SURGICAL RESULTS IN MALIGNANT GLAUCOMA REFRACTORY TO MEDICAL OR LASERTHERAPY

We investigated the surgical results in 25 patients identified with ma lignant (ciliary block) glaucoma. Four of these patients (16%) had suc cessful outcomes following laser treatment alone. Nineteen patients (7 6%) underwent microsurgery for glaucoma refractory to conventional med ical and/or laser therapy and are the subjects of this study. Core vit rectomy was successful in 4 of 6 pseudophakic patients (67%) and in 1 of 4 phakic patients (25%). Combined cataract extraction and vitrectom y had a higher success rate in patients undergoing posterior capsulect omy at the time of surgery (5 of 6 patients; 83%) compared with those patients left with an intact posterior capsular bag (1 of 4 patients; 25%). Intracapsular cataract extraction was successful in 1 of 2 patie nts (50%). We conclude that surgical vitrectomy in the presence of an intact posterior capsule may preclude the surgical resolution of aqueo us misdirection. In eyes with pre-existing cataract, we recommend comb ined lens extraction, primary posterior capsulectomy and surgical vitr ectomy for the surgical management of phakic malignant glaucoma.