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November 1989

Laser Capsulotomy Through Intraocular Lens Positioning Holes in Anterior Aqueous Misdirection

Author Affiliations

Riyadh, Saudi Arabia

Arch Ophthalmol. 1989;107(11):1569. doi:10.1001/archopht.1989.01070020647010

To the Editor.  —Abnormalities in aqueous circulation (ie, pupillary block, aqueous misdirection) are known to occur following cataract surgery, with or without lens implantation, and with or without trabeculectomy.1 Recently, aqueous misdirection has been redefined as a clinical spectrum that ranges from an anterior (retrocapsular) variety to the more classical posterior (intravitreal) form, commonly known as malignant glaucoma.2 Whereas the posterior form often requires aggressive treatment, such as neodymium (Nd)-YAG laser vitreolysis or pars plana vitrectomy, the anterior form can be managed by simple Nd-YAG laser capsulotomy.3In the absence of an intraocular lens (IOL), capsulotomy immediately establishes communication between the posterior and anterior chambers. However, with pseudophakia, an effective capsular opening must be outside the boundaries of the lens optic. To perform a capsulotomy in this location, adequate mydriasis is required, which cannot always be achieved. Alternatively, we have found that capsulotomy done through the

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