A patient underwent routine cataract surgery one month after uncomplicated cataract extraction and intraocular lens implantation of the contralateral eye. Intraoperatively, during the hydrodissection step of cataract extraction, the anterior chamber shallowed unexpectedly and the eye became very hard. The surgeon astutely became concerned for potential etiologies of positive posterior pressure including possibly an acute choroidal hemorrhage. Therefore, the main wound was sutured closed. Diamox 500mg IV was administered to the patient. Fundus examination ruled out choroidal hemorrhage. After 15 minutes had passed, the anterior chamber had deepened and the intraocular pressure returned to a normal range. Once lens was removed, posterior rent was identified as the etiology for the fluid deviation syndrome. The etiology of intraoperative AC shallowing can be separated into low (wound leak, insufficient inflow, excessive outflow) and high pressure (Fluid deviation syndrome, suprachoroidal hemorrhage/effusion, mechanical, orbital pressure). By understanding the pathogenesis and treatment of posterior pressure, one can prevent the unexpected from leading to further complications.
Presentation Date: 02/24/2022
Issue Date: 03/11/2022