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