Management of infusion misdirection syndrome during combined surgery of cataract and glaucoma

Objective To analyze clinical features the treatment and of infusion misdirection syndrome during combined surgery of cataract and glaucoma. Methods The data of 4 cases with infusion misdirection syndrome during the combined surgery from Mar. 2017 to Mar. 2018 were collected and retrospectively analyzed. All patients with chronic angle closure glaucoma underwent the combined surgery of trabeculectomy, phacoemulsification and intraocular lens implantation. Clinical features were sudden anterior chamber disappearance, iris prolapse and intraocular pressure elevation during phacoemulsification. The anterior chamber depth wasn’t maintained with injecting viscoelastic agent. No pain, irritability or other symptom was found. No fulminant choroidal hemorrhage occurred. Two cases were immediately given rapid intravenous injection of 20% mannitol 250 ml, and the other 2 cases were immediately performed vitreous cavity puncture on the pars plana. The operation continued after anterior chamber forming. Results The anterior chamber was formed in all 4 patients after treatment. All operations were successfully completed and intraocular lens was implanted in the capsule. Anterior chamber depth and intraocular pressure was normal at 3 days, 1 week and 1 month after surgery. Postoperative visual acuity all improved in different degrees. Conclusion Infusion misdirection syndrome occurs during phacoemulsification in patients with chronic angle closure glaucoma. It may be related to relaxation of the lens zonule. The anterior chamber depth can be maintained with correct diagnosis and proper treatment, the intraocular pressure can decrease, and the operation can be successfully completed with satisfactory surgical results. Key words: Infusion misdirection syndrome; Phacoemulsification; Surgery, combined, cataract, glaucoma