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

Abstract

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.