• Zonule Dialysis and Aqueous Misdirection Syndrome Description: Case of a 70 year old female glaucoma suspect (open angles; normal IOP; cup disc ratio of 0.7) operated for cataract removal of the left eye. After fragmentation and Phacoemulsification of the lens nucleus, adherent cortical materials in the peripheral capsule make the irrigation-aspiration procedure difficult. Manual rotation and clearing of the cortex material haphazardly damaged the approximated 4 o clock to 7 o clock hour zonules location making the capsulorhexis oblong and decentered (see 14:03). Checking of posterior capsule integrity through triamcinolone injection and anterior vitrectomy was also done. Since there was an intact posterior capsule, the surgeon decided to put the IOL in the bag. CTR was planned to be inserted but unavailable at the time of surgery. The remaining procedure went well not until the wound closure wherein there was an axial shallowing of the central and peripheral anterior chamber despite several attempts of stromal hydration and wound suturing. Aqueous misdirection was suspected because of the zonule dialysis and phaco fluid gushing in the anterior hyaloid and vitreous cavity. Peripheral iridectomy was performed to channel the pushing fluids in the anterior chamber. Additional suture was performed to secure the anterior chamber as well. Medical management with cycloplegic and anti glaucoma drugs apart from the routine post cataract regimen was given control the flow of aqueous fluid posteriorly. Sutures were removed 4 weeks after surgery. (Uploaded by Dr. Emerson Cruz, Philippines) Subspecialty: Cataract / Anterior Segment Level: Intermediate Uploaded By: ISRS Multimedia Library