Malignant Glaucoma (Posterior Aqueous Diversion Syndrome)

  • Marshall N. Cyrlin


Von Graefe1 first used the term malignant glaucoma to describe a devastating and unusual form of glaucoma that occurred following ocular surgery. This sequelae was asso­ciated with increased intraocular pressure (IOP) and flattening or shallowing of the anterior chamber. The word malignant was used to characterize the uniformly grave visual prognosis, but because of its relationship to cancer, many have objected to its use, preferring the term misdirection of aqueous. The current definition has been expanded to include classic malignant glaucoma and nonphakic malignant glaucoma as well as disorders occurring in other clinical situations. Classic malignant glaucoma is usually associated with a specific clinical scenario that occurs after incisional surgery (iridectomy or filtration) for primary angle-closure glaucoma, secondary or chronic angle-closure glaucoma, or at times open-angle glaucoma in phakic patients (Table 37.1). The occurrence of malignant glaucoma after cataract surgery and the persistence of malignant glaucoma following cataract surgery in the classic form have been termed as aphakic malignant glaucoma. The diagnosis nonphakic malignant glaucoma has been suggested for both aphakic and pseudophakic types 2 and may also be applied to the development of malignant glaucoma after combined cataract and filtration surgery. The term malignant-like glaucoma has been proposed for instances with similar clinical presentations but where different underlying pathophysiology may be present.


