POST-OP SHALLOW

ANTERIOR CHAMBER
 Early postoperative period (days 1-7)
 Intermediate postoperative period (days 7-30)
 late postoperative period (>30 days)
GRADES OF SHALLOW AC
GRADES OF SHALLOW AC
GRADES OF SHALLOW AC
Flat anterior chamber with hypotony

 Most commonly results from over filtration or bleb leaks

 Immediate postoperative hypotony is often accompanied by choroidal effusions or
detachment
Bleb leak

 A large soft contact lens, a symblepharon ring or the Simmons shell may impede aqueous
flow through the sclerostomy, encourage any buttonhole to heal, and help form the
chamber sooner.
 It is more likely if no intraoperative antimetabolite was used.
• In small wound dehiscence, either topical cyanoacrylate or tissue glue covered with a
bandage contact lens or a compression suture can be attempted.
Bleb leak

• The compression suture - by 9-0 nylon attached at the corneal limbus, fashioned in an X-
crossing at the leak site, and anchored in episcleral tissue posterior to the edge of the bleb.
• It can remain for several weeks before removal
FLAT ANTERIOR CHAMBER IN NORMOTENSIVE
AND HYPERTENSIVE EYES

 Normal or elevated IOPs with a flat anterior chamber indicate that excessive filtration is
not the cause of the flat chamber.
 The flat anterior chamber in such eyes is caused by increased volume or
 pressure behind the lens–iris diaphragm.
 Four mechanisms:
(1) pupillary block with an incomplete iridectomy
(2) expansion of the choroid or enlargement of the suprachoroidal space by blood or effusion
(3) increase in vitreous volume caused by blood or effusion
(4) the misdirection of aqueous
CILIARY BLOCK (MALIGNANT GLAUCOMA)
CILIARY BLOCK (MALIGNANT GLAUCOMA)
CILIARY BLOCK (MALIGNANT GLAUCOMA)