Transscleral Cyclodiode Laser Photocoagulation in the Treatment of Aqueous Misdirection Syndrome

Purpose: To describe the outcome of using transscleral cyclodiode laser ciliary body ablation as a novel treatment for aqueous misdirection syndrome. Design: Retrospective case series review. Participants: Five patients diagnosed with aqueous misdirection syndrome. Intervention: Patients successfully managed using transscleral cyclodiode laser. Main Outcome Measures: To evaluate demographic information, risk factors, visual acuity, medical treatment, intraocular pressure (IOP) control, and complications. Results: The patients were aged 27 to 78 years and 3 were female. All were hyperopic, with narrow iridocorneal angles and patent peripheral iridotomies (PI). Four developed aqueous misdirection syndrome after intraocular surgery and 1 developed it spontaneously in the presence of a patent PI after losing vision in the fellow eye to the same condition 8 years earlier. All 5 patients responded to transscleral cyclodiode laser photocoagulation with rapid deepening of the anterior chamber; 1 patient required a second treatment 1 year later. All patients had good long-term vision and IOP control. Conclusions: The outcome of transscleral cyclodiode ciliary body ablation in these patients supports the use of this technique in cases of aqueous misdirection syndrome where medical treatment has not been sufficient to control the IOP.