Vitrectomy–Phacoemulsification–Vitrectomy for the Management of Aqueous Misdirection Syndromes in Phakic Eyes
Received 17 October 2005; accepted 7 April 2006.
Objective
To describe vitrectomy–phacoemulsification–vitrectomy, a sequential 3-step surgical approach, in the management of malignant glaucoma/aqueous misdirection syndromes in phakic eyes.
Design
Retrospective, noncomparative, interventional case series.
Participants
Five eyes (4 angle-closure glaucoma and 1 open-angle glaucoma) of 5 patients with mean age of 66 years (range, 56–78). Four patients presented with aqueous misdirection syndrome and 1 patient presented for cataract extraction, having previously had malignant glaucoma in the fellow eye after phacoemulsification surgery.
Intervention
The operation performed had three steps: vitrectomy, phacoemulsification, and vitrectomy. Step 1: Preliminary vitrectomy involved limited core vitrectomy to “debulk” the vitreous and soften the eye. Step 2: Phacoemulsification was performed in a standard manner. Step 3: Residual vitrectomy, zonulohyaloidectomy and peripheral iridectomy (if not already present) were performed to create a free communication between the posterior and anterior segments.
Main Outcome Measures
Intraocular pressure, visual acuity, biomicroscopic anterior chamber depth, and complications.
Results
The time interval between the onset of malignant glaucoma and surgery ranged from 2 weeks to 3 months. All 4 patients with aqueous misdirection syndrome had relief of the aqueous misdirection postoperatively with anterior chamber deepening. Intraocular pressures on day 1 ranged from 6 to 28 mmHg (mean 15.6, mmHg), and at the last visit ranged from 8 to 30 mmHg (mean, 20.4 mmHg). One eye developed an early choroidal serosanguinous effusion requiring drainage.
Conclusions
The vitrectomy–phacoemulsification–vitrectomy approach was effective in this pilot series in the management of aqueous misdirection syndromes and malignant glaucoma in phakic eyes.
Birmingham and Midland Eye Centre, Birmingham, United Kingdom.
Correspondence to Mr Ash Sharma, MRCP, FRCOphth, Birmingham & Midland Eye Centre City Hospital, Dudley Road, Birmingham B18 7QU, United Kingdom.
Manuscript no. 2005-996.
The authors have no commercial or financial interests associated with the article.
ABSTRACT