Título / Title

MALIGNANT GLAUCOMA IRRESPONSIVE TO POSTERIOR VITRECTOMY

Introdução / Purpose

We report a case of malignant Glaucoma irresponsive to posterior vitrectomy surgery.

Material e Método / Methods

A 72-year-woman , only eye,presented with malignant glaucoma after many years post trabeculectomy surgery. She was submitted to a no-success yag laser hyaloidectomy and posterior vitrectomy surgery with complett toillet vitreous that going well but failed in its purpose after a month post operatory.

Resultados / Results

The patient has now atalamia , completely closure angle by synechiai, high intraocular pressure that is controlled through high oral dosis of anydrase innibitor and drops of beta blocker and alpha adrenergic agonist. As soon as possible she will be submitted to Ahmed valve implant surgery.

Discussão e Conclusões / Conclusion

Malignant glaucoma is caused by rotation of the ciliary body with inadequate direction of flow of the aqueous humor that is trapped in blisters in the vitreous core. Many times the posterior hyaloid breaks through the yag laser procedure, resolving the picture. In most cases, however, malignant glaucoma is resolved after vitreous cavity emptying surgery through posterior vitrectomy. However, in some rare cases as in this report, rotation and anterioration of the ciliary body, with misdirection of aqueous humor flow, does not only respond to vitrectomy, thus requiring implantation of a drainage valve implanted in the posterior chamber to control IOP.
The misdirection of aqueous humor flow causes permanent anteriorization of iris-IOL diaphragm resulting in atalamia and consequent blockage of the drainage angle, perpetuating the pathophysiological basis of malignant glaucoma.

Palavras Chave

Malignant glaucoma; ciliar body rotation; vitrectomy; vitreous; surgery fail.