Spontaneous onset pseudophakic malignant glaucoma secondary to zonular weakness and cilio-lenticular block

Malignant glaucoma (MG), also known as aqueous misdirection and cilio-vitreo-lenticular block, is an infrequent cause of secondary angle closure glaucoma. Despite conventional treatment, it often has a poor visual outcome. It is recognized clinically by raised intraocular pressure associated with shallowing of the peripheral and central anterior chamber in the presence of a patent peripheral iridotomy/iridectomy. Despite being known to occur after a variety of surgical procedures, it most commonly presents following filtration surgery in hypermetropic eyes with angle closure glaucoma. It can present within a range of postsurgical latencies, ranging from 1 day to many months. We describe a case of pseudophakic MG that was unusual in that it presented spontaneously many years following cataract surgery. We postulate the etiology of our spontaneous onset pseudophakic MG was the anterior subluxation of the large diameter intraocular lens secondary to zonular weakness.