MANAGEMENT OF INFUSION MISDIRECTION SYNDROME DURING CATARACT SURGERY WITH 26 GAUGE INJECTOR

To evaluate the efficacy and safety of retrolenticular fluid aspiration in the emergency management of acute intraoperative infusion misdirection syndrome (IMS).

 

The patient was a 70-year-old woman. Slit-lamp examination revealed a grade 2 nuclear cataract and Shaffer 4° open-angle in the left eye at the first visit to our department. Pseudoexfoliation (PEX) was observed in the slit lamp examination in the left eye.Surgery was performed under routine topical anesthesia (Alcaine, Alcon, USA). Lateral incisions were made with a 20G ophthalmic blade at 2 and 10 o'clock, and a clean corneal main incision was made with a 2.8 mm keratoma at 12 o'clock. Air-trypan blue liquid was injected into the anterior chamber for capsule staining. Capsulorhexis was completed under VEM (BiVisc,USA) containing 2% sodium hyaluronate and 3% chondroitin sulfate. The phacoemulsification process was performed with the Centruion (Vision System, Alcon) device.

In the patient who developed IMS, active retrolenticular fluid aspiration was performed by transconjunctival/ transscleral route from the pars plana (3.5 mm periphery from the limbus) with a 26G syringe. The direction of the needle was followed through the operating microscope throughout the procedure, and the aspirated fluid was taken from the retrolental anterior vitreous.IOP was monitored digitally throughout the aspiration procedure. The red reflex was followed up for possible suprachoroidal hemorrhage.

In the patient who developed IMS, active retrolenticular fluid aspiration was performed by transconjunctival/ transscleral route from the pars plana (3.5 mm periphery from the limbus) with a 26G syringe. The direction of the needle was followed through the operating microscope throughout the procedure, and the aspirated fluid was taken from the retrolental anterior vitreous.IOP was monitored digitally throughout the aspiration procedure. The red reflex was followed up for possible suprachoroidal hemorrhage. When the anterior chamber depth increased and the IOP decreased, the aspiration procedure was terminated, the injector was withdrawn slowly, tamponade was applied to the inlet and it was observed that there was no vitreous prolapse, and cataract surgery was continued.

 

In the management of IMS, decompression methods such as vitrectomy with the help of a trocar inserted through the pars plana or aspiration with a needle have been used more frequently. Retrolenticular fluid aspiration was performed from the patient with the help of a 26G injector and no retinal complication developed.