Successful recovery from misdirection syndrome in nanophthalmic eyes by performing an anterior vitrectomy through the anterior chamber

Abstract

Purpose: To determine the effectiveness of iridectomy, capsulotomy and anterior vitrectomy through the anterior chamber to treat misdirection syndrome in pseudophakic nanophthalmic eyes. Methods: This was a non-comparative study of seven nanophthalmic eyes from four consecutive patients. All eyes developed misdirection syndrome after successful cataract surgery. Treatment for misdirection syndrome involved capsulotomy and anterior vitrectomy through a peripheral iridectomy from the anterior chamber using a 25-gauge vitreous cutter. The best-corrected visual acuity, intraocular pressure and anterior and posterior segment findings were recorded before and after surgery. Results: Resolution of the aqueous misdirection was achieved in all but one eye. The single case of recurrence was observed after a mean follow-up of 45.6 ± 21.5 months and was caused by closure of the capsule hole by Elschnig’s pearls. This eye was successfully treated by enlargement of the lens capsule hole with a vitreous cutter. The mean intraocular pressure before surgery was 28.7 ± 4.4 mmHg, and this was significantly reduced to 13.7 ± 1.3 mmHg at the final visit. All but one patient, who had uveal effusion, maintained their best-corrected visual acuity. Conclusion: In this study, we investigated an alternative option for the treatment of misdirection syndrome in nanophthalmic eyes. We undertook a lens capsulotomy and anterior vitrectomy through a peripheral iridectomy from the anterior chamber using a 25-gauge vitreous cutter, which was able to create a communication hole between the anterior and posterior chambers.