Sir,

We thank Leyland and colleagues for sharing their views on the use of face-masks during ophthalmic surgery. As stated in our editorial, the wearing of face-masks during an operation to prevent potential microbial contamination of the incision is a long-standing surgical tradition.1 However, many well-meaning traditions have inconclusive evidence of benefit underlying them. It is proper to challenge those traditions and critically examine the scientific evidence for continuing them.

We recommended, in our editorial, the proper use of face-masks based on studies such as the prospective randomized study by Alwitry et al,2 which reported in the ophthalmic literature, significantly fewer bacterial counts from blood agar plates placed adjacent to the patient's head in the operating field when the surgeons wore face-masks compared to the group that did not wear masks. Also, the recently published retrospective analysis by Kamalarajah et al3 found the use of face-masks by the scrub nurse and surgeon to be protective against postoperative endophthalmitis after cataract surgery (P<0.001). We recognize that these data do not conclusively show that face-masks lower the risk for endophthalmitis. In fact, a Cochrane review found no conclusive evidence that wearing face-masks increases or reduces the number of surgical wound infections.4 Until further research is done, there is no scientific mandate for or against face-masks during cataract surgery. We respect the decision made by Leyland and colleagues to continue not wearing them. For us, however, the severe potential consequences of endophthalmitis and the possibility of even a small protective influence from face-masks drives our continued recommendation to use them.