Surgical results in malignant glaucoma refractory to medical or laser therapy

Abstract

We investigated the surgical results in 25 patients identified with malignant (ciliary block) glaucoma. Four of these patients (16%) had successful outcomes following laser treatment alone. Nineteen patients (76%) underwent microsurgery for glaucoma refractory to conventional medical and/or laser therapy and are the subjects of this study. Core vitrectomy was successful in 4 of 6 pseudophakic patients (67%) and in 1 of 4 phakic patients (25%). Combined cataract extraction and vitrectomy had a higher success rate in patients undergoing posterior capsulectomy at the time of surgery (5 of 6 patients; 83%) compared with those patients left with an intact posterior capsular bag (1 of 4 patients; 25%). Intracapsular cataract extraction was successful in 1 of 2 patients (50%). We conclude that surgical vitrectomy in the presence of an intact posterior capsule may preclude the surgical resolution of aqueous misdirection. In eyes with pre-existing cataract, we recommend combined lens extraction, primary posterior capsulectomy and surgical vitrectomy for the surgical management of phakic malignant glaucoma.