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.
An 83-year-old lady of Indian origin with PAC, bilateral pseudophakia and IOP of 35 mmHg on maximal medical therapy underwent an augmented trabeculectomy with MMC in the right eye. Preoperatively, the AC was moderately shallow in the right eye, and gonioscopy showed a closed angle. The left eye AC was shallow with some peripheral anterior synechiae. A month later, the AC remained shallow, and IOP was 15–20 mmHg on 3 topical glaucoma medications. The patient was referred to the glaucoma clinic where malignant glaucoma was diagnosed, and ZHV preformed. The AC deepened; IOP settled at 15 mmHg and VA was 20/30. 6 months later, she presented with blurred vision for 3 months in the same eye. Her IOP was 23 in the left eye, and the AC was shallow with peripheral irido-corneal touch. Malignant glaucoma was suspected, and she was treated with Atropine 1% drops in that eye. The vision improved to 20/30, the AC deepened, and the IOP was 19 mmHg at 7 days follow-up. However, on a routine follow-up visit 15 months after ZHV, IOP was raised at 34 mmHg and peripheral AC was shallow once more with iridocorneal touch. A repeat ZHV was performed after which the AC deepened []. 2 years after the second ZHV, the IOP was stable at 17 mmHg without medication.