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. 2021 May;35(5):1405-1410.
doi: 10.1038/s41433-020-1053-3. Epub 2020 Jun 26.

Reducing visible aerosol generation during phacoemulsification in the era of Covid-19

Kieren Darcy  1 , Omar Elhaddad  2   3 , Asaf Achiron  2   4 , Johannes Keller  2 , Duncan Leadbetter  2 , Derek Tole  2 , Sidath Liyanage  5
Affiliations

Reducing visible aerosol generation during phacoemulsification in the era of Covid-19

Kieren Darcy et al. Eye (Lond). 2021 May.

Abstract

Objective: To assess potential methods of reducing visible aerosol generation during clear corneal phacoemulsification surgery in the era of Covid-19.

Methods: Aerosol generation during phacoemulsification was assessed using a model comprising a human cadaveric corneoscleral rim mounted on an artificial anterior chamber. Typical phacoemulsification settings were used and visible aerosol production was recorded using high-speed 4K camera. Aerosolisation was evaluated under various experimental settings: Two different phacoemulsification tip sizes (2.2, 2.75 mm), varying levels of corneal moisture, the use of suction and blowing air in the surgical field, the use of hydroxypropyl methylcellulose (HPMC) coating of the cornea with a static and moving tip.

Results: This model demonstrates visible aerosol generation during phacoemulsification with a 2.75-mm phacoemulsification tip. No visible aerosol was noted with a 2.2-mm tip. The presence of visible aerosol was unrelated to corneal wetting. Suction in close proximity to the aerosol plume did not impact on its dispersion. Blowing air redirected the aerosol plume toward the ocular surface. Visible aerosol production was abolished when HPMC was used to coat the cornea. This effect lasted for an average of 67 ± 8 s in the static model. Visible aerosol generation was discerned during movement of the 2.2-mm tip toward the corneal wound.

Conclusions: We demonstrate visible aerosol production in the setting of a model of clear corneal phacoemulsification. Visible aerosol can be reduced using a 2.2-mm phacoemulsification tip and reapplying HPMC every minute during phacoemulsification.

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Conflict of interest statement

The authors declare that they have no conflict of interest.

Figures

Fig. 1
Fig. 1. Photograph showing the corneoscleral rim mounted on the anterior artificial chamber.
This is sited within a model head used for cataract training. The phacoemulsification probe is fixed in position.
Fig. 2
Fig. 2. Visible aerosol during phacoemulsification.
Photograph showing visible aerosol produced using continuous torsional phacoemulsification with the 2.75-mm tip.
Fig. 3
Fig. 3. No visible aerosol with 2.2-mm tip.
Photograph comparing visible aerosol production with the 2.2- and 2.75-mm tip.
Fig. 4
Fig. 4. Investigating reducing the visible aerosol plume.
Photographs showing a failure to aspirate visible aerosol using maximal Yankauer suction and b redirection of aerosol plume downwards by blowing air.
Fig. 5
Fig. 5. No visible aerosol with HPMC.
Photograph showing the cessation of visible aerosol during phacoemulsification on application of HPMC.
See this image and copyright information in PMC

Comment in

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