Safety of Receiving Anti-Vascular Endothelial Growth Factor Intravitreal Injection in Office-Based vs Operating Room Settings A Meta-analysis

IMPORTANCE Compared with the operating room (OR), office-based intravitreal injection (IVI) is considered a more cost-effective and convenient approach, yet clinical outcomes of IVIs with anti-vascular endothelial growth factor (VEGF) agents in different settings (office-based vs OR) have not been systematically evaluated. OBJECTIVE To evaluate the safety outcomes of IVI with anti-VEGF agents in the OR vs office-based setting. DATA SOURCES PubMed, Embase, Cochrane Library, Web of Science, and ClinicalTrials.gov were searched from inception to July 2020. STUDY SELECTION Eligible studies reporting on patients who received IVIs with anti-VEGF drugs with a clearly stated injection setting of the office or OR. DATA EXTRACTION AND SYNTHESIS Two reviewers independently screened studies, extracted data, and assessed risk of bias. Ameta-analysis was conducted to determine the rates of endophthalmitis (EO) and culture-positive EO. MAIN OUTCOMES AND MEASURES Rates of EO and culture-positive EO following anti-VEGF IVIs in the OR and office-based setting. RESULTS Thirty-one studies with a total of 1 275 815 injections were included. Comparative analysis suggested no difference between rates of EO after IVIs performed in the office and OR settings (odds ratio, 3.06; 95% CI, 0.07-139.75; P=.57; I-2 = 80%) were identified, yet a higher rate of culture-positive EO was found in the office setting (odds ratio, 21.52; 95% CI, 2.39-193.55; P=.006; I-2 = 0%). The pooled rates of EO following anti-VEGF IVIs were 0.03% (95% CI, 0.03-0.04) and 0.02%(95% CI, 0.01-0.04) in office and OR settings, respectively, and the pooled rates of culture-positive EO were 0.01% (95% CI, 0.01-0.02) and 0.01% (95% CI, 0-0.02). The pooled rates of other ocular and systemic adverse events were low. CONCLUSIONS AND RELEVANCE The rate of clinically suspected or culture-positive EO following anti-VEGF IVIs was low whether the procedure was performed in the office or OR setting. Bacterial spectrum could differ between the 2 settings. This meta-analysis could not determine if it is more appropriate to give treatment in the OR for safety reasons in low-income compared with higher-income regions in the world.

Automated summary

This study evaluated the safety outcomes of IVI with anti-VEGF agents in the office vs OR setting, finding a higher rate of culture-positive EO in the office setting. Overall, the rate of clinically suspected or culture-positive EO following anti-VEGF IVIs was low in both settings, but bacterial spectrum could differ between the two.