Evaluating the Risk of Thermal Damage to Dermal Tissue in Cataract Surgery Related Phacoemulsification

Background: Modern cataract surgery relies on a phacoemulsification handpiece which can generate excessive heat leading to corneal burns. Burns outside of the eye are 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.Methods3 trials using porcine skin 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.ResultsWith no drape, the tip without a sleeve caused char within 3.0 seconds while with a sleeve caused char at 10.0 seconds or above (Fig. 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 (Fig. 2). In all trials, charring was quicker without the silicone sleeve. No trials resulted in drape ignition.ConclusionsCharred 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℃ degrees with immediate destruction of the epidermis known to occur above 44℃. The silicone tip proved to be protective but not effective in preventing burns. The trial was not completed in an oxygen-enriched environment. 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.