EyeWorld India December 2020 Issue

SECONDARY FEATURE 24 EWAP DECEMBER 2020 Since then, Dr. Talley Rostov said she switched to bimanual phaco for better fluidics. “Bimanual phaco allows for separate irrigation and better fluidics,” she said. She also became more careful with her choice of OVD and more aware of the potential for wound burns with prolonged phaco, as well as the potential for occlusion of the phaco handpiece and how to avoid that. EWAP Editors’ note: Dr. Nijm is Founder and Medical Director, Warrenville EyeCare & LASIK, Warrenville, Illinois, and has interests with Carl Zeiss Meditec. Dr. Talley Rostov is Partner, Northwest Eye Surgeons, Seattle, Washington, and declared no competing interests. Corneal wound burn cases with Sumit “Sam” Garg, MD At the 2019 ASCRS Annual Meeting, Sumit “Sam” Garg, MD, Medical Director, Gavin Herbert Eye Institute, Irvine, California, described a couple of cases of wound burn and shared how he handled them. One occurred in a 55-year-old male with brittle diabetes and a dense, hand motion-only cataract. Dr. Garg used a 2.75-mm incision, a Malyugin ring at the start of the case, and Healon EndoCoat (Johnson & Johnson Vision) as his OVD. When the burn occurred, Dr. Garg said he kept operating through the same inci- sion, citing that phaco burns are not likely to happen again in the same place. After the cataract was successfully removed, Dr. Garg asked the panel how to manage the incision/burn site. “I think you need sutures. I’m a big fan in a case like this, or in any case where the wound is gaping, to have a mattress suture because I think it provides closure in two different vectors. I put that in before I get my viscoelastic out so I maintain the chamber,” he said. With cyanoacrylate glue and more sutures Dr. Garg said he was able to get the wound closed. Dr. Garg also described a case at the 2019 ASCRS Annual Meeting that was referred to him that already had wound burn and a persistent wound leak. “In this case I had to repair it,” he said. Dr. Garg showed how he made a partial punch using a 3.0 mm skin punch, allowing him to remove the unhealthy tissue. Dr. Garg then made a patch graft with a healthy corneal graft. “The pearl here is when you place your stitches, you can see the middle stitch I’m trying to make shorter to make sure it does not encroach on the visual axis,” he said. Dr. Garg said this improved the patient’s vision and closed the wound. Editors’ note: Dr. Garg has interests with Johnson & Johnson Vision. Kevin Miller, MD, conducted an experiment to study the thermal effects of phaco. The silicone test chambers capping each phaco probe simulate the cornea. The rubber bands simulate compression by the corneal incision. An infrared thermal camera (not shown) measures the heat produced at the “incisions” after ultrasound is activated. FLIR image showing heat generated by the three probes. The highest temperature in degrees Celsius within each of the three circles is displayed to the right. Any temperature above 50˚C is capable of producing a corneal burn. Source (all): Kevin Miller, MD