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Surgical management of aqueous misdirection by endoscopic vitrectomy with Hyaloido-Zonulo-Iridectomy

Eye (2026)Cite this article

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Abstract

Objective

To assess the outcomes of surgical management of aqueous misdirection (AM) by endoscopic pars plana vitrectomy with hyaloido–zonulo–iridectomy.

Materials and methods

In this prospective, longitudinal, noncomparative interventional study, 53 eyes from 46 patients with AM refractory to medical and laser therapy after intraocular surgery were enrolled. All eyes underwent lens removal (if phakic), endoscopic pars plana vitrectomy, and hyaloido–zonulo–iridectomy. Primary outcomes included intraocular pressure (IOP), best-corrected visual acuity (BCVA), anterior chamber depth (ACD), postoperative complications, relapse rate, and composite surgical success. Surgical success was defined as the combination of IOP control and anterior chamber reformation, using two alternative IOP thresholds ( ≥ 6 and ≤18 mmHg, or ≥6 and ≤21 mmHg). Continuous variables were analysed using linear mixed models and expressed as estimated means (est)± standard error.

Results

Mean age was 59.7 ± 12.2 years. The est. IOP decreased from 34.36 ± 0.82 mmHg to 17.47 ± 0.82 mmHg at 12 months (p < 0.001). The est. BCVA improved from 1.50 ± 0.07 to 0.70 ± 0.07 logMAR at 12 months (p < 0.001). The est. ACD increased from 0.70 ± 0.06 to 3.34 ± 0.06 mm (p < 0.001), with complete anterior chamber reformation in all eyes. Postoperative complications occurred in 22 eyes (41.8%), mostly transient and resolved with medical or YAG laser treatment; only one required glaucoma surgery. At 12 months, overall success was 98.1% using the ≤21 mmHg criterion and 75.5% using the ≤18 mmHg criterion. No relapses were observed.

Conclusions

Surgical management using lens removal, endoscopic anterior vitrectomy, and hyaloido–zonulo–iridectomy is a significantly effective and safe treatment for AM.

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Data availability

The datasets generated and/or analysed during the current study, which were used for all statistical analyses and for the creation of all figures, as well as the tables, are available from the corresponding author upon reasonable request.

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Author information

Author notes

  1. These authors contributed equally: Tan Do, Ha Thi Thu Pham.

Authors and Affiliations

  1. Vietnam National Eye Hospital, Hanoi, Vietnam

    Tan Do & Ha Thi Thu Pham

  2. University of Medicine and Pharmacy, Vietnam National University, Hanoi, Vietnam

    Tan Do

  3. Singapore National Eye Center, Singapore Eye Research Institute, Singapore, Singapore

    Andrea Servillo & Tin Aung

  4. Ophthalmology Unit, IRCSS Ospedale San Raffaele, Milan, Italy

    Andrea Servillo

  5. Duke-NUS Medical School, Singapore, Singapore

    Tin Aung

Authors
  1. Tan Do
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  2. Ha Thi Thu Pham
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  3. Andrea Servillo
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  4. Tin Aung
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Contributions

Conception or design of the work: HTTP, TD, TA. Acquisition, analysis, or interpretation of data: HTTP, TD, TA. Drafted the work or substantively revised it: HTTP, TD, AS, TA.

Corresponding author

Correspondence to Tan Do.

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Competing interests

TA serves on the Editorial Board of Eye. The authors declare no other conflicts of interest.

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Do, T., Pham, H.T.T., Servillo, A. et al. Surgical management of aqueous misdirection by endoscopic vitrectomy with Hyaloido-Zonulo-Iridectomy. Eye (2026). https://doi.org/10.1038/s41433-026-04265-y

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