Slit-lamp needle revision for aqueous misdirection after trabeculectomy.

Purpose

To describe a slit-lamp needle procedure for the management of aqueous misdirection after trabeculectomy in which more conventional therapies have failed. The pathophysiology of aqueous misdirection and explanation for the efficacy of this procedure are reviewed.

Methods

Two patients in whom aqueous misdirection developed after trabeculectomy refractory to standard medical and laser therapy underwent transcorneal needling to disrupt the anterior vitreous face and reform the anterior chamber.

Results

In both cases there was immediate resolution of clinical signs, with normalization of intraocular pressure throughout the 9-month follow-up period. One of the two eyes showed a slow but progressive advance in preexisting peripheral anterior synechia; however, intraocular pressure and axial anterior chamber depth remained normal in both eyes.

Conclusion

Transcorneal needle disruption of the anterior hyaloid through the peripheral iridectomy was effectively managed two cases of aqueous misdirection. Even if only transiently useful, this simple intervention may serve to minimize corneal damage from iris and lens trauma due to a flat anterior chamber.