Cataract Surgery Complications With Very Shallow Anterior Chamber, Posterior Synechiae And Iris Floppiness.

The aim is to describe a case of a 68-year-old female with a cataract, 1.2 mm anterior chamber depth with posterior synechiae, and to present a problem-solving pathway in the management of complications during surgery.

Department Ophthalmology, Faculty of Medical Sciences in Katowice, Medical University of Silesia, Katowice, Poland; Head: Professor Ewa Mrukwa-Kominek

The left eye (LE) was scheduled for cataract surgery. Before cataract surgery, due to advanced-stage glaucoma in both eyes BCDVA in the right eye (RE) was light perception and in the LE was hand movements. IOP was 19 mmHg in the RE and 24 mmHg in the LE. Preoperative 200 ml of 20% mannitol was administered. During the creation of side ports iris floppiness was noticed. Posterior synechiae were removed with visco-dissection and manually with a blunt spatula. Iris retractors were inserted. Continuous capsulorhexis was performed despite a broad pigment epithelium spot on the anterior lens obscuring the margin of the capsulorhexis. During capsulorhexis, moderate peripheral runout occurred due to the steepness of the lens, elevated pressure in the vitreous cavity, and viscoelastic runout. Cataract surgery was performed with phacoemulsification in the LE. The intraocular lens of 34 diopters was implanted into the bag. Directly after surgery patient could count fingers from a distance of 1 meter in the left eye. Further improvement of BCDVA in the RE was achieved to the 0.1 Snellen chart. IOP remained stable at the level of 15 mmHg in the operated eye.

A shallow anterior chamber is a challenge during cataract surgery because it reduces the already tight confines of the anterior segment of the eye. Surgeons can achieve successful outcomes in these challenging cases through the appropriate use of OVDs, the appropriate setting of fluidics, and surgical techniques.