Ultrasound-induced corneal incision contracture survey in the United States and Canada

PURPOSE: To ascertain factors associated with corneal incision contracture (wound burn) secondary to phacoemulsification in the United States and Canada. SETTING: John A. Moran Eye Center, University of Utah, Salt Lake City, Utah, USA, and University of Toronto, Toronto, Ontario, Canada. DESIGN: Cross-sectional study. METHODS: Through state and provincial societies, members were queried as to cataract surgery practices during the previous 3 years as well as the specifics associated with each case of wound burn, if any, encountered during that period. RESULTS: Eight hundred forty-two cataract surgeons reported on 920 095 surgeries and 341 wound burns (raw incidence 0.037%). After a multivariate analysis, the wound burn incidence was significantly inversely associated with the surgeon’s surgical volume (45% decrease per doubling of volume; 95% confidence interval, 38%-55%; P<.001), the surgical approach (P<.001), and the ophthalmic viscosurgical device (OVD) used (P=.004). Machine or ultrasound modality used, region of the U.S. or Canada, and incision size were not related to wound burn. CONCLUSION: Phacoemulsification-induced wound burn can be reduced by experience, by the approach used in nucleus disassembly, by choice of OVD, and most important, by not using ultrasound when the anterior chamber is filled with OVD. Financial Disclosure: Dr. Braga-Mele is a consultant to Abbott Medical Optics, Inc., Alcon Laboratories, Inc., and Bausch & Lomb. Dr. Olson has been a consultant to Abbott Medical Optics, Inc., Becton, Dickinson and Co., and Allergan, Inc. He has received grant support from Abbott Medical Optics, Inc. and Allergan, Inc. No other author has a financial or proprietary interest in any material or method mentioned.