Wound Burn In A Patient Undergoing Phacoemulsification Through Superior Incision

Cataract surgery, including phacoemulsification is the most frequently performed surgical procedure globally. The phacoemsulfication technique uses ultrasonic energy to emulsify the lens nucleus, which can generate heat and cause ocular tissue damage. Risks include excessive ultrasound power and friction between the phaco needle and irrigation sleeve, making thermal injury a relevant concern despite technological advances. The authors describe a case of thermal wound burn noted in a case of cataract undergoing phacoemulsification surgery.

Out patient department of Ophthalmology of tertiary care hospital

 A 52-year-old male presented with reduced vision in the left eye for two years, following successful cataract surgery in the right eye. His visual acuity (VA) was 6/9 in the right eye and 6/60 in the left. Intraocular pressure was 15 mmHg bilaterally, with an immature cataract noted in the left eye. Phacoemulsification was performed through a superior corneoscleral incision. On the first postoperative day, VA was 6/36 with IOP at 9 mmHg and diffuse corneal edema. By day four, VA improved to 6/12, with residual corneal edema and a bleb. Anterior segment optical coherence tomography (ASOCT) confirmed corneal thermal wound burn, mild type, with small peripheral Descemet membrane detachment and a fluid pocket (bleb) in stroma. The patient’s best corrected VA was 6/6 without any surgical intervention.

This case emphasizes the importance of careful technique during phacoemulsification, particularly with superior incisions, to reduce the risk of thermal damage.