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Aerosolization and Fluid Spillage During Phacoemulsification in Human Subjects

Authors Wong JKW, Kwok JSWJ, Chan JCH, Shih KC, Qin, Lau D, Lai JSM

Received 3 December 2020

Accepted for publication 14 January 2021

Published 27 January 2021 Volume 2021:15 Pages 307—313


Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 4

Editor who approved publication: Dr Scott Fraser

Jasper Ka Wai Wong,1 Jeremy Sze Wai John Kwok,1 Jonathan Cheuk Hung Chan,1 Kendrick Co Shih,1 ‪Renyuan Qin,2 Denvid Lau,2 Jimmy Shiu Ming Lai1

1Department of Ophthalmology, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong; 2Department of Architecture and Civil Engineering, College of Engineering, City University of Hong Kong, Hong Kong

Correspondence: Jimmy Shiu Ming Lai
Department of Ophthalmology, Li Ka Shing Faculty of Medicine, University of Hong Kong, Room 301, Block B, Cyberport 4, 100 Cyberport Road, Hong Kong
Tel +852 39621405

Background: Concerns had been raised for the potential hazard of SARS-CoV-2 transmissions via aerosols and fluid droplets during cataract surgeries amid the COVID-19 pandemic. This study aims to evaluate the rate of visible aerosol generation and fluid spillage from surgical wounds during phacoemulsification in human subjects.
Methods: This is a prospective consecutive interventional case series. High-resolution video captures of 30 consecutive uncomplicated phacoemulsification surgeries, performed by 3 board-certified specialists in ophthalmology, were assessed by 2 independent and masked investigators for intraoperative aerosolization and fluid spillage. Water-contact indicator tape was mounted on the base of the operating microscope, around the objective lens, to detect any fluid contact.
Results: No visible intraoperative aerosolization was detected in any of the cases, irrespective of different surgical practices among the surgeons with regard to wound size and position, lens fragmentation technique, power settings and means of ocular lubrication, or the different densities of cataract encountered. Large droplets spillage was noted from the paracentesis wounds in 70% of the cases. For all cases where fluid spill was detected on video, there was no fluid contact detected on the water-contact indicator tape.
Conclusion: Visible aerosolization was not detected during phacoemulsification in our case series. Although the rate of fluid spillage was high, the lack of detectable contact with the indicator tape suggested that these large droplets posed no significant infectious risks to members of the surgical team.

Keywords: phacoemulsification, aerosols, aerosolization, droplets, COVID

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