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2.
Genes (Basel) ; 13(7)2022 Jun 21.
Article in English | MEDLINE | ID: covidwho-1963782

ABSTRACT

The proposed SARS-CoV-2-induced dysregulation of the renin-angiotensin-aldosterone (RAAS) system results in endothelial dysfunction and microvascular thrombosis. The retinal plexuses contain terminal vessels without anastomotic connections, making the retina especially susceptible to ischemia. This study aimed to determine the role of selected polymorphisms of genes in the RAAS pathway in COVID-19 severity and their association with the presence of COVID-19 retinopathy. 69 hospitalized patients in the acute phase of COVID-19 without known systemic comorbidities and 96 healthy controls were enrolled in this prospective cross-sectional study. The retina was assessed with fundus photography using a Topcon DRI OCT Triton (Topcon Corp., Tokyo, Japan) in the COVID-19 unit. Genotyping of selected polymorphisms in the genes for ACE (rs4646994), ACE2 (rs2285666), and AGTR2 (rs1403543) was performed. The COVID-19 group was divided into mild (n = 12) and severe (n = 57), and then further divided according to the presence of COVID-19 retinopathy (Yes, n = 50; No, n = 19). The presence of the AGTR2 rs1403543-AA genotype was associated with a 3.8-fold increased risk of COVID-19 retinopathy (p = 0.05). The genotype frequencies of selected gene polymorphisms were not significantly associated with either the presence of COVID-19 or its severity. This is the first study demonstrating a borderline association of the AGTR2 rs1403543-AA genotype with COVID-19 retinopathy in males; hence, the AGTR2 rs 1403543 A allele might represent a genetic risk factor for COVID-19 retinopathy in males.


Subject(s)
COVID-19 , Retinal Diseases , Angiotensin-Converting Enzyme 2/genetics , COVID-19/complications , COVID-19/genetics , Cross-Sectional Studies , Humans , Male , Peptidyl-Dipeptidase A/genetics , Peptidyl-Dipeptidase A/metabolism , Polymorphism, Genetic , Prospective Studies , Receptor, Angiotensin, Type 2 , Retinal Diseases/genetics , SARS-CoV-2
3.
Indian J Ophthalmol ; 70(4): 1418-1420, 2022 04.
Article in English | MEDLINE | ID: covidwho-1939183

ABSTRACT

To report a case of MEWDS post-COVID-19 infection with multimodal imaging. A 17-year-old boy reported blurring of vision in both eyes 2 months and 10 days following the SARS-CoV-2 infection. Fundus examination revealed hypopigmented lesions nasal to the optic disc, inferior periphery, and near macula in both eyes. Multimodal imaging was consistent with MEWDS. A complete systemic workup was performed to exclude infectious etiology. Fundus lesions resolved with a course of oral corticosteroids and was confirmed on multimodal imaging.


Subject(s)
COVID-19 , Retinal Diseases , White Dot Syndromes , Adolescent , Fluorescein Angiography/methods , Humans , Male , Retinal Diseases/diagnosis , SARS-CoV-2
4.
J Chin Med Assoc ; 85(7): 793-798, 2022 07 01.
Article in English | MEDLINE | ID: covidwho-1927457

