Prophylactic anterior vitrectomy during cataract surgery in eyes at increased risk for aqueous misdirection

PURPOSE: Patients with chronic narrow angle glaucoma (CNAG) are at increased risk of developing aqueous misdirection (AM) following intraocular surgery. We present a retrospective case series on the use of posterior capsulorrhexis with core vitrectomy by an anterior approach (CAV) at the time of cataract extraction with or without glaucoma surgery as a prophylactic measure for the prevention of AM in CNAG. METHODS: Retrospective case series of six phakic eyes in four patients with CNAG and other risk factors for AM who underwent posterior capsulorrhexis and CAV at the time of cataract surgery with or without glaucoma surgery. The main outcome measures were best-corrected visual acuity (BCVA), intraocular pressure (IOP), and post-operative complications. RESULTS: Six eyes in four subjects underwent posterior capsulorrhexis with CAV at the time of cataract surgery. The case was combined with incisional glaucoma surgery in the five eyes with advanced visual field loss. The mean logMAR BCVA and IOP improved from 0.554 ± 0.398 and 25.2 ± 13 mmHg, respectively, at the pre-operative visit to 0.257 ± 0.218 and 12.2 ± 1.7 mmHg, respectively, at final follow-up. Both eyes with nanophthalmos developed non-appositional serous choroidals that resolved with atropine, but the left eye required additional treatment with synechiolysis, intraocular lens repositioning, limited AV and endocyclophotocoagulation. There were no permanent, vision-threatening complications. CONCLUSIONS AND IMPORTANCE: CAV can be safely combined with cataract surgery and glaucoma surgery, and it may be an effective intervention in eyes with CNAG and other risk factors for AM as a prophylactic measure against the development of AM.