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. A meta-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; I² = 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; I² = 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.

重要性 与手术室 (OR) 相比，基于办公室的玻璃体内注射 (IVI) 被认为是一种更具成本效益和方便的方法，但 IVI 与抗血管内皮生长因子 (VEGF) 药物在不同环境中的临床结果（办公室-based vs OR) 尚未得到系统评估。

目的 评估 IVI 与抗 VEGF 药物在 OR 与办公室环境中的安全性结果。

数据源 PubMed、Embase、Cochrane Library、Web of Science 和 ClinicalTrials.gov 的检索时间从开始到 2020 年 7 月进行。

研究选择 符合条件的研究报告了接受 IVI 和抗 VEGF 药物的患者，并明确说明了办公室或手术室的注射设置。

数据提取和综合 两名评审员独立筛选研究、提取数据并评估偏倚风险。进行荟萃分析以确定眼内炎 (EO) 和培养阳性 EO 的发生率。

主要结果和测量 在 OR 和办公室环境中抗 VEGF IVI 后 EO 和培养阳性 EO 的比率。

结果 共纳入 31 项研究，共 1 275 815 次注射。比较分析表明，在办公室和手术室进行 IVI 后的 EO 发生率没有差异（优势比，3.06；95% CI，0.07-139.75；P  = .57；I ²  = 80%），但发生率更高办公室环境中发现 EO 培养阳性（优势比，21.52；95% CI，2.39-193.55；P  = .006；I ² = 0%）。在办公室和手术室环境中，抗 VEGF IVI 后 EO 的合并率分别为 0.03% (95% CI, 0.03-0.04) 和 0.02% (95% CI, 0.01-0.04)，而培养阳性的合并率EO 分别为 0.01% (95% CI, 0.01-0.02) 和 0.01% (95% CI, 0-0.02)。其他眼部和全身不良事件的汇总发生率较低。

结论和相关性 无论手术是在办公室还是在手术室进行，抗 VEGF IVI 后临床怀疑或培养阳性 EO 的发生率都很低。两种设置之间的细菌谱可能不同。这项荟萃分析无法确定与世界上高收入地区相比，出于安全原因，在 OR 中进行治疗是否更适合低收入地区。