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Malignant glaucoma: causes, symptoms, diagnosis, treatment
Last reviewed: 23.04.2024
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[Epidemiology of malignant glaucoma
In 1951 Chandler established that the incidence of malignant glaucoma is 4% of patients operated on for glaucoma. Since then, filtering operations have undergone some changes. Currently, it is believed that malignant glaucoma develops less often.
Pathophysiology of malignant glaucoma
It is believed that surgical intervention changes the direction of the current of the intraocular fluid. Watery moisture is directed to the vitreous, and does not go forward through the pupil, which causes a smoothing of the anterior chamber angle and a relative or sharp increase in intraocular pressure. Relatively high is the pressure above 8 mm Hg. The anterior chamber becomes flat as a result of hyperfiltration followed by hypotension and choroid detachment. When a flat anterior chamber appears, an increase in intraocular pressure of no more than 10 mm Hg is expected, sometimes the pressure rises significantly (more than 30 mm Hg).
Symptoms of Malignant Glaucoma
In typical cases, there is a recent history of eye surgery. In patients, vision is clouded due to a shift in front of the iris or lens, but this condition is difficult to distinguish from blurred vision in the normal course of the postoperative period. Pain does not significantly increase intraocular pressure.
Diagnosis of malignant glaucoma
Biomicroscopy
The anterior chamber is uniformly narrow. The iris of the iris is absent. After the anti-glaucoma filtration operation, a filtration pad is visible, usually flat, without signs of external filtration. The level of intraocular pressure corresponds to that described above. If the pressure is increased significantly or there is a contact between the lens and the cornea, corneal edema may develop.
Gonioscopy
Usually, gonioscopy is impossible because of the obvious irido-corneal contact.
Rear Pole
A characteristic feature of this disease is the absence of visible choroid vessels.
Special researches
Extremely useful ultrasonic biomicroscopy. With its help, a typical flattening of the processes of the ciliary body and the absence of anterior choroidal vessels are determined.
Treatment of malignant glaucoma
Often an episode of increased pressure is treated with medication with local cycloplegic drugs and products that suppress the production of aqueous humor. If the therapeutic treatment is ineffective, surgical intervention is necessary. The key point to interrupt the increase of pressure - the gap anterior vitreous limiting membrane, which is carried out with a laser, if more peripheral lens or intraocular lens define a surface membrliy When this is not possible neobhoodimo holding vitrectomy pel plana. During the surgery, the surgeon must remember to rupture the anterior hyaloid membrane.