Department of Ophthalmology, Faculty of Medical Sciences, University of Fukui, Yoshida, Japan.
Department of Ophthalmology, Gunma University, Maebashi, Japan.
Sci Rep. 2020 Dec 17;10(1):22122. doi: 10.1038/s41598-020-79377-w.
Intravitreal injection (IVI) of anti-vascular endothelial growth factor (VEGF) is the standard treatment modality in various types of retinal diseases. However, endophthalmitis remains the most serious complication. Despite the lack of evidence that antibiotics prevent endophthalmitis, topical antibiotics are still used routinely in Japan. We conducted a retrospective multicenter study by analyzing records from patients who underwent IVI of anti-VEGF agents with or without antibiotic treatment. In the analysis of a total of 147,440 eyes, the incidence of endophthalmitis was 0.007%: 0.005% with no use of antibiotics, 0.009% with antibiotic pretreatment, 0.012% with posttreatment, and 0.005% with pre- and posttreatment. There was no statistically significant difference among the four groups (chi-square test, p = 0.57). Most facilities used masks, sterilized gloves, and drapes. Nine of the 10 eyes that developed endophthalmitis received topical antibiotics, and all infected eyes underwent IVI with aflibercept, not the prefilled syringe delivery system. In four patients who received multiple IVI, the detection of causative bacteria revealed resistance to used antibiotics. Data from this large population, treated with or without antibiotics, suggests that antibiotic prophylaxis does not reduce the rate of endophthalmitis after IVI.
玻璃体内注射（IVI）抗血管内皮生长因子（VEGF）是各种类型视网膜疾病的标准治疗方法。然而，眼内炎仍然是最严重的并发症。尽管没有证据表明抗生素可以预防眼内炎，但在日本，仍常规使用局部抗生素。我们通过分析接受抗 VEGF 药物 IVI 治疗且使用或不使用抗生素治疗的患者的记录，进行了一项回顾性多中心研究。在对总共 147440 只眼的分析中，眼内炎的发生率为 0.007%：不使用抗生素的发生率为 0.005%，抗生素预处理的发生率为 0.009%，治疗后的发生率为 0.012%，预处理和治疗后的发生率为 0.005%。四组之间无统计学差异（卡方检验，p=0.57）。大多数机构使用口罩、消毒手套和手术巾。10 只发生眼内炎的眼中有 9 只用了局部抗生素，所有感染的眼睛都接受了阿柏西普的 IVI，而不是预装注射器输送系统。在接受多次 IVI 的 4 名患者中，对致病细菌的检测显示对使用的抗生素产生了耐药性。来自接受或不接受抗生素治疗的大量人群的数据表明，抗生素预防并不能降低 IVI 后眼内炎的发生率。
