Skip to main content

Advertisement

SpringerLink
Log in

Current Concepts on Aqueous Misdirection

  • Diagnosis and Monitoring of Glaucoma (J Kammer, Section Editor)
  • Published:
Current Ophthalmology Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

To review the current understanding of the pathophysiology and management of aqueous misdirection syndrome.

Recent Findings

Aqueous misdirection syndrome represents a spectrum of disorders that converge on a common pathway of increasing posterior segment pressure and secondary angle closure glaucoma. Although the etiology of aqueous misdirection remains unclear and is likely multifactorial, recent data supports choroidal expansion as an inciting event in the pathogenesis of the syndrome. As such, the term aqueous misdirection may be a misnomer. Some would argue that the use of terminology such as acute and chronic fluid misdirection may better characterize the full spectrum of the disease process as it is known to occur at varying time points from intraoperatively to years postoperatively. Chronic fluid misdirection most commonly occurs following incisional surgery for primary angle closure glaucoma but has also been associated with numerous laser and invasive ocular surgeries. Regardless of the mechanism, many patients require incisional surgery for complete resolution. Recent literature suggests that variants of anterior vitrectomy with irido-zonulo-hyaloidectomy offer comparable rates of success when compared to pars plana vitrectomy.

Summary

Aqueous misdirection is a rare, and incompletely understood, form of secondary glaucoma characterized by diffuse shallowing of the anterior chamber in the presence of a patent iridotomy/iridectomy. It represents a spectrum of disorders that result in a cycle of increasing posterior segment pressure and secondary angle closure glaucoma that is notoriously refractory to medical intervention. Regardless of the mechanism, the syndrome can be well managed with incisional procedures that disrupt the anterior hyaloid face, debulk the vitreous, and establish an anterior-posterior communication either by a core or more complete anterior vitrectomy.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

Abbreviations

AC:

Anterior chamber

AFMS:

Acute fluid misdirection syndrome

AMS:

Aqueous misdirection syndrome

BCVA:

Best corrected visual acuity

CAIs:

Carbonic anhydrase inhibitors

CFMS:

Chronic fluid misdirection syndrome

CPC:

Cyclophotocoagulation

I/A:

Irrigation and aspiration

IOL:

Intraocular lens

IOP:

Intraocular pressure

IZH:

Irido-zonulo-hyaloidectomy

LPI:

Laser peripheral iridotomy

OCT:

Optical coherence tomography

PACG:

Primary angle closure glaucoma

PC:

Posterior chamber

PC-AHM:

Posterior chamber and anterior hyaloid membrane

PPV:

Pars plana vitrectomy

PXS:

Pseudoexfoliation syndrome

UBM:

Ultrasound biomicroscopy

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Tomey KF, Traverso CE. The glaucomas in aphakia and pseudophakia. Surv Ophthalmol. 1991;36(2):79–112. https://doi.org/10.1016/0039-6257(91)90124-x.

    Article  PubMed  Google Scholar 

  2. Ruben S, Tsai J, Hitchings R. Malignant glaucoma and its management. Br J Ophthalmol. 1997;81(2):163–7.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Shen CJ, Chen YY, Sheu SJ. Treatment course of recurrent malignant glaucoma monitoring by ultrasound biomicroscopy: a report of two cases. Kaohsiung J Med Sci. 2008;24(11):608–13. https://doi.org/10.1016/S1607-551X(09)70023-3.

    Article  PubMed  Google Scholar 

  4. von Graefe A. Beitrage zur pathologie und therapie des glaukoms. Arch Ophthalmol 1869;15. Arch Ophthalmol. 1869;15.

  5. Debrouwere V, Stalmans P, Van Calster J, Spileers W, Zeyen T, Stalmans I. Outcomes of different management options for malignant glaucoma: a retrospective study. Graefes Arch Clin Exp Ophthalmol. 2012;250(1):131–41. https://doi.org/10.1007/s00417-011-1763-0.

    Article  PubMed  Google Scholar 

  6. Halenda KM, Bollinger KE. Current concepts on aqueous misdirection. Curr Ophthalmol Rep. 2019;7(2):150–9. https://doi.org/10.1007/s40135-019-00211-2.

