Aerosol generation during phacoemulsification in live patient cataract surgery environment

Kaur, Simerdip; Kopsachilis, Nick; Zia, Rashid

doi:10.1097/j.jcrs.0000000000000510

Cited by 5 publications

(5 citation statements)

References 18 publications

(26 reference statements)

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“… 22 Most leading ophthalmological societies, including the Royal College of Ophthalmologists and Public Health of England, did not include PE as an AGP, supported by data from a modelling study. 23 , 24 Moreover, no infectivity study has revealed that conjunctival fluid or aqueous humor could transmit SARS-CoV-2, despite reports of positivity of these fluids for SARS-CoV-2 nucleic acid in some symptomatic COVID-19 cases. 25 , 26 Additionally, a large seroprevalence study in the US and Belgium with high community COVID-19 incidence rates revealed that most HCWs acquired the disease from the community rather than in-hospital.…”

Section: Discussionmentioning

confidence: 99%

Safety and Efficacy of Cataract Surgery Under a Local Infection Control Protocol Before and During a COVID-19 Wave in Thailand for Healthcare Workers and Patients: A Prospective Cohort from a Secondary Center

Rujkorakarn¹,

Patamatamkul²

2022

OPTH

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Purpose To assess the effectiveness of a local infection control protocol for cataract surgery (CS) during the coronavirus disease (COVID-19) pandemic and determine the trend of CSs and visual outcomes during this period, as compared to the pre-COVID-19 pandemic period. Methods This study was conducted at Suddhavej Hospital, Mahasarakham University, Mahasarakham, Thailand, between July 1, 2020, and March 31, 2021. In this two-phase study, we used only a COVID-19-screening questionnaire during the first phase and preoperative nasopharyngeal swab severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) testing for real-time reverse transcriptase-polymerase chain reaction in the second phase, during Thailand’s second COVID-19 wave. Nasopharyngeal swab SARS-CoV-2 nucleic acid testing, SARS-CoV-2 IgG/IgM, or anti-SARS-CoV-2 spike antibody seroconversion was used to detect COVID-19 infection among healthcare workers. We also compared cataract surgical volume and postoperative visual acuity of CS patients between the pre-COVID-19 period and during the COVID-19 pandemic period. Results A total of 947 patients underwent CS. Thirty-two healthcare workers and 275 patients tested negative for SARS-CoV-2 in the second study phase. CSs increased on average by 50.09% month-to-month when the surgery was resumed. The mean postoperative logMAR best-corrected visual acuity was significantly better in the COVID-19 pandemic period than in the pre-pandemic period (difference, 0.1 [95% CI: 0.00–0.12], p < 0.0001). Conclusion CS could be safely performed under an infection control protocol during the COVID-19 pandemic. The cataract surgical volume, with favorable visual outcomes, has an increasing trend after resuming elective surgeries.

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Section: Discussionmentioning

confidence: 99%

Safety and Efficacy of Cataract Surgery Under a Local Infection Control Protocol Before and During a COVID-19 Wave in Thailand for Healthcare Workers and Patients: A Prospective Cohort from a Secondary Center

Rujkorakarn¹,

Patamatamkul²

2022

OPTH

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“…(15) Other studies also did not show aerosol generation in the laboratory (16)(17)(18) and in living patients. (19) Furthermore, the phacoemulsification procedure starts with the replacement of aqueous humor with viscoelastic, which is then replaced by balanced salt solution from the phaco tip. (2) Even if aerosolization were to occur, it would be from the balanced salt solution, and not from the patient's aqueous humor.…”

Section: ❚ Discussionmentioning

confidence: 99%

Impacts of the COVID-19 pandemic on elective cataract surgeries

Tannous¹,

Mendes²,

Freitas³

et al. 2022

Einstein (São Paulo)

