Eyeworld

DECEMBER 2021 | EYEWORLD | 91 G Contact Foley: Lindsay.Foley@nyulangone.org Oriaifo: amenzeosa@gmail.com Panarelli: Joseph.Panarelli@nyulangone.org References continued 6. Debrouwere V, et al. Out- comes of different management options for malignant glaucoma: a retrospective study. Graefes Arch Clin Exp Ophthalmol. 2012;250:131–141. 7. Razeghinejad MR, et al. Lesser anterior chamber dimensions in women may be a predisposing factor for malignant glaucoma. Med Hypotheses. 2005;64:572– 574. Relevant disclosures Foley: None Oriaifo: None Panarelli: Aerie, Allergan, CorneaGen, Glaukos, New World Medical, Santen the laser is placed outside the optic of the IOL, where the anterior and posterior capsular leaf- lets are fused. Laser photocoagulation of the ciliary pro- cesses is another potential option, Drs. Foley and Panarelli said. This can help reduce the abnormal anatomic relationship between the ciliary processes and the anterior hyaloid face. If both medical and laser treatments fail at resolving the issue, they said iridozonulohy- aloidectomy with core vitrectomy is required. This procedure would create an uninterrupted passageway from the anterior chamber to the vitreous cavity that is needed to truly make the eye unicameral. Drs. Foley and Panarelli advised use of a depot steroid injection in these patients because they often develop significant intraocu- lar inflammation. "The prognosis of malignant glaucoma depends on the severity of the attack and is often guarded, but if diagnosed and treated early, the prognosis can be good," Drs. Foley and Panarelli said. must already have a peripheral iridotomy. "This allows the clinician to rule out angle closure due to pupillary block," they said. From there, the next step is to start medi- cal therapy with mydriatic-cycloplegic agents. These, they explained, tighten the zonules to pull the lens posteriorly. Drs. Foley and Panarel- li noted aqueous suppressants, hyperosmotic agents, and topical steroids as helpful to reduce aqueous production, decrease the volume of the vitreous, and reduce inflammation. "Medical treatment alone has been shown to be effective in about 50% of patients within 5 days (though some of these patients may actual- ly have annular choroidal effusions and not true MG)," they said. If medical treatment is not successful, the next step would be laser treatment, according to Drs. Foley and Panarelli, explaining that the idea is to create a passageway between the anterior chamber and the vitreous space. An Nd:YAG laser can disrupt the anterior hyaloid face, they said, noting that it's often most successful if Narrow angles on OCT anterior segment before cataract surgery with iridozonulohyaloidectomy on one of Dr. Oriaifo's patients Source: Amenze Oriaifo, MD

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