    Article  Google Scholar 

  7. Grzybowski A, Kanclerz P. Acute and chronic fluid misdirection syndrome: pathophysiology and treatment. Graefes Arch Clin Exp Ophthalmol. 2018;256(1):135–54. https://doi.org/10.1007/s00417-017-3837-0.

    Article  PubMed  Google Scholar 

  8. • Thompson AC, Vu DM, Postel EA, Challa P. Factors impacting outcomes and the time to recovery from malignant glaucoma. Am J Ophthalmol. 2020;209:141–50. https://doi.org/10.1016/j.ajo.2019.07.023A retrospective case series of sixty-four eyes that identifies factors associated with successful treatment of AMS such as early vitrectomy, use of oral carbonic anhydrase inhibitors, and anterior chamber reformation to shorten anatomic recovery and/or hasten IOP reduction.

    Article  PubMed  Google Scholar 

  9. •• Balekudaru S, Choudhari NS, Rewri P, et al. Surgical management of malignant glaucoma: a retrospective analysis of fifty eight eyes. Eye. 2017;31(6):947–55. https://doi.org/10.1038/eye.2017.32A large retrospective analysis of fifty-eight eyes that demonstrates high anatomic success and low recurrence rates of three surgical techniques including lensectomy and anterior vitrectomy (Group 1), vitrectomy and AC reformation (Group 2), and vitrectomy-phacoemulsficiation-vitrectomy (Group 3).

    Article  PubMed  PubMed Central  Google Scholar 

  10. Dervenis N, Mikropoulou AM, Dervenis P, Lewis A. Anterior segment approach for the surgical management of aqueous misdirection syndrome. J Cataract Refract Surg. 2017;43(7):877–8. https://doi.org/10.1016/j.jcrs.2017.06.018.

    Article  PubMed  Google Scholar 

  11. Eltz H, Gloor B. Trabeculectomy for angle block glaucoma—successes and failures. Klin Monatsbl Augenheilkd. 1980;177(11):556–61. https://doi.org/10.1055/s-2008-1057687.

    Article  PubMed  Google Scholar 

  12. Little BC, Hitchings RA. Pseudophakic malignant glaucoma: Nd:YAG capsulotomy as a primary treatment. Eye. 1993;7(1):102–4. https://doi.org/10.1038/eye.1993.21.

    Article  PubMed  Google Scholar 

  13. Pathak-Ray V, Bansal AK, Malhotra V. Bilateral aqueous misdirection syndrome after routine cataract surgery in angle closure. J Cataract Refract Surg. 2019;45(12):1826–9. https://doi.org/10.1016/j.jcrs.2019.07.034.

    Article  PubMed  Google Scholar 

  14. Azuara-Blanco A, Burr J, Ramsay C, et al. Effectiveness of early lens extraction for the treatment of primary angle-closure glaucoma (EAGLE): a randomised controlled trial. Lancet. 2016;388(10052):1389–97. https://doi.org/10.1016/S0140-6736(16)30956-4.

    Article  PubMed  Google Scholar 

  15. Duy TP, Wollensak J. Ciliary block (malignant) glaucoma following posterior chamber lens implantation. Ophthalmic Surg. 1987;18(10):741–4.

    PubMed  Google Scholar 

  16. Halkias A, Magauran DM, Joyce M. Ciliary block (malignant) glaucoma after cataract extraction with lens implant treated with YAG laser capsulotomy and anterior hyaloidotomy. Br J Ophthalmol. 1992;76(9):569–70. https://doi.org/10.1136/bjo.76.9.569.

    Article  PubMed  PubMed Central  Google Scholar 

  17. El-Harazi SM, Fellman RL, Feldman RM, Dang YNT, Chuang AZ. Bleb window cryopexy for the management of oversized, misplaced blebs. J Glaucoma. 2001;10(1):47–50. https://doi.org/10.1097/00061198-200102000-00009.

    Article  PubMed  Google Scholar 

  18. Zhou C, Qian S, Yao J, et al. Clinical Analysis of 50 Chinese Patients with aqueous misdirection syndrome: a retrospective hospital-based study. J Int Med Res. 2012. https://doi.org/10.1177/147323001204000437.

  19. Rumelt S, Bersudsky V, Blum-Hareuveni T, Rehany U. Preexisting and postoperative glaucoma in repeated corneal transplantation. Cornea. 2002;21(8):759–65. https://doi.org/10.1097/00003226-200211000-00005.

