{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,28]],"date-time":"2026-07-28T18:00:37Z","timestamp":1785261637084,"version":"3.55.0"},"reference-count":57,"publisher":"Public Library of Science (PLoS)","issue":"7","license":[{"start":{"date-parts":[[2026,7,28]],"date-time":"2026-07-28T00:00:00Z","timestamp":1785196800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:sec id=\"sec001\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Endophthalmitis is a rare but serious complication of intravitreal injections (IVI). To mitigate the risk of post-injection endophthalmitis (PIE), retinal specialists use different strategies, combining various prophylactic measures. However, existing systematic reviews have evaluated the effects of these measures in isolation, which does not consider their concurrent use in practice. A trustworthy systematic review with network meta-analysis (NMA) by providing a framework for simultaneous comparisons of different prophylactic combinations is essential to guide decision-making.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To present a protocol for addressing the comparative effects of different strategies for the prevention of PIE.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We will search Medline, EMBASE, Cochrane CENTRAL, Web of Science, and ClinicalTrials.gov from inception for randomized controlled trials and observational studies comparing any strategy for preventing PIE with an alternative strategy, or placebo, or no prophylactic strategy in patients aged 18 years or older who received IVI of any pharmacological agent for any indication except treatment of bacterial endophthalmitis. Paired reviewers will independently screen studies, extract the data and assess risk of bias for each outcome that includes infectious endophthalmitis, confirmed endophthalmitis, any endophthalmitis, need for surgical intervention for management of PIE, and best-corrected visual acuity. For each outcome, when possible, we will conduct frequentist random-effects NMAs. We will assess the certainty of evidence and interpret findings using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec004\">\n                    <jats:title>Discussion<\/jats:title>\n                    <jats:p>This systematic review and NMA will provide a comprehensive and up-to-date summary of the evidence addressing the effects of all available strategies for the prevention of PIE.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec005\">\n                    <jats:title>Registration<\/jats:title>\n                    <jats:p>\n                      Open Science Framework (\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/doi.org\/10.17605\/OSF.IO\/SJC4U\" xlink:type=\"simple\">https:\/\/doi.org\/10.17605\/OSF.IO\/SJC4U<\/jats:ext-link>\n                      ).\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pone.0354670","type":"journal-article","created":{"date-parts":[[2026,7,28]],"date-time":"2026-07-28T17:24:19Z","timestamp":1785259459000},"page":"e0354670","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["OphthoEvidence report: Comparative effects of prophylactic strategies for post-intravitreal injection endophthalmitis: Protocol for a systematic review and network meta-analysis"],"prefix":"10.1371","volume":"21","author":[{"given":"Maryam","family":"Ghadimi","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dena","family":"Zeraatkar","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5486-7211","authenticated-orcid":true,"given":"Jo\u00e3o Pedro","family":"Lima","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jinhui","family":"Ma","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sunir","family":"Garg","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter","family":"Kaiser","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Steel","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8448-1264","authenticated-orcid":true,"given":"Tien Yin","family":"Wong","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8952-0659","authenticated-orcid":true,"given":"Sobha","family":"Sivaprasad","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7756-5091","authenticated-orcid":true,"given":"Charles","family":"Wykoff","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9988-4146","authenticated-orcid":true,"given":"Varun","family":"Chaudhary","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2026,7,28]]},"reference":[{"issue":"3","key":"pone.0354670.ref001","doi-asserted-by":"crossref","first-page":"229","DOI":"10.1097\/ICU.0000000000001120","article-title":"Reducing rates of endophthalmitis from intravitreal injections - strategies and areas of controversy","volume":"36","author":"AF Durrani","year":"2025","journal-title":"Curr Opin Ophthalmol"},{"issue":"8","key":"pone.0354670.ref002","doi-asserted-by":"crossref","first-page":"1279","DOI":"10.1016\/j.ophtha.2018.01.022","article-title":"Endophthalmitis after intravitreal injection of vascular endothelial growth factor inhibitors: Management and visual outcomes","volume":"125","author":"K Xu","year":"2018","journal-title":"Ophthalmology"},{"key":"pone.0354670.ref003","first-page":"143","article-title":"Meta-analysis of infectious endophthalmitis after intravitreal injection of anti-vascular endothelial growth factor agents. 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