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In this meta‐analysis, we aim to compare the efficacy and safety of pars plana vitrectomy (PPV) versus tap‐and‐inject (TAI) of intravitreal antibiotics for the management of endophthalmitis secondary to intravitreal injections of anti‐vascular endothelial growth factor (VEGF) agents. A systematic literature search was conducted on Ovid MEDLINE, EMBASE, and Cochrane Central (January 2005–October 2022). The primary analysis compared initial PPV versus TAI and the secondary analysis examined the efficacy and safety of TAI alone compared to TAI followed by PPV. The quality of non‐randomized observational studies was assessed using the Newcastle‐Ottawa Scale. The quality of the evidence was assessed for each outcome. A random effects meta‐analysis was performed. Weighted mean differences (WMDs) with 95% confidence intervals were reported. Of the 7474 screened studies, nine studies reporting on 153 eyes were included. The change in mean best corrected visual acuity (BCVA) between endophthalmitis presentation and last follow‐up did not significantly differ between the initial TAI versus PPV groups (WMD = 0.05 units; 95% CI −0.12 to 0.22; p = 0.59; heterogeneity p = 0.41). The difference in pre‐ to post‐treatment mean BCVA did not significantly differ between eyes that received TAI alone or TAI followed by PPV (WMD = 0.04 units; 95% CI −0.42 to 0.51; p = 0.85; heterogeneity p = 0.74). While the meta‐analysis revealed no significant difference in the change in BCVA between PPV and TAI to treat endophthalmitis secondary to anti‐VEGF agents, the quality of evidence was low with potential for confounding and selection bias. Further well‐designed studies in this setting are needed. [ABSTRACT FROM AUTHOR]

What is known and objective Vascular endothelial growth factor ( VEGF) proteins are involved in the regulation of vascular endothelium, and their inhibition led to the development of a number of drugs used for malignancies or exudative neo-vascular age-related macular degeneration ( AMD). Case summary We report a case of ischemic stroke in an 87-year-old woman having received intravitreal aflibercept, a new anti- VEGF for AMD. She had been treated with ranibizumab since 2007. In 2013, ranibizumab was replaced with aflibercept, followed by a decrease in the International Normalized Ratio, complicated by a stroke a few days later. The rechallenge was positive. What is new and conclusion A potential time-dependent interaction between aflibercept and VKA antagonist and/or a direct effect of aflibercept may have contributed to the occurrence of the ischaemic stroke. Currently available data suggest some pharmacokinetic and pharmacodynamic effects of aflibercept by explaining its pro-thrombotic profile. [ABSTRACT FROM AUTHOR]