Aerosol generation during phacoemulsification in live patient cataract surgery environment.

PURPOSE: To investigate whether phacoemulsification is an aerosol-generating procedure in a live patient environment. SETTING: New Hayesbank Ophthalmology Services, Kent, United Kingdom. DESIGN: In vivo experimental human eyes study. METHODS: Aerosol particle counts sized 0.3 µm or lesser, more than 0.3 to 0.5 µm or lesser, more than 0.5 to 1 µm or lesser, more than 1 to 2.5 µm or lesser, more than 2.5 to 5 µm or lesser, and more than 5 to 10 µm or lesser were measured during elective phacoemulsification surgery of 25 eyes. The baseline particle count in the operating theater was measured on 2 separate days to assess for fluctuation. Then, 5 readings each during prephacoemulsification and phacoemulsification of all eyes were measured. The difference in aerosol generation during prephacoemulsification and phacoemulsification was also measured with the use of the mobile laminar air flow (LAF) machine. Finally, aerosol generation during phacoemulsification was measured using 2% hydroxypropyl methylcellulose (HPMC). RESULTS: There was no statistically significant difference in measurement of aerosol between the baseline measurements on both days and between each patient's prephacoemulsification and phacoemulsification stages of surgery. The LAF system showed statistically significant reduction in particles size of 0.3 µm or lesser, more than 0.3 to 0.5 µm or lesser, more than 0.5 to 1 µm or lesser, more than 1 to 2.5 µm or lesser, more than 2.5 to 5 µm or lesser, and more than 5 to 10 µm during phacoemulsification compared with that during prephacoemulsification (P value .00 for all particle sizes, t test). The use of 2% HPMC did not show any statistically significant reduction in particle measurements. CONCLUSIONS: Aerosol particles sized less than 10 µm are not produced during phacoemulsification of human crystalline lens in a live patient setting. The use of a mobile LAF machine significantly reduced the number of particles sized 10 µm or lesser within the surgical field.

Glueless and Sutureless Multi-Layer Amniotic Membrane Transplantation in a Patient With Pending Corneal Perforation.

Ocular graft-versus-host disease (GVHD) is a severe complication of allogenic hematopoietic stem cell transplantation (HSCT). It is a term used to describe a spectrum of signs and symptoms including ocular surface inflammation, dry eye syndrome, lacrimal and meibomian gland dysfunction. We present a case of a 73-year-old man with chronic myeloblastic leukaemia and chronic GVHD. On examination, severe corneal thinning was detected in his left eye. We performed multi-layer amniotic membrane patching of the affected area, in an ambulatory setting, without using sutures or glue, but only a bandage contact lens to keep amniotic membranes attached. Three months post-amniotic-membrane-patching symptoms improved, corneal integrity was maintained, and corneal thickness increased significantly. Multi-layer amniotic membrane patching without glue and sutures may be sufficient enough to prevent further deterioration of corneal thinning and can be safely performed as an outpatient procedure, reducing the need for tectonic corneal transplantation.

Descemet's membrane endothelial keratoplasty: surgical outcomes and endothelial cell count modelling from a UK centre.

PURPOSE: To report surgical outcomes and endothelial cell density (ECD) trends up to 2 years post-operatively in the first cohort of eyes undergoing Descemet's membrane endothelial keratoplasty (DMEK) for low-to-moderate risk indications at our UK centre. Tight corneal sutures were used to ensure high intraoperative pressure from intracameral air for 10-min and to maintain a good post-operative air fill. Outcomes were compared to a prior series at our unit of similar eyes having Descemet's stripping endothelial keratoplasty (DSEK). METHODS: Retrospective, interventional series. Inclusions: all DMEKs with a minimum of 1-month follow-up. EXCLUSIONS: prior glaucoma surgery, penetrating keratoplasty or anterior chamber lens. RESULTS: 88 DMEKs met inclusion. Median follow-up: 332 days. Main indication: Fuchs dystrophy (90%). COMPLICATIONS: re-bubbling 2%, primary failure 6%, retinal detachment 2%, rejection 3%. At 3 months, BCVA ≥6/6 and ≥6/9 were 67% and 86%, respectively. Graft survival at both 1 and 2 years was 94 ± 2%. Mean(±SD) cell-loss at 1 month, 3 months, 6 months, 12 months and 24 months: 30 ± 15%, 29 ± 16%, 33 ± 17%, 35 ± 17% and 48 ± 16%, respectively. Compared to a prior series at our unit of 210 low-to-moderate risk DSEKs, cell loss was lower for DMEK at all time-points (p < 0.001) through to 12 months but was not statistically different at 24 months. Mixed-modelling of ECD over time demonstrated the convergence of DMEK and DSEK curves by 2 years. CONCLUSIONS: DMEK using tissue from UK eye-banks resulted in high survival and excellent visual acuity. ECD through 1 year was superior to DSEK in a similar cohort. Our low re-bubble rate (2%) may be attributable to use of intracameral air at temporarily elevated intraocular pressure.