Pseudophakic Malignant Glaucoma Research Articles

Management of Late Onset Sequential Pseudophakic Malignant Glaucoma: A Case Report and Review of Literature

Introduction: Malignant glaucoma or aqueous misdirection syndrome (AMS) can present in the immediate post-operative period or even many years after cataract surgery. We report the clinical course and management of a patient who developed the disease in both eyes at different time intervals after uneventful cataract surgery.Patient and Clinical Findings: A 76-year-old man developed diffusely shallow anterior chamber (AC) and high intraocular pressure (IOP) in his right eye after 2 years of pseudophakia, which did not resolve with laser peripheral iridotomy. A similar episode happened in left eye after 3 years of cataract surgery in the presence of a patent laser iridotomy.Diagnosis, Interventions, and Outcome: Shallow anterior chamber in the presence of a patent PI and normal posterior segment confirmed the diagnosis. The right eye was successfully managed with Nd:YAG laser capsulo-hyaloidotomy and pharmacotherapy, whereas in left eye, pars plana vitrectomy (PPV) with irido-zonulo-anterior hyaloidectomy (IZH) was done. Recurrence was noted after PPV also, owing to blockage of surgical iridectomy, which was treated with Nd:YAG laser.Conclusion: Pseudophakic malignant glaucoma can present many years after cataract surgery. Pars plana vitrectomy with IZH is an effective mode of treatment for refractory cases. Laser capsulo-hyaloidotomy may be more useful in the acute phase of the disease.

Resolution of malignant glaucoma following laser capsulo-hyaloidotomy through the optic hole of intraocular lens

We report a case of pseudophakic malignant glaucoma who was managed with laser capsulo-hyaloidotomy through the dialing hole of the optic of the nonfoldable intraocular lens (IOL). Our case presented with sudden, painful decreased vision in the left eye since 15 days, 3 years after cataract surgery. There was a uniformly shallow anterior chamber with a high intraocular pressure (IOP) of 52 mm Hg and glaucomatous disc damage. After performing laser capsulo-hyaloidotomy through the optic hole of the IOL, we noticed deepening of the anterior chamber, improvement in vision, and good IOP control on antiglaucoma medication, thus showing complete resolution of aqueous misdirection and obviating the need for surgical management.

Clinical efficacy of inferior peripheral irido-capsulo-hyaloidotomy for pseudophakic malignant glaucoma.

The present research aimed to investigate the effects of Inferior peripheral irido-capsulo-hyaloidotomy for the management of pseudophakic malignant glaucoma. Ten pseudophakic eyes with aqueous misdirection were diagnosed between September 2017 and December 2018 (10 eyes of 8 patients), which were included in the prospective consecutive case series study. Seven eyes underwent Inferior laser peripheral irido-capsulo-hyaloidotomy, and three eyes underwent pars plana vitrectomy, zonulo-capsulo-hyaloidectomy, and inferior iridectomy. Eight eyes (80%) had angle-closure glaucoma. The mean duration of the follow-up was 12.25 ± 3.05months (ranging from 10-18months). The patients had a mean age of 69.25 ± 6years. The IOP at the onset of malignant glaucoma was found to be 33.8 ± 5.5mmHg, which was reduced to 13.9 ± 2.7mmHg at the final visit (P value = 0.002). The reduction in the number ± SD of anti-glaucoma medications (3.3 ± 0.48 to 1.4 ± 0.51) and improvement in mean ± SD LogMAR visual acuity (1.2 ± 0.06 to 0.61 ± 0.26) between the onset and final visit were significant (p = 0.004 and P = 0.005, respectively). All the patients responded to Inferior peripheral irido-capsulo-hyaloidotomy (with YAG laser or with the surgical procedure), which led to a significant reduction in intraocular pressure (IOP) and deepening of the anterior chamber. The success rate of peripheral irido-capsulo-hyaloidotomy with laser or surgical procedure in the inferior quadrant was high regarding pseudophakic malignant glaucoma patients. The establishment of a patent inferior communication between the vitreous cavity and the anterior chamber was the main component in the treatment of pseudophakic malignant glaucoma patients.

