Two cases of malignant glaucoma unresolved by pars plana vitrectomy
Case one was an 88-year-old woman with a history of pseudoexfoliation glaucoma in the right eye (OD) with maximum IOP >30 mmHg. Both eyes were pseudophakic and showed normal anterior chamber depth. Because her IOP OD could not be controlled with additional glaucoma eyedrops and oral acetazolamide, she underwent trabeculotomy. Three days after the trabeculotomy, she developed a flattening of the anterior chamber and an elevated IOP OD. She was diagnosed with malignant glaucoma. The condition could not be resolved with systemic hyperosmotic agents and oral carbonic anhydrase inhibitors, so she underwent an emergent PPV (total vitrectomy) using a 25 gauge vitreous cutter with vitreous base shaving and removal of the anterior hyaloid. Her anterior chamber deepened, and her IOP decreased to 10 mmHg the following day. Her IOP was maintained in the mid-teens OD by using three types of glaucoma eyedrops. Four months after PPV, her IOP increased to 70 mmHg again with a flat anterior chamber (, ). We hypothesize that the cilio-pupillary block mechanism was related to her clinical condition, and we performed an emergent iridectomy and local zonulectomy using a 25 gauge vitreous cutter. The posterior synechia of the iris was partially, but not completely, observed intraoperatively. Her anterior chamber had deepened (, ); for 10 months, her IOP has been maintained in the low-teens OD with the use of two types of glaucoma eyedrops.