Recurrence of aqueous misdirection following pars plana vitrectomy in pseudophakic eyes

We present a retrospective interventional case series of four patients with pseudophakic eye who developed recurrent aqueous misdirection following pars plana vitrectomy (PPV) for malignant glaucoma (MG). The patients were treated with neodymium: YAG (Yttrium Aluminum Garnet) laser hyaloidotomy/membranotomy through the patent peripheral iridectomy. The main outcome measure was resolution of MG. The intervention resulted in resolution of MG in all four cases. The cause for recurrence was an inflammatory membrane covering the hyaloidotomy opening in three eyes and the haptic of intraocular lens blocking the hyaloidotomy opening in one eye. Recurrence of aqueous misdirection even after vitrectomy may be related to obstruction of aqueous flow through the communication created, either by intraocular lens or fibrin. Treatment of this condition involves restoring aqueous flow to the anterior chamber from the anterior vitreous by treating the cause, and most often the YAG laser hyaloidotomy/membranotomy is successful in relieving the condition.