Malignant Glaucoma After Trabeculectomy-Diagnosis and Treatment Options: A Case Report.

Background and Clinical Significance: Malignant glaucoma, also described as aqueous misdirection syndrome, most commonly occurs following trabeculectomy in patients with primary angle-closure glaucoma and a shallow anterior chamber. Management aims to restore normal anterior segment anatomy, re-establish aqueous flow from the posterior to the anterior chamber, and achieve adequate intraocular pressure control. This report presents a case of malignant glaucoma developing after trabeculectomy, with emphasis on current diagnostic and therapeutic approaches. Case Presentation: A patient with primary angle-closure glaucoma, pseudophakia of the right eye, and a patent laser peripheral iridotomy, receiving maximal tolerated topical antiglaucoma therapy, was referred to the Department of Ophthalmology due to uncontrolled intraocular pressure. The patient was scheduled for trabeculectomy of the right eye. In the immediate postoperative period, intraocular pressure was adequately controlled. However, on postoperative day five, a significant elevation in intraocular pressure was observed, accompanied by persistent shallowing of the anterior chamber. Topical and systemic hypotensive therapy, posterior capsulotomy and hyaloidotomy were performed without improvement of the local condition. The patient was qualified for irido-zonulectomy with pars plana vitrectomy. Following surgical intervention, normalization of intraocular pressure was achieved, and the anatomy of the anterior chamber was restored.

Conclusions

Malignant glaucoma remains a challenging postoperative complication and is frequently refractory to conservative pharmacological and laser-based interventions. Early recognition and prompt surgical management, particularly irido-zonulectomy combined with pars plana vitrectomy, significantly increase the likelihood of anatomical and functional success.