    Article  PubMed  Google Scholar 

  20. Price FW, Price MO. Descemet’s stripping with endothelial keratoplasty in 200 eyes: early challenges and techniques to enhance donor adherence. J Cataract Refract Surg. 2006;32(3):411–8. https://doi.org/10.1016/j.jcrs.2005.12.078.

    Article  PubMed  Google Scholar 

  21. Foreman-Larkin J, Netland PA, Salim S. Clinical management of malignant glaucoma. J Ophthalmol. 2015;2015:1–6. https://doi.org/10.1155/2015/283707.

    Article  Google Scholar 

  22. Arya SK, Sonika, Kochhar S, Kumar S, Kang M, Sood S. Malignant glaucoma as a complication of Nd:YAG laser posterior capsulotomy. Ophthalmic Surg Lasers Imaging. 2004;35(3):248–50.

  23. Azuara-Blanco A, Dua HS. Malignant glaucoma after diode laser cyclophotocoagulation. Am J Ophthalmol. 1999;127(4):467–9. https://doi.org/10.1016/s0002-9394(98)00359-6.

    Article  PubMed  Google Scholar 

  24. Macken P, Buys Y, Trope GE. Glaucoma laser suture lysis. Br J Ophthalmol. 1996;80(5):398–401. https://doi.org/10.1136/bjo.80.5.398.

    Article  PubMed  PubMed Central  Google Scholar 

  25. Wand M, Schuman JS, Puliafito CA. Malignant glaucoma after contact transscleral Nd: YAG laser cyclophotocoagulation. J Glaucoma. 1993;2(2):110–1.

    Article  PubMed  Google Scholar 

  26. Sahay P, Maharana PK, Sharma N, Titiyal JS. Post laser-assisted in situ keratomileusis keratomycotic malignant glaucoma. BMJ Case Rep. 2017;2017. https://doi.org/10.1136/bcr-2017-222525.

  27. Angmo D, Nayak B, Gupta V. Post-strabismus surgery aqueous misdirection syndrome. Case Rep. 2015;2015. https://doi.org/10.1136/bcr-2015-210489.

  28. Montolío Marzo S, Lanzagorta Aresti A, Davó Cabrera JM, Alfonso Muñóz EA, Piá Ludeña JV, Palacios PE. Malignant glaucoma after XEN45 implant. Arch Soc Esp Oftalmol Engl Ed. 2019;94(3):134–7. https://doi.org/10.1016/j.oftale.2018.10.014.

    Article  Google Scholar 

  29. Yook E, Vinod K, Panarelli JF. Complications of micro-invasive glaucoma surgery. Curr Opin Ophthalmol. https://doi.org/10.1097/ICU.0000000000000457.

  30. Schlenker MB, Gulamhusein H, Conrad-Hengerer I, et al. Efficacy, safety, and risk factors for failure of standalone ab interno gelatin microstent implantation versus standalone trabeculectomy. Ophthalmology. 2017;124(11):1579–88. https://doi.org/10.1016/j.ophtha.2017.05.004.

    Article  PubMed  Google Scholar 

  31. Merritt JC. Malignant glaucoma induced by miotics postoperatively in open-angle glaucoma. Arch Ophthalmol. 1977;95(11):1988–9. https://doi.org/10.1001/archopht.1977.04450110082006.

    Article  PubMed  Google Scholar 

  32. Rieser JC, Schwartz B. Miotic-induced malignant glaucoma. Arch Ophthalmol. 1972;87(6):706–12. https://doi.org/10.1001/archopht.1972.01000020708018.

    Article  PubMed  Google Scholar 

  33. Brooks AM, Harper CA, Gillies WE. Occurrence of malignant glaucoma after laser iridotomy. Br J Ophthalmol. 1989;73(8):617–20. https://doi.org/10.1136/bjo.73.8.617.

    Article  PubMed  PubMed Central  Google Scholar 

  34. Krix-Jachym K, Żarnowski T, Rękas M. Risk factors of malignant glaucoma occurrence after glaucoma surgery. J Ophthalmol. 2017;2017:1–6. https://doi.org/10.1155/2017/9616738.

    Article  Google Scholar 

  35. de Preobrajensky N, Mrejen S, Adam R, et al. 23-gauge transconjunctival sutureless vitrectomy: a retrospective study of 164 consecutive cases. J Fr Ophtalmol. 2010;33(2):99–104. https://doi.org/10.1016/j.jfo.2009.12.006.

