use of an AC maintainer in Cataract Surgery

An anterior chamber maintainer is an additional infusion cannula which is inserted via the cornea or limbus in order to create a strong inflow of balanced salt solution. In a typical cataract surgery there is one source of fluid inflow: from the phaco tip’s side ports. In this case the AC maintainer is an additional inflow source which helps balance the two outflow paths: down the throat of the phaco needle and from incision leakage.

There are a few important considerations with an AC maintainer:

  • the incision for it should be made away from the phaco incision and paracentesis
  • the fit of the cannula must be snug so it does not fall out
  • the cannula should not be aimed at the corneal endothelium

The cataract cases which benefit the most from an AC maintainer are those where the posterior capsule is violated. This infusion prevents the anterior chamber pressure from falling and as a result there is minimal or no vitreous prolapse. Also some complex anterior segment reconstruction cases benefit from an AC maintainer such as suturing-in an IOL in a unicameral, post-vitrectomy eye.

The anonymous resident operating in this video is from Europe and the techniques shown are quite good. This young surgeon will certainly blossom into a very talented and accomplished surgeon in the near future. The video is sped up but is still about 15 minutes.

Click below to see a resident case with an AC maintainer:


  1. What exactly is the set on the fluid side of thing? I know how to place a maintainer canula, but what fluid are you using and how are you adjust the flow? Is this a bag of BSS that set up like an IV drip or are you using another method? Thanks in advance.
    -Tom Obertynski

    1. yes, usually a bag of BSS is attached to a tubing line and then to the AC maintainer. you can adjust the IV pole height to determine the infusion pressure for the AC maintainer

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