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有和无局部抗生素预防的玻璃体内注射抗血管内皮生长因子制剂后眼内炎发生率估计

Reibaldi, M., Pulvirenti, A., Avitabile, T., et al.

期刊名称:Retina

卷期:2018年第38卷第1期

摘要

摘要:目的:旨在评价玻璃体内注射抗血管内皮生长因子制剂后局部应用抗生素预防术后眼内炎的效果。方法:从开始到20163月,使用PubMedMedlineWeb of ScienceEmbaseCochrane Library进行系统文献检索,以确定玻璃体内注射抗血管内皮生长因子药物后报告眼内炎病例的文章。我们使用汇总分析来估计注射后进行局部抗生素预防或不进行局部抗生素预防的眼内炎病例发病率。我们用回归分析来分析研究特征对异质性的影响。结果:通过对电子数据库的搜索,我们确定并筛选了4561条独特的记录。我们评估了60篇文章,对符合纳入标准的患者队列进行了报告(12项随机临床试验,11项前瞻性队列研究和37项回顾性队列研究),其中包括244例眼内炎病例和639391次玻璃体内注射抗血管内皮生长因子剂。抗生素治疗组的最终汇总估计眼内炎比例为9 / 10,00095%可信区间,7 / 10,000-12 / 10,000),而无抗生素治疗组为3 / 10,00095%可信区间,2 / 10,000-5 / 10,000)。预防性局部用抗生素的眼内炎估计发生率约为未预防用药的三倍。随机效应回归分析显示,两组研究的特征均无显着影响效应值。结论:玻璃体腔内注射抗血管内皮生长因子制剂后的局部抗生素应用与眼内炎风险增高有关。

PURPOSE:To assess the effect of topical antibiotic prophylaxis on postoperative endophthalmitis after intravitreal injection of anti-vascular endothelial growth factor agents.METHODS:A systematic literature search was performed from inception to March 2016 using PubMed, Medline, Web of Science, Embase, and the Cochrane Library, to identify articles that reported cases of endophthalmitis after intravitreal injection of anti-vascular endothelial growth factor agents. We used a pooled analysis to estimate the incidence of cases of endophthalmitis who developed after injections performed with and without topical antibiotic prophylaxis. We used regression analysis to explore the effects of study characteristics on heterogeneity.RESULTS:From our search of electronic databases, we identified and screened 4,561 unique records. We judged 60 articles to have reported findings for cohorts of patients who met our inclusion criteria, (12 arms of randomized clinical trials, 11 prospective cohort studies, and 37 retrospective cohort studies), which included 244 cases of endophthalmitis and 639,391 intravitreal injections of anti-vascular endothelial growth factor agents. The final pooled estimate endophthalmitis proportions were 9/10,000 (95% confidence interval, 7/10,000-12/10,000) in the antibiotic-treated group and 3/10,000 (95% confidence interval, 2/10,000-5/10,000) in the untreated group. The estimated incidence of endophthalmitis with topical antibiotic prophylaxis was approximated three times the incidence without prophylaxis. Random effects regression showed that none of the study characteristics significantly affected the effect size in either group.CONCLUSION:Topical antibiotic after intravitreal injection of anti-vascular endothelial growth factor agents is associated with a higher risk of endophthalmitis.


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