1199: predicting a phaco wound burn

A phaco wound burn is a terrible complication that happens from the heat that is created by the friction of the ultrasonic movement of the phaco needle. And it can happen in just a second or two with devastating consequences as we have shown previously in this video and this case. There are risk factors for a phaco wound burn such as occlusion of the port, loss of inflow fluid, high ultrasound energy settings, and pressing the needle against the cornea instead of floating within the incision. This video is from a very experienced surgeon and it is remarkable because we see the warning sign that the phaco needle is blocked: the white cloud of pulverized lens material that is not being aspirated into the phaco tip. We even see that the intense heat that is created immediately boils the balanced salt solution! This is something that I have never seen in 20+ years.

Click to learn from this must-see video to prevent a future phaco wound burn:


  1. Thank you for sharing doctor uday!! I had the same case a few weeks back from a phacomorphic case. Lucky for surgeons who would benefit from the works of sharing, this video and mine. I ddnt knew this sign when it occured to me. When this occured to me, i just knew i need to STOP the phaco upon seeing the lens milk sign. Great learning for all. More power

    Dr Leo Pacquing


    1. Thanks for sharing your experience and your video. This complication can happen to any surgeon.

  2. I had a similar problem with my first phaco case in my new job at lincoln county hospital:i started my phaco training in 2003 and I never had it:to begin I noted the white stuff then noted incision areal becoming cloudy:so stopped :said the phaco tip is blocked :rectified that:was it healon 5 which i used?/do not know/completed the case to face this terrible wound leakage in a patient who is 90 year old with lens power of plus 30 dioptre :irish lady her son is a consultant anaesthetist in harlow:essex.
    I had to suture the wound then examine in afternoon and take her back to resuture then assess daily to discover:still leaking then take her again to theatre to resuture.
    I can tell you one for sure:suturing corneal wound burn is not like suturing normal cornea:it would not seal easily:nightmare

    Oral Bekir

    1. Thanks for sharing your experience. A horizontal mattress suture can be quite useful in these cases of phaco wound burn.

  3. I faced similar situation that too in a subluxated cataract case. I was able to manage the subluxation part quite all right with a ctr. But had a wound leak the next day. I managed the case by applying cyanoacrylate glue the next day. But it was a nightmare. Happened for thr first time with me.

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