Aerosol and droplet creation during oscillatory motion of the microkeratome amidst COVID-19 and other infectious diseases

Khamar, Pooja; Shetty, Rohit; Balakrishnan, Nikhil; Kabi, Prasenjit; Roy, Durbar; Basu, Saptarshi; Sinha Roy, Abhijit

PURPOSE: To quantify the atomization of liquid over the cornea during flap creation using microkeratome using high-speed shadowgraphy. SETTING: Laboratory investigational study. DESIGN: Laboratory study. METHOD: In an experimental setup, flap creation was performed on enucleated goat's eyes (n = 8) mounted on a stand using One Use-Plus SBK Moria microkeratome (Moria SA) to assess the spread of aerosols and droplets using high-speed shadowgraphy. Two conditions were computed. A constant airflow assumed uniform air velocity throughout the room. A decaying jet assumed that local air velocity at the site of measurements was smaller than the exit velocity from the air duct. RESULTS: With the advancement of the microkeratome across the wet corneal surface, the atomization of a balanced salt solution was recorded on shadowgraphy. The minimum droplet size was ∼90 μm. The maximum distance traversed was ∼1.8 m and ∼1.3 m assuming a constant airflow (setting of refractive surgery theater) and decaying jet condition (setting of an operating theater with air-handling unit), respectively. CONCLUSIONS: The microkeratome-assisted LASIK flap creation does seem to cause spread of droplets. The droplet diameters and velocities did not permit the formation of aerosols. Therefore, the risk of transmission of the virus to the surgeon and surgical personnel due to the microkeratome procedure seems to be low.