Aqueous Misdirection Malignant Glaucoma

In this poorly understood condition, which typically follows intraocular surgery but can also occur after contusion [33], the aqueous is misdirected posteriorly: rather than streaming toward the angle, it is flowing into or behind the vitreous. The increased intravitreal fluid volume pushes the lens/ iris complex forward, resulting in a very shallow AC.

Regarding therapy, cycloplegics, antiglaucoma medications, and YAG hyaloidotomy may be attempted, but the most promising approach is surgical, which is fairly complex. Vitrectomy, anterior hyaloidectomy, zonuloid-ectomy, iridectomy, and lens removal [29] need to be performed, which reopen the original channel for aqueous outflow.

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Radical combined anterior- and posterior segment surgery is the most effective treatment for eyes with aqueous misdirection. The conservative approach has a much lower success rate [13].

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