Eyeworld

SEPTEMBER 2021 | EYEWORLD | 17 Discussion Previous studies have suggested cataract sur- gery could be a potentially aerosol-generating procedure, yet the evidence is not definitive. A study on human cadavers demonstrated visible aerosol generation during phacoemulsification, however, a study on pig eye phacoemulsification did not show generation of aerosols. 1,2 The find- ings of this study showed aerosol of less than 10 μm is not produced during phacoemulsifica- tion of the human lens under routine operating conditions. This supports the recommendations of the American Academy of Ophthalmology, which state the risk for aerosol generation during phacoemulsification should be very low. 3 Furthermore, the results suggest that the use of OcuCoat does not significantly decrease the particle count and the LAF machine can be ef- fective in decreasing overall particle count. The authors argued the risk of spreading live coro- navirus from aerosolization in cataract surgery is low, and increased wait time between cases to decrease aerosol transmission is futile. In the preliminary study, there was no significant increase in particles before or during phacoemulsification in all five eyes of the three patients. When comparing patient 1 (no vari- ables) to patient 2 (LAF on), there was a signifi- cant decrease in particles in both the pre-phaco and during phaco categories. This indicates a reduction in particle quantity when using the LAF machine. When comparing patient 2 (LAF on) to patient 3 (LAF on and OcuCoat), there was only a borderline difference between the second eye of each patient, which the authors concluded was more likely a cumulative effect of the LAF machine rather than the actual effect of OcuCoat. There was no difference in particle count between the first eye of patient 2 and patient 3, implying the use of OcuCoat does not significantly decrease aerosolization. In the follow-on study of 20 eyes with use of the LAF machine and standard viscoelas- tic, there was significant reduction of particle size during phacoemulsification compared to pre-phacoemulsification. This implies that at least with the LAF machine turned on, there is no increase in particle count during phaco. continued on page 18 ensure he had access to the chamber, and the case generally went well. His main concern was to get the implant centered. The real issue came several days later when Dr. Ayres received a follow-up text from his pa- tient saying: "I was doing great over the week- end but this morning my vision has changed." The text was accompanied by what looked like a slit lamp picture from a smartphone with the IOL sideways. Dr. Ayres immediately found a time on his next OR day for the patient to come back, but he admitted that he was puzzled by this outcome and to this day doesn't know what happened. He noted that if the patient was not an eyecare professional, he wouldn't have kept the multifocal IOL in. When the patient came back for a follow-up procedure, the lens looked twisted, and the haptic was completely upside down. Dr. Ayres ended up explanting the lens and replacing it with another multifocal IOL that the patient had brought with him. Despite a successful surgery, Dr. Ayres wasn't 100% happy with the outcome because of the multifocal platform that was used, but he said the patient was happy postop and was 20/30 uncorrected on postop day 1. To watch/listen to the full episodes, go to ascrs.org/clinical-education/podcasts-qc. continued from page 14

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