Abstract
Abstract
Background
Persistent wound leakage after repeated needle-based anterior chamber paracentesis (ACP) has been reported. We describe progressive choroidal detachment (CD) with hemorrhagic suprachoroidal fluid associated with persistent leakage from a blade-created ACP wound. Procedural and repair videos, B-scan ultrasonography, and computed tomography documented wound findings and the clinical course.
Case presentation:
A 63-year-old Japanese woman with a pseudophakic right eye underwent her 24th intravitreal aflibercept injection for neovascular age-related macular degeneration. A markedly tense globe during cotton-swab compression prompted ACP under an operating microscope using a straight microvitreoretinal knife (0.9-mm blade diameter) also used for corneal side-port creation during cataract surgery. The same surgeon had performed four previous ACPs, generally in the same temporal corneal region. Retrospective video review identified blade entry through a pre-existing focal corneal opacity. The next day, visual acuity was hand motions, Goldmann applanation pressure was below 5 mmHg, and the anterior chamber was shallow. The corneal wound was Seidel-positive, whereas the scleral injection site was negative. Ultrasonography and computed tomography showed extensive CD. Following referral arrangements, she was assessed at a university hospital six days after ACP; CD had progressed, and surgical repair was performed that day. Stromal hydration failed, but a single 10 − 0 nylon suture achieved watertight closure. External drainage of hemorrhagic suprachoroidal fluid was followed by pars plana vitrectomy with temporary perfluorocarbon liquid to facilitate drainage of residual posterior fluid. CD resolved by postoperative day 14. Over nearly 12 months, eight faricimab injections without ACP were administered without recurrent leakage, hypotony, or CD. Final best-corrected visual acuity was 0.15 (approximately 20/133), pressure was 15 mmHg, and macular intraretinal fluid persisted.
Conclusions
Blade-created ACP wounds can remain non-self-sealing. Apparent cessation of aqueous egress does not confirm watertight closure. Persistent Seidel-positive hypotony, particularly with a shallow anterior chamber or early CD, should prompt consideration of early definitive wound closure and prompt posterior-segment assessment. For repeated ACP, deliberate selection of a different entry site, avoiding identifiable previous ACP wounds and visibly scarred or opaque tissue, is advisable.