Acute Fluid Misdirection Syndrome: a Case Report

Abstract

One of the rare intraoperative complications of cataract phacoemulsification is the fluid misdirection syndrome. It can occur at any stage of the operation and is expressed in shallowing of the anterior chamber, increased intraocular pressure in the absence of suprachoroidal effusion and hemorrhage. The pathogenesis of the syndrome is associated with the penetration of irrigation solution through the zonular fibers into the retrolental space and the anterior vitreous. The main ways to overcome this complication include interruption of surgery and continuation of it after self-treatment of the syndrome, aspiration of fluid from the vitreous body and irido-zonulo-hyaloido-vitrectomy.

The clinical case of a patient with bilateral acute syndrome of deviation of infusion flows was analyzed. The background for the development of the syndrome in both eyes was pseudoexfoliation syndrome. A two-stage operation was performed on the patient's right eye, which resulted in the implantation of an iridovitreal intraocular lens. An irido-zonulo-hyaloido-vitrectomy was performed on the left eye with the implantation of a posterior chamber intraocular lens into a capsular bag.

Effective measures for relieving the syndrome include working at lower «target intraocular pressure» values on the phacomachine and performing anterior irido-zonulo-hyaloido-vitrectomy, which allows for the «reconstruction» of the anterior chamber, returning it to its normal depth.