    Article  PubMed  Google Scholar 

  36. Wang Z, Huang J, Lin J, Liang X, Cai X, Ge J. Quantitative measurements of the ciliary body in eyes with malignant glaucoma after trabeculectomy using ultrasound biomicroscopy. Ophthalmology. 2014;121(4):862–9. https://doi.org/10.1016/j.ophtha.2013.10.035.

    Article  PubMed  Google Scholar 

  37. Prata TS, Dorairaj S, Moraes CGD, et al. Is preoperative ciliary body and iris anatomical configuration a predictor of malignant glaucoma development? Clin Exp Ophthalmol. 2013;41(6):541–5. https://doi.org/10.1111/ceo.12057.

    Article  PubMed  Google Scholar 

  38. von der Lippe I, Küchle M, Naumann GO. Pseudoexfoliation syndrome as a risk factor for acute ciliary block angle closure glaucoma. Acta Ophthalmol. 1993;71(2):277–9. https://doi.org/10.1111/j.1755-3768.1993.tb05004.x.

    Article  Google Scholar 

  39. Chandler PA. Malignant glaucoma. Am J Ophthalmol. 1951;34(7):993–1000. https://doi.org/10.1016/0002-9394(51)91168-3.

    Article  PubMed  Google Scholar 

  40. Chalkias I-N, Chalkias E, Halkias A. Management of pseudophakic malignant glaucoma in sunset syndrome: a case report and literature review. Med Hypothesis Discov Innov Ophthalmol J. 2019;8(2):92–5.

    Google Scholar 

  41. Greenfield JA, Smiddy WE, Greenfield DS. Malignant glaucoma after laser peripheral iridotomy. J Glaucoma. 2019;28(3):e44–5. https://doi.org/10.1097/IJG.0000000000001145.

    Article  PubMed  Google Scholar 

  42. Trope GE, Pavlin CJ, Bau A, Baumal CR, Foster FS. Malignant glaucoma: clinical and ultrasound biomicroscopic features. Ophthalmology. 1994;101(6):1030–5. https://doi.org/10.1016/S0161-6420(94)31222-X.

    Article  PubMed  Google Scholar 

  43. Wirbelauer C, Karandish A, Häberle H, Pham DT. Optical coherence tomography in malignant glaucoma following filtration surgery. Br J Ophthalmol. 2003;87(8):952–5. https://doi.org/10.1136/bjo.87.8.952.

    Article  PubMed  PubMed Central  Google Scholar 

  44. Epstein DL, Hashimoto JM, Anderson PJ, Grant WM. Experimental perfusions through the anterior and vitreous chambers with possible relationships to malignant glaucoma. Am J Ophthalmol. 1979;88(6):1078–86. https://doi.org/10.1016/0002-9394(79)90420-3.

    Article  PubMed  Google Scholar 

  45. Shaffer RN, Hoskins HD. Ciliary block (malignant) glaucoma. Ophthalmology. 1978;85(3):215–21. https://doi.org/10.1016/S0161-6420(78)35669-4.

    Article  PubMed  Google Scholar 

  46. Kawasaki S, Suzuki T, Yamaguchi M, et al. Disruption of the posterior chamber-anterior hyaloid membrane barrier during phacoemulsification and aspiration as revealed by contrast-enhanced magnetic resonance imaging. Arch Ophthalmol Chic Ill 1960. 2009;127(4):465–70. https://doi.org/10.1001/archophthalmol.2008.594.

    Article  Google Scholar 

  47. Kawasaki S, Tasaka Y, Suzuki T, et al. Influence of elevated intraocular pressure on the posterior chamber-anterior hyaloid membrane barrier during cataract operations. Arch Ophthalmol Chic Ill 1960. 2011;129(6):751–7. https://doi.org/10.1001/archophthalmol.2011.115.

    Article  Google Scholar 

  48. Lau OCF, Montfort JM, Sim BWC, et al. Acute intraoperative rock-hard eye syndrome and its management. J Cataract Refract Surg. 2014;40(5):799–804. https://doi.org/10.1016/j.jcrs.2013.10.038.

