Abstract
Purpose :
Aqueous misdirection syndrome, also known as malignant glaucoma, is a rare but serious condition that can present after routine uncomplicated phacoemulsification procedure. Clinical presentations can be subtle and its fluctuating and recurrent nature makes diagnosis difficult. Its pathophysiology is not fully understood, posing therapeutic challenge. We report a case of aqueous misdirection-like presentation in a pseudophakic patient.
Methods :
Case report
Results :
A 68-year-old Caucasian woman with previous narrow anterior chamber (AC) angle treated with bilateral peripheral iridotomies on Brinzolamide eye drops presented with symptoms of anisometropia and a left eye (LE) myopic surprise a few months after an uncomplicated LE phacoemulsification procedure. Repeat biometry did not show shallow AC and intraocular pressure (IOP) was normal at initial presentation. However, 2 years and 7 months after the operation, IOP was raised. Topical cycloplegic and anti-glaucoma medications relieved signs and symptoms, but effect was temporary with fluctuating IOP. Nd: YAG laser capsulotomy with subsequent cyclodiode laser were performed with good effect on IOP control.
Conclusions :
Clinical presentation of aqueous misdirection syndrome may be subtle and can occur weeks to years after routine uncomplicated phacoemulsification surgery. Short axial lengths, hypermetropia, female gender and shallow anterior chamber depths (ACD) are known risk factors. Myopic surprise may be the only initial presenting sign, and measurements of ACD, IOP and gonioscopic examination are essential when clinicians are suspecting aqueous misdirection syndrome on patients who has had recent uneventful cataract surgery.
This is a 2021 ARVO Annual Meeting abstract.