Alternative approach to treating malignant glaucoma after trabeculectomy with unplanned zonulectomy

PURPOSE To report the role of Healon5 injection combined with medications in patient with malignant glaucoma after trabeculectomy with unplanned zonulectomy. METHODS Two days after trabeculectomy with unplanned zonulectomy for neovascular glaucoma in an eye with diabetic retinopathy, a patient developed malignant glaucoma due to the ciliovitreal block caused by the vitreous herniation through the peripheral iridectomy to the limbal incision with flat bleb and anterior chamber, and the intraocular pressure was elevated to 33 mmHg. The medications for the management of malignant glaucoma failed to relieve the malignant mechanism, and Healon5, a viscoadaptive, viscoelastic, and ophthalmic viscosurgical device, was injected through a paracentesis until the anterior chamber became deep enough to block the vitreous herniation to the limbal incision. RESULTS After Healon5 injection, the intraocular pressure was reduced enough that the bleb was re-formed, and the anterior chamber remained deep, even without medication. CONCLUSIONS In patients presenting with malignant glaucoma after trabeculectomy with unplanned zonulectomy, Healon5 injection, combined with medications, may be a safe and effective approach before performing vitrectomy.