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Liddle C, Capone A, Trese M. PATIENT-PHYSICIAN FACE MASKING'S INFLUENCE ON THE POST-INTRAVITREAL INJECTION ENDOPHTHALMITIS. Retina 2024; 44:1203-1208. [PMID: 38363792 DOI: 10.1097/iae.0000000000004072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2024]
Abstract
PURPOSE The authors sought to determine if universal face mask guidelines implemented during the coronavirus disease 2019 pandemic significantly influenced the incidence of endophthalmitis following intravitreal injections (IVI). METHODS This retrospective cohort study reviewed the electronic health records from a retina-only practice located in Michigan. This study evaluated patients receiving IVIs over two distinct time periods of April 2019 to March 2020 and April 2020 to March 2021, which comprised our unmasked and masked groups, respectively. The authors then calculated the incidence of endophthalmitis following IVI and evaluated the cases of post-injection endophthalmitis for both time periods. RESULTS A total of 121,384 IVIs performed over the 2-year period of interest. Of these, 63,114 were unmasked and 58,270 were masked patient encounters. A total of 46 post-injection endophthalmitis cases were identified. Of these, 29 cases were from the unmasked period and 17 were from the masked period. This resulted in an incidence of endophthalmitis of 0.046% and 0.038% in the masked and unmasked groups, respectively. This difference did not rise to the level of statistical significance ( P = 0.1336). CONCLUSION This study suggests that the incidence of post-injection endophthalmitis was not influenced by the implementation of ophthalmologist-patient face masking after IVI during the coronavirus disease 2019 pandemic.
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Affiliation(s)
- Conner Liddle
- Department of Ophthalmology, Oakland University William Beaumont School of Medicine, Rochester, Michigan; and
| | - Antonio Capone
- Department of Ophthalmology, Oakland University William Beaumont School of Medicine, Rochester, Michigan; and
- Department of Ophthalmology, Associated Retinal Consultants, Royal Oak, Michigan
| | - Matthew Trese
- Department of Ophthalmology, Oakland University William Beaumont School of Medicine, Rochester, Michigan; and
- Department of Ophthalmology, Associated Retinal Consultants, Royal Oak, Michigan
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Navel V, Labetoulle M, Lazreg S, Brémond-Gignac D, Chiambaretta F. COVID-19 pandemic and impact of universal face mask wear on ocular surface health and risk of infection. J Fr Ophtalmol 2024; 47:104170. [PMID: 38569271 DOI: 10.1016/j.jfo.2024.104170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 02/17/2024] [Indexed: 04/05/2024]
Abstract
Universal mask wear is an effective public health intervention to reduce SARS-Cov-2 transmission, especially in enclosed public spaces and healthcare environments. Concerns have been raised about possible transmission of the SARS-Cov-2 through ocular secretions, leading to enhanced protective measures during ophthalmic procedures. However, there is some evidence for air jets from the upper edge of the surgical mask to the ocular surface, especially when the mask is not well fit. Prolonged airflow towards the ocular surface during expiration may alter tear-film stability, leading to hyperosmolarity and ocular surface inflammation. This also raises the question of whether the ocular surface is contaminated with oral flora from airflow directed toward the eyes, thus increasing the risk of ocular infection. Herein we review the impact of patient face mask wear on the ocular surface, eyelids and risk of ocular infection, particularly during ocular surgery. There is some evidence for increased incidence of dry eye or eyelid disease during periods of mandatory face mask wear. While high daily exposure is consistent with a direct association, this should be mitigated by various cofounding factors which could also affect the ocular health during the COVID-19 pandemic. An increased risk of post-intravitreal injection endophthalmitis, possibly due to face mask wear by the patient, including culture-positive endophthalmitis, has been reported in one retrospective study. Several measures have been shown to prevent or limit the risk of developing dry eye disease or exacerbation, eyelid cyst, and ocular infection during intravitreal injections.
