I had operated one patient for left eye cataract- Phaco with foldable IOL under topical anasthesia. (acrysof IQ), before seven days, Surgery was uneventful. At the end of surgery there was a shallow A/c, so I injected air, taken one suture and given pad and patch to the patient. On the second post op day A/C shallow with mild corneal edema, I put the patient on atropine eye drops, Moxicip eye drops, Prednisolone eye drops and Isol 5% eye drop 2 hrly . But A/C remains persistently shallow, about half plus only. On 5th day I injected air , given IV Mannitol, pad and patch, 6th day Deep A/C with free air . But on 6th day again anterior chamber flat with IOP 5mmHg . No Choroidal detachment seen. Cornea is clear with mild pigment dispersion on IOL. What may be the reason and how to proceed?
Dr Manisha Devani Morbi
Dear Dr. Morbi,
Did you check for aqueous leak from incision site and side ports by applying fluorescein?
Dr. Amandeep Singh
Dear Dr Morbi,
I would do a Seidel's test and check the IOP. These tests answer why the AC is shallow. Are both the haptics inside the bag or did you have to dial the lens a lot to get it inside the bag? These explain why there is deposition of pigment on the lens. Please let us know.
Dr H V Srinivas
Did you carry out the Seidel's test?
Please do a Siedel’s test with a sterile Flourescein strip and the post op drops. Check for retained capsular tag in the internal ostium. A secure wound should not leak a few minutes after completion of surgery and sometimes may require more than one suture to secure it in a watertight fashion. So, tell the patient that his eye is healing very slowly and it needs additional support and take him up to the theater and add sutures till there is no leak when the posterior lip of the external incision is depressed firmly. This should be done urgently please.
Dr. Ramesh D
Dear Dr. Manisha,
It is advisable to hydrate all ports including main wound at the end of surgery. If IOP is low and there is no choroidal detachment, the only possibility that remains is that of a leaking wound .Usually air injection+ hydration of wounds with BSS, and a little amount of BSS inj. in AC while hydrating works. Postop .CAP.Iopar SR od.for 4-5 days along with other topical steroidal+non steroidal antiinflamatory drops+antibiotic drop-all qid with 1hr interval in between each. Dilatation of pupil is to be avoided till air is absorbed & AC is markedly formed; this will prevent air entry in PC as well as formation of PAS. If still AC remains shallow, you may think of suturing of leaking wound. Malignant glaucoma also gives shallow AC but with raised IOP &might need help of Vitreous surgeon.
Dear Dr. Manisha,
What is the profile of the patient. Sometimes some patients inadvertently keep pressing on the eye and wound and that also could be the reason for shallowing. I had one such illiterate mother of an Income Tax Commissioner who would always report with a shallow A/c. When we carefully took the history, while putting the drops they were pressing on the sclera and causing the chamber to shallow. Hope this helps.
Dr. Tejas D. Shah
Dear Dr Manisha Devani Morbi,
Persistent shallow anterior chamber in a soft eye without choroidals would indicate that there is a wound leak. As suggested by the other respondents do a Seidels test using sterile drops and a sterile fluorescein strip. If no obvious leakage is seen, do a positive Seidels test where pressure is applied to the posterior lip of the wound. Make sure to check the side port also is not leaking.
Dr. Mathew Kurian