ABSTRACT

BACKGROUND: Although teleophthalmology has gained traction in recent years, it is at the center of the coronavirus disease pandemic. However, most hospitals are not ready owing to a severe lack of real-world experience. Furthermore, a limited number of studies have evaluated telemedicine applications on remote islands. This study aimed to evaluate real-world clinical and referral accuracy, image quality, physician-perceived diagnostic certainty, and patient satisfaction with telemedicine eye screening using a novel handheld fundus camera in a rural and medically underserved population. METHODS: This prospective study included 176 eyes from a remote island. All participants underwent a comprehensive ophthalmic examination. Nonmydriatic retinal images obtained using a handheld fundus camera were reviewed by two retinal specialists to determine image quality, diagnosis, and need for referrals. The agreement of diagnosis between image-based assessments was compared with that of binocular indirect ophthalmoscopic assessments. RESULTS: Image quality of fundus photographs was considered acceptable or ideal in 97.7% and 95.5% of eyes assessed by two reviewers, respectively. There was considerable agreement in diagnosis between the indirect ophthalmoscopic assessment and image-based assessment by two reviewers (Cohen's kappa = 0.80 and 0.78, respectively). Likewise, substantial agreement was achieved in the referrals. The sensitivity for referable retinopathy from the two reviewers was 78% (95% confidence interval [CI], 57%-91%) and 78% (95% CI, 57%-91%), whereas specificity was 99% (95% CI, 95%-99%] and 98% (95% CI, 93%-99%), respectively. For physicians' perceived certainty of diagnosis, 93.8% and 90.3% were considered either certain or reliable. Overall, 97.4% of participants were satisfied with their experiences and greatly valued the telemedicine services. CONCLUSION: Novel fundus camera-based telemedicine screening demonstrated high accuracy in detecting clinically significant retinopathy in real-world settings. It achieved high patient satisfaction and physician-perceived certainty in diagnosis with reliable image quality, which may be scaled internationally to overcome geographical barriers under the global pandemic.


Subject(s)
Diabetic Retinopathy , Ophthalmology , Physicians , Retinal Diseases , Telemedicine , Diabetic Retinopathy/diagnostic imaging , Humans , Prospective Studies , Telemedicine/methods
7.
Retin Cases Brief Rep ; 16(4): 403-406, 2022 Jul 01.
Article in English | MEDLINE | ID: covidwho-1909002

ABSTRACT

PURPOSE: To report a case of branch retinal artery occlusion associated with paracentral acute middle maculopathy on spectral-domain optical coherence tomography presumably related to heavy cannabis consumption. METHODS: Retrospective case report. Spectral-domain optical coherence tomography, fluorescein angiography, and optical coherence tomography angiography were performed. RESULTS: A 21-year-old healthy man described the acute onset of superior visual field loss in his right eye. He admitted smoking approximately 15 g daily of cannabis for several weeks during COVID-19 confinement. Ophthalmoscopic examination of the right eye showed inferotemporal retinal whitening. Spectral-domain optical coherence tomography illustrated evidence of the ischemic cascade with diffuse hyperreflectivity of the inner and middle retinal layers within the central region of the retinal infarct and paracentral acute middle maculopathy at the border of the infarct. Optical coherence tomography angiography demonstrated predominant flow signal loss at the level of the deep retinal capillary plexus. Fluorescein angiography and complete systemic workup were unremarkable. CONCLUSION: Branch retinal artery occlusion and paracentral acute middle maculopathy may be related to heavy cannabis use as the result of transient arterial vasospasm.


Subject(s)
COVID-19 , Cannabis , Macular Degeneration , Retinal Artery Occlusion , Retinal Diseases , Acute Disease , Adult , Cannabis/adverse effects , Fluorescein Angiography/methods , Humans , Infarction , Male , Retina , Retinal Artery Occlusion/chemically induced , Retinal Artery Occlusion/diagnosis , Retinal Diseases/chemically induced , Retinal Diseases/diagnosis , Retinal Vessels , Retrospective Studies , Tomography, Optical Coherence/methods , Young Adult
8.
BMJ Case Rep ; 15(5)2022 May 10.
Article in English | MEDLINE | ID: covidwho-1832380

ABSTRACT

We report a case of Susac syndrome after SARS-CoV-2 infection and subsequent vaccination that presented with meningitis and retinal microembolisation in the form of paracentral acute middle maculopathy (PAMM). After presenting with headache, fever and myalgia followed by scotomata, a woman in her 50s was hospitalised for meningitis; she had had mild COVID-19 infection 2 months prior to admission, having received the first vaccine dose 1 month prior to the neurological manifestation. Eye fundus examination and optical coherence tomography were suggestive of PAMM. D-dimer levels and erythrocyte sedimentation rate were elevated. Before infectious investigation results were available, she was started on empirical antibiotic and antiviral treatment. Having ruled out infectious causes, she was started on high-dose prednisolone. After 1 month, there was partial resolution of retinal lesions. This case highlights that exposure to SARS-CoV-2 antigen may be related to this rare syndrome; treatment with steroids may improve central and retinal impairment.


