled rate of endophthalmitis in the pharmacy-compounded group (6 studies) was 1:4664 injections, whereas the MPFS group (7 studies) was 1:5909 injections. The risk of endophthalmitis remained significantly lower for both pharmacy-compounded (RR = 0.52; 95% CI, 0.38-0.72; I2 = 11%, P < 0.0001) and MPFSs (RR = 0.53; 95% CI, 0.41-0.67; I2 = 39%, P < 0.00001) compared with GVP. There was no evidence of subgroup differences between pharmacy-compounded and MPFSs (P = 0.97). The quality of evidence using the Grading of Recommendations, Assessment, Development, and Evaluation framework was rated "low" for the overall prefilled versus GVP comparison and subgroup analysis by the preparation method.
CONCLUSION: Intravitreal injections using either pharmacy-compounded or MPFSs were associated with a 48% and 47% lower reported risk of endophthalmitis, respectively, compared with GVP. These findings suggest that PFSs may offer a safer alternative, although further prospective studies are needed.
FINANCIAL DISCLOSURE(S): Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
CLINICAL RELEVANCE: Intravitreal injections are among the most frequently performed medical procedures for retinal disease. Although generally safe, IVIs carry a small risk of endophthalmitis, leading to devastating vision loss. Given the high volume of injections performed annually, minimizing risk factors is essential.
METHODS: A systematic review and meta-analysis were conducted using PubMed, Embase, and Scopus following the Preferred Reporting Items for the Systematic Reviews and Meta-Analysis guidelines (PROSPERO ID: CRD420251030471). Studies comparing endophthalmitis risk among patients receiving IVI from manufacturer-prefilled syringes (MPFSs), pharmacy-compounded syringes, and glass vial preparations (GVPs) were included. Risk ratio meta-analyses assessed rates of all endophthalmitis and culture-positive cases.
RESULTS: A total of 11 studies were included for meta-analysis, with publication dates ranging from 2018 to 2023. A total of 1 523 597 injections in the combined PFS group and 5 907 310 injections in the glass vial group were analyzed. The pooled rate of endophthalmitis in PFSs was 1:5461 injections, whereas the rate with GVP was 1:3200 injections. The pooled rate of endophthalmitis was significantly lower with PFSs (risk ratio [RR] = 0.53; 95% confidence interval [CI], 0.44-0.64; I2 = 24%, P < 0.00001). When stratified by the preparation method, the pooled rate of endophthalmitis in the pharmacy-compounded group (6 studies) was 1:4664 injections, whereas the MPFS group (7 studies) was 1:5909 injections. The risk of endophthalmitis remained significantly lower for both pharmacy-compounded (RR = 0.52; 95% CI, 0.38-0.72; I2 = 11%, P < 0.0001) and MPFSs (RR = 0.53; 95% CI, 0.41-0.67; I2 = 39%, P < 0.00001) compared with GVP. There was no evidence of subgroup differences between pharmacy-compounded and MPFSs (P = 0.97). The quality of evidence using the Grading of Recommendations, Assessment, Development, and Evaluation framework was rated "low" for the overall prefilled versus GVP comparison and subgroup analysis by the preparation method.
CONCLUSION: Intravitreal injections using either pharmacy-compounded or MPFSs were associated with a 48% and 47% lower reported risk of endophthalmitis, respectively, compared with GVP. These findings suggest that PFSs may offer a safer alternative, although further prospective studies are needed.
FINANCIAL DISCLOSURE(S): Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.