Infusion misdirection syndrome: current state of issue

Abstract

Relevance. Description of the infusion misdirection syndrome (IMS) was first published by R. Mackool in 1993. Nowadays many definitions of this syndrome are used by different authors that sometimes leads to confusion in understanding of clinical situations. Purpose. To summarize current understanding of the etiological factors, the specific pathogenic mechanisms of the infusion misdirection syndrome and possible treatment and prophylaxis methods of this condition. Material and methods. The PubMed web platform was used to find relevant studies since 1992 until 2022 using the following keywords: infusion misdirection syndrome, aqueous misdirection syndrome, intraoperative fluid misdirection syndrome, subcapsular fluid entrapment, acute intraoperative rock-hard eye syndrome. Search query found 167 papers, only 10 papers were relevant for the topic of search. Other publications were also considered as a potential source of information when referenced in relevant articles. Results. Authors of this article support the opinion that IMS etiologically relates to irido-zonular dehiscence and disturbance of the vitreolenticular interface barrier. Manifestations of the IMS include retrocapsular lens fragments migration after uneventful phacoemulsification with intact capsular bag and vitreous hydration. The most severe IMS consequence is the acute intraoperative rock-hard eye syndrome. In intact capsules the zonular dehiscence may enable fluid to flow in an unusual pattern, facilitating its penetration to the posterior chamber. The role of vitreolenticular interface should be mentioned in the aspect of the IMS. Anterior hyaloid membrane detachment or Wieger's ligament destruction are risk factors for IMS development during phacoemulsification. Conclusion. IMS is the object of insufficient research in ophthalmology nowadays. There are many descriptions of IMS in literature, but no solutions to avoid this hidden complication of cataract surgery are proposed. Key words: infusion misdirection syndrome, phacoemulsification, irido-zonular dehiscence, vitreolenticular interface.