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The authors used a model consisting of a human cadaveric corneoscleral rim mounted on an artificial anterior chamber along with a high-speed 4K camera to investigate ways to reduce visible aerosol generation during clear corneal phacoemulsification surgery.
Visible aerosol generation was noted during phacoemulsification with a 2.75-mm tip but not with a 2.2-mm tip. The authors also found that visible aerosol production was eliminated when the cornea was coated with hydroxypropyl methylcellulose during active phacoemulsification, with this effect lasting an average of 67 ± 8 seconds in the static model.
– Raza M. Shah, MD
This abstract is available on the publisher's site.
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.