Malignant Glaucoma Following Cataract Surgery in a Nanophthalmic Eye: A Case Report

Purpose: We present a case of malignant glaucoma following cataract surgery in a nanophthalmic eye.Case summary: A 74-year-old woman with a nanophthalmic right eye (axial length 20.51 mm) underwent cataract surgery at a local hospital. One week postoperatively, she presented with a dislocated intraocular lens (IOL) and a shallow anterior chamber. Malignant glaucoma was suspected, and the patient underwent pars plana vitrectomy followed by neodymium-doped yttrium aluminum garnet laser posterior capsulotomy. Despite these interventions, the IOL remained anteriorly displaced, prompting referral to our institution for further management. Upon presentation, the patient exhibited an intraocular pressure (IOP) of 38 mmHg despite maximal medical therapy; spherical equivalent (SE) was -3.88 diopters. To differentiate pupillary block and establish a definitive diagnosis, laser iridotomy was performed; this resulted in a significant reduction in IOP to 10 mmHg and deepening of the anterior chamber. However, 19 days post-iridotomy, the IOP again increased to 39 mmHg; the SE worsened to -4.88 diopters. Slit-lamp examination and ultrasound biomicroscopy revealed a transparent membrane obstructing the iridotomy site behind the iris, consistent with a complex of disrupted ciliary zonules and the anterior hyaloid. Subsequently, photodisruption of this membrane was performed through the existing iridotomy. This intervention deepened the anterior chamber and achieved a wide-open iridocorneal angle. At the last follow-up, the patient had maintained an IOP of 10 mmHg without glaucoma medication. Furthermore, SE improved to -0.38 diopters, resulting in a best-corrected visual acuity of 1.0.Conclusions: Our case demonstrates the development of malignant glaucoma following cataract surgery and subsequent total vitrectomy and laser posterior capsulotomy in a nanophthalmic eye. Thorough irido-zonulo-hyaloidotomy demonstrated to be an effective approach for achieving significant IOP reduction.