1302: suturing a phaco wound burn

We have covered the topic of phaco wound burn many times and we even had a very astute resident prevent a phaco wound burn because of what he learned on CataractCoach. There are many factors that go into producing a phaco wound burn including more ultrasonic energy, a dense cataract, and the inability to pivot instruments and float in the center of the incision. This is the most important issue because it all lies in your hands (literally). This resident keeps making the mistake of failing to pivot in the incision and he pushes the phaco probe against the side of the corneal incision throughout the case. This prevents the flow of balanced salt solution from cooling the phaco needle and the friction then creates heat which instantly burns the cornea. The cornea is primarily protein like the thick albumin of a raw egg which turns from clear to white when heat is applied. The same thing happens to this cornea as it is cooked by the heat, it turns white.

egg white denatured
It’s ok to cook eggs, but please do not cook the cornea.
The post-op day 1 appearance shows corneal edema and Descemet folds but fortunately the incision is sealed with the three sutures that were placed.

To suture this incision is not easy and it requires patience and multiple sutures to achieve a water-tight closure. The key suture is the horizontal mattress suture which helps pull the roof of the incision down to the floor across the entire width of the corneal tunnel.

The horizontal mattress suture helps hold the roof of the incision tightly against the floor of the incision. The radial sutures help but they are often insufficient to create a water-tight closure with a phaco wound burn.

click to learn from this important case of a phaco wound burn and don’t let this happen to you:

link here

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