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Affiliation(s)
- V Navel
- CHU Gabriel-Montpied, Clermont-Ferrand, France
| | - M Labetoulle
- Service d'ophtalmologie, hôpital Bicêtre, Assistance publique-Hôpitaux de Paris, Le Kremlin Bicêtre, France
| | - S Lazreg
- Centre d'ophtalmologie Lazreg, Blida, Algeria
| | - D Brémond-Gignac
- Hôpital universitaire Necker-Enfants Malades, AP-HP, Paris, France
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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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Marin-Nieto J, Alba-Linero C, García-Basterra I. Correspondence. Retina 2024; 44:e3-e5. [PMID: 37490768 DOI: 10.1097/iae.0000000000003899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/27/2023]
Affiliation(s)
- Juan Marin-Nieto
- Department of Ophthalmology, University Hospital Virgen de la Victoria Málaga, Spain
- Department of Radiology and Physical Medicine. Ophthalmology and Otorhinolaryngology, University of Malaga (UMA), Malaga, Spain
| | - Carmen Alba-Linero
- Department of Ophthalmology, University Hospital Virgen de la Victoria Málaga, Spain
- Department of Radiology and Physical Medicine. Ophthalmology and Otorhinolaryngology, University of Malaga (UMA), Malaga, Spain
| | - Ignacio García-Basterra
- Department of Ophthalmology, University Hospital Virgen de la Victoria Málaga, Spain
- Department of Radiology and Physical Medicine. Ophthalmology and Otorhinolaryngology, University of Malaga (UMA), Malaga, Spain
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Mishra AV, Tong CM, Faes L, Cheema MK, Plemel D, Rubin U, Bao B, Nazarali S, Lapere SRJ, Somani R, Hinz BJ, Tennant MTS. Comparison of Endophthalmitis Rates after Alcohol-Based Chlorhexidine and Povidone-Iodine Antisepsis for Intravitreal Injections. Ophthalmol Retina 2024; 8:18-24. [PMID: 37611695 DOI: 10.1016/j.oret.2023.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Revised: 08/08/2023] [Accepted: 08/14/2023] [Indexed: 08/25/2023]
Abstract
OBJECTIVE Intravitreal injections (IVIs) are the most frequently performed intraocular procedure in Canada. Povidone-iodine (PI) is the current gold standard for antisepsis for IVI and is widely used; chlorhexidine (CH) is a possible alternative antiseptic agent. This study aims to compare rates of endophthalmitis after IVI with 0.05% chlorhexidine with a 4% alcohol base antisepsis to rates of endophthalmitis after IVI with 10% PI antisepsis. DESIGN Retrospective cohort study. SUBJECTS Eyes that received IVI between May 2019 and October 2022 at a group retina practice in Edmonton, Canada. METHODS Eyes at a single center received focal conjunctival application of either 10% PI antisepsis or 0.05% CH in 4% alcohol antisepsis for 30 seconds before each IVI. MAIN OUTCOME MEASURE Rates of endophthalmitis between the PI and CH groups. RESULTS A total of 170 952 IVIs were performed during the study period. A total of 31 135 were performed using CH prophylaxis compared with 139 817 with PI prophylaxis. Among all IVIs there were 49 total cases of endophthalmitis, 29 in the PI group (0.021%) and 20 in the CH group (0.064%). There was a statistically significant difference in the rates of endophthalmitis between the 2 groups (P < 0.001). The odds ratio for developing endophthalmitis with CH antisepsis was 3.1 (95% confidence interval, 1.9-5.2) compared with PI antisepsis. There were increased odds of developing endophthalmitis with aflibercept injection compared with bevacizumab (odds ratio, 3.48; 95% confidence interval, 2.09-7.24). CONCLUSIONS There is a statistically significant difference in rates of endophthalmitis between alcohol-based CH and PI antisepsis for IVI in our patient population utilizing the methods discussed. In our center, alcohol-based CH is now considered a second-line antiseptic agent. Further studies are warranted to further assess the endophthalmitis rate utilizing these 2 antiseptic agents. FINANCIAL DISCLOSURE(S) Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
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Affiliation(s)
- Amit V Mishra
- University of Alberta, Edmonton, Canada; Alberta Retina Consultants, Edmonton, Canada
| | | | - Livia Faes
- NIHR Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust & UCL, Institute of Ophthalmology, London, United Kingdom
| | | | | | - Uriel Rubin
- University of Alberta, Edmonton, Canada; Alberta Retina Consultants, Edmonton, Canada
| | - Bo Bao
- University of Alberta, Edmonton, Canada
| | | | - Steven R J Lapere
- University of Alberta, Edmonton, Canada; Alberta Retina Consultants, Edmonton, Canada
| | - Rizwan Somani
- University of Alberta, Edmonton, Canada; Alberta Retina Consultants, Edmonton, Canada
| | - Brad J Hinz
- University of Alberta, Edmonton, Canada; Alberta Retina Consultants, Edmonton, Canada
| | - Matthew T S Tennant
- University of Alberta, Edmonton, Canada; Alberta Retina Consultants, Edmonton, Canada.
