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   Table of Contents      
LETTER TO THE EDITOR
Year : 2019  |  Volume : 67  |  Issue : 1  |  Page : 174-175

Comment on: Pars-plana fluid aspiration for positive vitreous cavity pressure in anterior segment surgeries


1 Director-Fellowship Program, Cornea, Cataract, Refractive Surgery & Anterior Segment, Sita Lakshmi Glaucoma Centre, Ananad Eye Institute, Habsiguda, Hyderabad, Telangana, India
2 Fellow, Cornea & Anterior Segment, Sita Lakshmi Glaucoma Centre, Ananad Eye Institute, Habsiguda, Hyderabad, Telangana, India
3 Consultant, Glaucoma services, Sita Lakshmi Glaucoma Centre, Ananad Eye Institute, Habsiguda, Hyderabad, Telangana, India

Date of Web Publication21-Dec-2018

Correspondence Address:
Dr. Arjun Srirampur
Cornea, Cataract, Anterior Segment and Refractive Surgery, Director-Fellowship Program, Anand Eye Institute, Habsiguda, Hyderabad - 500 007, Telangana
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijo.IJO_723_18

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How to cite this article:
Srirampur A, Kalwad A, Balijepalli P, Katta KR. Comment on: Pars-plana fluid aspiration for positive vitreous cavity pressure in anterior segment surgeries. Indian J Ophthalmol 2019;67:174-5

How to cite this URL:
Srirampur A, Kalwad A, Balijepalli P, Katta KR. Comment on: Pars-plana fluid aspiration for positive vitreous cavity pressure in anterior segment surgeries. Indian J Ophthalmol [serial online] 2019 [cited 2019 Jun 18];67:174-5. Available from: http://www.ijo.in/text.asp?2019/67/1/174/248162



Sir,

We read the interesting article “Pars plana fluid aspiration for vitreous cavity pressure in anterior segment surgeries” by Kuriakose et al. published in Issue 4 of the Indian Journal of Ophthalmology (IJO), 2018. The authors proposed a novel surgical technique to address a complex and vexing intraoperative complication commonly encountered in anterior segment surgeries.[1]

The authors proposed this surgical technique for patients with shallow anterior chamber due to positive vitreous pressure, the causes of which could be poor akinesia, inadvertent pressure on the globe, proptosis, eyelid abnormalities, etc.[2] When these external causes are ruled out, infusion misdirection syndrome is another entity where there is misdirection of irrigating fluid into vitreous cavity that can occur due to excessive hydrodissection or during cortical aspiration.[3] Though the authors have ruled out external causes such as lid speculum issues, hand position and instrument position, one of the most important causes was missed, i.e., the type of local anesthesia and its adequacy. There were also no details regarding suspected infusion misdirection intraoperatively. Although it was mentioned that the aspiration was done before the surgery in patients where an aqueous misdirection was suspected, we are not sure if they intended that to be in cases with high possibility of aqueous misdirection intra/postoperatively as it happens post surgery and needs ultrasound biomicroscopy (UBM) for confirming the diagnosis.[4]

Half of the patients included in the study were above the age of 60 years, in whom the possibility of vitreous degeneration was high and aspiration of misdirected fluid alone was debatable. When we consider the safety issues of this technique, the authors suggested to continue aspiration till the syringe exits out of the eye, which could possibly cause damage to the pars plana. Incidence of complications with this procedure such as vitreous traction has been compared to that of intravitreal injections, but it may not hold true as fluid is aspirated with this technique compared to injection of fluid in the latter. In addition, an incorrect positioning of the needle increases the risk for lens touch and retinal breaks in addition to risk of damage to the pars plana. Currently available advancements including suture-less vitrectomy with 27 or 25-gauge needle would be safer alternatives.

Acknowledgements

Dr Satish Agraharam, Managing Director, Head of Vitreo Retina Services, Anand Eye Institute, Habsiguda, Hyderabad, India.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Kuriakose T, Jasper S, Thomas S. Pars-plana fluid aspiration for positive vitreous cavity pressure in anterior segment surgeries. Indian J Ophthalmol 2018;66:565-7.  Back to cited text no. 1
[PUBMED]  [Full text]  
2.
Reddy MK. Complications of cataract surgery. Indian J Ophthalmol 1995;43:201-9.  Back to cited text no. 2
[PUBMED]  [Full text]  
3.
Lau OC, Montfort JM, Sim BW, Lim CH, Chen TS, Ruan CW, et al. Acute intraoperative rock hard eye syndrome and its management. J Cataract Refract Surg 2014; 40:799-804.  Back to cited text no. 3
    
4.
Trope GE, Pavlin CJ, Bau A, Baumal CR, Foster FS. Malignant glaucoma: Clinical and ultrasound biomicroscopic features. Ophthalmology 1994; 101:1030-5.  Back to cited text no. 4
    




 

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