Refractory malignant glaucoma after secondary IOL implantation in an eye with 17-year-old vitrectomy: A case report

Malignant glaucoma (MG) results from aqueous misdirection and entrapment in the vitreous cavity. This process drives anterior displacement of the lens-iris diaphragm, causing uniform shallowing of the central and peripheral anterior chamber, typically with elevated intraocular pressure (IOP). Clear lens extraction with anterior vitrectomy remains the definitive intervention.

We report a rare case of MG following combined pars plana vitrectomy (PPV) and intraocular lens (IOL) implantation and detail its management. A 49-year-old Chinese male presented with a history of ocular trauma in the left eye, which was treated 17 years ago by PPV with lensectomy. After secondary IOL implantation with pupilloplasty was successfully performed, the patient experienced recurrent episodes of shallow anterior chamber and elevated IOP (peaking at 44 mm Hg), which could not be resolved by maximal medical therapy, suture-leakage assisted incision, or laser peripheral iridotomy.

The condition was considered postoperative MG.

The patient underwent a second surgery, which was trabeculectomy combined with partial irido-zonulo-hyaloid-vitrectomy.

Subsequent follow-up demonstrated stable anterior chamber depth and normalized IOP.

To resolve MG, the fundamental objective must be restoring pressure equilibrium across the ciliary body-zonules-lens-hyaloid-anterior vitreous complex. Achieving this requires reconstructing the complex's structural integrity and normalizing its regulatory function in aqueous humor circulation.