Microdroplet and spatter contamination during phacoemulsification cataract surgery in the era ofCOVID-19
AuthorMcGhee, CNJ; Dean, S; Freundlich, SEN; Gokul, A; Ziaei, M; Patel, D; Niederer, RL; Danesh-Meyer, H
Source TitleClinical and Experimental Ophthalmology
University of Melbourne Author/sDanesh-Meyer, Helen
Document TypeJournal Article
CitationsMcGhee, C. N. J., Dean, S., Freundlich, S. E. N., Gokul, A., Ziaei, M., Patel, D., Niederer, R. L. & Danesh-Meyer, H. (2020). Microdroplet and spatter contamination during phacoemulsification cataract surgery in the era ofCOVID-19. CLINICAL AND EXPERIMENTAL OPHTHALMOLOGY, 48 (9), pp.1168-1174. https://doi.org/10.1111/ceo.13861.
Access StatusAccess this item via the Open Access location
Open Access URLPublished version
IMPORTANCE: Determine phacoemulsification cataract surgery risk in a Covid-19 era. BACKGROUND: SARS-CoV-2 (Covid-19) transmission via microdroplet and aerosol-generating procedures presents risk to medical professionals. As the most common elective surgical procedure performed globally; determining contamination risk from phacoemulsification cataract surgery may guide personal protection equipment use. DESIGN: Pilot study involving phacoemulsification cataract surgery on enucleated porcine eyes by experienced ophthalmologists in an ophthalmic operating theatre. PARTICIPANTS: Two ophthalmic surgical teams. METHODS: Standardized phacoemulsification of porcine eyes by two ophthalmologists accompanied by an assistant. Fluorescein incorporated into phacoemulsification irrigation fluid identifying microdroplets and spatter. Contamination documented using a single-lens reflex camera with a 532 nm narrow bandpass (fluorescein) filter, in-conjunction with a wide-field blue light and flat horizontal laser beam (wavelength 532 nm). Quantitative image analysis using Image-J software. MAIN OUTCOME MEASURES: Microdroplet and spatter contamination from cataract phacoemulsification. RESULTS: With phacoemulsification instruments fully within the eye, spatter contamination was limited to <10 cm. Insertion and removal of the phacoemulsification needle and bimanual irrigation/aspiration, with irrigation active generated spatter on the surgeons' gloves and gown extending to >16 cm below the neckline in surgeon 1 and > 5.5 cm below the neckline of surgeon 2. A small tear in the phacoemulsification irrigation sleeve, presented a worse-case scenario the greatest spatter. No contamination above the surgeons' neckline nor contamination of assistant occurred. CONCLUSIONS AND RELEVANCE: Cataract phacoemulsification generates microdroplets and spatter. Until further studies on SARS-CoV-2 transmission via microdroplets or aerosolisation of ocular fluid are reported, this pilot study only supports standard personal protective equipment.
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