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Half a millilitre of fluorescein was incorporated into 400ml of balanced salt solution to identify microdroplet and splatter from phacoemulsification to simulate possible COVID-19 contamination. Five porcine eyes were mounted to an ophthalmic mannequin head and two surgeons (height 189cm, male and height 157cm, female) performed three separate cataract extraction operations along with an assistant. In experiment one, instruments were inserted with irrigation on from a superior approach, experiment two was temporal with instruments inserted with irrigation off and experiment three was temporal with irrigation on. Phacoemulsification machine settings were standardised. Photographs and videos of the experiments were taken to identify fluorescein splatter and microdroplets. Experiment one unfortunately was not captured with sufficient resolution to capture aerosolisation during phacoemulsification. Droplet formation was minimal with instruments in the eye (<10cm). Splatter and microdroplet contamination occurred in all experiments limited mainly to surgical gown and drapes with no evidence of splatter on neck, face, mask, glasses or surgical cap. The taller surgeon splatter was >16cm below gown neckline and >5.5cm below the shorter surgeon. There was no fluorescein contamination on the assistant of the instrument table, but some was found on sub-adjacent floor, drape and underside of microscope. The authors conclude standard PPE is likely sufficient currently. Activating irrigation only when in the eye may reduce possible contamination. Removal of drapes and cleaning of floors may carry slightly higher risk. More investigation is needed regarding the spread of SARS-CoV-2 from ocular fluid. Limitations of this study include small sample size, issues with resolution of camera and one ripped phacoemulsification sleeve.

Microdroplet and spatter contamination during phacoemulsification cataract surgery in the era of COVID-19.
McGhee C, Dean S, Freundlick S, et al.
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Ivan Yip

Alder Hey Children's Hospital, Liverpool, UK.

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