Frequency and Pattern of Postoperative Shallow AC Following Cataract Surgery Performed by Supervised Young Surgeons with Less Than 100 Cases of Surgical Experience

Background: Postoperative shallow anterior chamber is an important early complication of manual small-incision cataract surgery (MSICS). Improper tunnel construction and inadequate wound closure may increase its occurrence during the initial surgical learning period. To determine the frequency, pattern, causes and outcome of postoperative shallow anterior chamber following MSICS performed by supervised young surgeons with experience of fewer than 100 cases. Material and Methods: This prospective observational study included 300 eyes undergoing MSICS at a tertiary eye hospital. All procedures were performed by young surgeons under supervision. Anterior chamber depth, intraocular pressure and wound integrity were assessed on the first postoperative day. Shallow anterior chamber was graded according to the extent of iridocorneal proximity or contact. Its probable cause, management and final outcome were recorded. Associated operative factors were analysed using the Chi-square test or Fisher’s exact test. Odds ratios with 95% confidence intervals were calculated. Results: Postoperative shallow anterior chamber was observed in 16 eyes (5.3%). Grade 1 shallowing was present in nine eyes (3.0%), Grade 2 in five eyes (1.7%) and Grade 3 in two eyes (0.7%). Wound leak was the commonest cause and was found in nine affected eyes (56.3%). Hypotony without an evident leak was present in three eyes (18.8%). Eleven eyes (68.8%) required surgical intervention. Wound hydration or resuturing was performed in nine eyes and anterior chamber reformation in two eyes. Tunnel-related problems, premature entry, difficult nucleus delivery and poor wound integrity showed significant associations with shallow anterior chamber. All anterior chambers were formed after treatment. No persistent shallow chamber was observed. Conclusion: Postoperative shallow anterior chamber was uncommon and was usually mild. Wound leakage and faulty tunnel construction were the main contributory factors. Careful wound assessment and timely intervention resulted in satisfactory anatomical recovery.

Keywords: Anterior chamber, cataract surgery, tunnel, shallow anterior chamber, surgical training, wound leak.