Abstract
Purpose To evaluate two different approaches of anterior vitrectomy combined with hyaloidotomy, zonulectomy, and iridectomy (VHZI) for fluid misdirection syndrome (FMS) secondary to phacoemulsification with intraocular lens implantation combined with goniosynechialysis (phaco-IOL-GSL). Methods Nine patients with FMS who developed after a phaco-IOL-GSL procedure, were retrospectively studied from May 2015 to February 2018. They were treated with VHZI, in which 5 cases underwent local anterior vitrectomy via anterior chamber approach, and the others underwent comprehensive vitrectomy via pars plana approach. Main outcome measures were pre- and postoperative intraocular pressure (IOP), number of antiglaucoma medications, and relapse rate. Results Incidence of FMS secondary to phaco-IOL-GSL was 1.4% (9 in 652 eyes), which was promptly resolved in all affected cases. VHZI via anterior chamber approach resulted in a significant decrease in the mean IOP from 40.2 ± 9.7 mm Hg at presentation to 15.2 ± 4.8 mm Hg postoperatively (P=0.01). The median number of antiglaucoma medications reduced from 3 to 2 (P=0.066). Meanwhile, VHZI via pars plana approach also resulted in the reduction of the mean IOP values from 26.0 ± 5.7 mm Hg at presentation to 15.2 ± 3.3 mm Hg postoperatively (P=0.092). The median number of antiglaucoma medications also reduced from 3.5 to 1.5 (P=0.059). Relapse rate of the treatment through pars plana approach (0%, 0/4) was much lower than that through anterior chamber approach (40%, 2/5), although the difference was not statistically significant (P=0.444). Conclusions FMS is a rare but severe complication secondary to phaco-IOL-GSL. Compared to VHZI with local anterior vitrectomy via anterior chamber approach, VHZI with comprehensive anterior vitrectomy via pars plana approach might be a more effective procedure to treat FMS. The study has been registered in Contact ClinicalTrials.gov PRS Identifier: NCT04172857.
Highlights
In the past few years, phacoemulsification with intraocular lens implantation combined with goniosynechialysis has become significantly popular in the treatment of PACG due to its effectiveness and safety [1,2,3,4]
LE: left eye; RE: right eye, 1: phaco-IOL-GSL—phacoemulsification with intraocular lens implantation combined with goniosynechialysis, 2: PAS—peripheral anterior synechiae, 3: VHZI—anterior vitrectomy, hyaloidectomy, zonulectomy, and peripheral iridectomy. 4: cacg—chronic angle closure glaucoma. 5: LPI—laser peripheral iridotomy.#Relapse 9 days after VHZI.##Relapse 3 days after VHZI
Fluid misdirection syndrome was diagnosed in 9 patients (1.4%). ese patients had an average age of 60.8 ± 10.4 years. e male to female patient ratio was 1 : 8
Summary
In the past few years, phacoemulsification with intraocular lens implantation combined with goniosynechialysis (phaco-IOL-GSL) has become significantly popular in the treatment of PACG due to its effectiveness and safety [1,2,3,4]. Fluid misdirection syndrome (FMS) is a rare but severe complication observed after phaco-IOL-GSL due to its rapid progression and poor prognosis. To the best of our knowledge, the treatments and outcomes of FMS secondary to phaco-IOL-GSL have not been extensively studied. Current treatment options for FMS primarily include (1) medications, (2) neodymium:yttrium-aluminum-garnet (Nd:YAG) laser iridotomy with anterior hyaloidotomy in phakic eyes, (3) Nd: YAG laser iridotomy with posterior capsulotomy and hyaloidotomy in pseudophakic eyes, (4) transscleral cyclophotocoagulation, and (5) anterior vitrectomy. Anterior vitrectomy remains as an important choice
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