EyeWorld India December 2021 Issue

NEWS & OPINION EWAP DECEMBER 2021 47 when using the LAF machine. When comparing patient 2 (LAF on) to patient 3 (LAF on and OcuCoat), there was only a borderline difference between the second eye of each patient, which the authors concluded was more likely a cumulative effect of the LAF machine rather than the actual effect of OcuCoat. There was no difference in particle count between the first eye of patient 2 and patient 3, implying the use of OcuCoat does not significantly decrease aerosolization. In the follow-on study of 20 eyes with use of the LAF machine and standard viscoelastic, there was significant reduction of particle size during phacoemulsification compared to pre- phacoemulsification. This implies that at least with the LAF machine turned on, there is no increase in particle count during phaco. Discussion Previous studies have suggested cataract surgery could be a potentially aerosol-generating procedure, yet the evidence is not definitive. A study on human cadavers demonstrated visible aerosol generation during phacoemulsification, however, a study on pig eye phacoemulsification did not show generation of aerosols. 1,2 The findings of this study showed aerosol of less than 10 μm is not produced during phacoemulsification of the human lens under routine operating conditions. This supports the recommendations of the American Academy of Ophthalmology, which state the risk for aerosol generation during phacoemulsification should be very low. 3 Furthermore, the results suggest that the use of OcuCoat does not significantly decrease the particle count and the LAF machine can be effective in decreasing overall particle count. The authors argued the risk of spreading live coronavirus from aerosolization in cataract surgery is low, and increased wait time between cases to decrease aerosol transmission is futile. There were several limitations to this study. The sample size was small, especially in the preliminary study, limiting the overall power of the study. Furthermore, it is difficult to determine if these results can be universally applied at all surgical sites across the world, as the surgical techniques, like incision size or type of phacoemulsification machine, are not consistent across operating theaters. During the American Society of Cataract and Refractive Surgery (ASCRS) Journal Club discussion, members of the panel weighed in on how their personal practice patterns have changed in the COVID-19 era. The majority of the panelists had all elective cataract cases canceled following the initial rise of COVID-19 infections. Upon reopening, some of the panelists experienced longer turnover rates between surgical cases due to stricter decontamination protocols. Despite returning to pre-COVID surgical and clinical volume, all panelists maintained Aerosol generation during phacoemulsification in live patient cataract surgery environment Simerdip Kaur, MRCP, Nick Kopsachilis, MD, Rishid Zia, MRCSEd (Ophthal) J Cataract Refract Surg. 2021;47(6):695–701 Purpose: To investigate if phacoemulsification is an aerosol generating procedure in a live patient environment. Setting: New Hayesbank Ophthalmology Services, Kent, UK Design: In vivo experimental human eyes study Methods: We measured aerosol particle counts sized ≤0.3 μm, >0.3≤0.5 μm, >0.5≤1.0 μm, >1.0≤2.5 μm, >2.5≤5.0 μm, and >5.0≤10 μm during elective phacoemulsification surgery of 25 eyes. The baseline particle count in our operating theater was measured on 2 separate days to assess for fluctuation. Then we measured 5 readings each during pre-phacoemulsification and phacoemulsification of all eyes. We also measured the difference in aerosol generation during pre- phacoemulsification and phacoemulsification with the use of the mobile laminar air flow (LAF) machine. Lastly, we measured aerosol generation during phacoemulsification with the use of HPMC (2 % hydroxypropyl methylcellulose). Results: There was no significant difference in measurement of aerosol between the baseline measurements on both days and between each patient’s pre-phacoemulsification and phacoemulsification stages of surgery. The LAF system showed statistically significant reduction in particles size of ≤0.3 μm, >0.3≤0.5 μm, >0.5≤1.0 μm, >1.0≤2.5 μm, >2.5≤5.0 μm, and >5.0≤10 μm during phacoemulsification compared to pre-phacoemulsification (t-test, p value 0.00 for all particle sizes). The use of HPMC (2 % hydroxypropyl methylcellulose) did not show any statistically significant reduction in particle measurements. Conclusion: Aerosol particles sized <10 μm are not produced during phacoemulsification of human crystalline lens in a live patient setting. The use of a mobile laminar air flow (LAF) machine significantly reduced the number of particles sized ≤10 μm within the surgical field.