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.
A 77-year-old lady with PAC and an IOP of 34 mmHg without medication underwent a phacoemulsification in her right eye. The procedure was difficult with positive pressure and iris prolapsed through the temporal corneal section. 2 weeks postoperatively, IOP rose to 44 mmHg and AC shallowed significantly []. Nd: YAG laser anterior and posterior capsulotomy and hyaloidotomy were done through an inadvertent temporal PI. The AC deepened immediately after the procedure, and the IOP dropped to 34 mmHg. Over the next 2 weeks, the AC was deep, and IOP stabilized at 15 mmHg on topical latanoprost. In the meantime, she also underwent a routine phacoemulsification in the fellow eye. 4 months after her phacoemulsification, the right eye IOP had crept up to 32 mmHg on maximal tolerated medications and AC shallowed. ZHV was performed. Postoperatively, the AC deepened but the IOP control was inadequate, and CMO was noted. The CMO resolved on oral acetazolamide, topical prednisolone 1%, and ketorolac eye drops. However, gradually she developed intolerance to most topical medications. A year after ZHV, she noted blurred vision in the right eye. The IOP was over 30 mmHg, the AC moderately shallow and CMO had recurred. This time 270° cyclodiode laser was done, leading to resolution of the malignant glaucoma. The CMO partially resolved on oral acetazolamide. 2 years after the ZHV, her VA was 20/60 and IOP 22 mmHg without medication.