    Article  PubMed  Google Scholar 

  49. Kato N, Masuda Y, Oki K, Iwaki H, Tsuneoka H. Influence of irrigation dynamic pressure-assisted hydrodissection on intraocular pressure and the posterior chamber-anterior hyaloid membrane barrier during cataract surgery. Jpn J Ophthalmol. 2019;63(2):221–8. https://doi.org/10.1007/s10384-018-00646-3.

    Article  PubMed  Google Scholar 

  50. Mackool RJ, Sirota M. Infusion misdirection syndrome. J Cataract Refract Surg. 1993;19(5):671–2. https://doi.org/10.1016/s0886-3350(13)80032-6.

    Article  PubMed  Google Scholar 

  51. Shaffer RN. The role of vitreous detachment in aphakic and malignant glaucoma. Trans Am Acad Ophthalmol Otolaryngol Am Acad Ophthalmol Otolaryngol. 1954;58(2):217–31.

    Google Scholar 

  52. Basgil Pasaoglu I, Altan C, Bayraktar S, Satana B, Basarır B. Surgical management of pseudophakic malignant glaucoma via anterior segment-peripheral iridectomy capsulo-hyaloidectomy and anterior vitrectomy. Case Rep Ophthalmol Med. https://doi.org/10.1155/2012/794938.

  53. Kaplowitz K, Yung E, Flynn R, Tsai JC. Current concepts in the treatment of vitreous block, also known as aqueous misdirection. Surv Ophthalmol. 2015;60(3):229–41. https://doi.org/10.1016/j.survophthal.2014.12.004.

    Article  PubMed  Google Scholar 

  54. Quigley HA, Friedman DS, Congdon NG. Possible mechanisms of primary angle-closure and malignant glaucoma. J Glaucoma. 2003;12(2):167–80. https://doi.org/10.1097/00061198-200304000-00013.

    Article  PubMed  Google Scholar 

  55. Quigley HA. Angle-closure glaucoma–simpler answers to complex mechanisms: LXVI Edward Jackson memorial lecture. Am J Ophthalmol. 2009;148(5):657–669.e1. https://doi.org/10.1016/j.ajo.2009.08.009.

    Article  PubMed  Google Scholar 

  56. Tomey KF, Senft SH, Antonios SR, Shammas IV, Shihab ZM, Traverso CE. Aqueous misdirection and flat chamber after posterior chamber implants with and without trabeculectomy. Arch Ophthalmol Chic Ill 1960. 1987;105(6):770–3. https://doi.org/10.1001/archopht.1987.01060060056032.

    Article  Google Scholar 

  57. Greenfield DS, Tello C, Budenz DL, Liebmann JM, Ritch R. Aqueous misdirection after glaucoma drainage device implantation. Ophthalmology. 1999;106(5):1035–40. https://doi.org/10.1016/S0161-6420(99)00530-8.

    Article  PubMed  Google Scholar 

  58. Liebmann JM, Weinreb RN, Ritch R. Angle-closure glaucoma associated with occult annular ciliary body detachment. Arch Ophthalmol Chic Ill 1960. 1998;116(6):731–5. https://doi.org/10.1001/archopht.116.6.731.

    Article  Google Scholar 

  59. Hille K, Hille A, Ruprecht KW. Malignant glaucoma due to drug-related angioedema. Am J Ophthalmol. 2003;135(2):224–6. https://doi.org/10.1016/s0002-9394(02)01958-x.

    Article  PubMed  Google Scholar 

  60. Parver LM, Auker C, Carpenter D. Choroidal blood flow: III. Reflexive control in human eyes. Arch Ophthalmol. 1983;101:1604–6.

    Article  PubMed  Google Scholar 

  61. Shahid H, Salmon JF. Malignant glaucoma: a review of the modern literature. J Ophthalmol. 2012;2012:1–6. https://doi.org/10.1155/2012/852659.

    Article  Google Scholar 

  62. Weiss DI, Shaffer RN, Harrington DO. Treatment of malignant glaucoma with intravenous mannitol infusion. Medical reformation of the anterior chamber by means of an osmotic agent: a preliminary report. Arch Ophthalmol Chic Ill 1960. 1963;69:154–8. https://doi.org/10.1001/archopht.1963.00960040160004.

    Article  Google Scholar 

  63. Phelps CD. Angle-closure glaucoma secondary to ciliary body swelling. Arch Ophthalmol. 1974;92(4):287–90. https://doi.org/10.1001/archopht.1974.01010010297004.

