We were interested to read the article Purifying air over the operating field with a new mobile laminar airflow device to reduce the possibility of airborne contamination by Osher et al.1 This study concluded that the use of a portable laminar air flow device significantly reduced the occurrence of free-floating lint over the ocular surface and airborne particulate matter (measured by a particle counter) by 80% to 90%. These represent significant observations because, as mentioned by Osher et al., airborne particulate matter is a neglected source of serious postoperative infection.
This may be especially true if the current trend toward office-based surgery is continued. Office-based surgery represents a relatively new phenomenon in the United States. Presently, office-based operating conditions are not regulated with the same level of stringency as either a hospital or ambulatory surgery-based environment; they are commonly conducted within existing clinic minor procedure rooms, without any special provisions for clean air, special doors, overhead ventilation systems, and so on.
As a result, office-based surgery environments may be both especially vulnerable to airborne pathogens and especially well-suited for a safe, cost-effective, U.S. Food and Drug Administration–approved solution.
Years ago, we published on the use of a laminar downflow hood for the performance of office-based surgery corneal transplant operations over a 10-year period in the Netherlands, in which no instances of postoperative infection were encountered.
In the U.S., we have been performing office-based cataract and corneal transplantation surgery using this laminar downflow hood for more than a year now (Figure 1), again with no postoperative infections.2
This laminar downflow hood is not portable, unlike the laminar air flow device described by Osher et al., but it does subtend a larger surface area, covering both the operative site and the adjacent space, where instruments are rested. As a result, it may provide comparable control over airborne lint and particulate matter and may (speculatively) also reduce the amount of lint carried into the operating environment by instruments.
Overall, we are grateful to Osher et al. for publishing this important article, which may change the way that intraocular surgery, particularly in office-based settings, is routinely performed.
1. Osher RH, Figueiredo GB, Schneider JG, Kratholm J. Purifying air over the operating field with a new mobile laminar airflow device to reduce the possibility of airborne contamination. J Cataract Refract Surg 2021;47:1327–1332
2. Parker J, Krijgsman M, van Dijk K, Melles GR. Patient experience with office-based corneal transplantation. Cornea 2017;36:445–447