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.
A 77-year-old Caucasian male who had a routine extracapsular cataract extraction with a surgical PI in his right eye 15 years ago, was seen with complaints of blurred vision. His BCVA was 20/30. Nd: YAG laser posterior capsulotomy was done twice. It was repeated after a year as he was still complaining of blurred vision, and the ophthalmologist thought that the central capsular clearance was inadequate. A month later, he had no improvement, and his VA was 20/60. The AC was deep, and some vitreous was herniating though the inferotemporal pupillary margin. He was managed conservatively. A further 6 months later his VA had decreased to 20/200 and IOP was 32 mmHg. He was started on topical beta-blockers, but the IOP remained high. He was referred to the glaucoma clinic where a shallow AC with peripheral iris-cornea touch and vitreous herniation through the inferotemporal pupillary margin was noted. Malignant glaucoma was diagnosed, and ZHV performed. By the 6th postoperative week, the IOP increased to 40 mmHg. It was controlled on topical travoprost and brinzolamide. Gonioscopy showed that the angle was >270° closed. He also developed nonresponsive cystoid macular edema (CMO). On the last visit, 67 months after ZHV, his IOP was 14 mmHg on the aforementioned medications and BCVA was 20/120.