Posterior Globe Collapse After Cataract Surgery Wound Microleak In High Myope

Hypotony after cataract surgery is a very rare complication, especially in high myopes we have to be extra cautious since wound leak can occur due to thin scleral rigidity.  We present two case of wound microleak after uneventful phacoemulsification in high myope leading to posterior globe collapse rather than anterior chamber collapse due to hypotony. After wound suturing anterior chamber along with posterior globe was reformed with loss of retinal folds and intraocular pressure became normal. 

Both patients had eneventful phacoemulsification surgery in a tertiary eye care hospital. The surgery was uneventful and both patients were myopic with one patient had ICL implantation for high myopia previously.  On postoperative period developed hypotony with posterior globe collapse. The mechanism of posterior wall collapse in the absence of a shallow anterior chamber presents a mechanistic challenge after cataract surgery. 

In both our cases , there was probable wound microleak due to suture lysis in first case and severe vomiting in second case, with myopia and less scleral rigidity being common factor. The  anterior chamber reformation with clear corneal tunnel suturing was done and immediately globe formed with resolution of hypotony and chorioretinal folds. 

The treatment of hypotony maculopathy is dependent on correctly identifying the cause of hypotony and treating this cause as soon as possible. Delayed treatment of hypotony can result in permanent changes in the retina and choroid and cause vision loss . Treatment include anterior chamber reformation treating wound leak with suturing, bandage contact lens for microleak at wound site, posterior globe formation with air injected at the pars plana in the inferior temporal quadrant for volumetric replacement in the eye. Both our cases underwent corneal resuturing and globe reformation 

Sudden onset of vision loss or shallow anterior chamber postoperatively in high myopes need detailed fundus evaluation and intraocular pressure measurement , for identifying posterior globe collapse and wound microleak. Rectification of the same by wound exploration or bandage contact lens immediately  is needed  to prevent hypotonic maculopathy.