An exceptional presentation of malignant glaucoma: case report

Area of Science:

• Ophthalmology
• Surgical Complications
• Glaucoma Research

Background:

• Angle closure is a rare but serious complication after cataract surgery, particularly in pseudophakic patients with posterior chamber implants.
• It can manifest as malignant glaucoma or pseudophakic pupillary block, typically occurring soon after surgery but occasionally years later.
• The condition involves anterior displacement of the lens-iris-diaphragm complex.

Observation:

• A case of an 83-year-old female presenting with a painful red eye and reduced visual acuity 15 years post-cataract surgery.
• Examination revealed elevated intraocular pressure, corneal edema, peripheral athalamia, and importantly, an intact ciliary-lenticular block.
• This presentation is exceptional due to the delayed onset and the specific anatomical findings.

Findings:

• This is the first reported case of malignant glaucoma with an intact ciliary-lenticular block presenting 15 years after cataract surgery.
• The underlying pathophysiology remains unknown, highlighting a gap in current understanding.
• Management is challenging, with no established consensus, but early anterior vitrectomy and iridozonulohyaloidotomy are suggested.

Implications:

• This case expands the known timeline for malignant glaucoma post-cataract surgery.
• It underscores the need for vigilance in diagnosing and managing delayed angle closure, even with unusual features.
• Further research into the pathophysiology and optimal management strategies for such rare presentations is warranted to improve patient outcomes.