Pseudophakic malignant glaucoma - a case report

Ştefănescu-Dima, A; Tănasie, Cornelia Andreea; Mercuț, Maria Filoftea; Mercuț, Irina Maria; Ionete, Mara; Mocanu, Carmen

doi:10.22336/rjo.2019.41

Cited by 3 publications

(2 citation statements)

References 20 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Malignant glaucoma, also known as misdirection of aqueous humor or ciliary block, is a rare condition. It is characterized by elevated IOP, shallow anterior chamber, myopic shift [2], absence of suprachoroidal effusion [11], no response to miotics or peripheral iridectomy, and good response to cycloplegics [2,[5][6][7]12]. It is associated with anatomical conditions (axial hyperopia, a narrow angle [8,13], ciliary sulcus or plateau iris con guration [14]) or PEX-induced laxity of the zonule in the sunset syndrome [13] and in anterior IOL displacement [2], [13,14].…”

Section: Discussionmentioning

confidence: 99%

Elschnig’s Pearls as a possible predisposing factor for malignant glaucoma : a case report

barbé,

momal,

cooren

et al. 2024

Preprint

View full text Add to dashboard Cite

Background : Malignant glaucoma (MG) is associated with a narrow angle or pseudoexfoliation (PEX)-induced laxity of the zonule. We describe a rare case of MG in a patient with massive Elschnig’s Pearls (EP) causing aqueous misdirection syndrome. Case presentation : A 78 years-old female was referred with rapidly progressive left ocular pain with redness, blurred vision of 20/100 and intraocular pressure (IOP) of 60 mmHg. She had undergone cataract surgery 5 years prior without complications, with preoperative diagnosis of moderate capsular PEX syndrome. She was first treated by maximal pressure-lowering drops, intravenous ACETAZOLAMIDE and 10% MANNITOL, 1% ISOPTOPILOCARPINE and a patent laser iridotomy. Despite this, IOP remained high for 3 days. Shallow anterior chamber with angle closure, myopic shift and filling of the posterior chamber by massive EP led us to conclude to an aqueous misdirection syndrome. We then switched 1% ISOPTOPILOCARPINE for 1% ATROPINE and performed a posterior capsulotomy with anterior hyaloidotomy. This rapidly controlled the condition with posterior displacement of intraocular lens (IOL) and fading of the high-IOP associated symptoms. Conclusions: Identifying malignant glaucoma could be challenging in the absence of immediate surgical circumstances. This is, to our knowledge, the second description of EPassociated with MG. In this case, EP were thought to narrow the irido-corneal angle and to cause a relative pupillary blockage, subsequently triggering aqueous humour misdirection to the vitreous and forward displacement of the iris-IOL diaphragm in the context of moderate PEX-induced zonular laxity.

show abstract

Section: Discussionmentioning

confidence: 99%

Elschnig’s Pearls as a possible predisposing factor for malignant glaucoma : a case report

barbé,

momal,

cooren

et al. 2024

Preprint

View full text Add to dashboard Cite

show abstract

“…It suggests that in addition to ACD and AL, other factors should be considered that may associate with the development of malignant glaucoma. Previously, in ammation, zonular weakness and intact anterior hyaloid were proposed as triggering factors causing irido-cilio-vitreal block in aphakic or pseudophakic eyes [10,11]. However, these factors are di cult to quantify in patients.…”

Section: Introductionmentioning

confidence: 99%

Reduction in maximum ciliary body thickness could be a pre-existing predictor for pseudophakic malignant glaucoma

Qin,

Luo,

Zeng

et al. 2024

Preprint

View full text Add to dashboard Cite

Objective: Malignant glaucoma is a rare and vision threatening form of glaucoma occurring in certain postoperative patients. It presents difficult diagnostic challenge. Dentification of morphometric indicators enables to predict the development of pseudophakic malignant glaucoma (PMG). Methods: A retrospective cross-sectional study was conducted from June 2016 to May 2023. Patients who originally diagnosed with primary angle closure glaucoma and developed PMG after phacoemulsification were recruited, while those without PMG were matched eyes. The parameters such as central anterior chamber depth (ACD), trabecular-ciliary process angle (TCA), ciliary body thickness (CBTmax, CBT0 and CBT1000), and anterior placement of ciliary body (APCB) were measured by ultrasound biomicroscopy (UBM) at pre-onset, onset and 6-month after settlement of PMG. Results: A total of 60 eyes from 60 patients were recruited. No significant difference was found in the baseline characteristics such as age, best-corrected visual acuity, intraocular pressure, degrees of angle closure and axial length. Lens extraction markedly increased the CBTmax (0.95 ± 0.09 mm vs. 1.05 ± 0.11 mm), CBT0 (0.85 ± 0.11 mm vs.0.92 ± 0.13 mm) and TCA (62.61 ± 13.17 mm vs. 70.92 ± 10.65 mm) in matched eyes, but no such increases were observed in those developed PMG. Notably, among these parameters at pre-onset of PMG, a significant reduction of CBTmax (0.87 ± 0.09 mm vs. 0.95 ± 0.09 mm, P = 0.001) was only detected in the eyes that developed PMG, when compared to the matched eyes. These findings suggest an early predictor of CBTmax for PMG occurrence. Subsequently, zonulo-hyaloido-vitrectomy was performed to resolve the PMG, which was accompanied with a significant increase in the ACD, CBTmax, CBT0 and TCA, but not CBT1000 and APCB. Moreover, at pre-onset of PMG, CBTmax was the only factor producing significant prognostic value (0.74 [95% CI, 0.61-0.87], P = 0.001), which almost reaches the predictive ability at PMG attack (0.86 ([95% CI, 0.76-0.96], P < 0.001). Conclusion: A reduction in thickness of the ciliary body is pre-existed in the eyes with PMG, of which a reduced CBTmax may serve as an early predictor.

show abstract

Risks in the surgical treatment of far-advanced glaucoma in the only seeing eye

Frolov,

Kopchenova,

Tolstykh

et al. 2023

Glaucoma

View full text Add to dashboard Cite

This review summarizes the results of surgical treatment of faradvanced stage glaucoma in the only seeing eye. A literature search performed in the PubMed search engine and aimed at finding publications reporting the clinical outcomes of treatment in patients with glaucoma in the only seeing eye did yield sufficient data related to the topic. A comprehensive analysis of the available data was performed with an emphasis on the choice of treatment tactics and postoperative results at various times following a surgery. Several studies allowed to perform a comparison of the clinical advantages and costeffectiveness of medical treatment versus surgery for advanced glaucoma, as well as to assess potential risks and adverse outcomes such as glaucoma progression, postoperative scarring, hypotension and other complications. The results presented in this review suggest that common success criteria can provide uniformity in academic studies, but in daily clinical practice each glaucoma specialist must make a patientspecific decision in favor of either of these methods of treatment in order to guarantee an optimal result, both for the doctor and, of course, for the patient.

show abstract

Pseudophakic malignant glaucoma - a case report

Cited by 3 publications

References 20 publications

Elschnig’s Pearls as a possible predisposing factor for malignant glaucoma : a case report

Elschnig’s Pearls as a possible predisposing factor for malignant glaucoma : a case report

Reduction in maximum ciliary body thickness could be a pre-existing predictor for pseudophakic malignant glaucoma

Risks in the surgical treatment of far-advanced glaucoma in the only seeing eye

Contact Info

Product

Resources

About