Subject(s)
COVID-19 , Macular Degeneration , Retinal Diseases , Susac Syndrome , Female , Fluorescein Angiography/methods , Humans , Macular Degeneration/complications , Retinal Diseases/diagnosis , Retinal Diseases/drug therapy , Retinal Diseases/etiology , Retinal Vessels/pathology , SARS-CoV-2 , Tomography, Optical Coherence/methods
9.
Indian J Ophthalmol ; 70(2): 673-676, 2022 Feb.
Article in English | MEDLINE | ID: covidwho-1810682

ABSTRACT

A 41-year-old man presented to the emergency department complaining of decrease of vision in his left eye. Initial examination was consistent with retrobulbar optic neuritis, and an intravenous drip of methylprednisolone was started. On the third day, the fundus examination revealed the appearance of multiple Purtscher-like cotton-wool spots in the posterior pole and nasally to the optic disc, slight retinal whitening around the fovea, and cherry-red spot. The patient reported flu-like symptoms, and he tested positive at PCR (polymerase chain reaction) test for 2019-nCoV (2019 novel coronavirus) infection. Assuming possible 2019-nCoV-related vascular damage, we prescribed low-molecular-weight heparin. The lesions were regressing at follow-up, and we registered a complete visual recovery.


Subject(s)
COVID-19 , Retinal Diseases , Adult , Fundus Oculi , Humans , Male , Retina , SARS-CoV-2
10.
Curr Opin Pharmacol ; 64: 102231, 2022 06.
Article in English | MEDLINE | ID: covidwho-1797024

ABSTRACT

Coronavirus disease (COVID-19) outbreak has caused unprecedented global disruption since 2020. Approximately 238 million people are affected worldwide where the elderly succumb to mortality. Post-COVID syndrome and its side effects have popped up with several health hazards, such as macular degeneration and vision loss. It thus necessitates better medical care and management of our dietary practices. Natural flavonoids have been included in traditional medicine and have also been used safely against COVID-19 and several other diseases. Kaempferol is an essential flavonoid that has been demonstrated to influence several vital cellular signaling pathways involved in apoptosis, angiogenesis, inflammation, and autophagy. In this review, we emphasize the plausible regulatory effects of Kaempferol on hallmarks of COVID-19 and macular degeneration.


Subject(s)
COVID-19 , Macular Degeneration , Retinal Diseases , Aged , COVID-19/drug therapy , Flavonoids/therapeutic use , Humans , Kaempferols/pharmacology , Kaempferols/therapeutic use , Macular Degeneration/drug therapy , Macular Degeneration/metabolism , Retina/metabolism , Retinal Diseases/drug therapy
11.
JAMA Ophthalmol ; 140(5): 523-527, 2022 05 01.
Article in English | MEDLINE | ID: covidwho-1787614

