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Malignant Glaucoma

Graefe first described malignant glaucoma in 1869 as an elevated intraocular pressure (IOP) with a shallow or flat anterior chamber, usually as a result of ocular surgery. Aqueous misdirection, ciliary block glaucoma, and lens block angle closure are all names for malignant glaucoma. It is one of the most complicated and difficult glaucoma to treat, and if left untreated, it can lead to total blindness.

Symptoms Of Malignant Glaucoma

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

Causes of Malignant Glaucoma

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

Risk Factors for Malignant Glaucoma

  • 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 of Malignant Glaucoma

  • 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.

Diagnosis of Malignant Glaucoma

Malignant glaucoma is difficult to treat and diagnose. In phakic and pseudophakic patients, a slit-lamp examination will reveal anterior displacement of the lens-iris diaphragm. Physical symptoms of malignant glaucoma include unequal anterior chamber depths, increasing myopia, and progressive anterior chamber shallowing. If the iridectomy’s patency is called into question, a laser iridotomy can be performed again to rule out pupil block. If doctors discover a shallow anterior chamber associated with a wound leak, hypotony is a simple diagnosis. If there is no wound leak, the hypotony may be caused by choroidal effusion or excessive drainage into the subconjunctival space. If the iridotomy is patently high, choroidal hemorrhage should be stopped either clinically or by ultrasound examination.

Treatment for Malignant Glaucoma

Malignant glaucoma treatment focuses on 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. If a laser iridotomy is not available or the patency of a previous iridotomy cannot be established, one should be performed. The effect of medical therapy is not immediate, but approximately 50% of malignant glaucoma cases are removed within five days. If medical treatment fails, YAG laser therapy may be used to disrupt the posterior capsule and anterior hyaloid face. When laser therapy is not possible or is ineffective, posterior vitrectomy with disruption of the anterior hyaloid face must be performed. If you have been diagnosed with glaucoma or are experiencing symptoms, schedule an appointment right away.

To get your eye checked, visit Accra Specialist Eye Hospital – Voted the Best Eye Hospital in Ghana. Visit Accra’s Finest Eye care Facility today!  Our Services include are  Laser Eye Surgeries,  Micro Incision Cataract, Surgery (Phaco), Retina Surgeries, Phaco (Cataract), Glaucoma Surgeries, Cornea Surgery – Transplant , Oculoplastic Surgery and Child Eye Care Services.

We're an eye specialist hospital dedicated to providing the best care for you and your eyes. At Accra Specialist Eye Hospital, we are committed to delivering accessible and comprehensive eye care, to the highest possible standards. Our Expertise & Services Offered are Laser Eye Surgeries, Micro Incision Cataract, Surgery (Phaco), Retina Surgeries, Phaco (Cataract), Gluacoma Surgeries, Cornea Surgeru - Transplant , Oculoplastic Surgery and Child Eye Care Services. We're located at Tantra Hill - Accra.