Objective  To study the differential diagnosis and management of the infusion misdirection syndrome during phacoemulsification. Methods  This was a retrospective case study. Thirteen patients （13 eyes） diagnosed with infusion misdirection syndrome who suddenly developed a shallow anterior chamber and high intraocular pressure during phacoemulsification were selected by differential diagnosis between January 2005 and June 2013. Patients were treated with a 20% mannital rapid intravenous drip to decrease intraocular pressure， pars plana vitreous cavity puncture aspiration and dryness vitrectomy through a single channel by a 23G vitreoretinal surgical system. Results  Four eyes were treated with a 20% mannital rapid intravenous drip， 3 eyes underwent pars plana vitreous cavity puncture aspiration and 6 eyes underwent dryness vitrectomy through a single channel by a 23G vitreoretinal surgical system during the operation. The anterior chamber re-formed and intraocular pressure decreased after the above management procedures. The remaining operative procedures could be finished successfully. No posterior capsular rupture or vitreous prolapse occurred in any cases. Visual acuity was 0.2 in 3 eyes， 0.3-0.4 in 6 eyes and 0.5-0.6 in 4 eyes on 1 day postoperatively and 0.3-0.4 in 2 eyes， 0.5-0.6 in 6 eyes， and 0.7-0.8 in 5 eyes at 1 week postoperatively. The cornea was clear， anterior chamber depth was normal， the pupil was round and centered， and the IOL was in position in every operated eye. Conclusion  Infusion misdirection syndrome during phacoemulsification can be diagnosed definitely by differential diagnosis. A 20% mannital rapid intravenous drip， pars plana vitreous cavity puncture aspiration and especially single channel dryness vitrectomy by a 23/25G vitreoretinal surgery system can resolve shallow anterior chamber and high intraocular pressure that occurred during the operation. The rest of the operation could be finished successfully.