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 Caucasian male who had a routine extracapsular cataract extraction with a surgical PI in his right eye 15 years ago, was seen with complaints of blurred vision. His BCVA was 20/30. Nd: YAG laser posterior capsulotomy was done twice. It was repeated after a year as he was still complaining of blurred vision, and the ophthalmologist thought that the central capsular clearance was inadequate. A month later, he had no improvement, and his VA was 20/60. The AC was deep, and some vitreous was herniating though the inferotemporal pupillary margin. He was managed conservatively. A further 6 months later his VA had decreased to 20/200 and IOP was 32 mmHg. He was started on topical beta-blockers, but the IOP remained high. He was referred to the glaucoma clinic where a shallow AC with peripheral iris-cornea touch and vitreous herniation through the inferotemporal pupillary margin was noted. Malignant glaucoma was diagnosed, and ZHV performed. By the 6th postoperative week, the IOP increased to 40 mmHg. It was controlled on topical travoprost and brinzolamide. Gonioscopy showed that the angle was >270° closed. He also developed nonresponsive cystoid macular edema (CMO). On the last visit, 67 months after ZHV, his IOP was 14 mmHg on the aforementioned medications and BCVA was 20/120.