Commentary on: Practice pattern of cataract surgeons when operating on seropositive patients.

Occupational blood exposure leading to the spread of blood-borne viral infections (BBVIs) is emerging as a matter of concern among health care workers (HCWs) in the recent years. Human immunodeficiency virus (HIV), hepatitis B virus (HBV), and hepatitis C virus (HCV) form the majority of BBVIs reported among HCWs. According to WHO, HBV is more efficiently transmitted than HIV. This is because patients affected with HBV have a higher viral load in their blood, as opposed to HIV-positive individuals who have a lower viral load.[1] The risk of transmission is higher in HBV (30%) as compared to HIV (0.3%).[2] When it comes to the risk of seroconversion, the risk is higher for HBV (3.5%) and HCV (1.7%) as compared to HIV (0.3%).[34]

Among medical professionals, ophthalmologists are at highest risk of sharp injuries.[5] Blood splash and needlestick injuries (NSI) are the common causes of transmission of BBVIs among ophthalmologists and paramedical personnel.[6]

Centers for Disease Control and Prevention have given Universal precautions to minimize the risk of exposure to infected blood and transmission of BBVIs. It mainly emphasizes on prevention of contact with infected blood by using barrier methods, such as impervious gowns, gloves, goggles, and masks. Although preoperative screening reduces the risk of BBVIs, routine screening before cataract surgery does not include screening for HIV, HBV, and HCV. This increases the risk of BBVIs from undiagnosed seropositive patients among HCWs.

Since phacoemulsification is a small incision surgery, and most of the times the incision is made clear corneal, the risk of bleeding in these patients is negligible. Nevertheless, there is a likelihood of bleeding from limbal vessels and; in case of scleral incisions, episcleral, and scleral vessels are likely to bleed minimally. The major risk of transmission of BBVIs is through NSI where the barrier to blood contact is lost.

The prevalence of HBV, HCV, and HIV in adults in India is 2.4–15.9%, 1.2%, and 0.36%, respectively. The debate about the relative merits and demerits of universal screening versus universal precautions remains unresolved. In our practice, we screen all the patients for HBV, HCV, and HIV preoperatively. The decision to perform the surgery under topical anesthesia or peribulbar block is taken depending on the type of cataract. We prefer using a disposable kit and a seropositive case is usually posted as the last case of the day. Use of double gloves, impervious gowns, and masks is recommended to reduce the risk of BBVIs. We never refuse a seropositive patient for surgery. However, we owe it to ourselves, our HCWs and our patients, to ensure that optimal precautions are taken while handling seropositive patients.