Aqueous misdirection syndrome masking as myopic surprise following phacoemulsification surgery

Aqueous misdirection syndrome is a rare but serious condition that can present after routine phacoemulsification surgery. This report examines a case of myopic surprise following an uncomplicated left eye (LE) phacoemulsification surgery. The patient had previous bilateral peripheral iridotomies for narrow anterior chamber angles. Repeat biometry measurement of the pseudophakic LE did not show shallow anterior chamber, and intraocular pressure (IOP) was normal at initial presentation. However, approximately 3 years postoperatively, LE IOP was raised. Surgical management was considered as medical and laser procedures did not stop deterioration. Clinical presentation of aqueous misdirection syndrome may be subtle and can occur weeks to years after routine uncomplicated phacoemulsification surgery. Myopic surprise may be the only initial presenting sign. Patients who are at risk of aqueous misdirection syndrome should be followed up closely after cataract surgery with accurate gonioscopic assessments for early diagnosis and treatment to prevent optic nerve damage.

Aqueous misdirection after Nd:YAG goniopuncture in deep sclerectomy treated with Nd:YAG irido-zonulo-hyaloidotomy

Background: To report a case of aqueous misdirection after goniopuncture in deep sclerectomy treated with Nd:YAG laser irido-zonulo-hyaloidotomy. Case presentation: About 72 years old patient with pseudoexfoliation glaucoma who underwent deep sclerectomy, developed aqueous misdirection after Nd:YAG laser goniopuncture. Medical management failed and subsequent peripheral Yag laser iridotomy to expose the zonules coupled with laser zonulo-hyaloidotomy was done and an instant gush of aqueous and vitreous substance prolapse through the iridotomy was noticed. Later, the anterior chamber was deep and the pressure was controlled. Conclusions: Aqueous misdirection can occur after Nd:YAG laser goniopuncture. Nd:YAG laser irido-zonulo-hyaloidotomy can be effective in breaking the attack.

Aqueous misdirection syndrome following ab interno gelatin stent can be managed successfully with anterior vitrectomy approach

Introduction: Minimally invasive glaucoma surgery (MIGS) is a relatively new surgical technique available to glaucoma surgeons. The ab interno gelatin XEN stent (XEN®45, Allergan Inc., CA, USA) drains aqueous into the subconjunctival space and is theoretically less invasive than trabeculectomy and therefore carries less risk. Aqueous misdirection syndrome (AMS) is a rare but well-recognised complication of any intraocular surgery. Only four cases have been reported following XEN stents but their management and outcome was not discussed. We present a case of AMS following XEN implantation including management and outcome. Case presentation: A 78 year old lady with an axial length of 21.27 mm and a previous episode of acute angle closure glaucoma was treated with laser peripheral iridectomy and, later, clear crystalline lens extraction. However, she continued to have high intraocular pressure (IOP) and a shallow anterior chamber. Despite medical therapy, she developed worsening glaucoma. She had XEN implantation to her right eye with no intraoperative complication. Unfortunately, she developed signs of AMS. Medical and laser zonulohyaloidectomy failed to resolve the condition. She then had surgical iriodozonulohyaloidectomy and anterior vitrectomy which resolved the AMS. Discussion: Management of AMS has been well documented. However, incidence following novel surgical techniques, such as XEN implantation, is not well reported. We have shown that AMS following XEN can be successfully treated using an anterior approach.

Simultaneous bilateral aqueous misdirection following certolizumab therapy for rheumatoid arthritis

Aqueous misdirection syndrome is a rare, incompletely understood, sight-threatening eye condition that is difficult to diagnose and treat. We present a case of simultaneous bilateral aqueous misdirection following the administration of certolizumab in a 41-year-old women with rheumatoid arthritis and no known risk factors. To our knowledge, aqueous misdirection has not previously been associated with the use of tumour necrosis factor-alpha inhibitors.

CASE REPORT Management Cataract Complication and Malignant Glaucoma After Viterectomy Surgery and C3F8 Gas Tamponnade

Report a clinical presentation of patient with rhematogenous retinal detachment by viterectomy and high myopia with C3F8 gas tamponade. A 20-year-old female came into the outpatient clinic with blurry vision on the right eye as her chief complaint. It had been happening since 1 month ago. In examination, we found result of visual acuity RE 1/300 and LE 1/60 correction Sferis-16.00 5/7.5, anterior segment in a normal range. In posterior segment evaluation, there were RE detachment on 3-11 o’clock position and hole on 6 and 8 o’clock position. Then we performed vitrectomy and C3F8 gas tamponade. The first day after surgery, we found IOP 19,6 mmHg and Von Herrick III. Then after the second day, we found a pain on the right eye, TIO 47.3 mmHg, Von Herrick 0 and opaque lens. Then we performed iridectomy and intravitreal gas aspiration. After it were done, we found IOP 17.3 mmHg and Von Herrick 0. In anterior segment OCT evaluation, we found a narrow angle anterior segment. Then we planned to do a cataract extraction with using viscoelastic to perform the anterior chamber.Malignant glaucoma can occur in cases after vitrectomy action due to aqueous misdirection and emphasis on gas expansion on tamponade. Cataract extraction and gas aspiration can help open the anterior chamber and the intraocular pressure returns to normal