Use of intracameral antibiotics prophylaxis in patients with posterior capsular rupture during cataract surgery: systematic review and meta-analysis.

TOPIC: Posterior capsular rupture (PCR) during cataract surgery predisposes patients to postoperative endophthalmitis (POE). However, little is known about the prophylactic use of intracameral antibiotics (ICA) to prevent POE after PCR. This systematic review and meta-analysis assesed the efficacy of ICA in preventing POE in patients with PCR.

CLINICAL RELEVANCE: PCR increases the risk of POE by more than 6-fold, emphasizing the need for targeted prophylactic strategies. This study focused on the clinical importance of ICA in reducing the incidence of POE in this high-risk population.

METHODS

PubMed, Embase, and Cochrane were searched for articles published up to May 21, 2024, with the following strategy: (cataract OR phaco OR "Cataract Extraction" OR "manual small incision cataract surgery" OR phacoemulsification OR "extracapsular cataract extraction" OR ECCE) AND (intracameral OR "Intracameral Injection" OR "irrigating infusion fluid" OR "anterior chamber injection") AND (antibiotic OR moxifloxacin OR cefuroxime OR vancomycin OR cephalosporin OR prophylaxis). Studies were included that reported the incidence of endophthalmitis in patients with PCR during cataract surgery and a comparison of prophylactic ICA with no ICA. Statistical analysis was conducted using R software v. 4.3.2. The protocol was registered in PROSPERO (CRD42024558144).

RESULTS

The initial search yielded 1660 results. After removing duplicate records and ineligible studies, 193 remained and were thoroughly reviewed based on the inclusion criteria. 9 studies consisting of 2 randomized controlled trials and 7 observational studies were included in the meta-analysis. There were a total of 153 690 patients, with 50 207 (33.6%) patients in the ICA group and 103 483 (67.3%) in the no ICA group. There was a significantly lower incidence of endophthalmitis in the ICA group (odds ratio [OR] 0.41; 95% CI 0.26-0.65; P < .001; I2 = 9%). Independently, the use of prophylactic intracameral moxifloxacin was also related to a lower risk of endophthalmitis (OR 0.33; 95% CI 0.19-0.57; P < .001; I2 = 33%).

CONCLUSIONS

The findings suggest that the use of ICA is efficient in preventing postoperative endophthalmitis in patients who had PCR during cataract surgery.