The influence of universal face mask use on endophthalmitis risk after intravitreal anti-vascular endothelial growth factor injections during the COVID-19 pandemic

Abstract

Purpose : Routine use of face masks for both patients and physicians during intravitreal anti-vascular endothelial growth factor (VEGF) injections has increased with the emergence of the COVID-19 pandemic. This study evaluates the impact of physician, ancillary staff, and patient face mask use on rates and outcomes of post-injection endophthalmitis.

Methods : In this retrospective comparative cohort study, all eye receiving intravitreal anti-VEGF factor injections from 10/1/2019 to 7/31/2020 were included from twelve centers. Cases were divided into a “no face mask” group if no face masks were worn by the physician or patient during intravitreal injections or a “universal face mask” group if face masks were worn by the physician, ancillary staff, and patient during intravitreal injections. The main outcome measures were rate of endophthalmitis, visual acuity, and microbial spectrum.

Results : Of 505,968 intravitreal injections administered, 85 of 294,514 (0.0289%; 1 in 3,464 injections) cases of endophthalmitis occurred in the “no face mask” group, and 45 of 211,454 (0.0213%; 1 in 4,699 injections) cases occurred in the “universal face mask” group (odds ratio, 0.74; 95%CI, 0.51–1.18; p=0.097; Table 1). In the “no face mask” group, there were 27 cases (0.0092%; 1 in 10,908 injections) of culture-positive endophthalmitis compared to 9 cases (0.004%; 1 in 23,494 injections) in the “universal face mask” group (OR, 0.46; 95%CI, 0.22–0.99; p=0.041). Three cases of oral flora-associated endophthalmitis occurred in the “no face mask” group (0.001%; 1 in 98,171 injections) compared to one (0.0005%; 1 in 211,454) in the “universal face mask” group (p=0.645). At endophthalmitis presentation, mean logMAR visual acuity was 2.04 for “no face mask” group compared to 1.65 for the “universal face mask” group (p=0.022), although no difference was observed three months after treatment (p=0.764; Table 2).

Conclusions : Universal face mask use during intravitreal anti-VEGF injections did not show a statistically significant reduction in presumed endophthalmitis, but there was a reduced rate of culture-positive endophthalmitis. Future studies are warranted to assess the role of face mask use to reduce endophthalmitis risk, particularly that due to oral flora.

This is a 2021 ARVO Annual Meeting abstract.

 

Rates of endophthalmitis

 

Visual acuity outcomes