Malignant Glaucoma After Routine Cataract Surgery
Narrative Responses:
Purpose
To report a series of 20 eyes that developed malignant glaucoma following routine cataract surgery.
Methods
20 eyes in 18 patients who developed malignant glaucoma following routine cataract surgery by phacoemulsification with in the bag intraocular lens (IOL) placement were treated in a stepwise fashion and followed. Treatment began with medical therapy consisting of cycloplegia with or without aqueous suppressants, followed by laser iridozonulohyaloidotomy (IZH), anterior chamber (AC) reformation/IOL pushback and finally surgical
Results
All patients were females aged 44 to 86 years (average 67.5±13.7). Pre-operatively, baseline average refraction was +3.18±2.95D, axial length was 21.27±1.43mm and all had narrow or closed angles. Malignant glaucoma was diagnosed at 5.8±7.1 weeks postoperatively (range 1-24 weeks). At diagnosis, average refraction was -2.15±2.95D, ACD was 2.33±0.33mm, and IOP was 28.3±10.8mmHg on 1.3±1.6 medications. Two eyes responded to cycloplegia, seven required laser IZH, six required AC reformation/IOL pushback and five required vitrectomy. Post-treatment, the average refraction was -0.56±1.07D, ACD was 3.30±0.50mm, and IOP was 14.4±4.60mmHg on 1.1±1.4 medications. Cycloplegia was successfully tapered in all but three eyes.
Conclusion
Malignant glaucoma can occur following routine phacoemulsification and presents with myopic surprise, AC shallowing and possibly elevated IOP. We present 20 cases, mostly in female hyperopes with narrow angles. All responded to a combination of medical therapy, laser IZH, AC reformation/IOL pushback, and vitrectomy after which cycloplegia was often tapered.