Aqueous Misdirection Syndrome As A Complication Of Neodymium:Yag Posterior Capsulotomy
Published 2022 - 40th Congress of the ESCRS
Reference: CC02.12 | Type: Case report | DOI: 10.82333/5v9c-3806
Authors: Akshay Sehgal* 1 , Atul Bansal 1
1Ophthalmology,University Hospitals Coventry and Warwickshire NHS Trust, United Kingdom,Coventry,United Kingdom
A 79-year-old lady was seen in the glaucoma clinic. She was known to have bilateral primary open-angle glaucoma with pseudophakia. She had undergone right eye Nd:Yag capsulotomy for posterior capsular opacification eight weeks ago. This was her first follow-up visit after the laser. She was on four regular glaucoma medications in both eyes (topical beta blockers, alpha 2 agonists, carbonic anhydrase inhibitors and prostaglandin analogues).
On examination, the intraocular pressure was 22 mm Hg in the right eye and 18 mm Hg in the left eye. The right anterior chamber was uniformly very shallow. No inflammation or synechiae were noted. The left anterior chamber was deep. Gonioscopy performed demonstrated narrow angles in the right eye and wide-open angles in the left eye. Bilateral intra-ocular lens implants were in situ. The retina was flat and optic disc was status quo.
A diagnosis of right eye aqueous misdirection syndrome was made. Stat dose of phenylephrine 2.5% and Atropine 1% were instilled in the right eye. Anterior segment OCT was performed which confirmed the diagnosis. An hour after the instillation of the above eye drops, the right anterior chamber was found to have deepened and intraocular pressure had reduced to 18 mm Hg. The patient was prescribed cyclopentolate 1% eye drops twice a day for the right eye along with her regular eyedrops. During her next follow up visit after two weeks, the right anterior chamber was deep and intra-ocular pressure was within range.
Aqueous misdirection syndrome is a form of secondary glaucoma which typically presents with diffuse shallowing of the anterior chamber accompanied by elevated intraocular pressure. It is most commonly encountered after glaucoma surgery in eyes with prior chronic angle closure. However, it is also known to occur spontaneously or after any ophthalmic procedure.
There are very few cases reported in literature of patients developing aqueous misdirection as a complication of Nd:YAG posterior capsulotomy. In our patient, prompt medical therapy normalized intraocular pressure and deepened the anterior chamber. Early recognition and management of this rare complication is crucial to prevent further worsening of the condition and impact on vision.