Reducing visible aerosol generation during phacoemulsification in the era of Covid-19.
Journal
Eye (London, England)
ISSN: 1476-5454
Titre abrégé: Eye (Lond)
Pays: England
ID NLM: 8703986
Informations de publication
Date de publication:
05 2021
05 2021
Historique:
received:
14
05
2020
accepted:
16
06
2020
revised:
10
06
2020
pubmed:
28
6
2020
medline:
22
6
2021
entrez:
28
6
2020
Statut:
ppublish
Résumé
To assess potential methods of reducing visible aerosol generation during clear corneal phacoemulsification surgery in the era of Covid-19. 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. 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. 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.
Identifiants
pubmed: 32591733
doi: 10.1038/s41433-020-1053-3
pii: 10.1038/s41433-020-1053-3
pmc: PMC7318901
doi:
Substances chimiques
Aerosols
0
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
1405-1410Commentaires et corrections
Type : CommentIn
Références
Lai C-C, Liu YH, Wang C-Y, Wang Y-H, Hsueh S-C, Yen M-Y, et al. Asymptomatic carrier state, acute respiratory disease, and pneumonia due to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2): facts and myths. J Microbiol Immunol Infect. 2020. https://doi.org/10.1016/j.jmii.2020.02.012 .
doi: 10.1016/j.jmii.2020.02.012
pubmed: 33349601
pmcid: 7513876
Judson SD, Munster VJ. Nosocomial transmission of emerging viruses via aerosol-generating medical procedures. Viruses. 2019;11:940.
doi: 10.3390/v11100940
Tran K, Cimon K, Severn M, Pessoa-Silva CL, Conly J. Aerosol generating procedures and risk of transmission of acute respiratory infections to healthcare workers: a systematic review. Semple MG, editor. PLoS ONE. 2012;7:e35797.
Tang JW, Li Y, Eames I, Chan PKS, Ridgway GL. Factors involved in the aerosol transmission of infection and control of ventilation in healthcare premises. J Hosp Infect. 2006;64:100–14.
doi: 10.1016/j.jhin.2006.05.022
Song J-Y, Yun J-G, Noh J-Y, Cheong H-J, Kim W-J. Covid-19 in south korea—challenges of subclinical manifestations. N. Engl J Med. 2020;382:1858–9.
doi: 10.1056/NEJMc2001801
Usmani B, Iftikhar M, Latif A, Shah SMA. Epidemiology of primary ophthalmic procedures performed in the United States. Can J Ophthalmol. 2019;54:727–34.
doi: 10.1016/j.jcjo.2019.03.006
Wong R, Banerjee P, Kumaran N. Aerosol generating procedures in intraocular surgery. Eye. 2020. https://doi.org/10.1038/s41433-020-0997-7 .
Koshy ZR, Dickie D. Aerosol generation from high speed ophthalmic instrumentation and the risk of contamination from SARS COVID19. Eye. 2020. https://doi.org/10.1038/s41433-020-1000-3 .
Xia J, Tong J, Liu M, Shen Y, Guo D. Evaluation of coronavirus in tears and conjunctival secretions of patients with SARS‐CoV‐2 infection. J Med Virol. 2020;92:589–94.
doi: 10.1002/jmv.25725
Wu P, Duan F, Luo C, Liu Q, Qu X, Liang L, et al. Characteristics of ocular findings of patients with coronavirus disease 2019 (COVID-19) in Hubei Province, China. JAMA Ophthalmol. 2020. https://doi.org/10.1001/jamaophthalmol.2020.1291 .
Canelli R, Connor CW, Gonzalez M, Nozari A, Ortega R. Barrier enclosure during endotracheal intubation. N. Engl J Med. 2020;382:1957–8.
doi: 10.1056/NEJMc2007589
Workman AD, Welling DB, Carter BS, Curry WT, Holbrook EH, Gray ST, et al. Endonasal instrumentation and aerosolization risk in the era of COVID-19: simulation, literature review, and proposed mitigation strategies. Int Forum Allergy Rhinol. 2020. https://doi.org/10.1002/alr.22577 .
Vasquez Perez A, Liu C. Human ex vivo artificial anterior chamber model for practice DMEK surgery. Cornea. 2017;36:394–7.
Berdahl JP, DeStafeno JJ, Kim T. Corneal wound architecture and integrity after phacoemulsification evaluation of coaxial, microincision coaxial, and microincision bimanual techniques. J Cataract Refract Surg. 2007;33:510–5.
doi: 10.1016/j.jcrs.2006.11.012
Arba-Mosquera S, Klinner T. Improving the ablation efficiency of excimer laser systems with higher repetition rates through enhanced debris removal and optimized spot pattern. J Cataract Refract Surg. 2014;40:477–84.
Liesegang TJ, Bourne WM, Ilstrup DM. The use of hydroxypropyl methylcellulose in extracapsular cataract extraction with intraocular lens implantation. Am J Ophthalmol. 1986;102:723–6.
doi: 10.1016/0002-9394(86)90399-5
Wu Y-C, Chen C-S, Chan Y-J. The outbreak of COVID-19: an overview. J Chin Med Assoc. 2020;83:217–20.
doi: 10.1097/JCMA.0000000000000270
Kariwa H, Fujii N, Takashima I. Inactivation of SARS coronavirus by means of povidone-iodine, physical conditions and chemical reagents. Dermatology 2006;212:119–23.
doi: 10.1159/000089211
Eggers M, Koburger-Janssen T, Eickmann M, Zorn J. In vitro bactericidal and virucidal efficacy of povidone-iodine gargle/mouthwash against respiratory and oral tract pathogens. Infect Dis Ther. 2018;7:249–59.
doi: 10.1007/s40121-018-0200-7
Labiris G, Gkika M, Katsanos A, Fanariotis M, Alvanos E, Kozobolis V. Anterior chamber volume measurements with Visante optical coherence tomography and Pentacam: repeatability and level of agreement. Clin Exp Ophthalmol. 2009;37:772–4.
doi: 10.1111/j.1442-9071.2009.02132.x