Pars Plana Anterior Vitrectomy, Hyaloido-Zonulectomy, and Iridectomy for Aqueous Humor Misdirection

PURPOSE: To report a surgical technique for aqueous misdirection refractory to medical treatment consisting of combined pars plana vitrectomy, hyaloido-zonulectomy, and peripheral iridectomy. DESIGN: Noncomparative case series. METHODS: The charts of 5 pseudophakic patients who sought treatment for aqueous humor misdirection refractory to medical treatment from May 2008 trough February 2009 were reviewed. All 5 patients underwent anterior vitrectomy, hyaloido-zonulectomy, and peripheral iridectomy with an anterior vitrector through a pars plana incision. Main outcome measures were preoperative and postoperative visual acuity, intraocular pressure, medications, slit-lamp examination results, and fundus findings. RESULTS: Five female patients (age range, 23 to 89 years) had increased intraocular pressure and shallowing of the anterior chamber after cataract extraction or trabeculectomy, and none responded to conventional medical therapy. After surgery, prompt resolution of the aqueous misdirection was achieved in all cases. The follow-up was 7.6 months (range, 1 to 13 months). CONCLUSIONS: Aqueous misdirection refractory to medical treatment can be treated successfully with surgery consisting of partial pars plana vitrectomy, hyaloido-zonulectomy, and peripheral iridectomy. (Am J Ophthalmol 2010;150:82-87. (C) 2010 by Elsevier Inc. All rights reserved.)