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.
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 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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