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Objective: To evaluate the standards of practice of Brazilian cataract surgeons in relation to the protective measures adopted to mitigate the risks of transmission of COVID-19 during cataract surgery, in asymptomatic patients. Methods: A descriptive, cross-sectional, quantitative paradigm study, developed from a self-administered electronic questionnaire sent to ophthalmologists and residents/specialists in ophthalmology in Brazil, who performed cataract surgeries in 2019 and 2020, connected through social media and mail listing from local societies. Results: Of the 303 participating surgeons, 159 (n=52.2%) performed elective cataract surgeries between March 20 th , 2020 to June 1 st , 2020. Among the measures adopted by ophthalmologists with the purpose of preventing viral transmission, the patient's temperature was measured by 84.3% (n=134), and the verification of respiratory symptoms and contact/exposure to cases of COVID-19 by 87.4% (n=139). Most did not submit their patients to laboratory tests to detect 91.2%). In surgery, 44.7% (n=71) used an N95 mask, and 69.2% (n=110) kept their patients with a mask. No stage of phacoemulsification was modified in 144 (90.6%) participants, 13 (8.2%) added methylcellulose under the main incision, and two (1.3%), modified another surgical stage. Conclusion: The COVID-19 pandemic significantly interrupted part of cataract surgeries in Brazil from March to June 2020 and measures to prevent viral spread are being heterogeneously adopted by surgeons. Understanding these measures could be the first step to improve strategies to return to pre-pandemic levels.

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“…The recent COVID-19 pandemic has led to increasing interest in the fact that aerosol produced during cataract surgery can affect the safety of healthcare operators if a minimal viral RNA load can persist inside cells/tissues/fluids and be released with droplets/aerosol [ 29 – 31 ]. Although not related to “viral/bacterial load,” high-risk infection can occur during phacoemulsification generating of aerosol/droplets containing pathological sequences [ 32 ].…”

Section: Discussionmentioning

confidence: 99%

Phacoemulsification and nucleic acid-enriched aerosol: considerations from an eye model of cataract simulation

Cacciamani

Scarinci

Bruno

et al. 2021

Graefes Arch Clin Exp Ophthalmol

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Purpose The purpose of this study is to investigate whether phacoemulsification can generate aerosolized single-stranded RNA (ssRNA) and retain sequence integrity using an artificial eye model for experimental cataract surgery. Methods A simulation of cataract surgery was performed using an anterior chamber eye model filled with an ssRNA probe at different scalar dilutions (kanamycin positive control ssRNA). A plastic conical cage was built over the artificial eye surface of the mock-up. A total of 24 tests (twice reproduced) were performed, and five nitrocellulose strips were placed 15 cm from the artificial surface of the mock-up and used to collect aerosol particles, from each experiment. Phaco-activity was mimicked using a phacoemulsification equipped with a 2.75-mm tip, and strips were removed at the end of the procedure. RNA extraction, reverse transcription, and agarose gel electrophoresis were performed and compared. Results Strips collected aerosol droplets enriched with ssRNA, mainly at the higher concentrations tested, compared to related untouched standard solutions. Complementary DNA (cDNA) synthesis confirmed the presence of intact ssRNA fragments. As observed from densitometric analysis of resolved RNA in extracted samples and cDNA bands after retro-transcription, lower concentrations of ssRNA were also detected. Conclusions As the main output of the study, the phaco-generated aerosol can deliver an intact ssRNA sequence. Since the aerosol can potentially reach the operator’s face, any biological agent (virus/bacteria) potentially inside the anterior chamber of a patient undergoing cataract surgery, eventually escaping from biomolecular checks, can be potentially infective for operators. The data reported herein suggest that collective versus individual protective countermeasures should always be encouraged in ocular surgery and should not be restricted to coronavirus disease emergencies.

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Aerosol generation during phacoemulsification in live patient cataract surgery environment

Abstract: Aerosol sized less than 10 μm is not produced during phacoemulsification of human crystalline lens. A mobile laminar air flow machine significantly reduced the number of particles sized 10 μm or lesser within the surgical field.

Cited by 5 publications

References 18 publications

Safety and Efficacy of Cataract Surgery Under a Local Infection Control Protocol Before and During a COVID-19 Wave in Thailand for Healthcare Workers and Patients: A Prospective Cohort from a Secondary Center

Safety and Efficacy of Cataract Surgery Under a Local Infection Control Protocol Before and During a COVID-19 Wave in Thailand for Healthcare Workers and Patients: A Prospective Cohort from a Secondary Center

Impacts of the COVID-19 pandemic on elective cataract surgeries

Phacoemulsification and nucleic acid-enriched aerosol: considerations from an eye model of cataract simulation

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