Aqueous misdirection syndrome as a complication of neodymium:YAG posterior capsulotomy

ABSTRACT

To highlight aqueous misdirection syndrome as a rare complication of NdYAG posterior capsulotomy performed for posterior capsule opacification [PCO]. Case report. A 50 year old psuedophakic female who had NdYAG posterior capsulotomy six days before for posterior capsule opacification developed rise in intraocular pressure associated with flat anterior chamber. After brief history and a detailed ocular examination full-thickness iridotomy was performed with NdYAG laser. Patent iridotomy did not reduce the intraocular pressure. A-scan ultrasonography was performed which showed aqueous pockets in vitreous, leading to diagnosis of aqueous misdirection syndrome. Medical therapy comprising atropine, 0.5% timolol, mannitol, and acetazolamide was given. Anterior vitrectomy to disrupt un-interrupted anterior vitreous face was carried out to reduce vitreous volume and to reform anterior chamber. Medical and surgical therapy normalized intraocular pressure and resolved symptoms of aqueous misdirection syndrome. Aqueous misdirection syndrome can be a rare and serious complication of NdYAG posterior capsulotomy where early recognition is crucial. The role of echographic examination is also emphasized which must be performed as soon as possible