Cataract Surgery in Malignant Glaucoma from Complete Subluxation of Lens into Anterior Chamber

AIM AND OBJECTIVE: To report an unusual and difficult case of malignant glaucoma induced by a traumatic mature cataract that had migrated into the anterior chamber in a developmentally delayed patient. BACKGROUND: Malignant glaucoma can present due to multiple mechanisms, including trauma-induced cataract migration into the anterior chamber. CASE DESCRIPTION: A developmentally delayed female in her 40s with a history of self-abuse was found to have malignant glaucoma in the setting of a traumatic cataract that had migrated in front of the iris into the anterior chamber. Exam under anesthesia and ultrasound biomicroscopy (UBM) demonstrated complete subluxation of the lens into the anterior chamber. Perioperative techniques included prophylactic pars plana vitrectomy to alleviate posterior pressure as well as the creation of an irido-zonulo-hyaloido-vitrectomy (IZHV), which allowed for reformation of the anterior chamber. These maneuvers allowed for cataract surgery to be performed through a clear corneal incision, with anterior chamber intraocular lens implantation. The patient had improved vision, pressure, and pain. CONCLUSION: Malignant glaucoma can present in unique ways and the presence of a flat anterior chamber and increased posterior pressure can make surgery challenging. Initial pars plana vitrectomy in addition to the creation of an IZHV can help relieve posterior pressure and facilitate cataract extraction. It is important to factor in patient-specific situations and goals while selecting an intraocular lens. CLINICAL SIGNIFICANCE: Traumatic cataracts and malignant glaucoma can present in unique scenarios that may prove difficult to treat. Certain techniques can facilitate these challenging surgeries and provide the optimal outcome for patients. HOW TO CITE THIS ARTICLE: Sarrafpour S, Davies I, Ahmed O, et al. Cataract Surgery in Malignant Glaucoma from Complete Subluxation of Lens into Anterior Chamber. J Curr Glaucoma Pract 2021;15(3):164–167.