    Article  PubMed  Google Scholar 

  64. Simmons RJ. Malignant glaucoma. Br J Ophthalmol. 1972;56(3):263–72. https://doi.org/10.1136/bjo.56.3.263.

    Article  PubMed  PubMed Central  Google Scholar 

  65. Dave P, Senthil S, Rao HL, Garudadri CS. Treatment outcomes in malignant glaucoma. Ophthalmology. 2013;120(5):984–90. https://doi.org/10.1016/j.ophtha.2012.10.024.

    Article  PubMed  Google Scholar 

  66. Varma DK, Belovay GW, Tam DY, Ahmed IIK. Malignant glaucoma after cataract surgery. J Cataract Refract Surg. 2014;40(11):1843–9. https://doi.org/10.1016/j.jcrs.2014.02.045.

    Article  PubMed  Google Scholar 

  67. Wu Z-H, Wang Y-H, Liu Y. Management strategies in malignant glaucoma secondary to antiglaucoma surgery. Int J Ophthalmol. 2016;9(1):63–8. https://doi.org/10.18240/ijo.2016.01.11.

    Article  PubMed  PubMed Central  Google Scholar 

  68. Melamed S, Ashkenazi I, Blumenthal M. Nd-YAG laser hyaloidotomy for malignant glaucoma following one-piece 7 mm intraocular lens implantation. Br J Ophthalmol. 1991;75(8):501–3.

    Article  PubMed  PubMed Central  Google Scholar 

  69. Muqit MMK, Menage MJ. Malignant glaucoma after phacoemulsification: treatment with diode laser cyclophotocoagulation. J Cataract Refract Surg. 2007;33(1):130–2. https://doi.org/10.1016/j.jcrs.2006.07.041.

    Article  PubMed  Google Scholar 

  70. Herschler J. Laser shrinkage of the ciliary processes. a treatment for malignant (ciliary block) glaucoma. Ophthalmology. 1980;87(11):1155–9. https://doi.org/10.1016/s0161-6420(80)35117-8.

    Article  PubMed  Google Scholar 

  71. Stumpf TH, Austin M, Bloom PA, McNaught A, Morgan JE. Transscleral cyclodiode laser photocoagulation in the treatment of aqueous misdirection syndrome. Ophthalmology. 2008;115(11):2058–61. https://doi.org/10.1016/j.ophtha.2008.05.026.

    Article  PubMed  Google Scholar 

  72. Carassa RG, Bettin P, Fiori M, Brancato R. Treatment of malignant glaucoma with contact transscleral cyclophotocoagulation. Arch Ophthalmol. 1999;117(5):688–90.

    Article  PubMed  Google Scholar 

  73. Tang J, Du E, Li X. Combined surgical techniques for the management of malignant glaucoma. J Ophthalmol. 2018;2018:1–7. https://doi.org/10.1155/2018/9189585.

    Article  Google Scholar 

  74. Kuriakose T, Jasper S, Thomas S. Pars-plana fluid aspiration for positive vitreous cavity pressure in anterior segment surgeries. Indian J Ophthalmol. 2018;66(4):565. https://doi.org/10.4103/ijo.IJO_939_17.

    Article  PubMed  PubMed Central  Google Scholar 

  75. Smith JM, Mathias MT, Oliver SC, et al. The influence of needle gauge and infection source on vitreous aspirate cultures. Br J Ophthalmol. 2016;100(4):453–5. https://doi.org/10.1136/bjophthalmol-2015-307081.

    Article  PubMed  Google Scholar 

  76. Srirampur A, Kalwad A, Balijepalli P, Katta KR. Comment on: pars-plana fluid aspiration for positive vitreous cavity pressure in anterior segment surgeries. Indian J Ophthalmol. 2019;67(1):174. https://doi.org/10.4103/ijo.IJO_723_18.

    Article  PubMed  PubMed Central  Google Scholar 

  77. Tsai JC, Barton KA, Miller MH, Khaw PT, Hitchings RA. Surgical results in malignant glaucoma refractory to medical or laser therapy. Eye Lond Engl. 1997;11(Pt 5):677–81. https://doi.org/10.1038/eye.1997.176.

