Assessing visible aerosol generation during vitrectomy in the era of Covid-19

ObjectiveTo assess visible aerosol generation during simulated vitrectomy surgery. Methods: A model comprising a human cadaveric corneoscleral rim mounted on an artificial anterior chamber was used. Three-port 25 gauge vitrectomy simulated surgery was performed with any visible aerosol production recorded using high speed 4K camera. The following were assessed: (1) vitrector at maximum cut rate in static and dynamic conditions inside the model, (2) vitrector at air-fluid interface in physical model, (3) passive fluid-air exchange with a backflush hand piece, (4) valved cannulas under air, and (5) defective valved cannula under air.ResultsNo visible aerosol or droplets were identified when the vitrector was used within the model. In the physical model, no visible aerosol or droplets were seen when the vitrector was engaged at the air-fluid interface. Droplets were produced from the opening of backflush hand piece during passive fluid-air exchange. No visible aerosol was produced from the intact valved cannulas under air pressure, but droplets were seen at the beginning of fluid-air exchange when the valved cannula was defective.ConclusionsWe found no evidence of visible aerosol generation during simulated vitrectomy surgery with competent valved cannulas. In the physical model, no visible aerosol was generated by the high-speed vitrector despite cutting at the air-fluid interface.

Application of a Novel Film Sealant Technology for Penetrating Corneal Wounds: An Ex-Vivo Study

Aim: To compare the burst pressures of corneal wounds closed with a laser-activated, chitosan-based thin film adhesive against self-seal, sutures and cyanoacrylate. Methods: 2, 4 or 6 mm penetrating corneal wounds were created on 100 freshly enucleated bovine eyes. The wounds were closed using a laser-activated chitosan adhesive (n = 30), self-sealed (control) (n = 30), sutures (n = 20) or cyanoacrylate glue (Histoacryl®) (n = 20). The corneoscleral rim was dissected and mounted onto a custom burst pressure testing chamber. Water was pumped into the chamber at 9ml/hr. The fluid pressure prior to wound leakage was recorded as the ‘burst pressure’. Results: The burst pressure for the 2, 4 and 6 mm wounds were 239.2 mmHg (SD = ±102.4), 181.7 mmHg (SD = ±72.8) and 77.4 mmHg (SD = ±37.4) (p < 0.00001), respectively, for chitosan adhesive. Burst pressure was 36.4 mmHg (SD = ±14.7), 4.8 mmHg (SD = ±4.9) and 2.7 mmHg (SD = ±1.3) (p < 0.00001), respectively, for the self-sealed group. For 4 and 6mm wounds, burst pressures with sutures were 33.0 mmHg (SD = ±19) and 23.5 mmHg (SD = ±17.4) (p = 0.0087), respectively. For cyanoacrylate, burst pressures for 2 and 4 mm wounds were 698 mmHg (SD = ±240.3) and 494.3 mmHg (SD = ±324.6) (p = 0.020087), respectively. Conclusion: This laser-activated chitosan-based adhesive sealed bovine corneal wounds up to 6 mm in length. Burst pressure was higher for the adhesive than sutured or self-sealed wounds, but lower than for cyanoacrylate.

Nanoindentation Derived Mechanical Properties of the Corneoscleral Rim of the Human Eye

The corneoscleral rim of the eye represents a region with unique anatomical properties due to its location between the cornea and sclera / conjunctiva. It further has unique functional properties due to the location of adult corneal epithelial stem cells in the rim structure (limbus) itself. These stem cells are essential for the regeneration of the corneal epithelium and for preventing the conjunctival epithelium from growing onto the corneal surface, which could result in blindness. Survival and self-renewal properties of stem cells are known to depend on specific biological and biomechanical properties of its niche environment. We therefore aimed to measure the local mechanical properties of the human corneoscleral rim using a novel nanoindentation device (Bioindenter CSM Instruments, Neuchâtel, Switzerland) developed for soft tissues evaluation. Nanoindentation was performed using a spherical indenter of 0,5mm radius, a maximal load ranging between 20 μN to 30 μN and a penetration depth of several μm to 60μm. The hold period at maximum load was 180 seconds. Youngs modulus (E) was calculated using a Hertzian fit to the loading data. E of the central cornea was in the range of 19 kPa, while in the scleral region we found 17 kPa and the limbal rim region 10 kPa. Considerable creep relaxation occurred during the hold period at maximum load, which scaled with the elastic modulus of the different structures. These results reveal biomechanical properties of the corneoscleral rim with distinct mechanical properties for the three anatomical regions.