Malignant Glaucoma

introduction

What is Malignant Glaucoma?

Malignant Glaucoma was first described by Graefe in 1869 as an elevated IOP with a shallow or flat anterior chamber usually as a result of ocular surgery. Malignant glaucoma has taken other names over time like aqueous misdirection, ciliary block glaucoma, and lens block angle closure. It is one of the most complex and difficult of all glaucomas to be treated and it can even progress to complete blindness without proper treatment. 

Malignant Glaucoma Symptoms

  • Bleb needling
  • Infection and inflammation
  • Retinopathy of prematurity
  • Retinal detachment 
  • Trauma

Malignant Glaucoma Causes

  • Had angle closure glaucoma prior
  • Had filtration surgery- Trabeculectomy
  • Had Laser treatment like Peripheral laser iridotomy, trabeculectomy, and cyclophotocoagulation 
  • Use of miotics 

Malignant Glaucoma Risk Factors

  • Malignant glaucoma usually occurs in 2 to 4 percent of eyes that undergo surgery for angle closure glaucoma
  •  It can occur anytime after the operation but most cases occur right after incisional surgery. It can also occur days or years after iatrogenic causes like  trabeculectomy, cataract extraction with or without IOL implantation
  • Intravitreal injection
  • Needling of filtering blebs
prevention

Malignant Glaucoma Prevention

  • The eye is at risk of developing malignant glaucoma if it undergoes surgery. So it is important to get prophylactic laser iridotomy done. 
  • If angle glaucoma is present, all efforts should be made to break the attack before surgery.
  • If the attack cannot be broken, mydriatic cycloplegic therapy to be started after iridotomy and continued indefinitely. 

Malignant Glaucoma Diagnosis

Treating malignant glaucoma is difficult to treat and diagnose. The slit-lamp examination will reveal the anterior displacement of the lens-iris diaphragm in phakic and pseudophakic patients. You can diagnose malignant glaucoma physically by finding unequal anterior chamber depths, increasing myopia, and progressive shallowing of the anterior chamber. If the patency of the iridectomy is in doubt a laser iridotomy can be performed again to exclude pupil block. If doctors can find a shallow anterior chamber associated with a wound leak, it is easy to diagnose you with hypotony. If the hypotony is without a wound leak, it may be associated with choroidal effusion or with excessive drainage into the subconjunctival space. If the iridotomy is patent high, choroidal hemorrhage should be suspended either clinically or by ultrasound examination

Malignant Glaucoma Treatment

Malignant Glaucoma treatment is aimed at lowering IOP with aqueous suppressants, narrowing the vitreous with hyperosmotic agents, and attempting posterior displacement of the lens-iris diaphragm with a powerful cycloplegic such as atropine.  A laser iridotomy should be performed if one is not available or if patency of a former iridotomy cannot be established. The effect of medical therapy is not immediate, but about 50 percent of malignant glaucoma cases will be removed within five days.

If medical treatment is unsuccessful, YAG laser therapy may be used to disturb the posterior capsule and anterior hyaloid face. When laser therapy is not feasible or is unsuccessful, posterior vitrectomy must be performed with disruption of the anterior hyaloid face. If you are diagnosed with glaucoma or showing symptoms, do not hesitate and Book an appointment now.

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