An 81-year-old Caucasian lady with PACG was referred to the glaucoma clinic for raised IOP and blurred vision in the right eye. She had LPI and trabeculectomy 15 years ago and phacoemulsification with anterior vitrectomy 8 years ago. Her left eye had no vision due to complicated extracapsular cataract extraction, bullous keratopathy, and possible advanced glaucomatous optic atrophy. The IOP in the right eye was 22 mmHg on oral acetazolamide, topical pilocarpine 2%, latanoprost, and apraclonidine 1%. The VA was 20/40 with peripheral corneal edema and a shallow AC. Malignant glaucoma was thought to be the cause. Pilocarpine drops were stopped, and atropine started. However, the AC remained shallow. A ZHV was performed, and the AC deepened on the table. She subsequently underwent a penetrating keratoplasty for the preexisting pseudophakic bullous keratopathy. There has been no recurrence of malignant glaucoma for the last 7 years. On her last visit, the VA was 20/60 and IOP 18 mmHg without medications.
An 81-year-old Caucasian female was referred with an IOP of 48 mmHg on maximal medications and corneal edema after phacoemulsification. LPIs had been done in the past for PAC glaucoma (PACG). The AC was moderately shallow. An urgent trabeculectomy with intraoperative mitomycin C (MMC) application was done. The following morning, the IOP was 24 mmHg with a flat AC. Malignant glaucoma was suspected, and the patient started on atropine and topical steroids. Nd: YAG laser posterior capsulotomy and hyloidotomy were done, but the AC remained very shallow and the IOP increased to over 40 mmHg. The following week, a ZHV was performed, and the AC deepened intraoperatively []. Postoperatively, while the AC was deep, the IOP remained high and on gonioscopy, the angle was almost completely closed. She was started on dorzolamide-timolol fixed combination eyes drops. On her last visit, 32 months after ZHV, VA was 20/60 and IOP 14 mmHg on medications. There was corneal edema, and the AC remained deep.