EyeWorld India December 2021 Issue

NEWS & OPINION 46 EWAP DECEMBER 2021 by Hans Andrews, MD, Jordan Comstock, MD, and Jennifer Lindsey, MD Contact information Andrews: hans.w.andrews@vumc.org Lindsey: jennifer.lindsey@vumc.org Review of ‘Aerosol generation during phacoemulsification in live patient cataract surgery environment’ I n March 2020, COVID-19 placed an enormous stress on healthcare systems worldwide, and ophthalmologic cases were no exception. At the peak of the pandemic, many elective surgical services, including cataract surgery, were canceled. Ophthalmologists were confronted with empty offices and operating rooms. Fortunately, as new protocols were implemented, elective cases began to resume. Physicians and administrators have been plagued with the responsibility to reopen operative suites while also keeping patients and staff safe. The idea that cataract surgery is an aerosol-generating procedure is up for debate. If aerosol is generated from the lens or aqueous material, this could result in the spread of COVID-19 in the operating room. The purpose of this study was to characterize and quantify the generation of aerosol in the operating theater during cataract surgery on human eyes. The authors divided the study into two parts: a preliminary study and a follow-on study. In both parts, the authors included patients aged 50–80 who had visually significant cataracts and no other ophthalmic comorbidities. The preliminary study investigated 5 eyes of 3 patients, while the follow-on study had 20 eyes in 20 patients. The operating room used in this study had positive pressure ventilation and a high- efficiency particle filtration system. The study utilized a laminar airflow machine (LAF), which filters 99.995 % of particles more than 0.3 mm and improves air sterility. A particle counter was used to detect any aerosolized particles by sampling the air over 21 seconds while reporting the cumulative number of particles in six different size categories ranging from <0.3 mm to <10 mm. During each operation, five intermittent measurements were taken before phacoemulsifi -cation and five during phacoemulsification. The preliminary study set out to evaluate three main variables: (1) the effect of phacoemulsification on particle count, (2) the effect of LAF on particle count, and (3) the effect of OcuCoat (hydroxypropyl methylcellulose, Bausch + Lomb), a viscoelastic marketed to reduce aerosolization of particles, on particle count. These variables were tested on three patients. The first patient (one eye only) underwent standard cataract surgery with phacoemulsification comparing pre-phaco values to during phaco values. The second patient (eyes one and two) utilized the LAF machine for the entirety of the surgery on both eyes. The third patient (eyes one and two) utilized the LAF machine and OcuCoat viscoelastic. The follow-on study evaluated 20 eyes with the use of the LAF machine and standard viscoelastic. Results Baseline aerosol measurements were obtained in the operating room on two separate days, both before and after the LAF machine was turned on. There was no difference between day 1 and day 2, indicating no significant fluctuation in day-to-day measurements. Furthermore, there was no significant difference in particle size and quantity of particles with the LAF turned on or off. In the preliminary study, there was no significant increase in particles before or during phacoemulsification in all five eyes of the three patients. When comparing patient 1 (no variables) to patient 2 (LAF on), there was a significant decrease in particles in both the pre-phaco and during phaco categories. This indicates a reduction in particle quantity This article originally appeared in the September 2021 issue of EyeWorld . It has been slightly modified and appears here with permission from the ASCRS Ophthalmic Services Corp.