Abstract
Purpose :
Modern cataract surgery relies on a phacoemulsification handpiece to disassemble cataracts. The handpiece can generate excessive heat leading to corneal burns which are prevented by using irrigation. The occurrence of burns outside of the eye is not well documented. This study aimed to determine whether the handpiece could cause thermal injury to patients outside the eye and if the device is able to ignite drapes.
Methods :
Porcine skin was used due to its physiological similarity to human skin. 3 trials were completed to assess the possibility and speed of char occurring with the handpiece tip being in contact with different materials including the tip directly on a pig foot with no drape, a Henry Schein standard drape, and a 3M plastic Steri-Drape. Trials were performed with the silicone cover on the tip and without. Each trial was repeated 3 times with no statistically significant difference between trials of the same material (P<0.05). The Infiniti Vision System by Alcon Labs was used.
Results :
With no drape, the tip without sleeve caused char within 3.0 seconds while with sleeve caused char at 10.0 seconds or above(Figure 1). Trials with the standard drape did not cause char but did burn a hole through the drape regardless of the sleeve. The tip with the sleeve burnt through the plastic drape, charring in 2.7 seconds, while no sleeve led to the same result in less than 1.0 seconds(Figure 2). In all trials, charring was quicker without the silicone sleeve. No trials resulted in drape ignition.
Conclusions :
Charred skin is considered to be a 3rd-degree full-thickness burn with less severe burns possibly not being visible. One trial showed the body of the handpiece at 53.6°C degrees with immediate destruction of the epidermis known to occur above 44°C. The silicone tip proved to be protective but not effective in preventing burns. The trials were not completed in an oxygen-enriched environment. Increased risk of burn is present in true operating conditions due to the risk of ignition of the oxygen provided beneath the drape or via nasal cannula leading to the possibility of facial, airway, or nasal burns. While beneficial to consider in future studies, it did not prevent us from concluding that focused efforts on using the silicon tip, irrigation, and placing the phacoemulsification handpiece on a surface other than the patient could prevent burns from occurring.
This abstract was presented at the 2022 ARVO Annual Meeting, held in Denver, CO, May 1-4, 2022, and virtually.