ABSTRACT

Importance: COVID-19 is associated with systemic vascular damage; however, the risk posed to the retinal vasculature remains incompletely understood. Objective: To assess if there is a change in the incidence of retinal vascular occlusions after COVID-19 infection. Design, Setting, and Participants: This cohort study at an integrated health care organization (Kaiser Permanente Southern California) included patients without a history of retinal vascular occlusion who were diagnosed with COVID-19 infection between January 20, 2020, and May 31, 2021. Patients were excluded if they had a history of retinal artery occlusions (RAOs) or retinal vein occlusions (RVOs) more than 6 months before their COVID-19 diagnosis or if they were enrolled in Kaiser Permanente Southern California for less than 6 months before COVID-19 diagnosis. Exposures: COVID-19 infection. Main Outcomes and Measures: The change in the average biweekly incidence of new RAOs and RVOs after COVID-19 diagnosis. Adjusted incidence rate ratios (IRRs) were calculated to compare the incidence of retinal vascular occlusions before and after COVID-19 diagnosis after accounting for baseline demographic characteristics, medical history, and hospitalization. Results: A total of 432 515 patients diagnosed with COVID-19 infection were included in this study. The mean (SD) age was 40.9 (19.2) years, and 231 767 patients (53.6%) were women. Sixteen patients had an RAO (crude incidence rate, 3.00 per 1 000 000 patients), and 65 had an RVO (crude incidence rate, 12.20 per 1 000 000 patients) in the 6 months after COVID-19 diagnosis. The incidence of new RVOs was higher in the 6 months after COVID-19 infection compared with the 6 months before infection after adjusting for age; sex; self-reported race and ethnicity; body mass index; history of diabetes, hypertension, or hyperlipidemia; and hospitalization (adjusted IRR, 1.54; 95% CI, 1.05-2.26; P = .03). There was a smaller increase in the incidence of RAOs after COVID-19 diagnosis (IRR, 1.35; 95% CI, 0.64-2.85; P = .44). The peak incidence of RAOs and RVOs occurred 10 to 12 weeks and 6 to 8 weeks after COVID-19 diagnosis, respectively. Conclusions and Relevance: The findings of this study suggest that there was an increase in the incidence of RVOs after COVID-19 infection; however, these events remain rare, and in the absence of randomized controls, a cause-and-effect relationship cannot be established. Further large, epidemiologic studies are warranted to better define the association between retinal thromboembolic events and COVID-19 infection.


Subject(s)
COVID-19 , Retinal Artery Occlusion , Retinal Diseases , Retinal Vein Occlusion , Adult , COVID-19/epidemiology , COVID-19 Testing , Cohort Studies , Female , Humans , Incidence , Male , Retinal Artery Occlusion/diagnosis , Retinal Artery Occlusion/epidemiology , Retinal Diseases/diagnosis , Retinal Diseases/epidemiology , Retinal Vein Occlusion/diagnosis , Retinal Vein Occlusion/epidemiology , Retinal Vein Occlusion/etiology , Retrospective Studies , Risk Factors
12.
Am J Ophthalmol ; 236: 241-248, 2022 04.
Article in English | MEDLINE | ID: covidwho-1757062

ABSTRACT

PURPOSE: To determine the feasibility and accuracy of nonmydriatic ultra-widefield (UWF) fundus photographs taken in a hematology clinic setting for screening of sickle cell retinopathy (SCR) DESIGN: Prospective cohort study. METHODS: This single-site study took place at the Johns Hopkins Sickle Cell Center for Adults and the Wilmer Eye Institute. The study population was 90 eyes of 46 consecutive adults with sickle cell disease (SCD). Bilateral nonmydriatic fundus photos taken by clinic personnel during the participants' routine hematology appointment were graded by 2 masked retina specialists at the Wilmer Eye Institute for the presence of nonproliferative SCR (NPSR) and proliferative sickle retinopathy (PSR). A third retina specialist adjudicated in cases of grader disagreement. All participants underwent the standard dilated fundus examination (DFE) within 2 years of acquisition of UWF photographs. The main outcome measure was the sensitivity and specificity of nonmydriatic UWF images for the detection of NPSR and PSR RESULTS: PSR was noted in 19 of 90 eyes that underwent DFE and in 9 of 67 gradable UWF images. Interrater agreement between the 2 graders was moderate, with κ = 0.65 (range 0.43-0.87) for PSR. For gradable UWF photos, the sensitivity and specificity of detecting SCR using the nonmydriatic photos compared with the DFE were 85.2% and 62.5% for NPSR, respectively, and 69.2% and 100% for detection of PSR, respectively. One participant required ophthalmic therapy in both eyes for active sea-fan neovascularization. CONCLUSIONS: UWF imaging shows utility in screening for SCR and may help identify patients with PSR who require a DFE and who may benefit from treatment.


