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.
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.