VST Centre for Glaucoma Care, L. V. Prasad Eye Institute, Hyderabad, Telangana, India.
Indian J Ophthalmol. 2024 Nov 1;72(11):1630-1634. doi: 10.4103/IJO.IJO_16_24. Epub 2024 Oct 26.
To evaluate the causes of acute fluid misdirection (AFM) and the role of irido-zonulo-hyaloido-vitrectomy (IZHV) in the management of AFM.
Among the 95,712 cataract surgeries performed between April 2017 and August 2022 at a tertiary center, six eyes of six patients developed intraoperative AFM and underwent IZHV through the anterior approach. AFM was diagnosed intraoperatively when there was sudden shallowing of the anterior chamber with markedly elevated intraocular pressures (IOPs) not attributable to external causes or choroidal effusion/hemorrhage. The condition resolved with deepening of AC following IZHV.
Five eyes had angle closure disease (one of them also had pseudoexfoliation), and one eye had open-angle glaucoma. The mean preop IOP was 25.8 ± 7.3 mmHg, with an IOP range of 18-36. The mean number of preop AGM was 3 ± 1.7. Four eyes developed AFM during combined cataract and trabeculectomy, and two eyes during cataract surgery. Four eyes had aqueous misdirection during or after cortical aspiration, and two eyes after creation of internal trabeculectomy ostium. IZHV was performed for all eyes through an anterior approach using a 23G vitrector, which resulted in instant resolution and deepening of the anterior chamber. The mean follow-up was 8.75 months (1-48 months), the mean postoperative IOP was 16.1 ± 2.6 mmHg, and the mean number of AGM at the last follow-up was 2.8 ± 2.2. The anterior chamber was deep, and IOP was under control in all eyes with four eyes needing AGM. One eye developed postoperative aqueous misdirection due to blockade of the IZHV opening.
IZHV can be an effective solution for acute intraoperative AFM, which can be performed via an anterior approach by the anterior segment surgeon.
评估急性房水错位（AFM）的原因以及虹膜-睫状体-悬韧带-玻璃体切除术（IZHV）在 AFM 治疗中的作用。
在 2017 年 4 月至 2022 年 8 月期间在一家三级中心进行的 95712 例白内障手术中，有 6 例 6 只眼在术中发生 AFM，并通过前入路进行 IZHV。术中诊断为 AFM 时，前房突然变浅，眼压（IOP）显著升高，且无法归因于外部原因或脉络膜渗出/出血。IZHV 后前房深度加深，AFM 缓解。
5 只眼为闭角型青光眼（其中 1 只还伴有假性剥脱），1 只眼为开角型青光眼。术前平均眼压为 25.8±7.3mmHg，眼压范围为 18-36mmHg。术前平均前房角数为 3±1.7。4 只眼在白内障和小梁切除术联合进行时发生 AFM，2 只眼在白内障手术时发生 AFM。4 只眼在皮质抽吸过程中或之后房水发生错位，2 只眼在建立小梁切除术内口后房水发生错位。所有眼均通过前入路使用 23G 玻璃体切割器进行 IZHV，结果立即缓解，前房加深。平均随访时间为 8.75 个月（1-48 个月），术后平均眼压为 16.1±2.6mmHg，末次随访时平均前房角数为 2.8±2.2。所有眼的前房均加深，眼压得到控制，其中 4 只眼需要行前房角分离术。1 只眼由于 IZHV 开口阻塞而发生术后房水错位。
IZHV 是治疗术中急性 AFM 的有效方法，可由眼前节外科医生通过前入路进行。