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Shoaib KK, Abid MA, Aziz S. Endophthalmitis After Intravitreal Bevacizumab (Avastin) Injections: An Outbreak Investigated. Cureus 2023; 15:e36769. [PMID: 37123683 PMCID: PMC10145693 DOI: 10.7759/cureus.36769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/27/2023] [Indexed: 03/30/2023] Open
Abstract
Purpose To investigate an endophthalmitis outbreak in different eye hospitals after intravitreal (IVT) bevacizumab (Avastin) injections over two days. Place and duration of the study Mughal Eye Hospital, Nov 2022 to Jan 2023. Materials and methods All cases reported with endophthalmitis in Mughal Eye Hospital after administration of anti-vascular endothelial growth factor IVT injections in different hospitals on November 8-9, 2022, were studied. In all endophthalmitis cases, one to five IVT injections of antibiotics (vancomycin, ceftazidime, and dexamethasone) were given depending on the clinical picture. Results Thirty-six eyes of 34 patients who developed endophthalmitis were included in the study. Age (mean 53 years) ranged from 44 years to 70 years. There were 18 males and 16 females. Two patients had bilateral endophthalmitis. Thirty-three patients were given two to four IVT injections of antibiotics depending on the clinical response. Five cases of vitreous tap done before injecting antibiotics were found to have Pseudomonas. Anterior chamber wash was done in 15 cases to improve visualization for doing pars plana vitrectomy (PPV). In 24 patients PPV with silicon oil was done. Eighteen patients showed improvement as their hypopyon disappeared after IVT antibiotic injections. One patient developed corneal sloughing (she refused IVT antibiotic injections). One patient developed malignant/pupil block glaucoma. In two eyes, early PPV was done. Four eyes developed no perception of light. In our series, endophthalmitis patients started reporting one day after the injection. One patient who developed bilateral endophthalmitis developed bilateral cataracts with subluxations. One patient developed retinal detachment. One eye developed choroidal detachment. Conclusion IVT bevacizumab (Avastin) may be associated with an outbreak of endophthalmitis. Pseudomonas endophthalmitis is a very grave condition associated with severe morbidity.
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Abu-Ismail L, Al-Shami K, Al-Shami M, Nashwan AJ. The effect of COVID-19 pandemic and wearing face masks on ophthalmology practice: What is known so far? A narrative review. Front Med (Lausanne) 2022; 9:1019434. [PMID: 36518743 PMCID: PMC9742357 DOI: 10.3389/fmed.2022.1019434] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 11/07/2022] [Indexed: 08/29/2023] Open
Abstract
Face masks, along with other preventive measures, can help slow the spread of COVID-19. Despite the positive effect of the mask in combating the virus, it has some negative effects on the human body that must be followed up on and reduced. In this study, we discuss the impact of wearing face masks on the eye and the common issues associated with using them. The literature search was conducted using electronic databases such as PubMed and Google Scholar. Only articles published in English were included. A total of 39 relevant articles were deemed eligible. After the duplicate articles were removed, the titles and abstracts of 20 papers underwent full-text screening. The review comprised both prospective and retrospective investigations, case reports, and a series of reporting ocular symptoms following the use of face masks. The COVID-19 pandemic affected ophthalmology practices in managing patients. New factors must be considered, especially when dealing with anti-VEGF injections, such as the risk of endophthalmitis, tests and symptoms of patients with glaucoma, and the emerging symptoms associated with the COVID-19 vaccination. The use of face masks and breathing aids seemed to influence the tear film.
