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Acute and chronic fluid misdirection syndrome

Poster Details

First Author: P.Kanclerz POLAND

Co Author(s):    A. Grzybowski                    

Abstract Details


The aim of the study was to summarize our current understanding of the specific pathogenic mechanisms of malignant glaucoma and acute intraoperative rock-hard eye syndrome.


Institute for Research in Ophthalmology, Poznan, Poland Department of Ophthalmology, Medical University of Gdańsk, Poland


PubMed and Medline were the main resources for medical literature search. The following keywords were used in various combinations: infusion misdirection syndrome, aqueous misdirection syndrome, capsular block, ciliovitreal block, ciliary block, intraoperative fluid misdirection, subcapsular fluid entrapment, acute intraoperative rock-hard eye syndrome, positive vitreous pressure glaucoma, and malignant glaucoma


We analyzed 55 articles dated from 1951 to 2016. Acute intraoperative rock-hard eye syndrome occurs during uneventful phacoemulsification and is characterized by a very shallow anterior chamber with the absence of suprachoroidal effusion or hemorrhage and no noticeable pathology of the iris–lens diaphragm. It is based on inappropriate movement of fluid via the zonular fibers, and has also been described following the initial surgery. The pathophysiology of malignant glaucoma presents a similar mechanisms of ciliolenticular block of aqueous outflow. Faced with these situations, vitreous decompression is required, preferably with hyaloido-capsulo-iridectomy. In phakic eyes, concomitant cataract extraction is desirable.


We believe both of these clinical conditions should be considered as one syndrome. We suggest the term acute fluid misdirection syndrome for the cascade of events during phacoemulsification surgery. Chronic fluid misdirection syndrome better describes the nature of malignant glaucoma

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