Stepladder technique successful for malignant glaucoma

Malignant glaucoma can be successfully managed using the stepladder technique, including timely and appropriate interventions, claims a paper in the journal Ophthalmology.

Dr Paraaj Dave et al., L. V. Prasad Eye Institute, Hyderabad, India, reported the treatment outcomes in 28 eyes of 26 patients with malignant glaucoma between 1991 and 2009. The main outcome measures of the retrospective case series were IOP and central anterior chamber depth. Resolution was defined as eyes with an IOP of 21 mmHg or less and deepening of the central anterior chamber with or without topical anti-glaucoma medications.

The treatment algorithm consisted of anti-glaucoma medications and cycloplegics as first-line methods. The second-line therapies in pseudophakic eyes were laser hyaloidotomy and vitrectomy-hyaloidotomy-iridectomy (VHI) or transscleral cyclophotocoagulation (TSCPC).

Of the eyes studied, five were phakic and 23 were pseudophakic. Trabeculectomies were performed in 11 eyes, cataract surgery in 10 eyes and combined cataract and glaucoma surgery in 7 eyes.

The mean IOP decreased from 34±8.3 mmHg at presentation to 14.3±5.2 mmHg at the last follow up visit. Resolution of malignant glaucoma was seen in 27 eyes with 17 eyes resolved with one intervention and 10 eyes undergoing repeat procedures.

Medical treatment was advantageous in phakic eyes, laser hyaloidotomy was successful in pseudophakic eyes and vitrectomy and TSCPC was beneficial in refractory cases. The stepladder technique was successful in 96% of patients in the case series.

To read the abstract please click here.