Two cases of malignant glaucoma unresolved by pars plana vitrectomy
Case two was an 85-year-old man with a history of primary angle closure in both eyes (OU) and pseudoexfoliation glaucoma OD. He underwent phacoemulsification and aspiration (PEA), and intraocular lens (IOL) implantation OU. Following cataract surgery, he frequently exhibited a flattening of the anterior chamber and elevated IOP of >40 mmHg on maximal glaucoma medications. As his clinical condition OD was considered to be related to the malignant glaucoma mechanism, he underwent a YAG capsulohyaloidotomy and goniosynechialysis (GSL) for severe peripheral anterior synechia (PAS). Ten months after cataract surgery, his IOP OD was 32 mmHg, and his anterior chamber was still very shallow. He then underwent PPV (total vitrectomy) using a 25 gauge vitreous cutter with vitreous base shaving and removal of the anterior hyaloid, and GSL OD, at which point his anterior chamber deepened significantly and his IOP decreased to the low-teens. One month after PPV, he once again exhibited a flattening of the anterior chamber and severe PAS, and was referred to Kyoto University Hospital (, ). He presented with spontaneous IOL dislocation within the capsular bag. His IOP OD increased to 32 mmHg, and his visual acuity worsened to counting finger vision. He underwent an iridectomy without zonulectomy using a 25 gauge vitreous cutter near the area where Zinn’s zonule had been partially ruptured. We further performed GSL and trabectome surgery (NeoMedix Corporation, Tustin, CA, USA) (a surgical procedure that ablates an arc of trabecular mesh-work). His anterior chamber had deepened (, ); for 6 months, his IOP has been maintained in the high-teens OD by using additional glaucoma eyedrops.