Treatment outcomes and efficacy of pars plana vitrectomy-hyaloidotomy-zonulectomy-iridotomy in malignant glaucoma

Abstract

Aim: To study the treatment outcomes and efficacy of pars plana vitrectomy-hyaloidotomy-zonulectomy-iridotomy in malignant glaucoma. Method: A retrospective case series study of patients treated for malignant glaucoma between 2005 and 2017. The treatment included medical management as first-line in the form of cycloplegic with anti-glaucoma medications (AGM) or pars plana vitrectomy-hyaloidotomy-zonulectomy-iridotomy as second-line therapy. The resolution was defined as ‘deepening of central anterior chamber’ with intraocular pressure of ⩽ 21 mm Hg (minimum on two consecutive visits 1 week apart) with or without topical anti-glaucoma medications in the absence (complete success) or presence (qualified success) of systemic medications. Results: Twenty-three eyes of 22 patients were included. At the time of diagnosis of malignant glaucoma preceding surgeries were cataract surgery (13 eyes) and trabeculectomy (4 eyes). One eye each had phacotrabeculectomy, Yag capsulotomy and optical keratoplasty. Eighteen eyes were pseudophakic and two eyes were phakic. At presentation, mean intraocular pressure was 26.25 ± 14.78 mmHg which was decreased to 15.90 ± 8.12 mmHg (p < 0.0001) at final follow-up (median follow-up was 15.50 months). Fifteen (75%) eyes had complete success, 3 (15%) eyes had qualified success and 2 (10%) eyes had treatment failure. Of 15 eyes that had achieved complete success, 3 eyes had undergone medical management and 12 eyes undergone second-line procedure. There was no significant difference in visual acuity or number of anti-glaucoma medication at presentation and final follow-up (p > 0.05). Conclusions: Though malignant glaucoma is highly refractory to treatment, appropriate management in the form of medical or vitrectomy-hyaloidotomy-zonulectomy-iridotomy could achieve 90% success in this series.