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Aqueous misdirection syndrome masking as myopic surprise following phacoemulsification surgery
  1. Chung Shen Chean,
  2. Duminda Gabadage and
  3. Subhanjan Mukherji
  1. Ophthalmology Department, Northampton General Hospital, Northampton, UK
  1. Correspondence to Dr Chung Shen Chean; shen920815{at}


Aqueous misdirection syndrome is a rare but serious condition that can present after routine phacoemulsification surgery. This report examines a case of myopic surprise following an uncomplicated left eye (LE) phacoemulsification surgery. The patient had previous bilateral peripheral iridotomies for narrow anterior chamber angles. Repeat biometry measurement of the pseudophakic LE did not show shallow anterior chamber, and intraocular pressure (IOP) was normal at initial presentation. However, approximately 3 years postoperatively, LE IOP was raised. Surgical management was considered as medical and laser procedures did not stop deterioration. Clinical presentation of aqueous misdirection syndrome may be subtle and can occur weeks to years after routine uncomplicated phacoemulsification surgery. Myopic surprise may be the only initial presenting sign. Patients who are at risk of aqueous misdirection syndrome should be followed up closely after cataract surgery with accurate gonioscopic assessments for early diagnosis and treatment to prevent optic nerve damage.

  • anterior chamber
  • glaucoma
  • macula
  • pupil
  • visual pathway

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  • Contributors SM supervised the work. CSC led the writing of the case report. DG and SM were involved in the diagnostic work-up and management of the patient. CSC, DG and SM contributed to manuscript and image preparation, reviewing the draft and approving the final version.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.