Exploration on surgery of malignant glaucoma with prolonged absence of the anterior chamber: a retrospective consecutive case series

Abstract

Objective: To evaluate the surgical outcomes of anterior chamber restoration in patients with malignant glaucoma and a prolonged absence of the anterior chamber.

Methods: Five patients with malignant glaucoma and a long-term absence of the anterior chamber underwent a combination of anterior pars plana vitrectomy (aPPV), phacoemulsification cataract excision, intraocular lens implantation, peripheral iridotomy (PI), goniosynechialysis (GSL) (referred to aPPV + P + I + PI + GSL) at Beijing Tongren Hospital from October 2018 to June 2021. The study compared the changes in their visual acuity, intraocular pressure (IOP) and medication requirements between the pre-surgery period and their most recent follow-up visit.

Results: The five patients did not report any discomfort, such as pain, tearing, swelling, etc., in their affected eyes, and maintained a stable restoration of the anterior chamber. Among the affected eyes, only one eye demonstrated improved vision during the follow-up visit, while the remaining four eyes did not show any significant improvement. One eye underwent transscleral cyclophotocoagulation as an additional procedure, while the other four eyes did not require any further surgical intervention. In all cases, the intraocular pressure (IOP) was successfully controlled below 30 mmHg. Post-surgery, four eyes still required cycloplegia treatment, and three eyes continued to rely on eye drops to manage their IOP.

Conclusion: Despite minimal improvement in vision, surgical intervention successfully restored the anterior chamber in malignant glaucoma patients with a prolonged absence of anterior chamber. This restoration contributed to alleviating subjective complaints of discomfort and delaying eyeball atrophy.

Keywords: Malignant glaucoma; Prognosis; Shallow anterior chamber; Surgery treatment.

Fig. 1

Pre-surgery pictures of anterior segment of Case 1: Pictures 1 and 2 show the disappearance of the anterior chamber, while picture 3 shows synechia of iris with anterior lens capsule (white arrow in the pictures indicated NVI). In pictures 4 and 5, preoperative UBM images show absence of anterior and posterior chamber

Fig. 2

Pre-surgery and post-surgery color picture of anterior segment of Case 2, where, pictures 1 and 2 are pre-surgery color pictures, showing disappearance of anterior chamber, and the white arrow indicates CNI, picture 3 is the post-surgery color picture, showing formation of anterior chamber, and peripheral iridotomy incision in 5:00 position; In pictures 4 and 5, preoperative UBM images show that the iris is attached to the cornea and the anterior chamber is absent. UBM images six months after surgery show presence of anterior chamber and partially opening of anterior chamber angle (pictures 6 and 7)

Fig. 3

Picture 1 shows early post-surgery color picture of Case 3: mild corneal edema, formation of anterior chamber, and peripheral iridotomy incision was visible. UBM images six months after surgery shows formation of anterior chamber (Picture 2)

Fig. 4

Pre-surgery and post-surgery color pictures of Case 4: (1) Disappearance of anterior chamber is visible; (2) post-surgery formation of anterior chamber is visible, and the peripheral iridotomy incision is unobstructed. In pictures 3and 4, preoperative UBM images show that the iris is attached to the cornea and the anterior chamber is absent, supporting the diagnosis of malignant glaucoma. In pictures 5 and 6, UBM images seven months after surgery show deep anterior chamber and partially opening of anterior chamber angle

Fig. 5

Pre-surgery color picture of Case 5: disappearance of anterior chamber is visible