•Dilation of the pupil.

•Topical corticosteroids.

47.2Surgical Technique

If the patient is known to have rubeosis, inject bevacizumab into the AC the day before surgery.

47.2.1 Liquid Blood

The surgeon can choose between monomanual and bimanual techniques.

47.2.1.1 Monomanual Technique

•Make a paracentesis at a convenient location (see Sect. 39.1). The paracentesis should be slightly larger than the diameter of the cannula to be used.

•Use a cannula on a 5 or 10 ml syringe.

–Smaller syringes can also be used, but this will increase the frequency of cannula reinsertion into the AC.

•Irrigate the AC; gape the wound by pressing down on its lower lip with the cannula.

Pearl

When irrigating the AC, never use too strong a jet stream, and never direct it toward the endothelium.

–In a phakic eye, be careful not to injure the lens. Avoiding lens damage may be somewhat difficult if the blood is thick and completely blocks the view of the lens.

–Once most of the blood is out, carefully irrigate the posterior chamber. It can be a reservoir, releasing more blood postoperatively.

47.2.1.2 Bimanual Technique

•Insert an AC maintainer and open the infusion.

Q&A

Q What type of AC maintainer is the most optimal?

A As long as it is able to supply sufficient amounts of infusion, it does not matter. However, the “threaded” type (see Sect. 39.1) has a reduced risk of accidentally being pulled out as the surgeon rotates the eye during the irrigation.