Anterior Chamber Ciliary Body Ciliary Process Ultrasound Biomicroscopy Pupillary Block 
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  1. 1.
    von Graefe A. Beitrage zur Palhologie und Therapie des Glaukoms. Arch Ophthalmol. 1869;15:108.Google Scholar
  2. 2.
    Levene R. Malignant glaucoma: Proposed definition and classification. In: Shields MB, Pollack I, Kolker A, eds. Perspectives in Glaucoma. Transactions of the First Scientific Meeting of the American Glaucoma Society. Thorofare, NJ: Slack; 1988:243–350.Google Scholar
  3. 3.
    Weiss DI, Shaffer RN. Ciliary block (malignant glaucoma). Trans Am Acad Ophthalmol Otol. 1972;76:450.Google Scholar
  4. 4.
    Shaffer RN, Hoskins HD Jr. Ciliary block (malignant glaucoma). Ophthalmology. 1978;85:215.PubMedGoogle Scholar
  5. 5.
    Levene R. A new concept of malignant glaucoma. Arch Ophthalmol. 1972;87:497.PubMedGoogle Scholar
  6. 6.
    Chandler PA, Simmons RJ, Grant WM. Malignant glaucoma: Medical and surgical treatment. Am J Ophthalmol. 1968;66:495.PubMedGoogle Scholar
  7. 7.
    Simmons RJ. Malignant glaucoma. Br J Ophthalmol. 1972;56:263.CrossRefPubMedGoogle Scholar
  8. 8.
    Simmons RJ, Thomas IV, Yaqub MK. Malignant glaucoma. In: Ritch R, Shields MB, Krupin T, eds. The Glaucomas. CV Mosby: St. Louis; 1989:1251–1263.Google Scholar
  9. 9.
    Simmons RJ. Malignant glaucoma. III In: Epstein DL, ed. Chandler and Grant’s Glaucoma. Philadelphia, PA: Lea & Febiger; 1986:264–278.Google Scholar
  10. 10.
    Trope GE, Pavlin CJ, Bau A, et al. Malignant glaucoma: Clinical and ultrasound biomicroscopic features. Ophthalmology. 1994;101:1030.PubMedGoogle Scholar
  11. 11.
    Merritt JC. Malignant glaucoma induced by miotics postoperatively in open-angle glaucoma. Arch Ophthalmol. 1977;95:1988.PubMedGoogle Scholar
  12. 12.
    Hoshiwara I. Case report of simultaneous malignant glaucoma occurring 3 years after glaucoma surgery. Arch Ophthalmol. 1964;72:601.PubMedGoogle Scholar
  13. 13.
    Gorin G. Angle-closure glaucoma induced by miotics. Am J Ophthalmol. 1966;62:1063.PubMedGoogle Scholar
  14. 14.
    Jafar MS, Tomey KF. Malignant glaucoma manifesting bilaterally 15 months after peripheral iridectomy. Glaucoma. 1982;4:177.Google Scholar
  15. 15.
    Ellis PP. Malignant glaucoma occurring 16 years after successful filtering surgery. Ann Ophthalmol. 1984;16:177.PubMedGoogle Scholar
  16. 16.
    Wollensak I, Pham DT, Anders N. Ciliolenticular block as a late complication in pseudophakia. Ophthalmologe. 1995;92:280.PubMedGoogle Scholar
  17. 17.
    Hanish SJ, Lamberg RL, Gordon JM. Malignant glaucoma following cataract extraction and intraocular lens implant. Ophthalmic Surg. 1982;13:713.PubMedGoogle Scholar
  18. 18.
    Epstein DL. Pseudophakic malignant glaucoma-Is it really pseudomalignant? Am J Ophthalmol. 1987;103:231.PubMedGoogle Scholar
  19. 19.
    Arya SK, Sonika S, Kochhar S. Malignant glaucoma as a complication of Nd:YAG laser posterior capsulotomy. Ophthalmic Surg Lasers Imaging. 2004;35:248–250.PubMedGoogle Scholar
  20. 20.
    Azuara-Blanco A, Dua HS. Malignant glaucoma after diode laser cyclophotocoagulation. Am J Ophthalmol. 1999;127:467–469.CrossRefPubMedGoogle Scholar
  21. 21.
    Greenfield DS, Tello C, Budenz DL, Liebman JM, Ritch R. Aqueous misdirection after glaucoma drainage device implantation. Ophthalmology. 1999;106:1035–1040.CrossRefPubMedGoogle Scholar
  22. 22.
    Luntz MH, Rosenblatt M. Malignant glaucoma. Surv Ophthalmol. 1987;32:73.CrossRefPubMedGoogle Scholar
  23. 23.
    Brooks AM, Halper CA, Gillies WE. Occurrence of malignant glaucoma after laser iridotomy. Br J Ophthalmol. 1989;73:617.CrossRefPubMedGoogle Scholar
  24. 24.
    Robinson A, Plialnic M, Deutsch D, et al. The onset of malignant glaucoma after prophylactic laser iridotomy. Am J Ophthalmol. 1990;110:95.PubMedGoogle Scholar
  25. 25.
