Malignant glaucoma

Pearls Manager: Andrew Tatham

Malignant glaucoma or aqueous misdirection is a rare type of secondary angle closure glaucoma most commonly encountered after filtering surgery, though it can occur spontaneously or following any type of intraocular surgery, particularly in small eyes. Fluid accumulates behind and within the vitreous body leading to angle closure through a posterior pushing mechanism. Medical treatment includes; parasympatholytics (atropine, cyclopentolate), both initially and for long-term pupillary dilation and cycloplegia; aqueous suppressants given orally or topically; and hyperosmotics. Miotics are contraindicated. Surgical options include; iridotomy, YAG laser capsulotomy, cyclodiode laser, pars plana vitrectomy, and in phakic patients, lens extraction.

EGS Guidelines, 4th edition, Page 117.

References

1. Friedman DS, Weinreb RN. Consensus on Angle-closure and Angle-closure glaucoma. WGA Consensus Series, 2008.
2. Quigley HA. Angle-closure glaucoma-simpler answers to complex mechanisms: LXVI Edward Jackson Memorial Lecture. Am J Ophthalmol, 2009: 148:657-669.