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.
An 86-year-old Caucasian female was referred to the VR specialist for deteriorating vision in her right eye (2/200) due to a macular hole. The diagnosis was confirmed on optical coherence tomography, and she underwent a phacovitrectomy with internal limiting membrane peel, posterior chamber IOL implantation and gas tamponade with C2F6. On the first postoperative day, her AC was shallow and IOP 66 mmHg. This was thought to be because of gas overfill as the lower edge of the gas bubble was not visualized. The gas was released on 2 separate occasions by the VR surgeon. Laser and surgical PIs were done, but IOP remained extremely high on maximal medication, oral and intravenous hyperosmotic agents. B-scan ultrasonography ruled out suprachoroidal hemorrhage. Malignant glaucoma was diagnosed and 2 weeks after the VR surgery a ZHV was done. The rationale was that the remaining anterior vitreous was probably blocking communication between the anterior and posterior segments. Postoperatively, the AC deepened, and IOP decreased to 4 mmHg. However, there was no visual recovery, and the eye became phthisical over the next few months.