Posters

A challenging case of a malignant glaucoma in a myopic patient following a combined phacoemulsification and trabeculectomy procedure

Poster Details

First Author: A. Hajjar SPAIN

Co Author(s):    I. Sanchez   R. Hernandez   P. Ponton   R. Portilla   M. Tabares   I. Ruiz     

Abstract Details

Purpose:

To report a case of refractory malignant glaucoma after combined cataract and glaucoma filtration surgery in a myopic patient.

Setting:

Glaucoma section of the Department of Ophthalmology, at University Hospital of Burgos, Burgos, Spain.

Methods:

A case report of a 71–year-old myopic female who developed malignant glaucoma after undergoing combined phacoemulsification and trabeculectomy procedure for primary open-angle glaucoma. Best corrected preoperative visual acuity (BCVA) was recorded preoperatively and during the follow up. B-scan and ultrasound biomicroscopy (UBM) were performed for differential diagnosis. Medical and surgical treatments were also recorded.

Results:

Preoperative BCVA was 0.4. Postoperative examination on day 1 revealed flat anterior chamber (AC) with an intraocular pressure (IOP) of 30 mmHg, no wound leak and an absence of choroidal detachment on B-scan. Medical therapy was initiated with mannitol, mydriatics and topical antiglaucoma agents. Reformation of AC was attempted on day 2. After a successful laser peripheral iridotomy on day 3 AC remained very shallow and the IOP was of 22 mmHg. On day 7 the patient underwent pars plana vitrectomy but day 1 follow-up revealed a very shallow AC with IOP of 20 mmHg on full medical treatment. BCVA at the last visit was counting fingers.

Conclusions:

Malignant glaucoma is a rare but well recognised complication following glaucoma filtration surgery. Short eyes such as in hypermetropia or nanophthalmia are considered high risk for the development of malignant glaucoma. In this report however the patient had myopia and did not fit the usual phenotype. Malignant glaucoma is a diagnosis of exclusion and therefore required thorough investigations including repeat B-scans and UBM for differential diagnosis. Despite all the efforts and systematic approach including medical and surgical treatment the management of malignant glaucoma remains challenging in atypical cases and can result in profound vision loss and significant morbidity.

Financial Disclosure:

NONE