COVID-19 Masking Did Not Influence Bacteria Eye Infections from Anti-VEGF Injections

Sunir J. Garg, MD

Face-masking during intravitreal anti-VEGF injection administration during the COVID-19 pandemic did not influence the patient risk of post-injection endophthalmitis, a common eye infection, according to new findings.

In a new study presented at the American Society of Retina Specialists (ASRS) 2021 Scientific Meeting this weekend, investigators observed that transmission-reducing measures in response to COVID-19 risk—most prominently, masking—did not provide a supplemental benefit in reducing acute-onset bacterial endophthalmitis in patients receive anti-VEGF injections.

Led by Sunir J. Garg, MD, Professor of Ophthalmology at the Retina Service of Wills Eye Hospital at Thomas Jefferson University, investigators sought to observe the long-term impact of face mask use by physicians, ancillary staff, and patients on the rates and clinical outcomes of post-injection endophthalmitis.

Their retrospective cohort study compared face masks versus no face masks in the outcome of eyes receiving intravitreal anti-VEGF injections from October 2019 to July 2020 at 12 care centers across the US. Garg and colleagues sought a primary outcome of rates of endophthalmitis, as well as patient visual acuity and microbial spectrum scores, dependent on the wearing of masks at time of injection.

Their observed cohort population included 505,968 intravitreal injections—294,514 (58.2%) being “no face mask” treatment encounters, and 211,454 (41.8%) being masked encounters.

Investigators reported that just 85 cases of presumed endophthalmitis (0.0289%; 1 in 3464 injections) occurred in eyes from “no face mask” encounters. Another 45 cases of presumed endophthalmitis (0.0213%; 1 in 4699 injections) occurred in eyes from face mask encounters (OR, 0.74; 95% CI, 0.51 – 1.18; P = .097).

Investigators observed 27 cases of culture-positive endophthalmitis (0.0092%; 1 in 10,908 injections) in eyes from “no face mask” encounters, versus 9 cases (0.004%; 1 in 24,494 injections) in eyes from masked encounters (OR, 0.46; 95% CI, 0.22 – 0.99; P = .041).

There was no observed difference in 3 months post-treatment for mean logMAR visual acuity at presentation of endophthalmitis for either masking group.

Garg and colleagues concluded that physician and patient face mask use during intravitreal anti-VEGF injections did not significantly change the risk of presume acute-onset bacterial endophthalmitis. However, they did observe a reduced rate of culture-positive endophthalmitis cases among patients treated while masked.

The study, “The Influence of Universal Face Mask Use on Endophthalmitis Risk After Intravitreal Anti-VEGF Injections During the COVID-19 Pandemic,” was presented at ASRS 2021.