Background: The dramatic increase in
intravitreal injections (IVTs) has been accompanied by a greater need for safer procedures. The ongoing debate about topical
antibiotic prophylaxis after IVTs emphasizes the importance of large-scale studies. We aimed to study the role of topical
antibiotic prophylaxis in reducing the risk of acute
endophthalmitis after IVTs. Methods: Population-based cohort study, in France, from 2009 to 2018, including all French patients receiving IVTs of
corticosteroids or anti-
VEGF agents. Results: A total of 5,291,420 IVTs were performed on 605,434 patients. The rate of topical
antibiotic prophylaxis after IVTs progressively decreased during the study period, with a sharp drop in 2014 (from 84.6% in 2009 to 27.4% in 2018). Acute
endophthalmitis occurred in 1274 cases (incidence rate = 0.0241%). Although
antibiotic prophylaxis did not alter the risk of
endophthalmitis (p = 0.06), univariate analysis showed an increased risk after
fluoroquinolone and
aminoglycoside prophylaxis. This increased risk was not found in multivariate analysis. However, we observed an increased risk related to the use of fixed combinations of
fluoroquinolones and
aminoglycosides with
corticosteroids (
IRR = 1.89; 95% CI = 1.57-2.27%,
antibiotics combined with
corticosteroids). Conclusion: These results are consistent with the literature.
Endophthalmitis rates after IVTs did not decrease with topical
antibiotic prophylaxis. The use of a combination of
antibiotics and
corticosteroids doubles the risk of
endophthalmitis and should be avoided. Avoiding
antibiotic prophylaxis would reduce the costs and the potential risks of antibiotic resistance.