Hypotonous malignant glaucoma: aqueous misdirection with low intraocular pressure.

Area of Science:

• Ophthalmology
• Surgical complications

Background:

• Trabeculectomy is a common glaucoma surgery.
• Postoperative shallow anterior chamber with hypotony can occur.
• Choroidal effusion is typically associated with this condition.

Observation:

• Two patients developed axially shallow anterior chambers post-trabeculectomy.
• Hypotony was present, but choroidal effusion was absent.
• Ultrasound biomicroscopy visualized anterior chamber changes and ciliary body position.

Findings:

• Conservative treatment with cycloplegics and pars plana anterior vitrectomy were employed.
• Both interventions led to anterior chamber deepening.
• Ciliary body repositioned to a natural, posterior location.

Implications:

• These cases highlight a malignant glaucoma-like presentation without choroidal effusion.
• Successful management of hypotony and anterior chamber shallowing was achieved.
• Understanding these rare presentations is crucial for glaucoma surgical outcomes.