    Aminlati A, Sassani JW. Simultaneous bilateral malignant glaucoma following laser iridotomy. Graefes Arch Clin Exp Opbthalmol. 1993;231:12.CrossRefGoogle Scholar
  26. 26.
    Di Sclafani M, Liebmann JM, Ritch R. Malignant glaucoma following argon laser release of scleral flap sutures after trabeculectomy. Am J Ophthalmol. 1989;108:597.Google Scholar
  27. 27.
    Macken P, Buys Y, Trope GE. Glaucoma laser suture lysis. Br J Ophthalmol. 1996;80:398.CrossRefPubMedGoogle Scholar
  28. 28.
    Hardten DR, Brown JD. Malignant glaucoma after Nd:YAG cyclophotocoagulation. Am J Ophthalmol. 1991;111:245.PubMedGoogle Scholar
  29. 29.
    Pecora JL. Malignant glaucoma worsened by miotics in a postoperative angle-closure glaucoma patient. Ann Ophthalmol. 1979;11:1412.PubMedGoogle Scholar
  30. 30.
    Rieser JC, Schwartz B. Miotic-induced malignant glaucoma. Arch Ophthalmol. 1972;87:706.PubMedGoogle Scholar
  31. 31.
    Pollard AF. Secondary angle closure glaucoma in cicatricial retrolental fibroplasia. Am J Ophthalmol. 1980;89:651.PubMedGoogle Scholar
  32. 32.
    Kushner BJ. Ciliary block in retinopathy of prematurity. Arch Ophthalmol. 1982;100:1078.PubMedGoogle Scholar
  33. 33.
    Lowe RF. Malignant glaucoma related to primary angle closure glaucoma. Aust N Z J Ophthalmol. 1979;7:11.CrossRefGoogle Scholar
  34. 34.
    Weiss IS, Deiter PO. Malignant glaucoma syndrome following retinal detachment surgery. Ann Ophthalmol. 1974;6:1099.PubMedGoogle Scholar
  35. 35.
    Weber PA, Cohen JS, Baker O. Central retinal vein occlusion and malignant glaucoma. Arch Ophthalmol. 1987;105:635.PubMedGoogle Scholar
  36. 36.
    Jones BR. Principles in the management of oculomycosis. Trans Am Acad Ophthalmol Otol. 1975;79:15.Google Scholar
  37. 37.
    Lass JH, Thoft RA, Bellows AR, et al. Exogenous Nocardia asteroides endophthalmitis associated with malignant glaucoma. Ann Ophthalmol. 1981;13:317.PubMedGoogle Scholar
  38. 38.
    Schwartz AL, Anderson DR. “Malignant glaucoma” in an eye with no antecedent operation or miotics. Arch Ophthalmol. 1975;93:379.PubMedGoogle Scholar
  39. 39.
    Chandler PA, Grant WM. Mydriatic-cycloplegic treatment in malignant glaucoma. Arch Ophthalmol. 1962;68:353.PubMedGoogle Scholar
  40. 40.
    Epstein DL, Hashimoto JM, Anderson PJ, Grant WM. Experimental perfusions through the anterior and vitreous chambers with possible relationships to malignant glaucoma. Am J Ophthalmol. 1979;88:1078.PubMedGoogle Scholar
  41. 41.
    Epstein DL. Malignant glaucoma. In: Jakobiec FA, Sigelman J, eds. Advanced Techniques in Ocular Surgery. WB Saunders: Philadelphia, PA; 1984:158–168.Google Scholar
  42. 42.
    Quigley HA. Malignant glaucoma and fluid flow rate. [Editorial]. Am J Ophthalmol. 1980;89:879.PubMedGoogle Scholar
  43. 43.
    Epstein DL. Unifying concepts in malignant glaucoma. Glaucoma Under Pressure 1997 Symposium. American Academy of Ophthalmology Specialty Day. San Francisco, October 1997.Google Scholar
  44. 44.
    Epstein DL. The malignant glaucoma syndromes. In: Epstein DL, Allingham RR, Schuman JS, eds. Chandler and Grant’s Glaucoma. Media, PA: Williams & Wilkins; 1997:285–303.Google Scholar
  45. 45.
    Quigley HA, Friedman DS, Congdon NG. Possible mechanisms of primary angle-closure and malignant glaucoma. J Glaucoma. 2003;12:167–180.CrossRefPubMedGoogle Scholar
  46. 46.
    Epstein DL, Steinert RF, Puliafito CA. Neodymium-YAG laser therapy to the anterior hyaloid in aphakic malignant (ciliovitreal block glaucoma). Am J Ophthalmol. 1984;98:137.PubMedGoogle Scholar
  47. 47.
    Little BC, Hitchings RA. Pseudophakic malignant glaucoma: Nd:YAG capsulotomy as a primary treatment. Eye. 1993;7:102.PubMedGoogle Scholar
  48. 48.
    Little BC. Treatment of aphakic malignant glaucoma using Nd:YAG laser posterior capsulotomy. Br J Ophthalmol. 1994;78:499.CrossRefPubMedGoogle Scholar
  49. 49.
    Dugel PR, Heuer OK, Thach AB, et al. Annular peripheral choroidal detachment simulating aqueous misdirection after glaucoma surgery. Ophthalmology. 1997;104:439.PubMedGoogle Scholar
