GLAUCOMA 60 EWAP MARCH 2022 Malignant glaucoma is a rare complication, but it’s still something surgeons need to be on the lookout for after surgery, especially in the early postoperative period. Amenâe "riaifo, MD, defined malignant glaucoma as “uniform shallowing or flattening of both the central and peripheral anterior chambers in an eye with normal to elevated intraocular pressure despite one or more patent iridotomies.” “It’s also known as aqueous misdirection, ciliary block glaucoma, and lens block angle closure,” she said. Lindsay Foley, MD, and Joseph Panarelli, MD, said in an email to EyeWorld that “malignant glaucoma involves an alteration in the normal anatomic relationship among the lens, ciliary body, anterior hyaloid face, and vitreous.” “Whether aqueous is actually misdirected into the posterior chamber is still being debated,” they said. “However, all proposed mechanisms seem to involve abnormal vitreous fluid flow, resulting in fluid buildup behind the vitreous and creation of a significant posterior to anterior pressure gradient. This gradient drives the vitreous, lens, and iris forward, which further reduces vitreous permeability, creating a vicious cycle resulting in angle closure.”1,2,3 Dr. Oriaifo estimated that this complication occurs in 2% to 4% of eyes undergoing surgery for angle closure glaucoma. Drs. Foley and Panarelli cited published research that estimated prevalence of malignant glaucoma after angle closure surgery between 0.6% and 4%.1,4,5 Dr. Oriaifo said she’s only seen it a handful of times during training and her years in practice. Dr. Oriaifo said that while malignant glaucoma can happen at any time in the postoperative period, most cases occur shortly after the incisional surgery. Drs. Foley and Panarelli noted that it’s most commonly associated with trabeculectomy and tube shunts (the latter less commonly), but it has also been reported after cataract surgery, surgical iridectomy, pars plana vitrectomy, diode Get ahead of malignant glaucoma in high-risk eyes by Liz Hillman Editorial Co-Director This article originally appeared in the December 2021 issue of EyeWorld. It has been slightly modified and appears here with permission from the ASCRS Ophthalmic Services Corp. Contact information Foley: Lindsay.Foley@nyulangone.org Oriaifo: amenzeosa@gmail.com Panarelli: Joseph.Panarelli@nyulangone.org 0arrow anINes on 1%6 anterior seIOent DeHore cataract sWrIery with irido\onWNohyaNoidectoOy. Source: Amenze Oriaifo, MD
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