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Malignant glaucoma: causes, symptoms, diagnosis, treatment
Last reviewed: 08.07.2025
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[ Pathophysiology of malignant glaucoma
It is believed that the surgical intervention changes the direction of the flow of intraocular fluid. The aqueous humor is directed into the vitreous body, rather than passing forward through the pupil, which causes smoothing of the angle of the anterior chamber and a relative or sharp increase in intraocular pressure. Relatively high pressure is considered to be above 8 mm Hg. The anterior chamber becomes flat as a result of hyperfiltration with subsequent hypotension and choroidal detachment. When a flat anterior chamber appears, an increase in intraocular pressure of no more than 10 mm Hg is expected, sometimes the pressure increases significantly (more than 30 mm Hg).
Symptoms of Malignant Glaucoma
In typical cases, there is a history of recent eye surgery. Patients have blurred vision due to anterior displacement of the iris or lens, but this condition is difficult to distinguish from blurred vision in the normal postoperative period. There is no pain until intraocular pressure increases significantly.
Diagnosis of malignant glaucoma
Biomicroscopy
The anterior chamber is uniformly narrow. There is no iris bombage. After antiglaucoma filtering surgery, the filtration pad is visible, usually flat, with no signs of external filtration. The intraocular pressure level corresponds to that described above. If the pressure is significantly elevated or there is contact between the lens and the cornea, corneal edema may develop.
Gonioscopy
Gonioscopy is usually not possible due to obvious iridocorneal contact.
Posterior pole
A characteristic feature of this disease is the absence of visible choroidal vessels.
Special studies
Ultrasound biomicroscopy is extremely useful. It helps to identify the typical flattening of the ciliary body processes and the absence of the anterior choroidal vessels.
Treatment of malignant glaucoma
Often, an episode of increased pressure is treated with medications using local cycloplegic drugs and agents that suppress the production of aqueous humor. If therapeutic treatment is ineffective, surgical intervention is necessary. The key moment for interrupting the increase in pressure is a rupture of the anterior border membrane of the vitreous body, which is carried out using a laser if the surface of this membrane is determined peripherally to the lens or intraocular lens. If this is not possible, a pel plana vitrectomy must be performed. During the operation, the surgeon must remember the need to rupture the anterior hyaloid membrane.