Treatment of malignant glaucoma with contact transscleral cyclophotocoagulation.

Fivecasesofpseudophakicmalignant glaucoma were successfully treated with a single session of contact transscleralcyclophotocoagulation(CTCP) withdiodelaser(twenty4-Jspotsover 360°,1.5mmposterior to the limbus) after failureofNd:YAGlaserhyaloidotomy and vitreolysis. All patients except for case 2 had a preoperative diagnosis of chronic angle-closure glaucoma. At the end of the followup, all the eyes had a well-controlled intraocular pressure (IOP), with no medications required in 3 cases and topical b-blocker prescibed in 2. No major side effects of laser treatment were observed. Malignant glaucoma is a severe complicationofanteriorsegmentsurgerymainlyassociatedwitheyeswith angle-closure glaucoma. The term “malignantglaucoma”refers toaconditioncharacterizedbyocularhypertension with shallow or flat anterior chamber despite a patent iridotomy and a normal posterior segment anatomy.Theconditionistypicallyunresponsive to treatmentwithmiotics, but it can be relieved by cycloplegics. Differentpathogenicmechanismsmay beinvolved,suchasciliovitrealorciliolenticular block, but there is general agreementabout thepresenceofposteriordiversionofaqueous flow, leadingtoanteriordisplacementofthehyaloid and secondary angle closure. The treatment of choice for malignantglaucomaisNd:YAGlaseranteriorhyaloidotomy(throughthepupil, in aphakic or pseudophakic eyes, afterposteriorcapsulotomy,orthrough aperipheral iridectomy),possibly followed by Nd:YAG laser vitreolysis. When laser treatment is not possible oris ineffective,anteriorparsplanavitrectomy is usually required. Wereport5casesofpseudophakic malignant glaucoma, defined as ocular hypertension with a shallow central anterior chamber, patent peripheral iridotomy, and no evidence of choroidal effusion or other uveal abnormalitiesonB-scanechographic examination. Allpatientswere successfullytreatedwithCTCPanddiode laserafter failureofNd:YAGlaserhyaloidotomy and vitreolysis.