The impact of physician face mask use on endophthalmitis after intravitreal anti-vascular endothelial growth factor injections

Patel, Samir N.; Hsu, Jason; Sivalingam, Meera D.; Chiang, Allen; Kaiser, Richard S.; Mehta, Sonia; Park, Carl H.; Regillo, Carl D.; Sivalingam, Arunan; Vander, James F.; Ho, Allen C.; Garg, Sunir J.

PURPOSE: To evaluate the effect of physician face mask use on rates and outcomes of post-injection endophthalmitis. DESIGN: Retrospective, comparative cohort study METHODS: . SETTING: Single-center STUDY POPULATION: Eyes receiving intravitreal anti-vascular endothelial growth factor injections from 7/1/2013 to 9/1/2019. INTERVENTION: Cases were divided into “face mask group” if face masks were worn by the physician during intravitreal injections or “no talking group” if no face mask was worn but a no talking policy was observed during intravitreal injections. MAIN OUTCOME MEASURES: Rate of endophthalmitis, visual acuity, and microbial spectrum. RESULTS: Of 483,622 intravitreal injections administered, 168 out of 453,460 (0.0371%) cases of endophthalmitis occurred in the “no talking” group, and 9 out of 30,162 (0.0298%) cases occurred in the face mask group (odds ratio, 0.81; 95%CI, 0.41–1.57; p=0.527). Sixteen cases of oral flora-associated endophthalmitis were found in the “no talking” group (1 in 28,341 injections) compared to none in the face mask group (p=0.302). Mean logMAR visual acuity at presentation in cases that developed culture-positive endophthalmitis was significantly worse in the “no talking” group compared to the face mask group (17.1 lines lost from baseline acuity vs 13.4 lines lost; p=0.031), though no difference was observed at six months following treatment (p=0.479). CONCLUSION: Physician face mask use did not influence the risk of post-injection endophthalmitis compared to a no talking policy. However, no cases of oral flora-associated endophthalmitis occurred in the face mask group. Future studies are warranted to assess the role of face mask use to reduce endophthalmitis risk, particularly due to oral flora.