title: OUTCOMES OF PARS PLANA VITRECTOMY IN THE MANAGEMENT OF REFRACTORY AQUEOUS MISDIRECTION SYNDROME.
abstract: OBJECTIVE
  To determine the efficacy and complications of pars plana vitrectomy (PPV) and adjunct surgeries for aqueous misdirection refractory to medical therapy.
  
  
  METHODS
  A retrospective review of consecutive eyes with refractory aqueous misdirection at the King Khaled Eye Specialist Hospital between 2002 and 2010. Patients underwent two-port and three-port pars plana vitrectomy (PPV) with adjunct procedures including pars plana lensectomy combined with posterior capsulectomy, hyaloido-zonulo-iridectomy, and synechiolysis. Main outcome measures included anatomical success, functional success, and factors associated with the outcomes.
  
  
  RESULTS
  Sixty-nine eyes were evaluated over a mean follow-up period of 17.6 ± 3.8 months (3-156 months). Anatomical success was achieved in 62 eyes (90%) and functional success in 54 eyes (78%) that underwent PPV as a primary surgery. The factors associated with the altering misdirected aqueous flow and reducing intraocular pressure significantly associated with a two-line improvement of best-corrected visual acuity included surgical treatment within 4 weeks of presentation (P = 0.004) and preoperative intraocular pressure (P = 0.001). The success of two-port PPV and standard three-port PPV was similar (P = 0.7). The intraoperative and postoperative complications included retinal detachment in two eyes and endophthalmitis in one eye.
  
  
  CONCLUSIONS
  The PPV was effective for managing aqueous misdirection refractory to medical therapy. Two-port or three-port PPV did not change the success rate but early surgery improved both anatomical and functional outcomes.
authors.affiliation: *King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia; †Department of Ophthalmology, Bahrain Defense Force Hospital, Kingdom of Bahrain; ‡Division of Anterior Segment, Dhahran Eye Specialist Hospital, Dhahran, Kingdom of Saudi Arabia; and §Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: Ghada Y
authors.initials: GY
authors.lastname: Al Bin Ali
authors.forename: Ammar M
authors.initials: AM
authors.lastname: Al-Mahmood
authors.forename: Rajiv
authors.initials: R
authors.lastname: Khandekar
authors.forename: Emad B
authors.initials: EB
authors.lastname: Abboud
authors.forename: Deepak P
authors.initials: DP
authors.lastname: Edward
authors.forename: Igor
authors.initials: I
authors.lastname: Kozak
mesh_terms: D000368:Aged; D019468:Disease Management; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D012163:Retinal Detachment / Q000601:surgery*; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D014792:Visual Acuity; D014821:Vitrectomy / Q000379:methods*