Effectiveness of intracameral antibiotics in reducing postoperative endophthalmitis risk after cataract surgery: A meta-analysis

Purpose: Postoperative endophthalmitis is a rare but serious complication following cataract surgery, often leading to severe vision loss and increased healthcare burden. This systematic review and meta-analysis aimed to evaluate the effectiveness of intracameral antibiotic prophylaxis in reducing the risk of postoperative endophthalmitis. Design: A systematic review and meta-analysis. Methods: A comprehensive literature search was conducted across PubMed, Cochrane Library, Scopus, and EMBASE up to September 18, 2024. Studies were included if they compared intracameral antibiotic prophylaxis with no prophylaxis in patients undergoing cataract surgery. The primary outcome was the odds of developing postoperative endophthalmitis. Random-effects and quality-effects models were used for meta-analysis, with heterogeneity assessed via the I² statistic. Subgroup analyses were conducted based on antibiotic type, study design, and geographic region. Results: A total of 25 studies involving 5665,621 participants were included. The pooled odds ratio (OR) for the risk of endophthalmitis with intracameral antibiotics was 0.31 (95 % CI: 0.15–0.61), indicating a 69 % reduction in risk compared to no prophylaxis. Subgroup analysis revealed significant differences in efficacy based on antibiotic type, with moxifloxacin (OR: 0.24, 95 % CI: 0.20–0.29) and vancomycin (OR: 0.11, 95 % CI: 0.04–0.30) showing the greatest protective effects. Sensitivity analyses confirmed the robustness of results, though publication bias was suggested by funnel and Doi plots asymmetry. Conclusions: Intracameral antibiotic prophylaxis significantly reduces the risk of postoperative endophthalmitis following cataract surgery, with moxifloxacin and vancomycin showing the strongest protective effects. Given the variability in efficacy across antibiotic types, further randomized controlled trials are needed to optimize prophylactic strategies. These findings support broader adoption of intracameral antibiotics to enhance patient safety and reduce the global burden of post-cataract endophthalmitis.