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Haliyur R, Sinha AK, Andrews CA, Musch DC, Conrady CD, Zacks DN, Huvard MJ. NO EFFECT OF REAL-WORLD UNIVERSAL FACE MASKING ON POST-INTRAVITREAL INJECTION ENDOPHTHALMITIS RATE AT A SINGLE TERTIARY ACADEMIC CENTER. Retina 2024; 44:916-922. [PMID: 38207176 DOI: 10.1097/iae.0000000000004043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 12/19/2023] [Indexed: 01/13/2024]
Abstract
PURPOSE To determine whether universal masking during COVID-19 altered rate and outcomes of postinjection endophthalmitis. METHODS Retrospective, single-site, comparative, cohort study. Eyes diagnosed with endophthalmitis within 4 weeks of intravitreal injection at the University of Michigan from August 1, 2012, to November 15, 2022, were identified. Cases were considered "masking" between March 15, 2020, and November 15, 2022. Endophthalmitis rate, visual acuity, and microbial spectrum were investigated. RESULTS There were 20 postinjection endophthalmitis cases out of 72,194 injections (0.028%; one in 3,571 injections) premasking and 10 of 38,962 with universal masking (0.026%; one in 3,846 injections; odds ratio 0.9; 95% [confidence interval]: 0.4-2.0). Referral from the community was unchanged with 32 cases referred premasking (0.35 cases/month) and 10 cases with masking (0.31 cases/month). Presenting mean the logarithm of the minimum angle of resolution visual acuity with masking of all postinjection endophthalmitis cases trended worse (2.35 ± 0.40) compared with premasking (2.09 ± 0.48; P = 0.05) with light perception visual acuity more common with masking (31.6% vs. 10.9%, P = 0.06). There was no delay in time from procedure to initial treatment ( P = 0.36), no difference in the rate of initial treatment with tap and inject (T/I), and similar positive-culture rates ( P = 0.77) between the cohorts. Visual acuity after 30 days of follow-up was clinically unchanged (∼20/500 vs. 20/400; P = 0.59). CONCLUSION Universal masking had no effect on postinjection endophthalmitis rate or on the rate of culture-positive cases. Although presenting visual acuity appeared worse with masking, this was not statistically significant, and current treatment paradigms resulted in similar visual outcomes.
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Affiliation(s)
- Rachana Haliyur
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, Michigan
| | - Alina K Sinha
- University of Michigan Medical School, University of Michigan, Ann Arbor, Michigan
- University of Missouri Kansas City School of Medicine, Kansas City, Missouri
| | - Chris A Andrews
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, Michigan
| | - David C Musch
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, Michigan
- Department of Epidemiology, University of Michigan, Ann Arbor, Michigan
| | - Christopher D Conrady
- Departments of Ophthalmology and Visual Sciences, University of Nebraska Medical Center, Omaha, Nebraska; and
- Pathology and Microbiology, University of Nebraska Medical Center, Omaha, Nebraska
| | - David N Zacks
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, Michigan
| | - Michael J Huvard
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, Michigan
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Patel SN, Mokhashi N, Peck TJ, Cai LZ, Salabati M, Soares RR, Hinkle J, Chaudhary V, Kuriyan AE, Cohen MN, Hsu J, Garg SJ. Seasonal and environmental variations in endophthalmitis after intravitreal anti-vascular endothelial growth factor injection: a six-year review. Curr Eye Res 2022; 47:1288-1293. [PMID: 35759609 DOI: 10.1080/02713683.2022.2093383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
PURPOSE/AIM To evaluate seasonal and environmental variations on the incidence and outcomes of post-injection endophthalmitis. MATERIALS AND METHODS A single-center, retrospective cohort study was conducted including all patients diagnosed with post-injection endophthalmitis between 2013-2018. Associations between climate variables and endophthalmitis incidence were evaluated. RESULTS Of 423,297 injections administered, seasonal distribution in spring, summer, autumn, and winter was 26%, 27%, 25%, and 22%, respectively. Of 171 cases of endophthalmitis identified, seasonal distribution over the spring, summer, autumn, and fall was 25%, 23%, 26%, and 26%, respectively. Endophthalmitis incidence was not correlated with monthly precipitation (p = 0.45), monthly snowfall (p = 0.49), or monthly temperature (p = 0.65). Worse visual outcomes at initial endophthalmitis presentation were correlated with increased precipitation level (p = 0.025), but were not correlated with snowfall level (p = 0.228) or mean monthly temperature (p = 0.132). Although there were no seasonal variations of visual acuity at endophthalmitis presentation (p = 0.894), odds of final visual acuity returning to within two lines of pre-endophthalmitis visual acuity were worse among patients with endophthalmitis diagnosed in the spring (OR, 0.041; p = 0.016). CONCLUSION In contrast to previous work on post-cataract endophthalmitis, seasonal and weather factors were not associated with post-injection endophthalmitis risk or bacterial species isolated. Visual outcomes at initial endophthalmitis presentation were correlated with precipitation, and worse visual outcomes were seen in patients who developed endophthalmitis in the spring.
