Aerosol generation through phacoemulsification.

Lee, Hanbin; Naveed, Hasan; Ashena, Zahra; Nanavaty, Mayank A

PURPOSE To evaluate whether phacoemulsification is an aerosol-generating procedure (AGP) in an ex vivo experimental model. SETTING Sussex Eye Hospital, Brighton, United Kingdom. DESIGN Experimental study. METHODS In this ex vivo study on 15 porcine eyes, an optical particle counter was used to measure particles ≤10 µm using cumulative mode in the 6 built-in channels: 0.3 µm, 0.5 µm, 1 µm, 2.5 µm, 5 µm, and 10 μm aerosols during phacoemulsification. The two parts of the study were to: (1) assess the efficacy of the particle counter in the theater environment where there are dynamic changes in temperature and humidity; and (2) to measure aerosol generation with 3 phacoemulsification settings: (a) continuous power with 80% longitudinal (5 eyes); (b) continuous power with 100% torsional (5 eyes); and (c) continuous power with 80% longitudinal with application of hydroxypropyl methylcellulose (HPMC) on the ocular surface (5 eyes). Five measurements were taken pre-phacoemulsification and 5 during phacoemulsification per eye with a total of 75 measurements. RESULTS Maximum aerosols were captured effectively when the counter faced the aerosol source. There was no significant difference in aerosol generation of all sizes during each phacoemulsification setting with torsional, longitudinal and longitudinal with HPMC (p>001). Combining data of all 3 phacoemulsification settings (150 measurements from 15 eyes), there was no significant difference comparing pre-phacoemulsification and during phacoemulsification for aerosols ≤5µm (1455 vs 1363.85, p=0.60), >5-10μm (1.5 vs 1.03, p=0.43) and ≤10µm (1209 vs 1131.55, p=0.60). CONCLUSION Phacoemulsification did not generate aerosols ≤10 μm with continuous power using 80% longitudinal, 100% torsional or 80% longitudinal setting with HPMC on the surface.