Aqueous misdirection and flat chamber after posterior chamber implants with and without trabeculectomy.

Three patients developed flat anterior chamber and were ultimately diagnosed as having aqueous misdirection after trabeculectomy with extracapsular cataract extraction and posterior chamber lens implantation (glaucoma triple procedure). A fourth patient developed aqueous misdirection after posterior chamber lens implantation only (without trabeculectomy). This latter was cured by repeated pars plana vitrectomy, not requiring removal of the pseudophakos. In only one of the three eyes with the triple procedure did the lens have to be removed and anterior vitrectomy performed, whereas the remaining two were cured by neodymium-YAG laser disruption of the anterior hyaloid. In these two cases, the posterior capsule remained intact. Neodymium-YAG laser vitreolysis should be the first step in the management of these cases because of its safety compared with open surgery.