Tap and inject of intravitreal antibiotics versus pars plana vitrectomy for post-cataract surgery endophthalmitis: a meta-analysis.
Can J Ophthalmol
; 59(2): 73-78, 2024 Apr.
Article
in En
| MEDLINE
| ID: mdl-36803934
ABSTRACT
BACKGROUND:
The efficacy and safety of initial tap and inject (T/I) compared with pars plana vitrectomy (PPV) for acute postoperative bacterial endophthalmitis following cataract surgery is unclear. Understanding the comparative safety and efficacy of initial T/I and initial PPV can provide context for treatment decision making in this setting.METHODS:
A systematic literature search was performed on Ovid MEDLINE, EMBASE, and the Cochrane Library from January 1990 to January 2021. Comparative studies reporting on final best-corrected visual acuity (BCVA) following initial T/I or PPV in patients with infectious endophthalmitis secondary to cataract surgery were included. Cochrane's Risk of Bias in Non-Randomized Studies of Interventions (ROBINS-I) was used to evaluate the risk of bias, and GRADE criteria were used to assess certainty of evidence. A random-effects model was used for meta-analysis.RESULTS:
Seven nonrandomized studies reporting on 188 eyes at baseline were included in this meta-analysis. Initial T/I achieved a significantly better BCVA at last study observation than initial PPV (weighted mean difference [WMD]â¯=â¯-0.61 logMAR; 95% CI, -1.19 to -0.03; pâ¯=â¯0.04; I2â¯=â¯89%; nâ¯=â¯7 studies; GRADEâ¯=â¯very low). The incidence of enucleation was similar between initial T/I and initial PPV (risk ratio [RR]â¯=â¯0.73; 95% CI, 0.09-6.25; pâ¯=â¯0.78; I2â¯=â¯4%; nâ¯=â¯2 studies; GRADEâ¯=â¯very low). The risk of retinal detachment was similar between treatment modalities (RRâ¯=â¯0.29; 95% CI, 0.01-5.94; pâ¯=â¯0.42; I2â¯=â¯52%; nâ¯=â¯2 studies; GRADEâ¯=â¯very low).CONCLUSIONS:
The quality of evidence in this setting is limited. T/I had a significantly better BCVA at last study observation than initial PPV. Safety profiles were similar between T/I and PPV.
Full text:
1
Database:
MEDLINE
Main subject:
Cataract
/
Cataract Extraction
/
Endophthalmitis
Type of study:
Clinical_trials
/
Prognostic_studies
/
Systematic_reviews
Limits:
Humans
Language:
En
Year:
2024
Type:
Article