    Article  Google Scholar 

  78. Harbour JW, Rubsamen PE, Palmberg P. Pars plana vitrectomy in the management of phakic and pseudophakic malignant glaucoma. Arch Ophthalmol Chic Ill 1960. 1996;114(9):1073–8. https://doi.org/10.1001/archopht.1996.01100140275003.

    Article  Google Scholar 

  79. Byrnes GA, Leen MM, Wong TP, Benson WE. Vitrectomy for ciliary block (malignant) glaucoma. Ophthalmology. 1995;102(9):1308–11. https://doi.org/10.1016/s0161-6420(95)30870-6.

    Article  PubMed  Google Scholar 

  80. Sharma A, Sii F, Shah P, Kirkby GR. Vitrectomy–phacoemulsification–vitrectomy for the management of aqueous misdirection syndromes in phakic eyes. Ophthalmology. 2006;113(11):1968–73. https://doi.org/10.1016/j.ophtha.2006.04.031.

    Article  PubMed  Google Scholar 

  81. Kaushik S. Commentary: Malignant glaucoma—have we finally found an answer? Indian J Ophthalmol. 2019;67(7):1206. https://doi.org/10.4103/ijo.IJO_134_19.

    Article  PubMed  PubMed Central  Google Scholar 

  82. Al Bin Ali GY, Al-Mahmood AM, Khandekar R, Abboud EB, Edward DP, Kozak I. Outcomes of pars plana vitrectomy in the management of refractory aqueous misdirection syndrome. Retina. 2017;37(10):1916–22. https://doi.org/10.1097/IAE.0000000000001430.

    Article  PubMed  Google Scholar 

  83. •• Pakravan M, Esfandiari H, Amouhashemi N, Veisi A, Torkian P, Yazdani S. Mini-vitrectomy; a simple solution to a serious condition. J Ophthalmic Vis Res. 2018;13(3):231. https://doi.org/10.4103/jovr.jovr_192_17A retrospective case series of twenty-four pseudophakic eyes that demonstrates the technique of a clear corneal approach to anterior vitrectomy with IZH is an effective procedure for the management of AMS that circumvents a pars plana approach.

    Article  PubMed  PubMed Central  Google Scholar 

  84. Lois N, Wong D, Groenewald C. New surgical approach in the management of pseudophakic malignant glaucoma. Ophthalmology. 2001;108(4):780–3. https://doi.org/10.1016/S0161-6420(00)00642-4.

    Article  PubMed  Google Scholar 

  85. Żarnowski T, Wilkos-Kuc A, Tulidowicz-Bielak M, et al. Efficacy and safety of a new surgical method to treat malignant glaucoma in pseudophakia. Eye. 2014;28(6):761–4. https://doi.org/10.1038/eye.2014.53.

    Article  PubMed  PubMed Central  Google Scholar 

  86. Madgula IM, Anand N. Long-term follow-up of zonulo-hyaloido-vitrectomy for pseudophakic malignant glaucoma. Indian J Ophthalmol. 2014;62(12):1115–20. https://doi.org/10.4103/0301-4738.149128.

    Article  PubMed  PubMed Central  Google Scholar 

  87. Muñoz de Escalona Rojas JE, Gascón Ginel MI, Líndez Pérez de Andrade E, Bellido Muñoz RM, Romero Noguera C, Hermoso Fernández FM. Chronic fluid misdirection syndrome of aqueous humor after phacoemulsification: diagnosis, treatment and associated factors. Arch Soc Esp Oftalmol Engl Ed. 2019;94(10):491–4. https://doi.org/10.1016/j.oftale.2019.05.014.

    Article  Google Scholar 

  88. Ray VP, Malhotra V. Management of recurrent aqueous misdirection by anterior segment surgeon after failed pars plana posterior vitrectomy. Indian J Ophthalmol. 2019;67(7):1204. https://doi.org/10.4103/ijo.IJO_1430_18.

    Article  PubMed  PubMed Central  Google Scholar 

  89. Yu J, Chen X, Zhou D, Shen J, Wu Y, Sun Q. Clinical efficacy of ciliary ring incision combined with modified partial pars plana vitrectomy for malignant glaucoma. Med Sci Monit. 2018;24:3916–21. https://doi.org/10.12659/MSM.910672.

