Evaluating anterior segment structure using anterior segment optical coherence tomography in malignant glaucoma after Ahmed valve implantation

Abstract

Rationale: Malignant glaucoma is a rare condition that can be associated with surgery for glaucoma. In the present case report, we describe a case of malignant glaucoma occurring a week after Ahmed valve implantation. The change in anterior segment structure was identified using anterior segment optical coherence tomography (AS-OCT). Patient concerns: The 86-year-old woman with pseudoexfoliation glaucoma underwent Ahmed valve implantation. A week later, the intraocular pressure (IOP) increased to 74 mm Hg. Diagnosis: The anterior chamber was totally collapsed with conjunctival injection and edematous cornea. Finally, the patient was diagnosed with malignant glaucoma. The structure of anterior chamber was well-identified by AS-OCT. Interventions: The patient received Atropine instillation, Nd:YAG laser capsulotomy and disruption of the anterior hyaloid face, as well as maximal medical therapy for IOP reduction. However, the collapsed status of the anterior segment was not relieved, and the IOP was still high. Therefore, pars plana vitrectomy (PPV) with iridectomy was performed. Outcomes: Three days after PPV, deep chamber depth and open angle structure were noted using AS-OCT. Deep chamber depth and stable IOP (between 10 and 16) were maintained until 17 months after PPV. Lessons: AS-OCT is useful in the diagnosis and follow-up of malignant glaucoma.