Aqueous Misdirection with Low IOP

Aqueous misdirection is a rare condition typically characterized by elevated intraocular pressure (IOP) and a shallow or flat anterior chamber (AC). However, this video demonstrates a case of flat anterior chamber and aqueous misdirection but without elevated IOP in the setting of a functioning drainage device in the AC. The patient underwent a combined phacoemulsification and Ahmed glaucoma valve implant surgery. Postoperatively, the AC remained flat despite repeated attempts to inflate it with viscoelastic. A diagnosis of aqueous misdirection was made and a 25-gauge pars plana vitrectomy, zonulotomy and iridectomy surgery was performed. The VA improved to 20/125 with normal IOP of 17 mmHg 1 month after surgery. The anterior chamber remained deep with the tube and IOL in a good position.

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