AAO READING

“GLAUCOMA MALIGNANT”
Irma N. Iskandar
• Malignant glaucoma (also called aqueous
misdirection or ciliary block glaucoma) is a
rare but potentially devastating form of
glaucoma that usually presents following
ocular surgery in patients with a history of
angle closure or PAS
 ETIOLOGY

An open angle

Following cataract surgery

Various laser procedures

 CLINICAL SYMPTOMP
Flattening of both the central and peripheral
anterior chamber, is typically markedly
asymmetrical to the anterior chamber of the fellow
eye.

The anterior chamber is shallow or flat with

anterior displacement of the lens, pseudophakos,
or vitreous face

Optically clear “aqueous” zones may be seen in the

vitreous, highlighting the underlying pathology
 Anterior
rotation of
the ciliary
body

The lens
equator,
vitreous face,
and ciliary
A relative processes Posterior
block to misdirecti
aqueous on of the
movement aqueous

Some have proposed that PAC and malignant glaucoma may result from the
simultaneous presence of several factors, including a small eye, a propensity for
choroidal expansion, and reduced vitreous fluid conductivity.
DIFFERENTIAL DIAGNOSTIC

Early Post Operative

Choroidal effusion
Pupillary block
Suprachoroidal
hemorrhage
 MEDICAMENTOSA

Aggressive • β-adrenergic antagonists

aqueous • α2-adrenergic agonists
suppression • Carbonic anhydrase inhibitors

Reducing • Hyperosmotic agents

the vitreous

Miotics can make malignant glaucoma worse and therefore should not be used
 MANAGEMENT

YAG Laser

Argon laser photocoagulation of the ciliary processes

Laser iridotomy and medical management

Half of patients require surgical intervention alone

• The definitive surgical treatment is pars plana
vitrectomy with anterior hyaloido-
zonulectomy combined with an anterior
chamber deepening procedure.
TERIMA KASIH