Increased incidence of endophthalmitis after vitrectomy relative to face mask wearing during COVID-19 pandemic

Abstract

Background/aimsTo determine the incidence and causative pathogens of endophthalmitis after vitrectomy during strict face mask wearing in the COVID-19 period.MethodsThis was a retrospective multicentre study including 31 ophthalmological institutions of the Japanese Retina and Vitreous Society or Japan-Clinical Retina Study group. Patients who had undergone vitrectomy during 2019, the pre-COVID-19 period, and from July 2020 to June 2021, the COVID-mask period, were studied. The results of cataract surgery were used as a control. The total number of vitrectomies and the total number of postoperative endophthalmitis were determined. Then, the differences in the incidence of postoperative endophthalmitis between the pre-COVID-19 period and the COVID-mask period, and the type of pathogens causing the endophthalmitis were studied.ResultsThe incidence of postvitrectomy endophthalmitis was significantly lower in the pre-COVID-19 period with 16 568 surgeries and 18 endophthalmitis cases (0.11%) than in the COVID-mask period of 14 929 surgeries and 31 endophthalmitis cases (0.21%; p=0.031, OR=1.913, 95% CI 1.078 to 3.394). In the pre-COVID-19 period, 4 of the 18 eyes were culture positive, and all were of the Staphylococcus family. In the COVID-mask period, 9 of the 31 eyes were culture positive, and 4 cases were related to oral commensals including Streptococcus spp, which are reportedly very rare in endophthalmitis after vitrectomy.ConclusionsIt is necessary for physicians to be aware of the higher incidence of postvitrectomy endophthalmitis during the COVID-mask period, and to treat their patients appropriately.

Relationship between surgical field contamination by patient's exhaled air and the state of the drapes during eye surgery

“…One study used the schlieren imaging technique to record airflow around the eyes while participants were wearing masks 12 . A multicenter study in Japan reported an increase in the incidence of endophthalmitis after vitrectomy following the start of the COVID-19 pandemic 15 . The same study also reported that the incidence of endophthalmitis after cataract surgery did not increase.…”

The Bacterial Burden of Worn Face Masks – Observational Research and Literature Review

“…Several authors have associated the use of face masks skin eruptions, some involving S. aureus [77] including new occurrence or exacerbation of acne, rosacea, and seborrhoeic dermatitis [78]. Other authors note enrichment of the normal eye microbiota with S. aureus from exhaled breath and droplets while wearing a mask contributing to the development of eyelid inflammation (chalazion) [79,80] and infections of the cornea [81], also deeper eye infections in the context of treatments (endophthalmitis following vitrectomy) [82]. There is also some evidence that S. aureus can increase replication of the SARS-CoV-2 virus by 10-to 15-fold [83], though this seems more pertinent in the upper nose than on a mask, where the virus is unlikely to be replicating.…”

Endophthalmitis and COVID-19: A Narrative Literature Review

“…18,19 On the contrary, regarding PPV, Sakamoto et al observed a higher rate of endophthalmitis relative to face mask wearing during the pandemic. 20 Some of their cases were associated with oral commensals, an unusual cause of post vitrectomy endophthalmitis. 20 Endogenous cases, on the other hand, have been on the rise 14 , especially those caused by fungal pathogens.…”

“…20 Some of their cases were associated with oral commensals, an unusual cause of post vitrectomy endophthalmitis. 20 Endogenous cases, on the other hand, have been on the rise 14 , especially those caused by fungal pathogens. Schroff et al, 21 reported on 5 eyes with endophthalmitis in 7 patients with severe COVID-19 pneumonia and long-term CS therapy (80-180 days).…”