A 68-year-old patient undergoes phacoemulsification and in-the-bag IOL implantation. On day 1 postoperatively, the anterior chamber is flat, the IOP is 4 mmHg, and the wound is well apposed. Ultrasound biomicroscopy shows choroidal detachments. The most likely diagnosis is:

• A Malignant (aqueous misdirection) glaucoma
• B Overfiltration from wound leak leading to hypotony and choroidal detachment ✓
• C Pupillary block from IOL-iris contact
• D Delayed suprachoroidal hemorrhage

Explanation

Postoperative flat anterior chamber with low IOP and choroidal detachments in the early postoperative period most commonly results from overfiltration through the wound or from a wound leak (Seidel positive). Choroidal detachments (transudative) form secondary to hypotony; aqueous is produced faster than it can be replaced, causing choroidal expansion. Malignant glaucoma (aqueous misdirection) presents with flat AC and HIGH IOP (misdirection of aqueous posteriorly). Treatment for hypotony-related choroidal detachment is conservative initially; large or 'kissing' choroidal detachments require surgical drainage.

Reference: Khurana Comprehensive Ophthalmology, 7th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.