title: Vitrectomy-phacoemulsification-vitrectomy for the management of aqueous misdirection syndromes in phakic eyes.
abstract: OBJECTIVE
  To describe vitrectomy-phacoemulsification-vitrectomy, a sequential 3-step surgical approach, in the management of malignant glaucoma/aqueous misdirection syndromes in phakic eyes.
  
  
  METHODS
  Retrospective, noncomparative, interventional case series.
  
  
  METHODS
  Five eyes (4 angle-closure glaucoma and 1 open-angle glaucoma) of 5 patients with mean age of 66 years (range, 56-78). Four patients presented with aqueous misdirection syndrome and 1 patient presented for cataract extraction, having previously had malignant glaucoma in the fellow eye after phacoemulsification surgery.
  
  
  METHODS
  The operation performed had three steps: vitrectomy, phacoemulsification, and vitrectomy. Step 1: Preliminary vitrectomy involved limited core vitrectomy to "debulk" the vitreous and soften the eye. Step 2: Phacoemulsification was performed in a standard manner. Step 3: Residual vitrectomy, zonulohyaloidectomy and peripheral iridectomy (if not already present) were performed to create a free communication between the posterior and anterior segments.
  
  
  METHODS
  Intraocular pressure, visual acuity, biomicroscopic anterior chamber depth, and complications.
  
  
  RESULTS
  The time interval between the onset of malignant glaucoma and surgery ranged from 2 weeks to 3 months. All 4 patients with aqueous misdirection syndrome had relief of the aqueous misdirection postoperatively with anterior chamber deepening. Intraocular pressures on day 1 ranged from 6 to 28 mmHg (mean 15.6, mmHg), and at the last visit ranged from 8 to 30 mmHg (mean, 20.4 mmHg). One eye developed an early choroidal serosanguinous effusion requiring drainage.
  
  
  CONCLUSIONS
  The vitrectomy-phacoemulsification-vitrectomy approach was effective in this pilot series in the management of aqueous misdirection syndromes and malignant glaucoma in phakic eyes.
authors.affiliation: Birmingham and Midland Eye Centre, City Hospital, Birmingham, United Kingdom. ash_sharma_uk@yahoo.com
authors.forename: Ash
authors.initials: A
authors.lastname: Sharma
authors.forename: Freda
authors.initials: F
authors.lastname: Sii
authors.forename: Peter
authors.initials: P
authors.lastname: Shah
authors.forename: Graham R
authors.initials: GR
authors.lastname: Kirkby
mesh_terms: D000368:Aged; D000867:Anterior Chamber / Q000473:pathology; D001082:Aqueous Humor; D005128:Eye Diseases / Q000150:complications / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D005901:Glaucoma / Q000150:complications / Q000503:physiopathology / Q000601:surgery*; D015812:Glaucoma, Angle-Closure / Q000601:surgery; D005902:Glaucoma, Open-Angle / Q000601:surgery; D006801:Humans; D007429:Intraocular Pressure; D008875:Middle Aged; D018918:Phacoemulsification / Q000009:adverse effects; D012189:Retrospective Studies; D016896:Treatment Outcome; D014792:Visual Acuity; D014821:Vitrectomy / Q000009:adverse effects