Oliver Lau, Jessica Montfort, Sai Win, Benjamin Sim, Olivia Fox, Michael Wei, Ashima Aggarwala, Claire Ruan, Gaurav Bhardwaj, Ravjit Singh, Allan Bank, Minas Coroneo, Ashish Agar, Ian Francis

Purpose:
To describe a newly recognised entity, the Acute Intraoperative Rockhard Eye Syndrome (AIRES), and its management in six cases. AIRES is character-ised by anterior chamber (AC) shallowing and an acute, marked intraocular pressure (IOP) increase during phacoemulsification cataract surgery, preclud-ing further surgery, but with no evidence of choroidal haemorrhage.

Method:
Prospective, consecutive, non-comparative, interventional case series of phacoemulsification cataract surgery. Management was with emergent intraoperative pars plana needle aspiration (PPNA) of retrolenticular fluid with a 23-gauge needle attached to a 3 mL syringe. Follow-up was at 1 day, 1 week and 1 month. Resolution of AIRES, posterior segment integrity, and corrected distance visual acuity (CDVA) were documented.

Results:
Six patients with AIRES were identified in 298 cases. Mean age was 81 years; all were female with nuclear cataracts of grade 2–4 (LOCS II). In each case, PPNA successfully and immediately normalised AC depth and IOP, and completion of surgery proceeded uneventfully. Follow-up was 100%. Postoperative fundoscopy revealed transient mild vitreous haemor-rhage in one patient; new posterior vitreous detach-ment in one patient; and localised vitreous syneresis in three patients. CDVA in 5 of 6 patients was 6/4 at 1 month.

Conclusion:
AIRES presents with AC shallowing and marked IOP elevation during cataract surgery, occur-ring in 2% of cases in this series. PPNA effectively resolved each case immediately and was not associated with any significant complications.