Subject(s)
Anemia, Sickle Cell , Diabetic Retinopathy , Hematology , Retinal Diseases , Adult , Anemia, Sickle Cell/complications , Anemia, Sickle Cell/diagnosis , Diabetic Retinopathy/diagnosis , Fundus Oculi , Humans , Photography/methods , Prospective Studies , Retinal Diseases/diagnosis , Retinal Diseases/etiology
13.
Ophthalmol Retina ; 6(3): 254-255, 2022 03.
Article in English | MEDLINE | ID: covidwho-1747654

ABSTRACT

This prospective survey study demonstrates a lack of retina clinic patient knowledge about appropriate stem cell therapy applications for retinal disease.


Subject(s)
Retinal Diseases , Stem Cell Transplantation , Humans , Prospective Studies , Retina , Retinal Diseases/therapy
14.
Arq Bras Oftalmol ; 85(2): 186-189, 2022.
Article in English | MEDLINE | ID: covidwho-1742904

ABSTRACT

A 38-year-old woman presented with photopsias and progressive but painless loss of vision in her right eye. Of note, she had received the first dose of inactivated COVID-19 vaccine (Sinovac/China National Pharmaceutical Group) 2 weeks prior to the onset of symptoms. Ophthalmic evaluation revealed a wreath-like foveal pattern and multiple gray-white dots throughout the posterior pole associated with discrete vitreous inflammatory reaction. Multimodal imaging analysis confirmed a diagnosis of multiple evanescent white dot syndrome. The patient underwent treatment with corticosteroids and, over the following weeks, her visual acuity improved to standard pattern.


Subject(s)
COVID-19 , Retinal Diseases , White Dot Syndromes , Adult , COVID-19/prevention & control , COVID-19 Vaccines/adverse effects , Female , Fluorescein Angiography/methods , Humans , Retinal Diseases/diagnosis , Vaccination
16.
BMJ Open ; 12(2): e055845, 2022 Feb 01.
Article in English | MEDLINE | ID: covidwho-1673442

ABSTRACT

INTRODUCTION: Recent years have witnessed an upsurge of demand in eye care services in the UK. With a large proportion of patients referred to Hospital Eye Services (HES) for diagnostics and disease management, the referral process results in unnecessary referrals from erroneous diagnoses and delays in access to appropriate treatment. A potential solution is a teleophthalmology digital referral pathway linking community optometry and HES. METHODS AND ANALYSIS: The HERMES study (Teleophthalmology-enabled and artificial intelligence-ready referral pathway for community optometry referrals of retinal disease: a cluster randomised superiority trial with a linked diagnostic accuracy study) is a cluster randomised clinical trial for evaluating the effectiveness of a teleophthalmology referral pathway between community optometry and HES for retinal diseases. Nested within HERMES is a diagnostic accuracy study, which assesses the accuracy of an artificial intelligence (AI) decision support system (DSS) for automated diagnosis and referral recommendation. A postimplementation, observational substudy, a within-trial economic evaluation and discrete choice experiment will assess the feasibility of implementation of both digital technologies within a real-life setting. Patients with a suspicion of retinal disease, undergoing eye examination and optical coherence tomography (OCT) scans, will be recruited across 24 optometry practices in the UK. Optometry practices will be randomised to standard care or teleophthalmology. The primary outcome is the proportion of false-positive referrals (unnecessary HES visits) in the current referral pathway compared with the teleophthalmology referral pathway. OCT scans will be interpreted by the AI DSS, which provides a diagnosis and referral decision and the primary outcome for the AI diagnostic study is diagnostic accuracy of the referral decision made by the Moorfields-DeepMind AI system. Secondary outcomes relate to inappropriate referral rate, cost-effectiveness analyses and human-computer interaction (HCI) analyses. ETHICS AND DISSEMINATION: Ethical approval was obtained from the London-Bromley Research Ethics Committee (REC 20/LO/1299). Findings will be reported through academic journals in ophthalmology, health services research and HCI. TRIAL REGISTRATION NUMBER: ISRCTN18106677 (protocol V.1.1).