    Article  PubMed  PubMed Central  Google Scholar 

  90. Rani K, Gulati L, Rao L, Senthil L. 25G Pars plana vitrectomy and irido-zonulo-hyaloido-vitrectomy in the management of malignant glaucoma in phakic eyes following trabeculectomy. Retin Case Brief Rep. 2018;12(1):33–5. https://doi.org/10.1097/ICB.0000000000000407.

    Article  Google Scholar 

  91. Faisal AA, Kamaruddin MI, Toda R, Kiuchi Y. Successful recovery from misdirection syndrome in nanophthalmic eyes by performing an anterior vitrectomy through the anterior chamber. Int Ophthalmol. 2019;39(2):347–57. https://doi.org/10.1007/s10792-017-0818-6.

    Article  PubMed  Google Scholar 

  92. Dave P, Rao A, Senthil S, Choudhari NS. Recurrence of aqueous misdirection following pars plana vitrectomy in pseudophakic eyes. Case Rep. 2015;2015. https://doi.org/10.1136/bcr-2014-207961.

  93. Massicotte EC, Schuman JS. A malignant glaucoma-like syndrome following pars plana vitrectomy. Ophthalmology. 1999;106(7):1375–9. https://doi.org/10.1016/S0161-6420(99)00727-7.

    Article  PubMed  Google Scholar 

  94. Rekas M, Krix-Jachym K. Malignant glaucoma. In: Rumelt S, editor. Glaucoma - Basic and Clinical Aspects. London: InTech; 2013. https://doi.org/10.5772/53979.

    Chapter  Google Scholar 

  95. Pathak Ray V, Gulati I, Choudhari N. Intra-operative ostial irido-zonulo-hyaloido-vitrectomy with primary posterior capsulectomy for prevention of post-operative aqueous misdirection in combined phaco-trabeculectomy in primary angle closure glaucoma. Curr Eye Res. 2019;44(10):1087–90. https://doi.org/10.1080/02713683.2019.1625409.

    Article  PubMed  Google Scholar 

  96. Chaudhry NA, Flynn HW, Murray TG, Nicholson D, Palmberg PF. Pars plana vitrectomy during cataract surgery for prevention of aqueous misdirection in high-risk fellow eyes. Am J Ophthalmol. 2000;129(3):387–8. https://doi.org/10.1016/S0002-9394(99)00405-5.

    Article  PubMed  Google Scholar 

  97. Cashwell LF, Martin TJ. Malignant glaucoma after laser iridotomy. Ophthalmology. 1992;99(5):651–8; discussion 658–659. https://doi.org/10.1016/s0161-6420(92)31913-x.

    Article  PubMed  Google Scholar 

  98. Thompson AC, Challa P. Prophylactic anterior vitrectomy during cataract surgery in eyes at increased risk for aqueous misdirection. Am J Ophthalmol Case Rep. 2018;12:24–7. https://doi.org/10.1016/j.ajoc.2018.08.002.

    Article  PubMed  PubMed Central  Google Scholar 

  99. Ozeki N, Yuki K, Kimura I. Alternative approach to treating malignant glaucoma after trabeculectomy with unplanned zonulectomy. Clin Ophthalmol Auckl NZ. 2010;4:383–5. https://doi.org/10.2147/opth.s10297.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Ophthalmology, University of Alabama at Birmingham, Birmingham, AL, USA

    Nathan A. Fischer

  2. Department of Ophthalmology, University of Colorado School of Medicine, 1675 Aurora Court, Mailstop F-731, Aurora, CO, USA

    Leonard K. Seibold, Malik Y. Kahook & Jeffrey R. SooHoo

Authors
  1. Nathan A. Fischer
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Leonard K. Seibold
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Malik Y. Kahook
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Jeffrey R. SooHoo
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Jeffrey R. SooHoo.

Ethics declarations

Conflict of Interest

Nathan A. Fischer, Leonard K. Seibold, Malik Y. Kahook, and Jeffrey R. SooHoo each declare no potential conflicts of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

This article is part Topical Collection on Diagnosis and Monitoring of Glaucoma

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Fischer, N.A., Seibold, L.K., Kahook, M.Y. et al. Current Concepts on Aqueous Misdirection. Curr Ophthalmol Rep 8, 51–61 (2020). https://doi.org/10.1007/s40135-020-00230-4

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40135-020-00230-4

Keywords

Search

Navigation