Clinical Management of Malignant Glaucoma

Abstract

Malignant glaucoma remains one of the most challenging complications of ocular surgery. Although it has been reported to occur spontaneously or after any ophthalmic procedure, it is most commonly encountered after glaucoma surgery in eyes with prior chronic angle closure. The clinical diagnosis is made in the setting of a patent peripheral iridotomy and axial flattening of the anterior chamber. Intraocular pressure is usually elevated, but it may be normal in some cases. Although the exact etiology of this condition is not fully understood, several mechanisms have been proposed and it is thought to result from posterior misdirection of aqueous humor into or behind the vitreous. This review discusses pathophysiology, differential diagnosis, imaging modalities, and current treatment strategies for this rare form of secondary glaucoma.

Figure 1

Ultrasound biomicroscopy (UBM) of malignant glaucoma. (a) The patient with a history of angle closure glaucoma and a patent laser iridotomy presented after glaucoma filtration surgery with elevated intraocular pressure. UBM showed shallow anterior chamber and anterior rotation of the ciliary body. (b) After treatment with cycloplegic medication and topical steroids, the anterior chamber deepened and the ciliary body returned to normal position. C, cornea; I, iris; B, ciliary body; and M, hyaloid membrane (reprinted by permission from [51]).

Figure 2

Malignant glaucoma treatment. (a) The patient presented after glaucoma filtration surgery with a shallow chamber and markedly elevated intraocular pressure, not responding to initial treatment with cycloplegia and laser. (b) After pars plana vitrectomy, the anterior chamber was deep and the intraocular pressure was normalized.