Current Concepts on Aqueous Misdirection

Purpose of Review: In this article, we review the pathophysiology and recent advances in the management of aqueous misdirection. Recent Findings: Aqueous misdirection remains a rarely encountered and incompletely understood ophthalmologic problem. Despite advances in surgical techniques, with a great variety of interventions available to surgeons, durable success is limited with relatively high recurrence rates. Core vitrectomy with hyaloidectomy/zonulectomy/iridectomy continues to be regarded as the most definitive therapy, although limited anterior vitrectomy may have comparable efficacy. Summary: Aqueous misdirection is a rare secondary angle-closure glaucoma that usually occurs in the post-operative setting in anatomically smaller eyes with primary angle-closure glaucoma. The pathophysiologic mechanisms underlying this disease are not well understood. However, it ultimately leads to an abnormal pressure gradient between the posterior and anterior segments of the affected eyes. Several interventions may successfully mitigate aqueous misdirection. However, due to the low prevalence of the disorder and to difficulty studying the condition in a controlled setting, rates of treatment success, disease recurrence, and prognosis among affected eyes remain uncertain.