Eyeworld

64 | EYEWORLD | AUGUST 2019 G UCOMA RESEARCH HIGHLIGHT by Maxine Lipner EyeWorld Senior Contributing Writer Contact information Greenfield: d.greenfield@med.miami.edu iridotomy, and there have only been approxi- mately a dozen cases previously reported," Dr. Greenfield said. "Typically, this is seen as a post- operative complication of glaucoma filtration surgery in hyperopic eyes and presents with ele- vated IOP and shallowing of both the peripher- al and axial anterior chamber." Although poorly understood, the pathophysiology is thought to involve an alteration of the anatomic rela- tionship among the lens, ciliary body, anterior hyaloid face, and vitreous leading to diversion of aqueous into the posterior segment. While the treatment may require surgi- cal intervention, medical therapy can suffice in approximately 50% of patients, he noted. This patient was treated conservatively for about 7 months with cycloplegia and aqueous suppression. Despite normal IOP, the patient P rimary angle closure glaucoma (PACG) accounts for 25% of world- wide glaucoma and affects approxi- mately 20 million people. Prophylactic laser peripheral iridotomy (LPI) is rec- ommended in eyes with anatomically narrow anterior chamber angles who are at increased risk for PACG. Laser iridotomy is a common procedure in the U.S., with 50,000 procedures performed annually. A small subset of patients may develop adverse effects such as visual dysphotopsia due to stray light reaching the retina or transient IOP elevation. David Greenfield, MD, treated a 58-year-old patient with PACG who developed a rare complica- tion following an uneventful LPI—malignant glaucoma. 1 "It is extremely uncommon to develop malignant glaucoma as a complication of laser Malignant glaucoma risk following laser peripheral iridotomy Malignant glaucoma can sometimes result even from a safe laser iridotomy. Source: David Greenfield, MD About the doctor David Greenfield, MD Douglas R. Anderson Distinguished Professor of Ophthalmology Bascom Palmer Eye Institute Miami References 1. Greenfield JA, et al. Malignant glaucoma after laser periph- eral iridotomy. J Glaucoma. 2019;28:e44–e45. 2. He M, et al. Laser peripheral iridotomy for the prevention of angle closure: a single centre, randomised controlled trial. Lancet. 2019;393:1609–1618. Financial interests Greenfield: None continued on page 66

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