EyeWorld is the official news magazine of the American Society of Cataract & Refractive Surgery.
Issue link: https://digital.eyeworld.org/i/1291013
I MY WORST COMPLICATION N FOCUS 48 | EYEWORLD | OCTOBER 2020 by Liz Hillman Editorial Co-Director Managing cases of corneal wound burn 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. About the doctors Lisa Nijm, MD, JD Founder and Medical Director Warrenville EyeCare & LASIK Warrenville, Illinois Audrey Talley Rostov, MD Partner Northwest Eye Surgeons Seattle, Washington T hanks to improvements in phaco technology and ophthalmic viscoelas- tic devices (OVD), wound burn in cataract surgery is a rare complication. But when it does happen, it can com- promise 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, Kevin Miller, MD, shared this image of a mild phaco burn from one of his cases. Note the fish-mouthed external incision. The cornea is scarred. The 10-0 nylon suture has been removed. This is a mild, older wound burn that was referred to Dr. Miller. Notice the corneal scar. It will persist indefinitely, he said. This is a fresh wound burn produced by someone else that Dr. Miller sent to EyeWorld. It took three sutures to close the incision. This is a severe wound burn produced by a former fellow of Dr. Miller. It took five sutures to close this <3 mm incision. Source (all): Kevin Miller, MD there is a greater likelihood with more dense nuclei and when there isn't as much fluid move- ment 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+ nu- clear 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