  50. 50.
    Liebmann JM, Weinreb RN, Ritch R. Angle-closure glaucoma associated with occult annular ciliary body detachment. Arch Ophthalmol. 1998;16:731.Google Scholar
  51. 51.
    Rheindorf O. Uber Glaukom. Klin Monatsbl Augenheilkd. 1877; 25:148.Google Scholar
  52. 52.
    Weiss DI, Shaffer RN, Harrington DO. Treatment of malignant glaucoma with intravenous mannitol infusion: Medical reformation of the anterior chamber by means of an osmotic agent: A preliminary report. Arch Ophthalmol. 1963;69:154.PubMedGoogle Scholar
  53. 53.
    Beckman H, Blau RP. Oral steroid therapy for ciliary (pseudomalignant glaucoma). Glaucoma. 1981;3:169.Google Scholar
  54. 54.
    Herschler J. Laser shrinkage of the ciliary processes: A treatment for malignant (ciliary block) glaucoma. Ophthalmology. 1980;87:1155.PubMedGoogle Scholar
  55. 55.
    Weber PA, Henry MA, Kapetansky FM, et al. Argon laser treatment of the ciliary processes in aphakic glaucoma with flat anterior chamber. Am J Ophthalmol. 1984;97:82.PubMedGoogle Scholar
  56. 56.
    Risco JM, Tomey KF, Perkins TW. Laser capsulotomy through intraocular lens positioning holes in anterior aqueous misdirection. Arch Ophthalmol. 1989;107:1569.PubMedGoogle Scholar
  57. 57.
    Momeda S, Hayashi H, Oshima K. Anterior pars plana vitrectomy for phakic malignant glaucoma. Jpn J Ophthalmol. 1983;27:73.Google Scholar
  58. 58.
    Benedikt O. A new operative method for the treatment of malignant glaucoma. Klin Monatsbl Augenheilkd. 1977;170:665.PubMedGoogle Scholar
  59. 59.
    Luntz MH, Harrison R, Schenker H. Management of secondary glaucoma. In: Luntz MH, Harrison R, Schencker HI, eds. Glaucoma Surgery. Baltimore: Williams & Wilkins; 1984:107–116.Google Scholar
  60. 60.
    Boke W, Teichmann KDS, Junge W. Experiences with ciliary block (“malignant”) glaucoma. Klin Monatsbl Augenheilkd. 1980;177:407.CrossRefPubMedGoogle Scholar
  61. 61.
    Koerner FH. Anterior pars plana vitrectomy in ciliary and iris block glaucoma. Graefs Arch Clin Exp Ophthalmol. 1980;214:119.CrossRefGoogle Scholar
  62. 62.
    Weiss H, Shin DH, Kollarits CR. Vitrectomy for malignant (ciliary block) glaucomas. Int Ophthalmol Clin. 1981;21:113.CrossRefPubMedGoogle Scholar
  63. 63.
    Lynch MG, Brown RH, Michels RG, et al. Surgical vitrectomy for pseudophakic malignant glaucoma. AM J Ophthalmol. 1986;102:148.CrossRefGoogle Scholar
  64. 64.
    Byrnes GA, Leen MM, Wong TP, et al. Vitrectomy for ciliary block (malignant) glaucoma. Ophthalmology. 1995;102:1308.PubMedGoogle Scholar
  65. 65.
    Harbour JW, Rubsamen PE, Palmberg P. Pars plana vitrectomy in the management of phakic and pseudophakic malignant glaucoma. Arch Ophthalmol. 1996;114:1073.PubMedGoogle Scholar
  66. 66.
    Tsai JC, Barton KA, Miller MH, et al. Surgical results in malignant glaucoma refractory to medical or laser therapy. Eye. 1997;11:677.PubMedGoogle Scholar
  67. 67.
    Lois N, Wong D, Groenwald C. New surgical approach in the management of pseudophakic malignant glaucoma. Ophthalmology. 2001;108:780–783.CrossRefPubMedGoogle Scholar
  68. 68.
    Shields MB. Glaucomas following ocular surgery. In: Shields MD, ed. Textbook of Glaucoma. Baltimore: Williams & Wilkins; 1998:345–3500.Google Scholar
  69. 69.
    Shaffer RN. The role of vitreous detachment in aphakic and malignant glaucoma. Trans Am Acad Ophthalmol Otolaryngol. 1954;58:217.PubMedGoogle Scholar
  70. 70.
    Tello C, Chi T, Shepps G, et al. Ultrasound biomicroscopy in pseudophakic malignant glaucoma. Ophthalmology. 1993;100:410.Google Scholar

Copyright information

© Springer Science+Business Media, LLC 2010

Authors and Affiliations

  • Marshall N. Cyrlin
    • 1
    • 2
    • 3
  1. 1.Oakland University William Beaumont School of MedicineRochesterUSA
  2. 2.Glaucoma Services, William Beaumont Eye InstituteRoyal OakUSA
  3. 3.SouthfieldUSA

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