Assessing visible aerosol generation during vitrectomy in the era of Covid-19

Liyanage, Sidath; Ramasamy, Pathma; Elhaddad, Omar; Darcy, Kieren; Hudson, Andrew J.; Keller, Johannes

doi:10.1038/s41433-020-1052-4

Cited by 5 publications

(6 citation statements)

References 6 publications

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“…There was no detectable aerosol generation during microkeratome-assisted LASIK and vitrectomy. 52–54 However, experiments on porcine eyes and models of human cadaveric corneoscleral rim mounted on an artificial anterior chamber showed visible aerosol produced during phacoemulsification. 55 , 56 Besides, the studies of Workman et al on human cadaver heads demonstrated that cold instrument and microdebrider use did not generate visible aerosols, but endoscopic endonasal surgery using a high-speed drill and cautery use generated large amounts of aerosols.…”

Section: Resultsmentioning

confidence: 99%

Evidence of SARS-CoV-2 Transmission Through the Ocular Route

Xie

Zhang

2021

OPTH

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Purpose Currently, the coronavirus disease 2019 (COVID-19) pandemic is raging around the world. However, the transmission of its pathogen, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is not fully clear. It is still controversial whether the ocular transmission of SARS-CoV-2 exists. This review aimed to summarize the evidence of SARS-CoV-2 ocular transmission. Methods Online articles were searched till October 23, 2020 in Pubmed, Embase, and websites of World Health Organization, Centers for Disease Control and Prevention COVID-19, American Academy of Ophthalmology, and American Society of Cataract and Refractive Surgery under the search strategy of ((((“COVID-19”[Mesh]) OR (“SARS-CoV-2”[Mesh])) OR (2019 novel coronavirus)) OR (2019-nCoV)) AND ((((“Conjunctivitis”[Mesh]) OR (Ocular Surface)) OR (“Eye”[Mesh])) OR (“Ophthalmology”[Mesh])). The language was not restricted. After screening, 1445 records were excluded and 168 references original articles were finally included. Results Cells of ocular surface express both the receptor of angiotensin-converting enzyme 2 (ACE2) and transmembrane serine protease 2 (TMPRSS2), offering molecular bases for the ocular susceptibility to SARS-CoV-2. Accumulated COVID-19 patients presented conjunctivitis as the initial or the only symptom. Whether COVID-19 patients had ocular symptoms or not, SARS-CoV-2 was detectable on the ocular surface, and the isolated virus was infectious, proving that the ocular surface can not only be a reservoir but also a source of contagion. SARS-CoV-2 may reach the ocular surface by hand-eye contact and aerosols. Once SARS-CoV-2 reaches the ocular surface, it may transfer to other systems through the nasolacrimal system or hematogenous metastasis. Conclusion The ocular surface can serve as a reservoir and source of contagion for SARS-CoV-2. SARS-CoV-2 can be transmitted to the ocular surface through hand-eye contact and aerosols, and then transfer to other systems through nasolacrimal route and hematogenous metastasis. The possibility of ocular transmission of SARS-CoV-2 cannot be ignored.

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Section: Resultsmentioning

confidence: 99%

Evidence of SARS-CoV-2 Transmission Through the Ocular Route

Xie

Zhang

2021

OPTH

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“…Another study revealed that phacoemulsification did not generate aerosols of 10 μm or smaller with continuous power using 80% longitudinal, 100% torsional, or 80% longitudinal setting with HPMC on the surface [ 39 ]. Visible aerosol generation during vitrectomy surgery has been also evaluated using a physical model, although this study did not find evidence of visible aerosol generation during simulated vitrectomy surgery [ 40 ].…”

Section: Risk Of Sars-cov-2 Transmission Through Ophthalmic Procedurementioning

confidence: 99%

Novel Insights into the Transmission of SARS-CoV-2 Through the Ocular Surface and its Detection in Tears and Conjunctival Secretions: A Review

et al. 2020

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SARS-CoV-2 is a highly transmissible virus that spreads mainly via person-to-person contact through respiratory droplets, or through contact with contaminated objects or surfaces from an infected person. At present we are passing through a phase of slow and painful understanding of the origin, epidemiological profile, clinical spectrum, and risk profile of the virus. To the best of our knowledge there is only limited and contradictory evidence concerning SARS-CoV-2 transmission through other routes. Importantly, the eye may constitute not only a potential site of virus replication but also an alternative transmission route of the virus from the ocular surface to the respiratory and gastrointestinal tract. It is therefore imperative to gain a better insight into the potential ophthalmological transmission route of the virus and establish directions on best practice and future models of care for ophthalmological patients. This review article critically evaluates available evidence on the ophthalmological mode of viral transmission and the value of earlier identification of the virus on the eye. More evidence is urgently needed to better evaluate the need for protective measures and reliable ocular diagnostic tests to diminish further pandemic spread.

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“…Previous studies suggest that any aerosol droplets can potentially deliver nucleic acids [ 4 – 8 ]. The release of aerosol from experimental phacoemulsification was previously reported using real-time imaging or luminol techniques [ 17 – 21 ]. A porcine-eye mock-up showed that phacoemulsification is a low-risk aerosol-generating procedure, which is also supported by the low transmission risk for SARS-CoV-2 by tears [ 22 – 24 ].…”

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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Assessing visible aerosol generation during vitrectomy in the era of Covid-19

Cited by 5 publications

References 6 publications

Evidence of SARS-CoV-2 Transmission Through the Ocular Route

Evidence of SARS-CoV-2 Transmission Through the Ocular Route

Novel Insights into the Transmission of SARS-CoV-2 Through the Ocular Surface and its Detection in Tears and Conjunctival Secretions: A Review

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

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