VOL: 47 ISSUE: 6 JUNE: 2021
AEROSOLIZATION DURING PHACOEMULSIFICATION
With COVID-19 a continuing risk, understanding whether ophthalmic procedures generate aerosols that may promote infection is essential. According to a study of 25 eyes in 23 patients, phacoemulsification does not. The study used an optical particle counter to measure aerosol particles ranging from less than 0.3 μm to 10.0 μm in the air surrounding a cataract surgical field. No significant differences were found in aerosol particles present before surgery, during the pre-phacoemulsification phase of cataract surgery, or during phacoemulsification. Use of a mobile laminar air flow (LAF) machine significantly reduced all sizes of aerosol particles, while the use of a 2% solution of hydroxypropyl methylcellulose during phacoemulsification had no effect. Aerosol particles of less than 10 μm are not produced during phacoemulsification in a live patient setting, the authors concluded. Kaur S et al., “Aerosol generation during phacoemulsification in live patient cataract surgery environment”, Vol 47, Issue 6, 695–701.
PRIORITISING PHACO CASES AFTER COVID-19 EMERGENCY
Faced with a backlog of more than 700 patients, a protocol that prioritised cataract surgery patients allowed surgeons to operate on all priority cases within three months. The protocol was implemented at a large tertiary referral centre and gave highest priority to white and brunescent cataracts, binocular patients with visual acuity of 20/200 or less, and monocular patients with VA of 20/63 or less. Medium priority was given to patients with anisometropia, glaucoma, and low to moderate risk for angle closure. Time waiting for surgery was considered a separate and over-riding factor. Median waiting time for all patients was 3.51 ± 1.57 months, with 191 patients waiting 4.5 months or more. The protocol proved effective, providing a timely surgical opportunity for priority cases, the authors said. Vieira R et al., “Return of phacoemulsification after emergency status related to COVID-19: experience of a tertiary referral centre”, Vol 47, Issue 6, 691–694.
LOOKING BACK ON THE LANDMARK FLOMAX STUDY
“A single study that leads to a profound change in practice and to a better and safer operation is a rare event,” writes David J Spalton FRCS in June’s guest editorial. The landmark 2005 study by Chang and Campbell describing intraoperative floppy-iris syndrome (IFIS) and its principal cause – use of the α-blocker tamsulosin (Flomax) – is one, he argues. Tamsulosin use even years before cataract surgery can result in iris billowing, prolapse, and progressive constriction, leading to serious complications during cataract surgery. Pharmaceutical management with phenylephrine or Mydrane can help, as can a soft-shell surgical technique and careful chamber management. “We must congratulate Chang and Campbell on their ability to think outside the box (and the eye!),” he concluded. Spalton DS, “Taking the flow out of Flomax”, Vol 47, Issue 6, 689–90.