Key Takeaways

• A Bayesian meta-analysis of 54 studies and more than 6.8 million cataract surgeries found antibiotic injection was associated with an approximately 79% reduction in the odds of postoperative endophthalmitis
• Investigators calculated a 100% posterior probability of clinically meaningful benefit and a 99.1% probability that future studies would confirm the finding

Intraoperative antibiotic injection was associated with a substantially lower risk of postoperative endophthalmitis compared with conventional topical eye drop regimens following cataract surgery, according to findings from a large Bayesian meta-analysis.¹

The analysis included 54 studies encompassing 6,867,422 cataract surgeries, including 3,501,802 procedures in which antibiotic injection therapy was administered. Investigators reported that antibiotic injection was associated with an approximately 79% reduction in the odds of postoperative endophthalmitis compared with conventional postoperative regimens.

The study was published online August 25, 2026, in the Journal of Cataract & Refractive Surgery.

Investigators conducted a systematic search of PubMed, Embase, and the Cochrane Library for studies evaluating antibiotic injections during cataract surgery compared with conventional postoperative regimens. The researchers used a Bayesian random-effects meta-analysis to estimate the overall treatment effect and between-study heterogeneity. Treatment effects were expressed as odds ratios (ORs) with 95% credible intervals (CrIs). 

Across the 54 studies, antibiotic injection was associated with an OR of 0.208 for postoperative endophthalmitis compared with standard regimens (95% CrI, 0.161-0.268). The Bayesian analysis also found a 100% posterior probability that antibiotic injection provided a clinically meaningful benefit, which investigators defined as an OR below 0.80. Additionally, the model estimated a 99.1% probability that future studies would confirm the observed benefit. Sensitivity analyses supported the primary findings.

The findings provide additional evidence supporting intraoperative antibiotic administration as an infection-prevention strategy and may also bolster interest in approaches designed to reduce patients' reliance on postoperative drops.

The analysis specifically evaluated the risk of endophthalmitis associated with antibiotic injection and does not, based on the published abstract, provide detailed comparisons of individual antibiotic agents, dosing strategies, or injection routes. The available results also do not report secondary safety outcomes associated with specific intracameral or subconjunctival protocols.

Because the meta-analysis incorporated both randomized and nonrandomized evidence, differences among the underlying studies should also be considered when interpreting the pooled treatment effect. Still, the investigators concluded that antibiotic injection during cataract surgery was associated with a significant reduction in postoperative endophthalmitis risk, with sensitivity analyses supporting the robustness of the finding.

Reference

1. Ramos M, Barbosa LM, Ramos SM, et al. Antibiotic injection in cataract surgery and risk of endophthalmitis: a Bayesian meta-analysis. J Cataract Refract Surg. Published online August 25, 2026. doi:10.1097/j.jcrs.0000000000002045.