Surgical management of malignant glaucoma: a retrospective analysis of fifty eight eyes

Purpose To assess outcomes of surgical management of malignant glaucoma in terms of re-formation of anterior chamber Methods This was a retrospective analysis of consecutive patients who underwent surgical treatment for malignant glaucoma between January 1995 and December 2013 at a tertiary care ophthalmic institute, with a minimum follow up of 2 months. Results Fifty eight eyes of 58 patients were included. Fifty two (89.7%) patients had primary angle closure glaucoma. The majority had undergone glaucoma filtration surgery earlier (n = 53, 91.4%). Lensectomy and anterior vitrectomy was performed in 15 (25.9%) eyes (Group 1). Vitrectomy and anterior chamber re-formation was performed in 27 (46.6%) eyes (Group 2). Vitrectomyphacoemulsification-vitrectomy was performed in 16 (27.6%) eyes (Group 3). Communication between the two segments of eye through anterior hyaloid, lens capsule complex and/or iris was achieved in all groups. The median follow-up (Inter-quartile range) was 30 (71.5) months. Anterior chamber re-formation was achieved in 56 (96.5%) eyes at final visit. The improvement in mean +/- SD LogMAR visual acuity (1.1 +/- 1 to 0.7 +/- 0.8) and reduction in number +/- SD of anti-glaucoma medications (2.1 +/- 1.1 to 1 +/- 1.6) between onset and final visit were significant (P = 0.02 and < 0.01, respectively). The intraocular pressure (mm Hg) at onset and at final visit was 30.7 +/- 17.4 and 14 +/- 6.2, 32.8 +/- 12.6 and 15.3 +/- 7.4, and 27.2 +/- 14 and 10.9 +/- 3 in groups 1-3, respectively (all P < 0.01). Conclusion Our anatomical success rate was high. The key element in achieving this outcome was the establishment of a patent communication between the vitreous cavity and the anterior chamber.