Malignant glaucoma due to dislocated intraocular lens into the vitreous cavity: A case report

This report describes a case of elevated intraocular pressure (IOP) in a patient who developed malignant glaucoma due to the intraocular lens (IOL) falling into the vitreous cavity.

A 92-year-old man visited a physician complaining of decreased vision in the left eye 10 years after uneventful left phacoemulsification. His best-corrected visual acuity (BCVA) was 20/20, and IOP was 14 mmHg. The IOL had completely fallen into the vitreous cavity. Although surgery was recommended, the patient opted for observation because of his advanced age, right eye blindness due to childhood trauma, and fear of surgery. After one week, he was referred to our hospital with sudden pain and decreased vision in the left eye, and it was found that his BCVA had dropped to counting fingers and IOP elevated to 59 mmHg. The anterior chamber was shallow and the IOL was positioned on the posterior surface of the iris without any movement. The patient was diagnosed with malignant glaucoma due to aqueous misdirection caused by a displaced IOL, and vitrectomy was performed to remove the IOL. During surgery, the IOL rapidly fell into the cavity after the vitreous body was removed. On postoperative day 1, the anterior chamber deepened and IOP decreased. At the last follow-up, four months postoperatively, the BCVA had improved to 20/25, and the IOP was stable at 17 mmHg.

The differential diagnoses that may cause a sudden increase in the IOP and flattening of the anterior chamber, as in this case, include pupillary block glaucoma, choroidal detachments, suprachoroidal hemorrhage, and malignant glaucoma. Based on clinical course and examination results, a diagnosis of malignant glaucoma was made. In this case, based on the clinical course, it is believed that malignant glaucoma was triggered by the anterior displacement of a dislocated IOL into the vitreous cavity, followed by aqueous misdirection. Even if peripheral iridectomy is performed, it is ultimately necessary to remove the IOL from the vitreous cavity. Therefore, removal of the IOL is considered the fundamental treatment for this condition.

IOL displacement into the vitreous cavity can elevate IOP, resulting in malignant glaucoma. However, these symptoms can improve significantly after vitrectomy with IOL removal.