J Korean Ophthalmol Soc.  2015 Apr;56(4):638-642. 10.3341/jkos.2015.56.4.638.

A Case of Malignant Glaucoma in a Vitrectomized Eye

• Son GS
• Kim MJ
• Chung HJ
• Chung YS
• Choi JY

• KMID: 2215719
• DOI: http://doi.org/10.3341/jkos.2015.56.4.638

Abstract

PURPOSE
To report a case of malignant glaucoma in an eye vitrectomized 5 years previously due to endophthalmitis.
CASE SUMMARY
A 55-year-old male visited clinic due to a painful right eye 2 days in duration. Five years ago, he suffered endophthalmitis in his right eye and underwent pars plana vitrectomy. On slit-lamp examination, shallow anterior chamber depth of 2 central corneal thickness and corneal edema were observed along with remnant cortical lens material behind the intraocular lens. Intraocular pressure was 68 mm Hg measured using applanation tonometry. Maximal medical treatment failed to lower the intraocular pressure on the first day of visit. The very next day, anterior chamber became shallower less than 0.5 central corneal thickness and intraocular pressure was 70 mm Hg. Posterior capsular syndrome was suspected on anterior optical coherence tomography and neodymium:yttrium-aluminum-garnet laser posterior capsulotomy was performed, however, normal anterior chamber could not be restored. Despite continuous medical therapy for 3 weeks, the patient's symptoms worsened and intraocular pressure increased over 99 mm Hg and therefore, the Ahmed glaucoma valve was implanted. One day after the operation, intraocular pressure decreased to 10 mm Hg and anterior chamber depth became deeper with the depth of over 5 central corneal thickness. At the final visit 4 months postoperatively, intraocular pressure and normal anatomy of the anterior segment were well maintained.
CONCLUSIONS
Malignant glaucoma syndrome can occur even in vitrectomized eyes and capsular block syndrome can initiate this. Malignant glaucoma syndrome in a vitrectomized eye resistant to maximal medical treatment can be treated with Ahmed valve implantation.

Keyword

Ahmed valve implantation; Capsular block syndrome; Intraocular pressure; Malignant glaucoma syndrome; Vitrectomized eye

MeSH Terms

Anterior Chamber
Corneal Edema
Endophthalmitis
Glaucoma*
Humans
Intraocular Pressure
Lenses, Intraocular
Male
Manometry
Middle Aged
Posterior Capsulotomy
Tomography, Optical Coherence
Vitrectomy

Figure

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  Figure 1. Anterior segment examination on the first day of visit. (A) Slit lamp examination. Marked corneal edema and shallow anterior chamber (around 2 central corneal thickness). Note white solid arrow designating whitish material behind intraocular lens which seemed to be remnant cortical material. (B) Anterior segment optical coherence tomography. Shallow anterior chamber and sharp chamber angle are observed. Note a white hollow arrow designating dense liquid material confined between intraocular lens and posterior capsule. This dense liquid material is pooled right behind the intraocular lens and corresponds to whitish material presented as a solid arrow in (A).

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  Figure 2. Ocular ultrasonography on the first day of visit. Note that there is no hypoechoic lesion on posterior part of eye such as episcleral hemorrhage or choroidal effusion.

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  Figure 3. Anterior segment examination on the second day of visit. (A) Slit lamp examination. Note a white solid arrow designating slit-like narrow anterior chamber. (B) Anterior segment optical coherence tomography. Note white hollow arrows pointing at square edge of intraocular lens. Intraocular lens is pushing iris directly against to posterior cornea.

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  Figure 4. Slit lamp examination 4 months after the operation. White solid arrow is pointing the tip of Ahmed valve behind intraocular lens which was implanted into vitreous cavity. White hollow arrow is pointing the patent posterior capsulotomy site performed by Nd:YAG laser. Nd:YAG = neodymium: yttrium-aluminum-garnet.

Reference

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