{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,8,27]],"date-time":"2025-08-27T08:40:19Z","timestamp":1756284019498,"version":"3.44.0"},"reference-count":23,"publisher":"BMJ","issue":"12","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2021,12,17]]},"published-print":{"date-parts":[[2021,12]]},"abstract":"<jats:p>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\u2009years 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.<\/jats:p>","DOI":"10.1136\/bcr-2021-242777","type":"journal-article","created":{"date-parts":[[2021,12,31]],"date-time":"2021-12-31T05:25:42Z","timestamp":1640928342000},"page":"e242777","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["Aqueous misdirection syndrome masking as myopic surprise following phacoemulsification surgery"],"prefix":"10.1136","volume":"14","author":[{"given":"Chung Shen","family":"Chean","sequence":"first","affiliation":[{"name":"Ophthalmology Department, Northampton General Hospital, Northampton, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Duminda","family":"Gabadage","sequence":"additional","affiliation":[{"name":"Ophthalmology Department, Northampton General Hospital, Northampton, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Subhanjan","family":"Mukherji","sequence":"additional","affiliation":[{"name":"Ophthalmology Department, Northampton General Hospital, Northampton, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2021,12,31]]},"reference":[{"key":"2025082701040853000_14.12.e242777.1","doi-asserted-by":"crossref","first-page":"108","DOI":"10.1007\/BF02721215","article-title":"Beitr\u00e4ge Zur Pathologie und therapie des Glaucoms","volume":"15","author":"Graefe","year":"1869","journal-title":"Graefes Archiv f\u00fcr Ophthalmologie"},{"key":"2025082701040853000_14.12.e242777.2","doi-asserted-by":"crossref","first-page":"1843","DOI":"10.1016\/j.jcrs.2014.02.045","article-title":"Malignant glaucoma after cataract surgery","volume":"40","author":"Varma","year":"2014","journal-title":"J Cataract Refract Surg"},{"key":"2025082701040853000_14.12.e242777.3","doi-asserted-by":"publisher","DOI":"10.1007\/s00417-011-1763-0"},{"key":"2025082701040853000_14.12.e242777.4","doi-asserted-by":"crossref","first-page":"1330","DOI":"10.1016\/S0161-6420(93)31479-X","article-title":"Ultrasound biomicroscopy in pseudophakic malignant glaucoma","volume":"100","author":"Tello","year":"1993","journal-title":"Ophthalmology"},{"key":"2025082701040853000_14.12.e242777.5","doi-asserted-by":"publisher","DOI":"10.1016\/S0161-6420(95)30870-6"},{"key":"2025082701040853000_14.12.e242777.6","doi-asserted-by":"crossref","first-page":"688","DOI":"10.1001\/archopht.117.5.688","article-title":"Treatment of malignant glaucoma with contact transscleral cyclophotocoagulation","volume":"117","author":"Carassa","year":"1999","journal-title":"Arch Ophthalmol"},{"key":"2025082701040853000_14.12.e242777.7","doi-asserted-by":"crossref","first-page":"1035","DOI":"10.1016\/S0161-6420(99)00530-8","article-title":"Aqueous misdirection after glaucoma drainage device implantation","volume":"106","author":"Greenfield","year":"1999","journal-title":"Ophthalmology"},{"key":"2025082701040853000_14.12.e242777.8","doi-asserted-by":"crossref","first-page":"155","DOI":"10.3928\/15428877-20080301-03","article-title":"Hypotonous malignant glaucoma: aqueous misdirection with low intraocular pressure","volume":"39","author":"Burgansky-Eliash","year":"2008","journal-title":"Ophthalmic Surg Lasers Imaging"},{"key":"2025082701040853000_14.12.e242777.9","doi-asserted-by":"publisher","DOI":"10.1136\/bjo.81.2.163"},{"key":"2025082701040853000_14.12.e242777.10","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1155\/2012\/852659","article-title":"Malignant glaucoma: a review of the modern literature","volume":"2012","author":"Shahid","year":"2012","journal-title":"J Ophthalmol"},{"key":"2025082701040853000_14.12.e242777.11","doi-asserted-by":"crossref","first-page":"398","DOI":"10.1016\/j.sjopt.2018.11.005","article-title":"Spontaneous malignant glaucoma: case report and review of the literature","volume":"33","author":"Gonz\u00e1lez-Mart\u00edn-Moro","year":"2019","journal-title":"Saudi J Ophthalmol"},{"key":"2025082701040853000_14.12.e242777.12","doi-asserted-by":"publisher","DOI":"10.1016\/0039-6257(87)90101-9"},{"key":"2025082701040853000_14.12.e242777.13","doi-asserted-by":"crossref","first-page":"183","DOI":"10.2147\/OPTH.S75698","article-title":"Aqueous misdirection syndrome: an interesting case presentation","volume":"9","author":"Moinul","year":"2015","journal-title":"Clin Ophthalmol"},{"key":"2025082701040853000_14.12.e242777.14","doi-asserted-by":"crossref","unstructured":"Handzel DM , Alani A , Handzel RP . 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