Excerpt from Postoperative Flat Anterior Chamber

Synonyms, Key Words, and Related Terms: anterior chamber depth, shallow anterior chamber, anterior segment surgery, bleb leaks, wound leaks, hypotony

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Background

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 (in excess of 30 days).

Pathophysiology

In the early postoperative period, a shallow anterior chamber is often associated with a soft eye, but it also may 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 will result in a clearly visible flow of fluid (Seidel positive).

Frequency

United States

No good statistical data are available on the frequency of occurrence. Clearly, the condition is encountered more frequently in glaucoma 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.

Mortality/Morbidity

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

Race

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

Sex

No differences are anticipated in frequency between males and females.

Age

No data are available.

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