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 antiVEGF 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.