COPENHAGEN, Denmark — Aqueous misdirection glaucoma, or malignant glaucoma, is a rare, challenging situation that requires early, aggressive treatment, according to one speaker here. It occurs in most cases after angle-closure glaucoma surgery in eyes that are predisposed by shorter axial length, a larger lens, and anteriorly positioned and rotated ciliary processes.
The mechanism involves the occurrence of a sudden decompression after surgery, leading to lens apposition to the ciliary processes, anterior rotation of ciliary processes and posterior aqueous misdirection. The aqueous is trapped in the vitreous and displaces the iris-lens diaphragm forward, causing angle closure,Giorgio Marchini, MD, explained at the European Glaucoma Society meeting.
“The most typical sign is when you see the ciliary processes compressed against the iris,” he said.
There are several treatment options aimed at restoring the normal aqueous outflow and reducing IOP, ranging from simple medical therapy to laser techniques and surgery. However, the therapeutic effect is based on two milestones, Marchini said.
“The first is removing the lens if present, and the second is creating a conduit between the anterior chamber and the vitreous cavity,” he said.
Phacoemulsification with complete vitrectomy, iridectomy and zonulectomy has been shown to have the best results, with a 0% relapse rate.
“Relapse is frequent with other methods, up to 100% with medications only,” Marchini said.
After treatment, long-term administration of cycloplegic drugs is mandatory to avoid anterior displacement of the ciliary processes.
- Disclosure: Marchini has no relevant financial disclosures.