Postoperative Flat Anterior Chamber

Postoperative Flat Anterior Chamber

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Anterior chamber depth as ascertained by slit lamp examination has long been used as an important parameter in assessing postoperative status following major intraocular surgery. Prior to the second half of the 20th century, most cataract extractions and corneal transplantations were performed without the placement of edge-to-edge ophthalmic sutures. Therefore, a formed anterior chamber signified the reestablishment of the integrity of the globe sufficiently to impede or eliminate the leaking of aqueous humor. A shallow (or absent) anterior chamber can occur in the early, intermediate, or late postoperative period. This article defines the early postoperative period (days 1-7), the intermediate postoperative period (days 7-30), and the late postoperative period (>30 days).

In the early postoperative period, a shallow anterior chamber is often associated with a soft eye, but it may also be present with normal or even elevated intraocular pressure. The combination of a soft eye and a shallow anterior chamber occurring within the first several days following intraocular surgery often signifies a leak of aqueous fluid from the anterior chamber through the operative wound. Presence of a wound leak can be ascertained at the slit lamp with application of fluorescein dye to the wound site. Slight pressure on the globe results in a clearly visible flow of clear aqueous fluid (Seidel positive) within the fluorescein-stained tear film.

United States

No good statistical data are available on the frequency of occurrence. With modern small-incision cataract surgery, the incidence of wound leak has decreased markedly. Postoperative flat or shallow anterior chamber is encountered more frequently in glaucoma [1] and corneal transplantation than in routine cataract extraction. The highest overall incidence may be following repair of extensive perforating injuries.

International

Difference in frequency internationally will be related to the availability of state-of-the-art microsurgical technology and equipment, including sutures and instruments. Yet, no objective statistical evidence has been reported.

The condition is strictly related to the globe and is not associated with mortality or systemic morbidity.

No data are available relating to racial difference in frequency or severity.

No differences are anticipated in frequency between males and females.

No data are available.

[Guideline] Glaucoma Panel, Preferred Practice Patterns Committee. Primary open-angle glaucoma. San Francisco (CA): American Academy of Ophthalmology (AAO); 2005.

de Barros DS, Navarro JB, Mantravadi AV, et al. The early flat anterior chamber after trabeculectomy: a randomized, prospective study of 3 methods of management. J Glaucoma. 2009 Jan. 18(1):13-20. [Medline].

Ono T, Yuki K, Shiba D, Abe T, Kouyama K, Tsubota K. Postoperative flat anterior chamber: incidence, risk factors, and effect on the long-term success of trabeculectomy. Jpn J Ophthalmol. 2013 Nov. 57(6):520-8. [Medline].

Hosoda S, Yuki K, Ono T, Tsubota K. Ophthalmic viscoelastic device injection for the treatment of flat anterior chamber after trabeculectomy: a case series study. Clin Ophthalmol. 2013. 7:1781-5. [Medline]. [Full Text].

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Azuara-Blanco A, Dua HS. Malignant glaucoma after diode laser cyclophotocoagulation. Am J Ophthalmol. 1999 Apr. 127(4):467-9. [Medline].

Beigi B, O’Keefe M, Algawi K, Acheson R, Burke J. Sulphur hexafluoride in the treatment of flat anterior chamber following trabeculectomy. Eye. 1997. 11 (Pt 5):672-6. [Medline].

Chisalita D, Poiata I, Cozma D. [Postoperative flat anterior chamber. The therapeutic approach]. Oftalmologia. 1997. 41(3):251-6. [Medline].

Dugel PU, Heuer DK, Thach AB, Baerveldt G, Lee PP, Lloyd MA, et al. Annular peripheral choroidal detachment simulating aqueous misdirection after glaucoma surgery. Ophthalmology. 1997 Mar. 104(3):439-44. [Medline].

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Andrew A Dahl, MD, FACS Assistant Professor of Surgery (Ophthalmology), New York College of Medicine (NYCOM); Director of Residency Ophthalmology Training, The Institute for Family Health and Mid-Hudson Family Practice Residency Program; Staff Ophthalmologist, Telluride Medical Center

Andrew A Dahl, MD, FACS is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, American Intraocular Lens Society, American Medical Association, American Society of Cataract and Refractive Surgery, Contact Lens Association of Ophthalmologists, Medical Society of the State of New York, New York State Ophthalmological Society, Outpatient Ophthalmic Surgery Society

Disclosure: Nothing to disclose.

Simon K Law, MD, PharmD Clinical Professor of Health Sciences, Department of Ophthalmology, Jules Stein Eye Institute, University of California, Los Angeles, David Geffen School of Medicine

Simon K Law, MD, PharmD is a member of the following medical societies: American Academy of Ophthalmology, Association for Research in Vision and Ophthalmology, American Glaucoma Society

Disclosure: Nothing to disclose.

J James Rowsey, MD Former Director of Corneal Services, St Luke’s Cataract and Laser Institute

J James Rowsey, MD is a member of the following medical societies: American Academy of Ophthalmology, American Association for the Advancement of Science, American Medical Association, Association for Research in Vision and Ophthalmology, Florida Medical Association, Sigma Xi, Southern Medical Association, Pan-American Association of Ophthalmology

Disclosure: Nothing to disclose.

Hampton Roy, Sr, MD Associate Clinical Professor, Department of Ophthalmology, University of Arkansas for Medical Sciences

Hampton Roy, Sr, MD is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, Pan-American Association of Ophthalmology

Disclosure: Nothing to disclose.

Bradford Shingleton, MD Assistant Clinical Professor of Ophthalmology, Harvard Medical School; Consulting Staff, Department of Ophthalmology, Massachusetts Eye and Ear Infirmary

Bradford Shingleton, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Ophthalmology

Disclosure: Nothing to disclose.

James V Aquavella, MD Professor of Ophthalmology, Department of Ophthalmology, University of Rochester School of Medicine, University of Rochester Eye Institute

James V Aquavella, MD is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, American Medical Association, Contact Lens Association of Ophthalmologists, and International College of Surgeons

Disclosure: Nothing to disclose. R Marshall Ford, MD Cornea Fellowship, Flaum Eye Institute at University of Rochester School of Medicine and Dentistry

R Marshall Ford, MD is a member of the following medical societies: American Academy of Ophthalmology and American Society of Cataract and Refractive Surgery

Disclosure: Nothing to disclose.

Gregory J McCormick, MD Consulting Staff, Corneal and Refractive Surgery, Vermont Laser Vision at Timber Lane and Ophthalmic Consultants of Vermont

Gregory J McCormick, MD is a member of the following medical societies: American Academy of Ophthalmology, American Society of Cataract and Refractive Surgery, International Society of Refractive Surgery, and Medical Society of the State of New York

Disclosure: Nothing to disclose.

Postoperative Flat Anterior Chamber

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