warning: phaco wound burn!

This is among the most important cataract surgery videos that you will see in your lifetime. Really. I have taught thousands of cataract surgeries to nearly 200 resident ophthalmologists over the past 20 years and I have only seen this complication a couple of times. But, make no mistake, this complication could happen to you!

The phaco needle becomes very hot due to friction from the ultrasonic energy. I showed this picture to explain how the heat can build up very quickly (just a few seconds)

Even if you have great phaco ultrasound settings, if you fail to pivot within the incision, that will lead to a host of problems including a much higher risk of a phaco wound burn. And that is the problem in this surgery, performed by a resident ophthalmologist with about 60 cataract surgeries of experience. This young doctor does not pivot the hands enough to keep the instruments floating in the incision. You should never push the phaco needle up against the side of the silicone sleeve and then against the cornea — either the incision wall (like this case) or the incision roof / floor.

This patient started with a dense, white, brunescent cataract and that is also a risk factor for a phaco wound burn because we will need to use more ultrasonic energy to emulsify this nucleus.
Four linear suture passes plus an additional X suture were required to close this 2.8 mm incision due to the corneal burn, which coagulates the corneal proteins and causes contracture.

Click below to see why this phaco wound burn happened and how to address it:


  1. For how many time do you leave the sutures in place after a phase burn like this?. I had one of those a month ago and I leaved very very tight cross sutures, with a very unhappy patient for the next weeks because of the super high astigmatism. Imagine how stressed I was, with a patient which his pre-op VA was 20/80, ending up with a first week postop of 20/400… I removed the sutures just yesterday and the patient almost immediately achieved 20/30 of visual acuity. It was so reliefing for the patient and of course for me…

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