Pseudophakic malignant glaucoma - a case report

Purpose. To report a case of malignant glaucoma in a pseudophakic female patient, with no history of glaucoma, resolved through pars plana anterior vitrectomy. Case presentation. An 80-year-old female patient presented in our Emergency Department after a five-day history of pain in her left eye (LE). In the last day, the patient noticed marked visual loss and ocular pain. Visual acuity was light perception and Goldman tonometry was 80 mmHg in her LE. The biomicroscopy revealed absent peripheral and central anterior chamber (AC) and posterior chamber (PC) pseudophakia. Posterior segment ecography showed no vitreous or choroidal abnormalities. A peripheral laser YAG iridotomy was made and the patient was treated with intravenous 20% mannitol, topical timolol, topical brimonidine, and topical cycloplegics. 12 hours later, despite a patent iridotomy in the LE eye, intraocular pressure (IOP) was 55 mmHg, absent AC with severe corneal edema. The diagnosis of pseudophakic malignant glaucoma was made and laser YAG capsulotomy was performed with no resolution of symptoms and signs. 24 hours later, we performed pars plana anterior vitrectomy. Postoperatively, the AC depth increased and the IOP decreased to 20mmHg. After a week, the patient was discharged with hand movement perception visual acuity in her LE, 20 mmHg IOP, reduced corneal edema, normal depth AC. After a month, the corneal edema resolved, the visual acuity was 2/50, IOP was 20mmHg, and the AC had a normal depth. Conclusion. Malignant glaucoma is a sight threatening condition, reported in pseudophakic eyes. Although, literature describes cases solved by cycloplegics and laser YAG capsulotomy, our patient needed pars plana anterior vitrectomy for the resolution of symptoms and signs.

Pseudophakic Malignant Glaucoma Treatment Assisted with Anterior Segment Optical Coherence Tomography: A Case Report

PSEUDOPHAKIC malignant glaucoma is diagnosedbased on the presence of a shallow or flat centraland peripheral anterior chamber in the presenceof patent iridectomy, with intraocular pressure（IOP） of 22 mm Hg or more after lens extraction andintraocular lens implantation.1 Pseudophakic malignantglaucoma is one of the most challenging complicationsfaced by surgeons. Initial medication includes topicalcycloplegics, osmotic agents.

Efficacy and safety of a new surgical method to treat malignant glaucoma in pseudophakia

To assess the efficacy and safety of a relatively new surgical method in pseudophakic malignant glaucoma patients. This study is a retrospective, non-comparative, interventional case series. Ten eyes of nine pseudophakic malignant glaucoma patients with mean age of 63.3 years were analysed. All 10 eyes underwent a novel surgical technique, an anterior chamber capsulo-hyaloidectomy and anterior vitrectomy through the peripheral iridectomy. Main outcome measures were: reformation of the anterior chamber, intraocular pressure (IOP), best-corrected visual acuity (BCVA), and complications. All 10 eyes with pseudophakic malignant glaucoma were treated successfully by using a new surgical technique. All cases had a relief of aqueous misdirection with anterior chamber deepening during and after the surgery and post-operative intraocular pressure (IOP) normalization. No relapses have been observed so far. There were no complications during surgery and in the post-operative period. The presented surgical technique seems to be safe and effective in all cases of malignant glaucoma in pseudophakia.

Long-term follow-up of zonulo-hyaloido-vitrectomy for pseudophakic malignant glaucoma.

Purpose:To report long-term follow-up of zonulo-hyaloido-vitrectomy (ZHV) via anterior approach for pseudophakic malignant glaucoma refractory to medical treatment.Design:Noncomparative case-series.Materials and Methods:Medical records of 9 patients who sought treatment for aqueous humor misdirection refractory to medical treatment were reviewed. All patients underwent anterior vitrectomy, hyaloido-zonulectomy, and peripheral iridectomy (PI) via an anterior approach. Main outcome measures were preoperative and postoperative visual acuity, intraocular pressure, medications, slit-lamp examination, and fundus findings.Results:10 eyes of 9 patients (7 female, 2 male) who underwent ZHV for refractory pseudophakic malignant glaucoma between 2003 and 2010 were included in this case-series. The mean age of patients was 77.4 ± 9.0 years, mean follow-up duration 50.2 ± 27.2 months. Recurrence of malignant glaucoma was noted in 40% (four cases) after a successful ZHV on long-term follow-up.Conclusions:An anterior segment surgeon can treat malignant glaucoma refractory to medical treatment successfully by vitrectomy, hyaloido-zonulectomy, and PI. This can be done via an anterior approach and patients require long follow-up to rule out a relapse despite a successful outcome in the short term.

