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).

İnfüzyon yanlış yönlendirme sendromu (IMS), suprakoroidal efüzyon veya kanamanın olmadığı ve iris-lens diyaframında belirgin bir patolojinin olmadığı, eksenel olarak çok sığ bir ön kamara ile karakterize nadir bir klinik durumdur. Genellikle olaysız fakoemülsifikasyon sırasında, özellikle hipermetrop gözlerde ortaya çıkar.(1)

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.Cortex aspiration was performed with automatic bimanual irrigation/aspiration. It was determined digitally that IOP was elevated, with sudden anterior chamber narrowing, iris prolapse, and difficulty in administering VEM to the anterior chamber after cortex cleaning. Trying to lower the IOP with palmar massage and then an ıntracapsular hydrophobic acrylic intraocular lens (IOL) (Acriva-VSY) was placed with VEM. The case was evaluated for suprachoroidal hemorrhage and the fundus and red reflux were normal, and it was decided that IMS developed.

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 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.