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.
A 63-year-old Caucasian gentleman with schizophrenia was referred to the glaucoma clinic by his optician with bilateral pale optic discs, IOPs over 60 mmHg and vision of counting fingers in both eyes. In both eyes, AC was shallow; the angle completely closed, and the optic discs cupped and pale. A diagnosis of chronic angle closure was made, and bilateral LPIs done. The patient was started on oral acetazolamide and 3 topical glaucoma medications. A month later, the IOP had reduced to 21 mmHg in the right eye. Right eye phacotrabeculectomy under general anesthesia was done with prior explanation of the poor prognosis for visual recovery to the relatives. Intraoperatively, a floppy iris was noted which responded to intracameral phenylephrine. Postoperatively, the AC was shallow and IOP 16 mmHg. A week later, the IOP crept to 23 mmHg, the AC remained shallow with a fibrinous deposit over the pupil. Malignant glaucoma was considered to be the cause and ZHV performed. The AC deepened on the table, but the next morning, the AC was shallow with fibrin covering the pupil and the PI. Nd: YAG laser lysis of the fibrin and anterior hyaloidotomy through the PI was done. The AC deepened immediately. The IOP has been stable over the next 4 years at 18 mmHg without glaucoma medications. However, VA was counting fingers.