Li Fang, Zhang Weijie, Zhou Jibo
College of Health Science and Technology, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Department of Ophthalmology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
BMC Ophthalmol. 2025 Aug 18;25(1):473. doi: 10.1186/s12886-025-04298-z.
We report a case of acute fluid misdirection syndrome during Intraocular Collamer Lens (ICL) implantation in a patient with high axial myopia.
A 36-year-old woman was referred for high myopia correction through double incision viscoelastic-free ICL implantation. During surgery on the left eye, the anterior chamber (AC) shallowed abruptly upon initiation of standard balanced salt solution irrigation. Despite maneuvers, the AC reformation was inadequate, and progressive pupillary constriction was observed. Emergency management including par plana aspiration of retro capsular fluid and intraoperative atropine drops were performed. On postoperative day 1, the ICL tightly adhered to the iris. By postoperative day 7, the AC depth of left eye increased from 2.38 mm to 3.21 mm, and the iridocorneal angle widened from 19.4 to 30.6. The patient’s visual acuity improved.
This case suggests an association between preoperative long axial length with anteriorly rotated ciliary processes and intraoperative fluid misdirection in refractive surgery. Pars plana aspiration and transient ciliary muscle paralysis may mitigate this complication.
我们报告了一例在高度轴性近视患者眼内植入Collamer人工晶状体（ICL）期间发生急性液体错流综合征的病例。
一名36岁女性因高度近视矫正转诊，接受双切口无粘弹剂ICL植入手术。在左眼手术过程中，开始用标准平衡盐溶液冲洗时前房突然变浅。尽管采取了措施，但前房恢复不佳，且观察到瞳孔逐渐缩小。进行了包括经睫状体扁平部抽吸后囊下液体和术中滴注阿托品等紧急处理。术后第1天，ICL与虹膜紧密粘连。到术后第7天，左眼的前房深度从2.38毫米增加到3.21毫米，虹膜角膜角从19.4度扩大到30.6度。患者视力提高。
该病例提示术前眼轴长且睫状突向前旋转与屈光手术中术中液体错流之间存在关联。经睫状体扁平部抽吸和短暂睫状肌麻痹可能减轻这种并发症。
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