Purpose: To evaluate efficacy of current treatments of aqueous misdirection syndrome and explore its possible risk factors.
Patients and methods: 50 patients (57 eyes) with aqueous misdirection syndrome at ShanghaiEye & ENTHospitalwere included. Data collected included demographics, initial clinical characteristics and ocular outcomes at our follow-up. The main outcome measures were best-corrected visual acuity (BCVA), intraocular pressure (IOP), number of antiglaucoma medications, recurrences and complications. Treatment success was assessed by Kaplan-Meier survival analysis and Cox proportional-hazards regression model were used to explore the risk factors influencing the prognosis of aqueous misdirection syndrome.
Results: Final mean BCVA improved significantly (P = 0.002) and was correlated with baseline BCVA after a mean follow-up period of 34.47 months. Final mean IOP (P < 0.001) and average number of antiglaucoma medications (P < 0.001) were significantly reduced. Patients with higher IOP baseline (P = 0.015) and/or shorter axial length (P = 0.033) were more likely to suffer from treatment failure. Recurrences were observed in 2 of 10 pseudophakic and in 1 of 40 phakic eyes. Complications (24.00%, 12/50) after pars plana vitrectomy (PPV) included choroidal detachment, corneal decompensation, retinal detachment, vitreous hemorrhage and hyphema.
Conclusions: PPV, laser treatments augmented by medical regimens were effective to relieve aqueous misdirection syndrome. Surgical intervention should be taken earlier in eyes with higher baseline IOP and/or shorter axial length. Total vitrectomy-zonulectomy-iridectomy is probably a novel surgical approach in treating recalcitrant cases.