Optical coherence tomography and ultrasound biomicroscopy in the management of pseudophakic malignant glaucoma

Optical coherence tomography and ultrasound biomicroscopy in the management of pseudophakic malignant glaucoma

Surgical Management of Pseudophakic Malignant Glaucoma via Anterior Segment-Peripheral Iridectomy Capsulo-Hyaloidectomy and Anterior Vitrectomy

Purpose. To describe our surgical technique in the management of pseudophakic malignant glaucoma refractory to conventional treatment. Methods. Two pseudophakic eyes with malignant glaucoma underwent peripheral iridectomy, lens capsulectomy, hyaloidectomy, and anterior vitrectomy through a clear corneal incision by using a vitreous cutter. Results. Prompt resolution of malignant glaucoma was achieved in both cases and no recurrence was observed during postoperative followup of five months. Conclusions. An anterior segment surgeon can treat pseudophakic malignant glaucoma successfully by using a vitreous cutter inserted through a corneal incision and performing peripheral iridectomy, capsulo-hyaloidectomy, and anterior vitrectomy.

Pars plana vitrectomy in the management of phakic and pseudophakic malignant glaucoma.

To determine the indications for and outcome of pars plana vitrectomy in the management of phakic and pseudophakic malignant glaucoma. Retrospective review. Tertiary referral ophthalmic hospital. Twenty-two patients (24 eyes) who underwent pars plana vitrectomy in the management of malignant glaucoma. Fourteen eyes were phakic and 10 were pseudophakic at the initial vitrectomy. The primary indication for vitrectomy was failure of other therapies. In phakic eyes, the initial vitrectomy was successful in terminating malignant glaucoma without further surgery in 7 (100%) of 7 eyes that underwent lensectomy and in 5 (71%) of 7 eyes that not did not undergo lensectomy. The primary indication for lensectomy was corneal edema caused by lens-corneal touch. In pseudophakic eyes, the initial vitrectomy was successful in 9 (90%) of 10 eyes. Removal of the intraocular lens was performed in 1 eye. Perioperative complications included transient serous choroidal detachment in 2 eyes, transient exudative retinal detachment in 1 eye, and suprachoroidal hemorrhage in 1 eye. Pars plana vitrectomy is effective in treating phakic and pseudophakic malignant glaucoma. Success is contingent on establishing a pathway for aqueous flow into the anterior chamber, which usually is accompanied by intraoperative deepening of the anterior chamber. In phakic eyes, lensectomy may be considered for marked corneal edema, for dense cataract, or when the anterior chamber will not deepen during vitrectomy.

Ultrasound Biomicroscopy in Pseudophakic Malignant Glaucoma

Malignant glaucoma (ciliary block glaucoma; aqueous misdirection glaucoma) is an incompletely understood, rare and serious complication of intraocular surgery. A woman with pseudophakic malignant glaucoma underwent successful neodymium: YAG (Nd:YAG) laser photodisruption of the anterior hyaloid face with resolution of the glaucoma. High-resolution ultrasound biomicroscopy was used to image the anterior segment and anterior chamber angle before and after laser surgery. Ultrasound biomicroscopy provided cross-sectional images of the iris, posterior chamber intraocular lens (IOL), and ciliary body and their relative positions before and after resolution of the malignant glaucoma. Anterior rotation of the ciliary body and anterior chamber shallowing normalized after rupture of the anterior hyaloid face. High-resolution ultrasound biomicroscopy provided images consistent with accepted concepts of the pathophysiology of this disease and offers great promise for the future elucidation of the anatomic mechanisms underlying various forms of glaucoma.

Pseudophakic malignant glaucoma: Nd:YAG capsulotomy as a primary treatment

Malignant glaucoma is one of the most serious but rare complications of anterior segment surgery. It is best known following trabeculectomy but has been reported following a wide variety of anterior segment procedures including extracapsular cataract extraction with posterior chamber lens implantation. It is notoriously refractory to medical treatment alone and surgical intervention has had only limited success. An additional treatment option in pseudophakic eyes is that of peripheral Nd:YAG posterior capsulotomy, which is minimally invasive and can re-establish forward flow of posteriorly misdirected aqueous through into the drainage angle of the anterior chamber. We report our experience of seven cases of malignant glaucoma in pseudophakic eyes and of the successful use of Nd:YAG posterior capsulotomy in re-establishing pressure control in five of these eyes, thereby obviating the need for acute surgical intervention.

Pseudophakic Malignant Glaucoma in a Child

We report a pseudophakic malignant glaucoma attack in the early postoperative period in the normal eye of an 8-year-old child who had undergone extracapsular cataract extraction with posterior chamber (modified Sinskey type) intraocular lens implantation for congenital zonular cataract. Intensive antiglaucoma medical therapy did not resolve the glaucoma, but vitreous aspiration and anterior chamber reformation proved successful.