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Aqueous misdirection syndrome: an interesting case presentation

Authors Moinul P, Hutnik C

Received 11 October 2014

Accepted for publication 24 November 2014

Published 29 January 2015 Volume 2015:9 Pages 183—186

DOI https://doi.org/10.2147/OPTH.S75698

Checked for plagiarism Yes

Review by Single-blind

Peer reviewer comments 4

Editor who approved publication: Dr Scott Fraser


Prima Moinul,1 Cindy ML Hutnik2

1Faculty of Medicine, University of Calgary, Calgary, AB, Canada; 2Ivey Eye Institute, St Joseph’s Health Care, Department of Ophthalmology, University of Western Ontario, London, ON, Canada


Objective: To report a case of an aqueous misdirection-like presentation in a pseudophakic patient.
Design: Retrospective case review.
Participant: An 84-year-old pseudophakic gentleman presented with bilateral blurred vision 8 years after cataract surgery. A refractive shift with shallow anterior chambers and elevated intraocular pressures were noted. No corneal edema was noted. Although aqueous suppression and topical atropine would relieve the signs and symptoms, the effect was temporary with fluctuating and variable changes in refraction, anterior chamber depth, and intraocular pressure. The presence of patent iridotomies had no effect on the fluctuations. A pars plana vitrectomy and surgical iridectomy were successful in preventing further fluctuations.
Conclusion: Aqueous misdirection is a form of secondary angle closure glaucoma marked by elevated intraocular pressures, myopic shift in refraction, and central shallowing of the anterior chamber. Here, a case of a pseudophakic patient experiencing bilateral and fluctuating signs and symptoms resembling aqueous misdirection is presented. Surgical intervention with a pars plana vitrectomy and iridectomy prevented further fluctuations.

Keywords: aqueous misdirection, glaucoma, pars plana vitrectomy, secondary angle closure

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