NEW YORK (Reuters Health) – The risk of developing endophthalmitis after intravitreal injection of anti-vascular endothelial growth factor (VEGF) is not increased when healthcare workers and patients wear face masks, according to a large retrospective study.
It has been unclear if and how the use of face masks affects the risk of post-injection endophthalmitis (PIE), researchers note in Ophthalmology. Some studies suggest “patient face mask use during intravitreal injections may direct bacterial dispersion and expiratory airflow toward the eye, which could potentially increase the risk of PIE,” write Dr. Sunir J. Garg of Wills Eye Hospital and Thomas Jefferson University, in Philadelphia, and colleagues.
“Endophthalmitis is an uncommon but potentially devastating complication of intravitreal injection,” Dr. Garg told Reuters Health by email. “Our study confirmed that the infection rate without face mask use is very low. When everyone in the injection room wore a mask during the COVID-19 pandemic, the post-injection endophthalmitis (PIE) rate remained low.”
He and his colleagues reviewed clinical and billing records involving eyes that received anti-VEGF injections over ten months in 2019 and 2020 at 12 academic medical centers. They included all patients diagnosed with presumed PIE after intravitreal injection of bevacizumab, ranibizumab, or aflibercept, but excluded those treated with intravitreal brolucizumab or steroids.
Cases of endophthalmitis were defined by the decision of the treating physician to inject intravitreal antibiotics, they researchers note, either during a tap-and-inject procedure or during pars plana vitrectomy.
More than 500,000 intravitreal anti-VEGF injections were performed, with 130 cases of presumed PIE (0.026%, or one per 3,892 injections). Cultures were available in 116 (89.2%) of those cases.
When neither doctor nor patient wore a mask, the rate of presumed endophthalmitis was 0.0289%, with 27 culture-positive cases (0.0092%). The rates were 0.0213% and 0.004%, respectively, when both healthcare workers and patients wore masks.
The rate of PIE did not differ significantly between the two groups (odds ratio, 0.74; P=0.097), but the rate of culture positivity did (OR, 0.46; P=0.041).
The rate of oral-flora-associated endophthalmitis was 0.0010% in the no-mask group versus 0.0005% in the universal-masking group (OR, 0.46; P=0.65).
Three months after surgery, the mean Snellen VA, converted to logarithm of the minimum angle of resolution (logMAR), was 1.07 versus 1.01, respectively (P=0.764).
Experts not involved in the study welcomed the findings.
“Overall, this study should be reassuring to physicians and to patients,” Dr. Paul S. Bernstein, a professor of ophthalmology and visual sciences at the University of Utah School of Medicine’s Moran Eye Center, in Salt Lake City, told Reuters Health by email.
Dr. Merina Thomas, an assistant professor of ophthalmology at Casey Eye Institute of Oregon Health and Science University in Portland, said, “The results in this well-written paper may affect whether physicians will recommend continued use of face masks during intravitreal injections.”
“Limitations of this study include its retrospective nature; difficulty in powering, especially regarding the incidence of oral flora-associated endophthalmitis, as the incidence is quite low; and lack of standardized injection protocols among institutions,” she told Reuters Health by email.
SOURCE: https://bit.ly/3qpB5YJ Ophthalmology, online May 18, 2021.
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