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Hyperopic patients with a previous history of malignant glaucoma can be made aware of an imminent attack by observing when their VA improves without the aid of corrective spectacles. Surgeons need to be aware that biometric measurements and IOL calculations in these abnormal eyes may be inaccurate, particularly if the measurements are made when the patient is in absolute or relative aqueous misdirection. This case illustrates that extremely large refractive shifts () 8.0 D) in association with aqueous misdirection are possible, even in eyes that are not of extremely short axial length. ReferencesCarassa RG, Bettin B, Fiori M et al. (1999):Treatment of malignant glaucoma with contact transscleral cyclophotocoagulation. Arch Ophthalmol 117: 688-690. Holladay JT, Gills JP, Leidlein J et al. (1996): Achieving emmetropia in extremely short eyes with two piggyback posterior chamber intraocular lenses. Ophthalmology

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