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Affiliation(s)
- Samir N Patel
- The Retina Service of Wills Eye Hospital, Mid Atlantic Retina, Thomas Jefferson University, Philadelphia, PA
| | - Nikita Mokhashi
- Lewis Katz School of Medicine, Temple University, Philadelphia, PA
| | - Travis J Peck
- The Retina Service of Wills Eye Hospital, Mid Atlantic Retina, Thomas Jefferson University, Philadelphia, PA
| | - Louis Z Cai
- The Retina Service of Wills Eye Hospital, Mid Atlantic Retina, Thomas Jefferson University, Philadelphia, PA
| | - Mirataollah Salabati
- The Retina Service of Wills Eye Hospital, Mid Atlantic Retina, Thomas Jefferson University, Philadelphia, PA
| | - Rebecca R Soares
- The Retina Service of Wills Eye Hospital, Mid Atlantic Retina, Thomas Jefferson University, Philadelphia, PA
| | - John Hinkle
- The Retina Service of Wills Eye Hospital, Mid Atlantic Retina, Thomas Jefferson University, Philadelphia, PA
| | - Varun Chaudhary
- Hamilton Regional Eye Institute, St Joseph's Healthcare Hamilton, Division of Ophthalmology, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Ajay E Kuriyan
- The Retina Service of Wills Eye Hospital, Mid Atlantic Retina, Thomas Jefferson University, Philadelphia, PA
| | - Michael N Cohen
- The Retina Service of Wills Eye Hospital, Mid Atlantic Retina, Thomas Jefferson University, Philadelphia, PA
| | - Jason Hsu
- The Retina Service of Wills Eye Hospital, Mid Atlantic Retina, Thomas Jefferson University, Philadelphia, PA
| | - Sunir J Garg
- The Retina Service of Wills Eye Hospital, Mid Atlantic Retina, Thomas Jefferson University, Philadelphia, PA
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Scarpa G, Urban F, Scarpa M, Formentini S, Beccastrini A. Intravitreal Injections during the COVID-19 Outbreak in Northern Italy: An Innovative Approach for a High Quality and Safe Treatment. Eur J Ophthalmol 2022; 32:3667-3673. [PMID: 35132906 DOI: 10.1177/11206721221078554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Intravitreal injection (IVI) is a standard procedure performed in ophthalmology to treat several conditions, and is performed in different settings across countries. The Italian guidelines recommend this intervention is performed in an operating room to minimize the risk of infections, while in other countries, including Canada, USA and the UK, IVIs are performed in the ophthalmologist's office. The 2020 COVID-19 outbreak caused a dramatic modification in outpatient care. Consequently, non-urgent surgical activities, like IVIs, were subjected to a drastic reduction. METHODS We conducted observational study which investigated the outcomes of IVIs performed in an ophthalmologist's office using a mobile laminar flow unit, the Operio mobile (Toul Meditech, Operio®) versus an operating room setting. RESULTS Use of the Operio mobile allowed the safety performance of 3838 IVIs during COVID-19 and significantly reduced the waiting time of the first visit. This results in a faster intervention without affecting the technical IVI procedure that remained unchanged comparing the two settings. Specifically, we observed a 26% reduction in operation costs for each IVI performed in the office, which can be translated to a higher impact when considering the total number of IVIs performed over one year. CONCLUSION The use of the Operio mobile in an ophthalmologist's office provides flexibility to perform IVIs, assuring patient safety, reducing healthcare personnel employment times, and the waiting lists for the patients, increasing the number of surgeries and improving the cost-effectiveness of the procedure.
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Affiliation(s)
- Giuseppe Scarpa
- 18173Azienda ULSS n 2 Marca Trevigiana, Treviso, Veneto, Italy
| | - Francesca Urban
- 18173Azienda ULSS n 2 Marca Trevigiana, Treviso, Veneto, Italy
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The Influence of Universal Face Mask Use on Endophthalmitis Risk after Intravitreal Anti-Vascular Endothelial Growth Factor Injections. Ophthalmology 2021; 128:1620-1626. [PMID: 34019955 PMCID: PMC8130590 DOI: 10.1016/j.ophtha.2021.05.010] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 05/03/2021] [Accepted: 05/11/2021] [Indexed: 12/25/2022] Open
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.
