Malignant glaucoma after phacoemulsification: Treatment with diode laser cyclophotocoagulation

Abstract

Phacoemulsification was performed in an 84-year-old woman with ocular hypertension and narrow drainage angles, previously treated by neodymium:YAG (Nd:YAG) laser peripheral iridotomy. Despite temporal zonular weakness, the surgery was uneventful. An intraocular lens (IOL) was placed and centered in the capsular bag. Two months later, the patient presented with malignant glaucoma. The IOL optic was anteriorly displaced in the capsular bag, and the IOL shift correlated with a -4.0 diopter myopic refractive error. There was no response after medical treatment or Nd:YAG hyaloidotomy. One week later, a single treatment with transscleral diode laser cyclophotocoagulation was performed. The intraocular pressure normalized and the anterior chamber deepened within 48 hours. The patient's condition has remained stable for 3 months with no further treatment; the Snellen visual acuity is 6/9. If medical therapy fails to control malignant glaucoma, cyclodiode laser treatment may be more effective and have fewer risks than current laser and surgical interventions.