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Increased incidence of endophthalmitis after vitrectomy relative to face mask wearing during COVID-19 pandemic
  1. Taiji Sakamoto1,2,
  2. Hiroto Terasaki1,2,
  3. Toshifumi Yamashita1,2,
  4. Hideki Shiihara1,2,
  5. Ryoh Funatsu1,2,
  6. Akinori Uemura3
  7. The Japanese Retina and Vitreous Society
    1. 1Department of Ophthalmology, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
    2. 2Japan-Clinical Retina Study Group (J-CREST), Kagoshima, Japan
    3. 3Department of Ophthalmology, Kagoshima City Hospital, Kagoshima, Japan
    1. Correspondence to Dr Taiji Sakamoto, Ophhtalmology, Kagoshima University, Kagoshima, Kagoshima, Japan; tsakamot{at}


    Background/aims To determine the incidence and causative pathogens of endophthalmitis after vitrectomy during strict face mask wearing in the COVID-19 period.

    Methods This 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.

    Results The 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.

    Conclusions It 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.

    • Covid-19
    • Infection
    • Retina

    Data availability statement

    Data are available upon reasonable request.

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    • TS and HT contributed equally.

    • Correction notice This article has been corrected since it was first published. There was an error in the first column of table 1 and this has now been updated.

    • Collaborators Members of the Japan Clinical Retina Study group (J-CREST), a private retina research group and a board member of the JRVS: Department of Ophthalmology, Diabetes Center, Tokyo Women's Medical University: Shigehiko Kitano, Kunihiro Ishikawa; Department of Ophthalmology, Faculty of Medicine, Miyazaki University: Yasuhiro Ikeda, Naohiro Sugita, Go Mawatari; Department of Ophthalmology, Faculty of Medicine, Saga University: Hiroshi Enaida, Soichiro Yamamoto, Yoshiyuki Kobayashi; Department of Ophthalmology, Kagoshima University Graduate School of Medical and Dental Sciences: Taiji Sakamoto, Toshifumi Yamashita, Hiroto Terasaki, Ryoh Funatsu, Hideki Shiihara; Department of Ophthalmology, Graduate School of Medical Sciences, Kyushu University: Koh-Hei Sonoda, Atsunobu Takeda, Keijiro Ishikawa, Shoji Notomi, Muneo Yamaguchi, Shunji Nakatake; Department of Ophthalmology, Graduate School of Medicine, University of the Ryukyus: Hideki Koizumi, Yukihide Yamauchi, Nobuhiro Terao, Naoya Imanaga, Shota Sawaguchi; Department of Ophthalmology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University; Susumu Ishida, Ryo Ando, Riki Kijima; Department of Ophthalmology, Hyogo College of Medicine: Fumi Gomi, Takashi Araki; Department of Ophthalmology, Institute of Biomedical Sciences, Tokushima University Graduate School: Yoshinori Mitamura; Department of Ophthalmology, Izuro Imamura hospital: Norihito Doi, Takashi Mizushima, Yuko Fujiwara, Shoki Miyake, Yuka Mizushima, Kihoko Kato; Department of Ophthalmology, Kagawa University Faculty of Medicine: Kiyoshi Suzuma, Yuki Nakano, Rie Osaka; Department of Ophthalmology, Kagoshima City Hospital: Akinori Uemura, Keita Yamakiri; Department of Ophthalmology, Kurume University School of Medicine: Shigeo Yoshida, Nobuhiro Kato, Kei Furushima; Department of Ophthalmology, Mie University Graduate School of Medicine: Mineo Kondo, Kumiko Kato; Department of Ophthalmology, Nara Medical University: Nahoko Ogata, Tetsuo Ueda, Yuutaro Mizusawa, Hironobu Jimura: Department of Ophthalmology, National Defense Medical College: Masaru Takeuchi, Takayuki Kanda, Tomohito Sato: Department of Ophthalmology, Sakai Hospital Kinki University Faculty of Medicine; Shunji Kusaka, Chiharu Iwahashi, Sayaka Yamao: Department of Ophthalmology, Sakura Medical Center, Toho University; Takatoshi Maeno, Hidetaka Masahara: Department of Ophthalmology, Shinshu University School of Medicine: Toshinori Murata, Takao Hirano; Department of Ophthalmology, Shiga University of Medical Science: Masahito Ohji, Tomoko Sawada; Department of Ophthalmology, St Luke's International University Yoko Ozawa, Norihiro Nagai: Department of Ophthalmology, St. Marianna University School of Medicine; Hitoshi Takagi, Tatsuya Jujo: Department of Ophthalmology, Tokyo Medical University Hachioji Medical Center: Masahiko Shimura, Masaki Asakage, Kanako Yasuda; Department of Ophthalmology, Tokyo Women's Medical University: Tomohiro Iida, Ichiro Maruko, Taiji Hasegawa, Atsushi Ohnami, Yukari Kodama; Department of Ophthalmology, Tsukazaki Hospital: Hitoshi Tabuchi, Daisuke Nagasato; Department of Ophthalmology, Yokohama City University Medical Center: Kazuaki Kadonosono, Maiko Maruyama-Inoue, Shin Tanaka; Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine: Akitaka Tsujikawa, Kenji Suda; Department of Ophthalmology & Visual Science, Nagoya City University Graduate School of Medical Sciences: Tsutomu Yasukawa, Aki Kato; Division of Ophthalmology, Department of Surgery, Kobe University Graduate School of Medicine; Sentaro Kusuhara: Kobe Eye Center; Yasuo Kurimoto, Yasuhiko Hirami, Masayo Takahashi; Kyorin Eye Center, Kyorin University School of Medicine: Makoto Inoue, Akito Hirakata, Takashi Koto, Kazunari Hirota, Tomoka Ishida, Yoshimasa Ando, Masaharu Mizuno, Aya Takahashi.

    • Contributors TS and HT equally contributed to this study. TS: study conception, interpretation of data, drafting, and revising the work. HT: acquisition and analysis of data and drafting of the work. TY, HS: interpretation of data and revising the work. RF: analysis of data and revising the work. AU: acquisition of data and revising the work. TS is responsible for the overall content as the guarantor. All authors read and approved the final manuscript for submission.

    • Funding This work was supported in part by JSPS KAKENHI grant number 21H03095.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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