Management of recurrent aqueous misdirection by anterior segment surgeon after failed pars plana posterior vitrectomy

Aqueous misdirection (AM) is a dreaded complication, but fortunately quite rare. It usually occurs after intervention for angle closure glaucoma. When pharmacotherapy and/or laser interventions are unsuccessful, then the surgical management hitherto most commonly undertaken is pars plana posterior vitrectomy. We describe the management of recurrent AM via the anterior route, when it occurred following relapse as pars plana posterior vitrectomy failed to result in long-term normalization of anterior chamber and intraocular pressure. Anterior vitrector with anterior vitrectomy settings was used by a glaucoma specialist to carry out the procedure.

A clinical analysis on malignant glaucoma after phacoemulsification with the placement of an intraocular lens / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To investigate the clinical features and stepwise treatment method of malignant glaucoma after phacoemulsification.<p>METHODS: A retrospective analysis was made on clinical data of 16 cases(18 eyes)with malignant glaucoma after phacoemulsification with in-the-bag IOL placemen from June, 2010 to May, 2018 in Gansu Provincial Hospital. Malignant glaucoma was treated by a stepwise treatment method. First, the combination of ciliary muscle paralysis and hypotensive drugs were used to treat malignant glaucoma, followed by laser iridozonulohyaloidotomy, then anterior chamber reformation, and finally with surgical iridozonulohyaloidovitrectomy. Data of diopter, anterior chamber depth, anterior chamber angle and intraocular pressure were analyzed before and after treatment.<p>RESULTS: Malignant glaucoma tends to occur after phacoemulsification and in-the-bag IOL placement 4.1±2.3wk. One eye received drug therapy alone,7 eyes received YAG laser crystal posterior capsule incision, 6 eyes received anterior chamber angioplasty, and 4 eyes received crystal posterior capsule incision+front vitrectomy. After treatment, the diopter was +0.48±0.89D, the anterior chamber depth was 3.14±0.33mm, the intraocular pressure was 15.3±4.7mmHg, 14 eyes with wide anterior chamber angle.<p>CONCLUSION: The stepwise treatment of malignant glaucoma after phacoemulsification showed a reduction in myopia, deepening of the central anterior chamber, opening of the anterior chamber, and decreased intraocular pressure.