Masking Does Not Decrease Endophthalmitis After Intravitreal Injection

A Male Nurse/Doctor Prepares a Coronavirus Disease (COVID-19) Vaccine. He is Wearing a Protective Face Shield, FPP2 mask, PPE and Protective Gloves Preparing for Vaccination Campaign Against COVID-19
The COVID-19 pandemic-era protocol did not reduce the odds of an infection following globe-penetrating injections, a study shows.

A universal patient and clinician masking mandate to decrease the spread of COVID-19 did not reduce the incidence of postintravitreal injection endophthalmitis, according to findings published in Retina.

Incidence rates of endophthalmitis following intravitreal injection were retrospectively reviewed from patient records collected between 2017 and 2020 at Houston Methodist Hospital. COVID-19-related masking policies were put into place in March of 2020.

Out of a total of 134,097 injections, 47 (0.035%) resulted in endophthalmitis. Stratified by the pandemic period, the pre-pandemic rate was 0.036% and post-pandemic rate was 0.031% (P =.847).

Patients with presumed endophthalmitis presented between 1 and 12 (mean, 4.65) days after injection before the pandemic and between 1 and 12 (mean, 4.14) days during the pandemic (P =.994). The average patient was approximately 76±14.9 years old, had a preinjection acuity of 0.50±0.59 logMAR. At 6 months the acuity was 0.88±0.78.

Among eyes that were cultured, 28% and 17% were culture positive before and after the onset of the pandemic, respectively.

Endophthalmitis cases before and after the onset of the pandemic were associated with aflibercept (61% vs 72%), ranibizumab (34% vs 14%), and bevacizumab (5% vs 14%), respectively. There were no differences between time periods for eye types, with overall rates among eyes with neovascular age-related macular degeneration (AMD) (55%), diabetic eye disease (32%), retinal vein occlusion (11%), and uveitis (2%).

The study investigators did note that numerically more injections were performed during the masking mandate than during an equivalent time period prior to the masking protocol (mean, 3134 vs 3203 injections per month; total, 21,940 vs 22,418 injections; P =.408).

This study was likely limited by the overall low rate of postintravitreal injection endophthalmitis and a larger sample size was likely required to observe significant differences.

The study authors concluded that there was little evidence to suggest that universal patient and clinician masking affected rates of postintravitreal injection endophthalmitis.


Naguib MM, Ghauri S, Mukhopadhyay A, Schefler AC. Endophthalmitis after intravitreal injections during the covid-19 pandemic with implementation of universal masking. Retina. 2021;41(11):2208-2214. doi:10.1097/IAE.0000000000003193