Page 84 - The Book Pi in eye

Rajesh Khanna, MD

wounds, larger wound openings, and wound burns, improper
hydration to close wound, improper stitching or lack of stitching the
wound.
Seidel’s test is a good way to detect the leak. Colored dye is
instilled on the eye and blue light is shone. Colorless fluid escaping
the eye is detected against the blue background. In extreme self-
evident cases the anterior chamber may collapse, the iris may touch
the cornea and even extrude through the wound. Luckily modern
techniques have decreased this complication.

Increased Intraocular Pressure
We know glaucoma as being associated with increased pressure of
the eye. After surgery, hyper inflating the eye with fluid or leaving
viscoelastic jelly could increase the load on the drainage. The drainage
channels could also become compromised by trauma, inflammation,
and mechanical blockage (viscoelastic jelly, red and white blood cells,
or lens fibers) leading to increased eye pressure.
Mild increase in eye pressure can resolve on its own, moderate
requires pressure lowering drops or pills. Extreme spikes may require
burping of the wound under sterile conditions to release the fluid on
viscoelastic jelly.

Vitritis
Similar to cells in anterior chamber cells may invade vitreous
chamber affecting vision. More likely with posterior capsular rupture,
prolonged surgery, lens pieces in the vitreous jelly and systematic
diseases. Early onset can distinguish it from infection. Mild cases are
treated with steroidal and non-steroidal drops. Vitrectomy is required
in extreme cases that affect transmission of light and hence vision.

Cystoid Macular Edema
Fluid may accumulate in the macula. It appears in a flower shaped
pattern due to the unique architecture of the macula. Diabetes,
posterior capsule tear, vitrous loss, vitritis are the usual suspects. It
can be detected based on suspicion aided by OCT, flouroscien
angiography, and later even on direct macular examination. Treatment
starts with steroid and nonsteroidal drops and may proceed to intra-
vitral steroid injection. If a membrane on macula develops, membrane
peel with vitrectomy is an option.

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