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Creating aerosolized droplets in phacoemulsification

Published:October 17, 2020DOI:https://doi.org/10.1016/j.jcjo.2020.09.013
      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.
      • Rai A.S.
      • Mele R.
      • Rai A.S.
      • Braga-Mele R.
      Addressing the concerns of aerosolization during phacoemulsification due to COVID-19: human cadaveric eye with trypan blue [e-pub ahead of print].
      Vertical torque on the wound and long incisions increased droplet production. Hydroxypropyl methylcellulose coating the cornea decreased droplet production.
      • Darcy K.
      • Elhaddad O.
      • Achiron A.
      • et al.
      Reducing visible aerosol generation during phacoemulsification in the era of Covid-19 [e-pub ahead of print].
      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.

      Footnotes and Disclosure

      The authors have no proprietary or commercial interest in any materials discussed in this article.

      References

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        • Mele R.
        • Rai A.S.
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        Eye (Lond). 2020; (Accessed August. 7, 2020)https://doi.org/10.1038/s41433-020-1053-3