Malignant glaucoma and its management

Malignant glaucoma continues to present a difficult clinical challenge to the ophthalmologist. This probably reflects the fact that the exact mechanism behind its aetiology is still not clearly understood. This perspective presents an update on the management of malignant glaucoma in light of the results obtained at Moorfields Eye Hospital during the past 3 years and on reviewing the recent literature.

The term malignant glaucoma was coined by Von Graefe in 1869.1 He noted that following peripheral iridectomy for acute angle closure glaucoma a number of patients developed shallowing of the anterior chamber together with high intraocular pressure. The subsequent prognostic outlook for such eyes was typically poor, hence the term ‘malignant’. This descriptive term remains appropriate today as the condition continues to be one of the most difficult types of secondary glaucoma to manage. Other terms have been used to describe the condition including cilio-lenticular block, ciliary block, and aqueous misdirection glaucoma. However, these terms are based on supposition relating to the underlying aetiology and until a better understanding of the pathomechanism of the condition is attained the term ‘malignant glaucoma’ expresses its seriousness and will continue to be used. Malignant glaucoma remains a condition with a poor outcome. At the outset diagnosis may be delayed and as a result there may be delay in administering optimal medical therapy. Many eyes do not respond to medical therapy and the surgical management remains difficult and controversial.