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Malignant Glaucoma After Laser Peripheral Iridotomy

Greenfield, Jason A.; Smiddy, William E., MD; Greenfield, David S., MD

doi: 10.1097/IJG.0000000000001145
Case Report/Small Case Series: PDF Only

Purpose: We describe a patient with primary angle-closure glaucoma who developed malignant glaucoma following laser peripheral iridotomy.

Methods: A 58-year-old male presented with peripheral and central anterior chamber shallowing following an uncomplicated Nd: YAG laser peripheral iridotomy. Intraocular pressure and B-scan echography were normal, and there was −1.5 diopter asymmetric myopia. Despite treatment with aqueous suppression and cycloplegia for 7 months, the patient developed progressive myopic shift and anterior chamber shallowing.

Results: The patient underwent 23-gauge pars plana vitrectomy and lensectomy using a standard 3-port technique, and sulcus posterior chamber intraocular lens implantation in the left eye. Twelve months postoperatively, the anterior chamber has remained deep, best-corrected visual acuity is 20/15, and the IOP is 11▒mmHg.

Conclusions: Malignant glaucoma is a rare complication of laser iridotomy and should be considered in eyes with progressive anterior chamber shallowing and myopia despite normal intraocular pressure.

Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Palm Beach Gardens, FL

Disclosures and acknowledgments: Financial Funding/Support: P30EY014801 University of Miami core grant; Research to Prevent Blindness Unrestricted grant, New York, New York; an unrestricted grant from Mr. and Mrs. Thorne B. Donnelley, Chicago, IL, and the Maltz Family Endowment for Glaucoma Research, Cleveland, Ohio.

Conflicts of Interest: JA Greenfield: None. WE Smiddy: None DS Greenfield: C. Consultant: Aerie Pharmaceuticals, Allergan Inc, Alcon Inc, Bausch + Lomb, Eyenovia, Galimedix, Pfizer Inc, Quark Pharmaceuticals, Santen Prior Presentations: This manuscript has not been presented previously.

Reprints: David S. Greenfield, MD, Bascom Palmer Eye Institute, 7101 Fairway Drive, Palm Beach Gardens, FL, 33418 (e-mail: dgreenfield@med.miami.edu).

Received September 29, 2018

Accepted November 18, 2018

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