A malignant glaucoma-like syndrome following pars plana vitrectomy

Objective: To report two cases of a malignant glaucoma-like syndrome following pars plana vitrectomy. Design: Two interventional case reports. Intervention: The first patient was treated with a neodymium:YAG laser peripheral iridectomy with hyaloidectomy and with intracameral tissue plasminogen activator. The second patient was treated with a posterior approach iridectomy through residual hyaloid, zonules, and iris. Main Outcome Measures: Axial anterior chamber depth and intraocular pressure (IOP). Results: The interventions resulted in deepening of the anterior chambers and normalization of IOPs. Conclusion: A pseudomalignant glaucoma syndrome may be related to obstruction of aqueous flow, either by residual anterior hyaloid or by fibrin and other inflammatory debris at the level of the ciliary body-zonular apparatus. Treatment of this syndrome involves restoring aqueous flow to the anterior chamber by disrupting the residual anterior hyaloid or clearing fibrin or inflammatory debris. The clinician should not disregard the possibility of a pseudomalignant glaucoma syndrome following vitrectomy despite the fact that vitrectomy has traditionally been considered a curative treatment for malignant glaucoma.