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Bacterial Dispersion Associated With Various Patient Face Mask Designs During Simulated Intravitreal Injections. Am J Ophthalmol 2021; 223:178-183. [PMID: 33129809 PMCID: PMC7598764 DOI: 10.1016/j.ajo.2020.10.017] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2020] [Revised: 10/21/2020] [Accepted: 10/24/2020] [Indexed: 12/11/2022]
Abstract
PURPOSE We sought to investigate bacterial dispersion with patient face mask use during simulated intravitreal injections. DESIGN Prospective cross-sectional study. METHODS Fifteen healthy subjects were recruited for this single-center study. Each participant was instructed not to speak for 2 minutes, simulating a "no-talking" policy, while in an ophthalmic examination chair with an blood agar plate secured to the forehead and wearing various face masks (no mask, loose fitting surgical mask, tight-fitting surgical mask without tape, tight-fitting surgical mask with adhesive tape securing the superior portion of the mask, N95 mask, and cloth mask). Each scenario was then repeated while reading a 2-minute script, simulating a talking patient. The primary outcome measures were the number of colony-forming units (CFUs) and microbial species. RESULTS During the "no-talking" scenario, subjects wearing a tight-fitting surgical mask with tape developed fewer CFUs compared with subjects wearing the same mask without tape (difference 0.93 CFUs [95% confidence interval 0.32-1.55]; P = .003). During the speech scenarios, subjects wearing a tight-fitting surgical mask with tape had significantly fewer CFUs compared with subjects without a face mask (difference 1.07 CFUs; P = .001), subjects with a loose face mask (difference 0.67 CFUs; P = .034), and subjects with a tight face mask without tape (difference 1.13 CFUs; P < .001). There was no difference between those with a tight-fitting surgical mask with tape and an N95 mask in the "no-talking" (P > .99) and "speech" (P = .831) scenarios. No oral flora were isolated in "no-talking" scenarios but were isolated in 8 of 75 (11%) cultures in speech scenarios (P = .02). CONCLUSION The addition of tape to the superior portion of a patient's face mask reduced bacterial dispersion during simulated intravitreal injections and had no difference in bacterial dispersion compared with wearing N95 masks.
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Patel SN, Hsu J, Sivalingam MD, Chiang A, Kaiser RS, Mehta S, Park CH, Regillo CD, Sivalingam A, Vander JF, Ho AC, Garg SJ. The Impact of Physician Face Mask Use on Endophthalmitis After Intravitreal Anti-Vascular Endothelial Growth Factor Injections. Am J Ophthalmol 2021; 222:194-201. [PMID: 32888902 PMCID: PMC7462768 DOI: 10.1016/j.ajo.2020.08.013] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 08/05/2020] [Accepted: 08/05/2020] [Indexed: 11/29/2022]
Abstract
PURPOSE To evaluate the effect of physician face mask use on rates and outcomes of postinjection endophthalmitis. DESIGN Retrospective, comparative cohort study. METHODS Setting: Single-center. StudyPopulation: Eyes receiving intravitreal anti-vascular endothelial growth factor injections from July 1, 2013, to September 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. MainOutcomeMeasures: 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% confidence interval, 0.41-1.57; P = .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 = .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 = .031), though no difference was observed at 6 months after treatment (P = .479). CONCLUSION Physician face mask use did not influence the risk of postinjection 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 attributable to oral flora.
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Affiliation(s)
- Samir N Patel
- Wills Eye Hospital, Mid Atlantic Retina, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Jason Hsu
- Wills Eye Hospital, Mid Atlantic Retina, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Meera D Sivalingam
- Wills Eye Hospital, Mid Atlantic Retina, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Allen Chiang
- Wills Eye Hospital, Mid Atlantic Retina, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Richard S Kaiser
- Wills Eye Hospital, Mid Atlantic Retina, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Sonia Mehta
- Wills Eye Hospital, Mid Atlantic Retina, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Carl H Park
- Wills Eye Hospital, Mid Atlantic Retina, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Carl D Regillo
- Wills Eye Hospital, Mid Atlantic Retina, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Arunan Sivalingam
- Wills Eye Hospital, Mid Atlantic Retina, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - James F Vander
- Wills Eye Hospital, Mid Atlantic Retina, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Allen C Ho
- Wills Eye Hospital, Mid Atlantic Retina, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Sunir J Garg
- Wills Eye Hospital, Mid Atlantic Retina, Thomas Jefferson University, Philadelphia, Pennsylvania, USA.
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