Quantification of aerosol generation during phacoemulsification cataract surgery using light-scattering laser photometry

Author Block: Gelareh Sahar Noureddin, Alfonso Iovieno, Maryam Eslami, Travers Weaver, Howard Meadows, Sonia N. Yeung.

Disclosure Block: G.S. Noureddin: Any direct financial payments including receipt of honoraria; Name of for-profit or not-for-profit organization(s); Allergan. Any direct financial payments including receipt of honoraria; Description of relationship(s); Speaker's honorarium 2019. A. Iovieno: None. M. Eslami: None. T. Weaver: None. H. Meadows: None. S.N. Yeung: None.

Purpose: To determine whether phacoemulsification cataract surgery is an aerosol-generating medical procedure (AGMP) and therefore, to help determine the personal protective equipment required by healthcare providers in the era of the COVID-19 pandemic, as COVID-19 can be transmitted via aerosolization during AGMPs.
Study Design: In this laboratory-based simulation, phacoemulsification cataract surgery was performed on porcine eyes. At a fixed distance, a DustTrak^TM DRX Aerosol Monitor Model 8534 (DustTrak) was positioned to quantify particle generation during surgery. Experiments were run in triplicate for two wound sizes, 2.4 and 2.75mm. Positive controls were established by measuring particle generation from an aerosolizing spray-bottle. Negative controls were established while the phacoemulsification machine was not in use.
Methods: The DustTrak was used to measure particulate matter (PM) mass fractions for each of three particle sizes, PM1, PM2.5, and PM4 (in microns), every 2 seconds during surgery and for one minute after. The main outcome measure was an increase in the mass fraction of aerosolized particles of various sizes.
Results: There was no significant aerosolization of particles during cataract surgery for both the 2.4 and 2.75mm wound sizes.
Conclusions: Phacoemulsification cataract surgery was not found to be an AGMP. In the midst of the COVID-19 pandemic, ophthalmologists can continue to use droplet precautions while performing this surgery.