Tao Brendan K, Li Xiaole, Chen Natalie, Huang Ryan, Mihalache Andrew, Gou David, Zeraatkar Dena, Xie Jim S, Popovic Marko M, Zaslavsky Kirill, Navajas Eduardo V, Kertes Peter J, Wong David T, Kohly Radha P, Muni Rajeev H
Faculty of Medicine, The University of British Columbia, Vancouver, British Columbia, Canada.
Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
Ophthalmology. 2025 May;132(5):578-589. doi: 10.1016/j.ophtha.2024.12.006. Epub 2024 Dec 9.
To compare face-masking protocols for post-intravitreal injection endophthalmitis (PIE) prophylaxis.
Although mask mandates are lifted, ophthalmologists may question whether continued investment into face masks will influence rates of PIE.
We included comparative studies of PIE incidence by masking policy (i.e., standard care [no restrictions], no-talking, physician masking, or universal masking [patient and physician]). A frequentist network meta-analysis (Mantel-Haenszel method with fixed effects) synthesized direct and indirect evidence. Subgroup analysis excluded studies that systematically introduced new prophylactic techniques (e.g., prefilled syringes) during the observation period. The Risk of Bias in Nonrandomized Studies of Interventions Risk of Bias in Nonrandomized Studies of Interventions and Grading of Recommendations, Assessment, Development, and Evaluation tools evaluated risk of bias and evidence certainty.
We analyzed 17 studies (2 595 219 injections, 830 events [0.032%]). For the overall PIE outcome (17 studies; 2 595 219 injections), PIE incidence was significantly lower with no-talking (odds ratio [OR], 0.56; 95% confidence interval [CI], 0.39-0.82; I = 0%) and physician masking (OR, 0.72; 95% CI, 0.53-0.99; I = 0%) policies when compared to standard care. Although PIE rates between standard care and universal masking did not differ in the main analysis (OR, 0.83; 95% CI, 0.67-1.02), subgroup analysis revealed a significantly lower rate of any PIE with universal masking (OR, 0.70; 95% CI, 0.55-0.91; I = 0%) compared with standard care. For the culture-positive (14 studies; 2 347 419 injections), Streptococcus (10 studies; 1 966 903 injections), and culture-negative (15 studies; 2 213 322 injections) outcomes, PIE rates between pairs of intervention groups generally did not reach significance, likely due to limited study power. As one exception, the incidence of culture-positive PIE was significantly lower with a no-talking policy (OR, 0.45; 95% CI, 0.23-0.92; single direct estimate) compared with standard care, although this result was not consistent in the subgroup analysis. As well, in the subgroup analysis, universal masking was significantly associated with a lower incidence of culture-negative PIE than standard care (OR, 0.68; 95% CI, 0.47-0.98; I = 0%).
Low- or very low-certainty evidence suggests that no-talking and physician masking policies may reduce PIE rates compared with standard care. Although data were available only for endophthalmitis, the overall comparative safety of these interventions remains unclear.
FINANCIAL DISCLOSURE(S): The author(s) have no proprietary or commercial interest in any materials discussed in this article.
比较玻璃体内注射后眼内炎（PIE）预防的面罩使用方案。
尽管口罩强制令已解除，但眼科医生可能会质疑继续投入使用口罩是否会影响PIE的发生率。
我们纳入了按口罩使用政策（即标准护理[无限制]、不交谈、医生佩戴口罩或普遍佩戴口罩[患者和医生均佩戴]）比较PIE发生率的研究。采用频率学派网状荟萃分析（固定效应的Mantel-Haenszel方法）综合直接和间接证据。亚组分析排除了在观察期内系统性引入新预防技术（如预填充注射器）的研究。干预性非随机研究中的偏倚风险以及推荐分级、评估、制定和评价工具评估了偏倚风险和证据确定性。
我们分析了17项研究（2595219次注射，830例事件[0.032%]）。对于总体PIE结果（17项研究；2595219次注射），与标准护理相比，不交谈（优势比[OR]，0.56；95%置信区间[CI]，0.39 - 0.82；I² = 0%）和医生佩戴口罩（OR，0.72；95%CI，0.53 - 0.99；I² = 0%）方案的PIE发生率显著更低。虽然在主要分析中标准护理和普遍佩戴口罩之间的PIE发生率没有差异（OR，0.83；95%CI，0.67 - 1.02），但亚组分析显示与标准护理相比，普遍佩戴口罩的任何PIE发生率显著更低（OR，0.70；95%CI，0.55 - 0.91；I² = 0%）。对于培养阳性（14项研究；2347419次注射）、链球菌（10项研究；1966903次注射）和培养阴性（15项研究；2213322次注射）结果，干预组之间的PIE发生率通常未达到显著差异，可能是由于研究效能有限。作为一个例外，与标准护理相比，不交谈政策的培养阳性PIE发生率显著更低（OR，0.45；95%CI，0.23 - 0.92；单个直接估计值），尽管该结果在亚组分析中不一致。同样，在亚组分析中，普遍佩戴口罩与标准护理相比，培养阴性PIE的发生率显著更低（OR，0.68；95%CI，0.47 - 0.98；I² = 0%）。
低确定性或极低确定性证据表明，与标准护理相比，不交谈和医生佩戴口罩政策可能会降低PIE发生率。尽管仅获得了关于眼内炎的数据，但这些干预措施的总体比较安全性仍不清楚。
作者对本文中讨论的任何材料均无所有权或商业利益。
