By Lisa B. Arbisser, MD
This large survey found that the incidence of post-phaco wound burn could be significantly decreased by increasing procedure volume and changing certain approaches to surgery.
The authors sent web-based surveys to members of ophthalmology societies on their cataract surgery practices during the previous three years, as well as the specifics associated with each case of wound burn encountered during that period. Responses were received from 842 cataract surgeons and were based on 920,095 surgeries and 341 wound burns.
The raw wound burn incidence was 0.037 percent. It was significantly inversely associated with a surgeon's surgical volume (P < 0.001), with a 45 percent decrease per doubling of volume. The next most important factors related to wound burn incidence were surgical approach (P < 0.001) and use of OVD (P = 0.004).
The authors say that OVD use is a risk factor that is probably avoidable. They advise that if an OVD has been used, irrigation and aspiration should be performed for 10 to 15 seconds at the beginning of every case so the working space above the nucleus is free of OVD. Working in an OVD-free space protects against OVD-related wound burn risk, they say.
Wound burn incidence in this survey was about half that reported in the authors' 2006 survey. Machine or ultrasound modality used, region of the U.S. or Canada, and incision size were not related to wound burn in the current survey. The divide-and-conquer, carousel and stop-and-chop surgical techniques were all similar in terms of wound burn risk and had an adjusted incidence at least twice that of all the other chop approaches. Use of Healon5, followed by Ocucoat and Duovisc/Viscoat, was associated with the highest rates of wound burn.
The authors say the lesson of these results is not necessarily to have a busy surgical practice but rather to train one's approach so that ultrasound is used only when needed and at as low a level as possible if seeking to minimize wound burn. They found that those who tend to be heavy on the machine pedal have a greater risk for wound burns.
They conclude that phacoemulsification-induced wound burn can be reduced by greater surgeon experience, the approach used in nucleus disassembly, choice of OVD and not using ultrasound when the anterior chamber is filled with OVD. This is an excellent review of wound burn, with sound suggestions for avoidance.