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 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.