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Editors Selection IGR 10-4
Surgery: Cyclodestruction for aqueous misdirection
Comment by Harmohina Bagga on:
22360 Transscleral cyclodiode laser photocoagulation in the treatment of aqueous misdirection syndrome, Stumpf TH; Austin M; Bloom PA et al., Ophthalmology, 2008; 115: 2058-2061
Aqueous misdirection although rare, is an extremely frustrating condition often resistant to medical and laser therapy. In a retrospective case series, Stumpf et al. (1744) report their experience with transscleral cyclophotocoagulation (CPC) as an alternative to surgical intervention in patients with aqueous misdirection refractory to medical therapy and laser iridotomy. They attribute the success of CPC to the hypothesis that focal application of laser causes shrinkage of ciliary processes thereby breaking the ciliolenticular block. This is consistent with prior reports of success with transpupillary argon laser photocoagulation of ciliary processes in treating aphakic patients with aqueous misdirection.
Transscleral cyclophotocoagulation (CPC) may be an alternative therapy for treatment of aqueous misdirectionThey describe five patients successfully treated with CPC after failure of medical therapy including cycloplegia with atropine, patent iridotomy and in some cases YAG capsulotomy to resolve the aqueous misdirection. The intraocular pressure continued to remain well controlled and anterior chamber deep for up to 15-96 months follow-up. The authors are to be commended for presenting an easy, safe and effective alternative for this resistant condition. However, the study is limited by its retrospective design as well as the inconsistent and variable treatment parameters used in all patients. The rationale behind the variable number of quadrants treated, the power and the total number of pulses used in all five patients is unclear. Finally, the authors fail to mention if the success rate with CPC was uniform or if only the cases successfully treated with CPC were reported.
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