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Affiliation(s)
- Luai Abu-Ismail
- Department of Ophthalmology, Islamic Hospital, Amman, Jordan
| | - Khayry Al-Shami
- Department of Clinical Medical Sciences, Faculty of Medicine, Yarmouk University, Irbid, Jordan
| | - Manar Al-Shami
- Department of Clinical Medical Sciences, Faculty of Medicine, Yarmouk University, Irbid, Jordan
- Princess Basma Hospital, Ministry of Health, Irbid, Jordan
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Merani R, Johnson MW, McCannel CA, Flynn HW, Scott IU, Hunyor AP. Clinical Practice Update: Management of Infectious Endophthalmitis After Intravitreal Anti-VEGF Injection. JOURNAL OF VITREORETINAL DISEASES 2022; 6:443-451. [PMID: 37009541 PMCID: PMC9954776 DOI: 10.1177/24741264221116487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Although infectious endophthalmitis after intravitreal antivascular endothelial growth factor injections is rare, it is the most feared and potentially devastating complication of this procedure. There is no high-level evidence to provide definitive guidance on the management of endophthalmitis occurring after intravitreal injection (IVI). This clinical practice update reviews the published literature regarding post-IVI endophthalmitis and highlights areas in which further research is needed to better guide its management.
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Affiliation(s)
- Rohan Merani
- Concord Repatriation General
Hospital, Sydney, NSW, Australia
- Save Sight Institute, Specialty
of Clinical Ophthalmology and Eye Health, Faculty of Medicine and Health,
University of Sydney, Sydney, NSW, Australia
- Faculty of Medicine and Health
Sciences, Macquarie University, Sydney, NSW Australia
| | - Mark W. Johnson
- Department of Ophthalmology and
Visual Sciences, Kellogg Eye Center, University of Michigan, Ann Arbor, MI,
USA
| | - Colin A. McCannel
- UCLA Stein Eye Institute;
Department of Ophthalmology, David Geffen School of Medicine at UCLA,
University of California, Los Angeles, CA, USA
| | - Harry W. Flynn
- Department of Ophthalmology,
Bascom Palmer Eye Institute, Miami, FL, USA
| | - Ingrid U. Scott
- Departments of Ophthalmology and
Public Health Sciences, Penn State College of Medicine, Hershey,
Philadelphia, PA, USA
| | - Alex P. Hunyor
- Save Sight Institute, Specialty
of Clinical Ophthalmology and Eye Health, Faculty of Medicine and Health,
University of Sydney, Sydney, NSW, Australia
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Safety Measures for Maintaining Low Endophthalmitis Rate after Intravitreal Anti-Vascular Endothelial Growth Factor Injection before and during the COVID-19 Pandemic. J Clin Med 2022; 11:jcm11030876. [PMID: 35160327 PMCID: PMC8837000 DOI: 10.3390/jcm11030876] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 01/24/2022] [Accepted: 02/03/2022] [Indexed: 02/06/2023] Open
Abstract
During the COVID-19 pandemic, intravitreal injections are performed with patients wearing masks. The risk of endophthalmitis after intravitreal injection is reported to increase due to an influx of exhaled air containing oral bacteria from the upper part of the mask onto the ocular surface. We retrospectively investigated the incidence of endophthalmitis when intravitreal anti-vascular endothelial growth factor (anti-VEGF) injections were performed using the same infection control measures before and during the pandemic. Vitreoretinal specialists performed intravitreal injections of anti-VEGF agents in the outpatient room of a university hospital. Infection control measures before and during the pandemic included covering the patient’s eye with adhesive face drape and irrigating the ocular surface with 0.25% povidone-iodine before draping, and immediately before and after injection. Before the COVID-19 pandemic (February 2016 to December 2019), one case of endophthalmitis occurred among 31,173 injections performed (0.0032%; 95% confidence interval (CI), 0.000008–0.017872%). During the COVID-19 pandemic (January 2020 to August 2021), one case of endophthalmitis occurred among 14,725 injections performed (0.0068%; 95% CI, 0.000017–0.037832%). There was no significant difference between the two periods (Fisher’s exact test: p = 0.5387). Even during the COVID-19 pandemic, very low incidence of endophthalmitis after intravitreal injection can be maintained by implementing basic infection prophylactic measures, including face draping and 0.25% povidone-iodine irrigation, established before COVID-19 pandemic.
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