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] = –0.61 logMAR; 95% CI, –1.19 to
–0.03; p = 0.04; I2 = 89%; n = 7 studies; GRADE = very low). The incidence of enucleation was similar
between initial T/I and initial PPV (risk ratio [RR] = 0.73; 95% CI, 0.09–6.25; p = 0.78; I2 = 4%; n = 2 studies; GRADE = very low). The risk of retinal detachment was similar
between treatment modalities (RR = 0.29; 95% CI, 0.01–5.94; p = 0.42; I2 = 52%; n = 2 studies; GRADE = 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.
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Article info
Publication history
Published online: February 16, 2023
Accepted:
January 24,
2023
Received in revised form:
November 28,
2022
Received:
July 4,
2022
Publication stage
In Press Corrected ProofIdentification
Copyright
© 2023 Canadian Ophthalmological Society. Published by Elsevier Inc. All rights reserved.
