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It only takes a second for a burn to happen
I spend most of my week in private practice doing cataract and refractive surgery at the Maloney Vision Institute in Los Angeles. But I love teaching surgery to bright, enthusiastic resident ophthalmologists, so I've made sure to reserve time for this. As Chief of Ophthalmology at Olive View UCLA Medical Center, I spend many hours a week doing hands-on training with the UCLA/Jules Stein Eye Institute residents. And part of that is reviewing videos of cases that were performed by the residents earlier in the week.
Part of my teaching in the wet-lab is to have the residents pinch the phaco needle with their fingers, then step on the pedal. They are amazed at how quickly the ultrasound energy causes heat build-up at the phaco needle and, if they continue, a burn on their fingers.
 The clear corneal incision has been burned and is now fish-mouthed open. |
Unfortunately, one of the senior residents still had a phaco burn to his clear corneal incision.
What causes a phaco burn?
1. Excessive heat creation. Lack of phaco power modulations, excessive ultrasound energy, friction between the phaco tip and the incision.
2. Insufficient cooling. Lack of fluid flow around an overly-tight incision, not remembering to be selective with ultrasound energy.
3. A combination of the above.
In the modern age of phaco power modulations, I think we can greatly reduce the incidence of these burns. The bottom line is minimize the energy placed into the eye and make the incision slightly leaky. Maybe if I charge residents a dollar for every minute of phaco energy they place in the eye...