Eyeworld

18 | EYEWORLD | SEPTEMBER 2021 ASCRS NEWS References 1. Darcy K, et al. Reducing visible aerosol generation during phacoemulsification in the era of Covid-19. Eye. 2021;35:1405–1410. 2. Lee H, et al. Aerosol gener- ation through phacoemulsifi- cation. J Cataract Refract Surg. 2020;46:1290–1296. 3. Chodosh J, et al. Special considerations for ophthalmic surgery during the COVID-19 Pandemic. 2020. American Academy of Ophthalmology. Contact Andrews: hans.w.andrews@vumc.org Lindsey: jennifer.lindsey@vumc.org air flow machine referred to in the article. None of the members of the panel have implemented this air flow system in their operating rooms. However, they all agreed a safe and effective air flow system in the operating room is imperative to prevent bacterial and viral infections, not limited to COVID-19. As ophthalmologists resume the full spec- trum of surgical cases, the COVID-19 pandemic continues to impact practice patterns, surgical decision-making, and overall safety measures. The panelists discussed how many patients remain hesitant to undergo elective surgery and attend clinic appointments. They agreed the results of this study provide reassurance to themselves, their staff members, and their patients that there is no significant aerosoliza- tion during phacoemulsification. We remain hopeful that the emergence of the COVID-19 vaccine will provide a further sense of security for patients. There were several limitations to this study. The sample size was small, especially in the preliminary study, limiting the overall power of the study. Furthermore, it is difficult to deter- mine if these results can be universally applied at all surgical sites across the world, as the surgical techniques, like incision size or type of phacoemulsification machine, are not consistent across operating theaters. During the ASCRS Journal Club discussion, members of the panel weighed in on how their personal practice patterns have changed in the COVID-19 era. The majority of the panelists had all elective cataract cases canceled following the initial rise of COVID-19 infections. Upon reopening, some of the panelists experienced longer turnover rates between surgical cas- es due to stricter decontamination protocols. Despite returning to pre-COVID surgical and clinical volume, all panelists maintained strict social distancing regulations in their waiting rooms and operative care units. The ASCRS Journal Club also discussed the mobile laminar Aerosol generation during phacoemulsification in live patient cataract surgery environment Simerdip Kaur, MRCP, Nick Kopsachilis, MD, Rishid Zia, MRCSEd (Ophthal) J Cataract Refract Surg. 2021;47(6):695–701 n Purpose: To investigate if phacoemulsification is an aerosol generating procedure in a live patient environment. n Setting: New Hayesbank Ophthalmology Services, Kent, U.K. n Design: In vivo experimental human eyes study n Methods: We measured aerosol particle counts sized ≤0.3 µm, >0.3≤0.5 µm, >0.5≤1.0 µm, >1.0≤2.5 µm, >2.5≤5.0 µm, and >5.0≤10 µm during elective phacoemulsification surgery of 25 eyes. The baseline particle count in our operating theater was measured on 2 separate days to assess for fluctuation. Then we measured 5 readings each during pre- phacoemulsification and phacoemulsification of all eyes. We also measured the difference in aerosol generation during pre-phacoemulsification and phacoemulsification with the use of the mobile laminar air flow (LAF) machine. Lastly, we measured aerosol generation during phacoemulsification with the use of HPMC (2% hydroxypropyl methylcellulose). n Results: There was no significant difference in measurement of aerosol between the baseline measurements on both days and between each patient's pre-phacoemulsification and phacoemulsification stages of surgery. The LAF system showed statistically significant reduction in particles size of ≤0.3 µm, >0.3≤0.5 µm, >0.5≤1.0 µm, >1.0≤2.5 µm, >2.5≤5.0 µm, and >5.0≤10 µm during phacoemulsification compared to pre-phacoemulsification (t-test, p value 0.00 for all particle sizes). The use of HPMC (2% hydroxypropyl methylcellulose) did not show any statistically significant reduction in particle measurements. n Conclusion: Aerosol particles sized <10 µm are not produced during phacoemulsification of human crystalline lens in a live patient setting. The use of a mobile laminar air flow (LAF) machine significantly reduced the number of particles sized ≤10 µm within the surgical field. continued from page 17

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