Three days after encircling scleral buckling with extensive cryotherapy for a rhegmatogenous detachment, a 68-year-old hypertensive patient develops corneal oedema, aqueous flare with cells, a small hypopyon, rubeosis iridis and raised intraocular pressure. The retina remains flat. What is the most likely mechanism?

• A Postoperative infectious endophthalmitis from buckle erosion
• B Anterior segment ischaemia from interruption of ciliary circulation ✓
• C Toxic reaction to residual subconjunctival antibiotic
• D Acute postoperative uveal effusion syndrome

Explanation

Anterior segment ischaemia follows extensive buckling combined with detachment or cautery of multiple rectus muscles and widespread cryotherapy, especially in elderly patients with vascular disease such as hypertension or diabetes. Ischaemia of the anterior uvea produces corneal oedema, fibrinous uveitis, hypopyon, neovascularisation and pressure changes that mimic infection, but the retina is flat and pain is disproportionate. Management is intensive steroids and systemic support rather than antibiotics.

Reference: Ryan's Retina, 6th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.