Outcomes of Medical and Surgical Management in Aqueous Misdirection Syndrome

Abstract

Purpose

To report the outcomes of medical and surgical management in patients diagnosed with aqueous misdirection syndrome (AMS).

Patients and Methods

A retrospective chart review of all cases diagnosed with AMS at a single tertiary care eye center during the period from 2014 to 2021. Outcome measures were anatomical success (deepening of the anterior chamber (AC)), functional success (improvement in visual acuity), and treatment success (control of intraocular pressure (IOP)).

Results

A total of 26 eyes with AMS from 24 patients were included. The patients were followed for a mean duration of 24 ± 18 months. Although some patients initially responded to medical and laser therapy, all but one (3.8%) eventually required surgery during the first 3 months after presentation. The mean duration from presentation until surgery was 45.9 ± 45.8 days (range: 2–119 days). The majority of cases (69.2%) were managed by pars plana vitrectomy. At the last follow-up visit, anatomical success was achieved in 20 (76%) eyes, 15 (57%) eyes had a final visual acuity that was either similar to or better than baseline, and successful control of IOP was achieved in 17 (65%) eyes. Univariate analysis revealed that a history of trabeculectomy as a cause of AMS was a risk factor for treatment failure (OR, 7.8; 95% CI, 1.16–52.35; P, 0.02).

Conclusion

Our findings indicate that medical and laser management of AMS provide temporary control, and almost all patients eventually require surgery within the first 3 months. A history of trabeculectomy was found to be a risk factor for treatment failure.

Keywords:

• aqueous misdirection syndrome
• malignant glaucoma
• angle-closure glaucoma
• hyaloidotomy

Ethics Statement

The study was approved by the Institutional Review Board (IRB) at King Khalid Eye Specialist Hospital. The protocol of the study was followed by the Declaration of Helsinki. Given the nature of retrospective study reviewing the files for data collection and without any identity to any patient in our project, a written informed consent was impossible and impracticable to obtain.

Disclosure

The authors report no conflicts of interest in this work.