Background: Aqueous misdirection syndrome (AMS) typically occurs after surgery for angle closure glaucoma, or surgery in hyperopic eyes with narrow angles. Pars plana vitrectomy (PPV) is often considered the definitive treatment for AMS. The authors describe a rare case of AMS developing de novo after PPV in an eye without any prior history of AMS, angle closure glaucoma, or narrow angles.

Methods: Interventional case report.

Results: A 72-year-old woman with vitreomacular traction syndrome developed an acute rhegmatogenous retinal detachment and underwent an uneventful PPV, posterior hyaloid peel, cryopexy, and C3F8 gas insertion. Initial postoperative raised intraocular pressure (IOP) was successfully managed medically. She returned 6 days postoperatively with a highly elevated IOP refractory to medical treatments, and signs of AMS. She therefore underwent emergency C3F8 removal, phacoemulsification, posterior chamber IOL insertion, anterior vitrectomy, peripheral irido-capsulo-hyaloidectomy, and retamponade with 30% SF6. In 2 years of follow-up, there has been no recurrence of AMS and her IOP has remained normal.

Conclusions: This case demonstrates that AMS can develop in vitrectomized eyes without a pre-existing history of AMS, angle closure glaucoma, or narrow angles. AMS should therefore be considered as a potential cause of raised IOP in association with a shallow anterior chamber following vitrectomy.