Contributor: Gordon K. Klintworth
Aqueous misdirection syndrome (malignant glaucoma, secondary angle closure glaucoma with ciliary block, ciliary block glaucoma) is a special form of secondary glaucoma [glaucoma - secondary] in which an elevated intraocular pressure persists following glaucoma surgery. In 1869 von Graefe introduced the term malignant glaucoma for this syndrome. Later Shaffer concluded that forward flow of aqueous humor was blocked in the plane of the ciliary body, the vitreous, and the equator of the lens and in 1972 Weiss and Shaffer coined the term ciliary block glaucoma to emphasize the location of the barrier to aqueous flow. Eyes with shallow anterior chambers and angle-closure glaucoma [glaucoma - angle closure] may be made worse by medical or surgical therapy, especially filtering surgery. The vitreous seems to become compressed against the ciliary body at the vitreous base and this prevents an anterior flow of aqueous humor, which then seems to be directed backward through the vitreous or through a break in the anterior hyaloid near its attachment to the ciliary body. When fluorescein-stained saline is injected into the anterior chamber of such eyes the anterior chamber fails to deepen and the dye reaches the retrovitreal space. Also the intraocular pressure becomes elevated and can be lowered by aspirating pockets of fluid within and behind the detached vitreous.