Malignant Glaucoma Seven Years After Cataract Surgery. A Case Report.

University Hospital of the Canary Islands (Tenerife, Spain)

A 90 years old woman underwent cataract surgery in both eyes in an external center. She required extraction of nuclear fragments via pars plana vitrectomy and implantation of an anterior chamber intraocular lens (IOL) in her right eye (RE). In her left eye (LE), the patient had an uncomplicated cataract surgery with implantation of the IOL in the posterior chamber. Seven years later, the patient presented in the emergency department with an episode of mid-dilated and non-reactive mydriasis, shallow anterior chamber without iridocorneal contact and poorly responsive high intraocular pressure (IOP) of 64 mmHg in her LE. Any pathologies of the posterior segment, which could be responsible for the rise of the IOP, were excluded. Considering all these data and the fact that the patient was pseudophakic, we established the diagnosis of late-onset malignant glaucoma. It was not possible to perform a laser peripheral iridotomy in the acute phase, because of the patient's lack of collaboration. Hence, we decided to initiate medical treatment with topical beta-blockers, alpha-agonists and atropine for three days. The patient developed further narrowing of the anterior chamber. We performed laser iridotomy on day 4, without response. On day 5, the patient developed iridocorneal contact. We then performed urgent anterior vitrectomy, peripheral iridectomy and conformation of the anterior chamber, achieving good IOP control and anterior chamber stability.

Malignant glaucoma after cataract surgery occurs in less than 0.1% of the cases. It may happen intraoperatively, during the early postoperative phase and months or, as in our case, even years after the surgery. Although 50% of the cases resolve with medical treatment in the first five days, recurrencies occur in all of the cases. Urgent surgery must be performed on the appearance of alarming symptoms such as iridocorneal contact. The most effective treatment with the lowest recurrency rate is pars plana vitrectomy with irido-zonulo-hyaloidotomy.