Aqueous Misdirection Syndrome Post-Cataract Surgery: A Case Report And Management Strategies

To report a case of aqueous misdirection syndrome (AMS) following routine phacoemulsification, emphasizing early recognition, diagnostic challenges, and management strategies to restore anterior chamber depth and intraocular pressure (IOP) control.

A case report from Al-Shifa Trust Eye Hospital, Rawalpindi.

A 61-year-old female underwent uneventful phacoemulsification but presented postoperatively with a shallow anterior chamber, optic displacement into the anterior chamber, and iris incarceration. The differential diagnosis included aqueous misdirection and pupillary block glaucoma. Initial medical therapy with cycloplegics, oral acetazolamide, and hyperosmotic agents temporarily reduced IOP. However, symptoms recurred, necessitating Nd:YAG laser hyaloidotomy to re-establish aqueous flow.

Results:

Following laser hyaloidotomy, the anterior chamber deepened, and IOP stabilized at 8 mmHg with ongoing medical therapy. At the 23-day follow-up, the IOL was well-positioned, the anterior chamber remained deep, and visual acuity improved to 20/40.

This case highlights aqueous misdirection as a rare but serious postoperative complication of cataract surgery. Early differentiation from pupillary block and other causes of secondary angle closure is critical. Timely Nd:YAG hyaloidotomy proved effective in restoring aqueous dynamics and IOP control, underscoring the need for heightened clinical suspicion and aggressive management to prevent vision loss.