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Jenny Wang, Elena Bitrian; Predisposing Factors and Treatment Outcomes of Aqueous Misdirection. Invest. Ophthalmol. Vis. Sci. 2018;59(9):2741. doi: https://doi.org/.
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© ARVO (1962-2015); The Authors (2016-present)
Aqueous misdirection is a rare form of secondary angle closure glaucoma characterized by a shallow or flat anterior chamber without pupillary block. It is classically thought to result from posterior misdirection of aqueous into or behind the vitreous, though the precise etiology remains poorly understood. We report a series of cases of aqueous misdirection with clinical characteristics and treatment outcomes.
A retrospective study of patients with aqueous misdirection at Mayo Clinic in Rochester between 2013 and 2017 was performed. Diagnostic criteria were defined as central and peripheral anterior chamber shallowing with a patent peripheral iridotomy or slit-lamp exam excluding pupillary block in the absence of choroidal effusion or hemorrhage. Twelve subjects and 13 eyes where identified. Data collected included age, sex, axial length, lens status, prior glaucoma diagnosis, surgical procedure preceding aqueous misdirection, treatment modality, and intraocular pressure (IOP) before and after treatment.
Of the 12 subjects identified, 8 were female. Mean age at presentation was 66. Nine eyes had the diagnosis of angle closure glaucoma, 2 pseudoexfoliation, 1 neovascular glaucoma, and 1 had no prior diagnosis of glaucoma. All patients were pseudophakic at presentation. Mean axial length was 21.08±1.97mm. The surgical procedure that preceded diagnosis was cataract extraction in 7 eyes, combined cataract extraction with Ahmed in 1 eye, Ahmed alone in 1 eye, and trabeculectomy in 2 eyes. 2 patients presented without preceding ocular surgery. None of the cases responded to medical therapy alone. Definitive treatment was Nd:YAG capsulotomy/vitreolysis in 7 eyes, trabeculectomy in 2 eyes, pars plana vitrectomy with iridectomy/zonulectomy in 2 eyes, anterior vitrectomy with iridectomy/zonulectomy in 1 eye, and pars plana vitrectomy with IOL explantation in 1 eye. Mean IOP at diagnosis was 37±19 mmHg and after definite treatment was 15±3 mmHg.
Aqueous misdirection was seen following a variety of anterior segment procedures, with cataract extraction being most common. Although Nd:YAG capsulotomy/vitreolysis can be effective, vitrectomy was still definitive treatment in refractory cases.
This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.
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