An 89-year-old lady with high hypermetropia was referred by her optician for raised IOPs of 49 and 40 mmHg in the right and left eye, respectively. She had bilateral cataracts reducing VAs to 20/60 right and 20/30 in left eye. The optic discs were healthy. She was commenced on topical prostaglandin analogs and subsequently had phacotrabeculectomy with MMC in the right eye. On the first postoperative visit, the AC was very shallow with iridocorneal touch and IOP 24 mmHg. Malignant glaucoma was suspected and topical atropine 1% was started. An air bubble was injected to reform the AC. The AC remained shallow. On the advice from one of us (NA), the surgeon performed a ZHV and noted that the AC had deepened intraoperatively. However, the AC was shallow and IOP 35 mmHg the following day. She was then referred to the glaucoma clinic, and a repeat ZHV was done. The emphasis was to remove the anterior vitreous. Following the procedure, her AC deepened, and IOP was 22 mmHg. A month later, her vision improved to 20/60 but her IOP was raised at 40 mmHg with a moderately shallow AC. It was felt that the PI was blocked by vitreous and Nd: YAG laser hyaloidotomy was done through the PI. The AC deepened immediately after the laser. The IOP was initially controlled on 3 topical medications. Two years later, VA was 20/40, the IOP 23 mmHg on a timolol-dorzolamide fixed combination and AC deep. In the interim, her left eye which had raised IOP and >180° of iridotrabecular contact underwent a routine phacoemulsification with no subsequent complications.
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.