ABSTRACT
Purpose : To evaluate the incidence of post-injection endophthalmitis in patients wearing facemasks. We hypothesize that the incidence of post-injection endophthalmitis in patients wearing facemasks would be significantly greater than patients who were not wearing facemasks. Methods : A retrospective cohort study was performed at a private retinal practice in Ohio. The practice management database was searched using CPT codes for endophthalmitis over two, six-month periods. The first cohort from 6/01/2019-12/31/2019, and the second, following universal facemask usage due to COVID 19, from 6/01/2020-12/31/2020. Patients who developed endophthalmitis post-intravitreal injection during the study period had their charts reviewed. Data collected included: age, sex, visual acuity, medication injected, administering physician, date of diagnosis, length of follow up, intervention, and cultured organism. Means of variables and chi-squared analyses were performed to determine statistical difference between non-masked and masked cohorts. Results : A total of 25029 intravitreal injections were performed in the first study period with 34019 injections in the second. Of those injections, endophthalmitis occurred in 8 and 12 patients respectively. Incidence of post-injection endophthalmitis in the 2019 was .00039 and .00041 in 2020 (p-value= 0.8289). The mean age of patients was 69 years in 2019 and in 68 years in 2020. Average length of follow up in 2019 was 472 days, and 74 days in 2020. Average change in visual acuity from diagnosis to last follow up was .707 in 2019 and .945 in 2020. In 2019 all six positive cultures grew coagulase negative staph, in 2020 the three positive cultures yielded Streptococcus mitis, gram positive cocci, and rare skin flora. Conclusions : We reject our hypothesis of, if patients were wearing masks during intravitreal injections, then there would be a significantly greater incidence of postinjection endophthalmitis. There was no significant association between wearing facemasks and post-injection endophthalmitis within our six-month study periods in 2019 and 2020. However, cultures between the two cohorts yielded different organisms, with one culture in 2020 presenting an organism typically found in oral flora.
ABSTRACT
Purpose : To evaluate the risks and impact of COVID-19, SARS-CoV-2, on a private ophthalmology practice in Ohio and analyze the fluctuation in patient visits and surgeries before and during the COVID-19 pandemic. Methods : A retrospective analysis was performed using outpatient clinic logs for patients seen during the first 10 weeks of 2020 and compared to outpatient clinic logs for 10 weeks during the COVID-19 pandemic. During the twenty-week period, the number of appointments, intravitreal injections, and surgeries, most commonly retinal detachments, epiretinal membrane (ERM), and vitreous hemorrhages, were compared. Additionally, consideration was given to potential measures to reduce the spread and maintain prepandemic clinical care levels. The number of appointments, injections administered, and surgeries completed or postponed were analyzed before and during the COVID-19 pandemic. The practice implemented additional precautions for patients and staff. These included, but were not limited to, temperature checks, hand sanitizer availability, required use of face masks, and asking patients to come alone to appointments;with the exception of patients that were wheelchair bound, suffered from dementia, were under the age of 18, or required a translator. Results : During the first 10 weeks of 2020, the practice saw an average of 2,205 visits a week. In week one of the pandemic, the average was 1,147 patients per week, a 54% drop. An overall 40% drop was seen in surgical cases;vitreous hemorrhage surgeries decreased by 35%, retinal detachment surgeries decreased 25%, and ERM peels reduced by 60%. The drop in ERM's were mostly due to rescheduling. Intravitreal injections during the first 10 weeks averaged 1,025 (SD±112) per week. During the start of the 10 COVID-19 weeks, intravitreal injections averaged 852 (SD±122) per week and by the last weeks injections averaged 972 (SD±142) per week. Conclusions : In the early stages, the initial number of outpatient visits declined by 54%, the average number of intravitreal injections did not change in a similar pattern. This represents the importance of patients' triage and prioritizing urgent cases.