University of Sydney, Sydney, New South Wales, Australia.
Sydney Eye Hospital, Sydney, New South Wales, Australia.
Acta Ophthalmol. 2018 Aug;96(5):435-441. doi: 10.1111/aos.13417. Epub 2017 Apr 25.
There is increasing evidence that topical antibiotics, given before and/or after intravitreal injections, are ineffective in preventing endophthalmitis and are possibly harmful. In addition to the lack of efficacy and increased development of resistant organisms, the use of topical antibiotics adds significantly to the cost of delivering intravitreal therapy. Despite this, in many countries, it is still common practice to use pre- and/or postinjection topical antibiotics. This review outlines the general principles of effective antibiotic prophylaxis, and the evidence regarding topical antibiotic use as a prophylactic measure for endophthalmitis following intravitreal injections. A key distinguishing feature of intravitreal injections from most other invasive procedures is the fact that they are often repeated on multiple occasions to the same eye. Given the lack of evidence to support topical antibiotics as an effective method of prophylaxis for postinjection endophthalmitis, it appears that more widespread education of ophthalmologists is required to avoid continued inappropriate use. Revision of drug labels in some jurisdictions, and amendment of local/professional society guidelines, may be required to assist in achieving this goal. Emphasis should be placed on antisepsis and aseptic technique, which are the major proven methods of endophthalmitis prevention, rather than antibiotics.
越来越多的证据表明，在玻璃体内注射前后给予局部抗生素预防眼内炎无效，甚至可能有害。除了缺乏疗效和增加耐药菌的产生外，局部抗生素的使用还显著增加了玻璃体内治疗的成本。尽管如此，在许多国家，在玻璃体内注射前后仍普遍使用局部抗生素。本文概述了有效抗生素预防的一般原则，以及关于局部抗生素作为玻璃体内注射后眼内炎预防措施的使用的证据。与大多数其他侵入性操作相比，玻璃体内注射的一个关键区别特征是，它们通常会多次重复用于同一只眼睛。鉴于没有证据表明局部抗生素是预防注射后眼内炎的有效方法，似乎需要对眼科医生进行更广泛的教育，以避免继续不当使用。在某些管辖区，可能需要修订药物标签，并修改当地/专业协会的指南，以协助实现这一目标。应强调消毒和无菌技术，这是预防眼内炎的主要有效方法，而不是抗生素。
