EyeWorld India December 2020 Issue

SECONDARY FEATURE 22 EWAP DECEMBER 2020 A mild phaco burn. Note the fish-mouthed external incision. The cornea is scarred. The 10-0 nylon suture has been removed. A fresh wound burn. It took three sutures to close the incision. A mild, older wound burn. Notice the corneal scar. It will persist indefinitely, he said. A severe wound burn. It took five sutures to close this <3 mm incision. Source (all): Kevin Miller, MD Managing cases of corneal wound burn by Liz Hillman Editorial Co-Director Contact information Nijm: lmnijm@uic.edu Talley Rostov: atalleyrostov@nweyes.com Garg: gargs@uci.edu T hanks to improvements in phaco technology and ophthalmic viscoelastic devices (OVD), wound burn in cataract surgery is a rare complication. But when it does happen, it can compromise a patient’s quality of vision, often inducing astigmatism. Lisa Nijm, MD, JD, and Audrey Talley Rostov, MD, shared their experience with wound burn. ‘It was a good early lesson’ “I had read about wound burn and knew of its potential, but with newer technology and with viscoelastic, it’s pretty uncommon. However, there is a greater likelihood with more dense nuclei and when there isn’t as much fluid movement in the chamber,” Dr. Nijm said. The case Dr. Nijm handled several years ago had both risk factors present. Her patient was an 86-year-old female who had a 4+ nuclear sclerotic cataract with 3+ cortical changes and a 3+ posterior subcapsular cataract. Her vision was count fingers before surgery. “While I was removing the nucleus with phaco, there was a point that I think a portion of very dense cataract became occluded in the tubing, and I noticed there was whitening at the wound. I knew this was problematic and I immediately stopped,” Dr. Nijm said. “I also had been using additional viscoelastic to try and protect the corneal endothelium from the increased ultrasound power, but in doing so, I may have inadvertently reduced fluid movement as well.” Dr. Nijm said there is a careful AT A GLANCE • Corneal wound burn during phacoemulsification can happen quickly. • It’s often associated with denser cataracts and occurs due to friction, not enough fluid movement, and phaco tip occlusion. • Phaco wound burns can induce astigmatism. This article originally appeared in the October 2020 issue of EyeWorld . It has been slightly modified and appears here with permission from the ASCRS Ophthalmic Services Corp.