Simple additions to standard personal protective equipment can further enhance safety during ophthalmology examinations and cataract surgery.
“I was an early adopter of PPE and other safety measures against COVID-19 but soon felt the need for a further degree of protection, particularly during phaco, which is an aerosol-generating procedure,” Lucio Buratto, MD, said in an interview with Ocular Surgery News.
On Jan. 31, 2020, the WHO director-general declared the COVID-19 outbreak to be a public health emergency of international concern. Three weeks later, when Buratto was flying home to Italy from an ophthalmology meeting in Florida, the questions being asked of passengers about symptoms of this new disease raised a red flag.
“As soon as I went back to my office, I ordered face masks, sanitizers and gloves and immediately started putting new safety protocols in place. When the coronavirus ‘bomb’ exploded, we were already well organized for spaced-out appointments, social distancing and temperature control, and our patients were well informed on the use of face masks and hand hygiene. We also offered our employees free parking places to encourage the use of personal cars rather than public transport,” he said.
The breath shields offered at the time by various companies were mounted on slit lamps, surgical microscopes and other instruments, but Buratto said he was not fully satisfied. He contacted companies to ask if they could produce something larger and more protective, and eventually a new shield for the operating microscope was designed and produced by E. Janach.
“It is a hemicylinder that surrounds your head and is securely fixated to the oculars of the operating microscope,” Buratto said.
However, he was still concerned about the transmission of virus particles through infected aerosol and droplets during phacoemulsification.
“The vibration of the ultrasonic handpiece creates high quantities of aerosolized droplets and shoots them in all directions. We therefore created transparent, single-use drapes that are fixated with adhesive tape to the shield and microscope, creating a thin, large barrier from droplets (Figure 1),” Buratto said. “In addition, to reduce aerosol generation, I cover with methylcellulose the portion of the phaco tip that remains outside the eye, and this acts as a barrier to either aerosol formation or dispersion.”
Furthermore, Buratto recommends use of protective caps on the fixed binoculars as a “simple remedy” for preventing transmission of minor pathologies.
The hemicylindrical shields used for the operating microscope can also be used when examining patients at the slit lamp. Due to the close face-to-face proximity, slit lamp examination can be high risk for virus transmission for both patients and eye care professionals, hence the need for an effective barrier.
To further enhance safety during slit lamp examination, Buratto designed with E. Janach plastic removable eye guards to mount on the eyepiece rings.
“A slit lamp is often utilized by more than one physician, and the eyepiece needs to be thoroughly disinfected every time by every new user. I had eye guards made in different colors, one color for each one of us to avoid confusion, and we can mount them and take them off every time we use an instrument,” he said.
This specially made protective equipment, in addition to the adoption of strict safety protocols and regular COVID-19 testing for all members of staff and all patients scheduled for surgery, have secured Buratto’s clinic a “COVID-free clinic” certificate and designation as a Global Safe Site against COVID-19.
“This is rewarding, but even more rewarding is the fact that none of our employees, when given the choice, have opted for working from home. Everybody feels safe here, patients and workers,” Buratto said.
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