Subject(s)
Ophthalmology , Optometry , Retinal Diseases , Telemedicine , Artificial Intelligence , Humans , Ophthalmology/methods , Randomized Controlled Trials as Topic , Referral and Consultation , Retinal Diseases/diagnosis , Telemedicine/methods
17.
BMC Ophthalmol ; 21(1): 452, 2021 Dec 27.
Article in English | MEDLINE | ID: covidwho-1639496

ABSTRACT

BACKGROUND: We report one case of rare acute macular neuroretinopathy (AMN) in an elderly patient with hypertension and one case of common paracentral acute middle maculopathy (PAMM) in a patient with diabetes mellitus to illustrate the difference between the two diseases. CASE PRESENTATION: This report describes two cases, one involving AMN and the other PAMM. The first patient was a 70-year-old man complaining of blurred vision for 3 days. He was examined with fundus photography, optical coherence tomography angiography (OCTA) and optical coherence tomography (OCT); a diagnosis of AMN was established. The second patient was a 50-year-old woman who complained of decreased vision during the past month. She had had diabetes mellitus for 6 years. From the ophthalmic imaging examination, the patient was diagnosed with PAMM and non-proliferative diabetic retinopathy (NPDR). Both patients were treated with drugs for improving microcirculation and neurotrophic drugs; however, there was no significant improvement in visual acuity. CONCLUSIONS: AMN is more common in young patients and is rarely observed in elderly patients with systemic diseases. The OCTA examination has an auxiliary diagnostic value for deep retinal capillary network ischaemia. Meanwhile, OCT examination has important imaging value in differentiating AMN from PAMM and can help avoid missed diagnoses.


Subject(s)
Macular Degeneration , Retinal Diseases , White Dot Syndromes , Acute Disease , Aged , Female , Fluorescein Angiography , Humans , Male , Middle Aged , Retinal Diseases/diagnosis , Tomography, Optical Coherence
18.
Graefes Arch Clin Exp Ophthalmol ; 260(5): 1457-1473, 2022 May.
Article in English | MEDLINE | ID: covidwho-1616130

ABSTRACT

PURPOSE: To review the role of curcumin in retinal diseases, COVID era, modification of the molecule to improve bioavailability and its future scope. METHODS: PubMed and MEDLINE searches were pertaining to curcumin, properties of curcumin, curcumin in retinal diseases, curcumin in diabetic retinopathy, curcumin in age-related macular degeneration, curcumin in retinal and choroidal diseases, curcumin in retinitis pigmentosa, curcumin in retinal ischemia reperfusion injury, curcumin in proliferative vitreoretinopathy and curcumin in current COVID era. RESULTS: In experimental models, curcumin showed its pleiotropic effects in retinal diseases like diabetic retinopathy by increasing anti-oxidant enzymes, upregulating HO-1, nrf2 and reducing or inhibiting inflammatory mediators, growth factors and by inhibiting proliferation and migration of retinal endothelial cells in a dose-dependent manner in HRPC, HREC and ARPE-19 cells. In age-related macular degeneration, curcumin acts by reducing ROS and inhibiting apoptosis inducing proteins and cellular inflammatory genes and upregulating HO-1, thioredoxin and NQO1. In retinitis pigmentosa, curcumin has been shown to delay structural defects of P23H gene in P23H-rhodopsin transgenic rats. In proliferative vitreoretinopathy, curcumin inhibited the action of EGF in a dose- and time-dependent manner. In retinal ischemia reperfusion injury, curcumin downregulates IL-17, IL-23, NFKB, STAT-3, MCP-1 and JNK. In retinoblastoma, curcumin inhibits proliferation, migration and apoptosis of RBY79 and SO-RB50. Curcumin has already proven its efficacy in inhibiting viral replication, coagulation and cytokine storm in COVID era. CONCLUSION: Curcumin is an easily available spice used traditionally in Indian cooking. The benefits of curcumin are manifold, and large randomized controlled trials are required to study its effects not only in treating retinal diseases in humans but in their prevention too.


