Eyeworld

I MY WORST COMPLICATION N FOCUS 50 | EYEWORLD | OCTOBER 2020 Contact Nijm: lmnijm@uic.edu Talley Rostov: atalleyrostov@nweyes.com it is important if you see any potential signs to immediately stop, remove the phaco tip, check for an occlusion, ensure fluid is prop- erly moving in the eye, and carefully proceed forward. 'I switched to bimanual phaco for better fluidics' Dr. Talley Rostov had one case of wound burn in her career, more than a decade ago. "Healon 5 [Johnson & Johnson Vision] had recently come out, and I had heard it was useful for maintaining the chamber in complex cases. I had a patient with a dense cataract and IFIS. I didn't realize just how well the Healon 5 main- tained the chamber and did not allow circula- tion of fluid. This was also with older phaco technology," Dr. Talley Rostov explained. continued from page 49 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 inci- sion/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, allow- ing 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. Relevant disclosures Garg: Johnson & Johnson Vision Contact Garg: gargs@uci.edu The wound burn that resulted from this combination was difficult to close, requiring sutures and glue. The patient had significant astigmatism, even after sutures were removed, Dr. Talley Rostov said. Fortunately, it was cor- rectable with glasses. Since then, Dr. Talley Rostov said she switched to bimanual phaco for better fluidics. "Bimanual phaco allows for separate irriga- tion and better fluidics," she said. She also became more careful with her choice of OVD and more aware of the poten- tial for wound burns with prolonged phaco, as well as the potential for occlusion of the phaco handpiece and how to avoid that. Relevant disclosures Nijm: Carl Zeiss Meditec Talley Rostov: None

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