Prefilled syringes and post-intravitreal injection endophthalmitis: A network meta-analysis
Why this work is in the frame
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Bibliographic record
Abstract
Optimally, syringe-filling technique may reduce the risk of post-injection endophthalmitis (PIE), yet there is wide variation between ophthalmologists and jurisdictions regarding syringe-filling practices. This frequentist network meta-analysis (PROSPERO: CRD42024555196) of rare events sought to compare the odds of PIE between manufactured prefilled syringes (PFS), compounded syringes, and traditional vial preparation of syringes (VPS) for intravitreal anti-vascular endothelial growth factor therapy. Given outcome rarity, we included studies whose primary outcome was PIE incidence. From 20 observational studies (3746 PIE events; 41,611,960 injections), the odds of PIE were significantly lower with PFS (OR: 0.45, 95 % confidence interval [CI]: 0.40-0.49) and compounded syringes (OR: 0.69, 95 % CI: 0.64-0.74) compared to VPS. The odds of PIE were significantly lower with PFS compared to compounded syringes (OR: 0.65, 95 % CI: 0.58-0.72). The odds of culture-positive PIE were significantly lower with PFS than both VPS (OR: 0.15, 95 % CI: 0.06-0.41) and compounded syringes (OR: 0.15, 95 % CI: 0.05-0.44). No significant difference in culture-positive PIE was observed between VPS and compounded syringes (OR: 1.02, 95 % CI: 0.66-1.58). Low certainty evidence supports that PFS significantly reduce the rate of clinical and culture-positive PIE compared to VPS and compounded syringes. Future studies should further characterize the role of confounding.
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Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.000 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.007 | 0.002 |
| Bibliometrics | 0.001 | 0.002 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.001 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from it