Creating aerosolized droplets in phacoemulsification

Abstract

Creating aerosolized droplets in phacoemulsification A wetlab was set up using porcine eyes, an artificial anterior chamber maintainer, and an Alcon Infiniti phacoemulsification system (Fort Worth, TX; Fig. A). Colouring dye was placed in the irrigation fluid for easy identification of droplets on a white paper surface surrounding the eye. During simulated phacoemulsification, droplet/aerosol production occurred when the irrigation ports were in the incision, but not when they were entirely within the anterior chamber. A similar study, using cadaveric eyes and a 2.2 mm phacoemulsification sleeve, also found that no droplet/aerosol was produced when instruments were held entirely within the anterior chamber. 1 Vertical torque on the wound and long incisions increased droplet production. Hydroxypropyl methylcellulose coating the cornea decreased droplet production. 2 With phacoemulsification settings at maximum power and no hydroxypropyl methylcellulose on the cornea, the furthest documented droplet radius was 13.2 cm with a 2.75 mm keratome incision (Fig. B) versus 1.9 cm with a 2.2 mm keratome incision (Fig. C). These observations, along with evidence of low transmission risk for coronavirus disease 2019 from the tear film, suggest that phacoemulsification is low risk as an aerosol-generating procedure.

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

“…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 ].…”