In routine cataract surgery, an anterior chamber maintainer (ACM) can be used to ensure globe stability and a deep operative field by providing continuous fluid infusion through a dedicated limbal incision. Unlike the intermittent irrigation provided by a phacoemulsification handpiece, an ACM delivers a constant inflow of balanced salt solution (BSS), which effectively counteracts fluid egress from the main incision and helps prevent surge, the sudden shallowing of the chamber that can occur during high-vacuum aspiration. This steady-state pressure protects the corneal endothelium and minimizes fluctuations of the posterior capsule, reducing the risk of intraoperative rupture. Additionally, the ACM allows the surgeon to perform specific maneuvers, such as cortical aspiration or IOL insertion, without the continuous use of expensive ophthalmic viscosurgical devices (OVDs). By maintaining a pressurized anterior segment through gravity-fed or pump-assisted infusion, the ACM facilitates a “visco-free” surgical environment that can be more cost-effective and reduces the risk of postoperative intraocular pressure spikes caused by retained OVD.