Subject(s)
COVID-19 , Curcumin , Diabetic Retinopathy , Macular Degeneration , Reperfusion Injury , Retinal Diseases , Retinal Neoplasms , Retinitis Pigmentosa , Vitreoretinopathy, Proliferative , Animals , Curcumin/pharmacology , Endothelial Cells , Humans , Rats , Reperfusion Injury/prevention & control , Retinal Diseases/drug therapy
20.
Ophthalmology ; 128(11): 1620-1626, 2021 11.
Article in English | MEDLINE | ID: covidwho-1510165

ABSTRACT

PURPOSE: Routine use of face masks for patients and physicians during intravitreal anti-vascular endothelial growth factor (VEGF) injections has increased with the emergence of the coronavirus disease 2019 pandemic. This study evaluates the impact of universal face mask use on rates and outcomes of post-injection endophthalmitis (PIE). DESIGN: Retrospective, multicenter, comparative cohort study. PARTICIPANTS: Eyes receiving intravitreal anti-VEGF injections from October 1, 2019, to July 31, 2020, at 12 centers. METHODS: 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. MAIN OUTCOME MEASURES: Rate of endophthalmitis, microbial spectrum, and visual acuity (VA). RESULTS: Of 505 968 intravitreal injections administered in 110 547 eyes, 85 of 294 514 (0.0289%; 1 in 3464 injections) cases of presumed endophthalmitis occurred in the "no face mask" group, and 45 of 211 454 (0.0213%; 1 in 4699) cases occurred in the "universal face mask" group (odds ratio [OR], 0.74; 95% confidence interval [CI], 0.51-1.18; P = 0.097). In the "no face mask" group, there were 27 cases (0.0092%; 1 in 10 908 injections) of culture-positive endophthalmitis compared with 9 cases (0.004%; 1 in 23 494) 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 with 1 (0.0005%; 1 in 211 454) in the "universal face mask" group (P = 0.645). Patients presented a mean (range) 4.9 (1-30) days after the causative injection, and mean logarithm of the minimum angle of resolution (logMAR) VA at endophthalmitis presentation was 2.04 (~20/2200) for "no face mask" group compared with 1.65 (~20/900) for the "universal face mask" group (P = 0.022), although no difference was observed 3 months after treatment (P = 0.764). CONCLUSIONS: In a large, multicenter, retrospective study, physician and patient face mask use during intravitreal anti-VEGF injections did not alter the risk of presumed acute-onset bacterial endophthalmitis, but there was a reduced rate of culture-positive endophthalmitis. Three months after presentation, there was no difference in VA between the groups.


Subject(s)
Angiogenesis Inhibitors/administration & dosage , COVID-19/epidemiology , Disease Transmission, Infectious/prevention & control , Endophthalmitis/prevention & control , Eye Infections, Bacterial/prevention & control , N95 Respirators , Comorbidity , Endophthalmitis/epidemiology , Endophthalmitis/etiology , Eye Infections, Bacterial/epidemiology , Eye Infections, Bacterial/etiology , Follow-Up Studies , Incidence , Intravitreal Injections/adverse effects , Retinal Diseases/drug therapy , Retinal Diseases/epidemiology , Retrospective Studies , United States/epidemiology , Vascular Endothelial Growth Factor A/antagonists & inhibitors
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