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 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.