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Spontaneous simultaneous bilateral malignant glaucoma of a patient with no antecedent history of medical or surgical eye diseases

Authors Jarade E, Dirani A, Jabbour E, Antoun J, Tomey K

Received 7 February 2014

Accepted for publication 25 March 2014

Published 27 May 2014 Volume 2014:8 Pages 1047—1050

DOI https://doi.org/10.2147/OPTH.S62096

Checked for plagiarism Yes

Review by Single-blind

Peer reviewer comments 2


Elias F Jarade,1,2 Ali Dirani,3 Elyse Jabbour,3 Joelle Antoun,3 Karim F Tomey1

1Beirut Eye Specialist Hospital, Beirut, Lebanon; 2Mediclinic Dubai Mall, Dubai, United Arab Emirates; 3Hotel Dieu de France Hospital, Saint Joseph University, Beirut, Lebanon

Purpose: Malignant glaucoma, or aqueous misdirection syndrome, is a condition characterized by sudden intraocular pressure (IOP) elevation, and it is usually unilateral and induced by ocular surgical intervention or by medical therapy. Here, we report a case of simultaneous bilateral malignant glaucoma in a young patient with no history of any ocular diseases.
Case report: A case of a 24-year-old female with no apparent previous history of ocular medical or surgical conditions was referred to our hospital because of recent bilateral IOP elevation associated with a severe drop in vision and shallow anterior chamber with no posterior segment anomalies detected by ocular ultrasound in both eyes. Yttrium aluminum garnet (YAG) laser iridotomy dropped the IOP only temporarily and the patient received topical atropine treatment with combined trabeculectomy and anterior vitrectomy.
Results: In this case, the patient had a typical presentation of bilateral malignant glaucoma and her IOP dropped only temporarily following laser iridotomy to rise again shortly thereafter. Also, deepening of the anterior chamber and IOP decrease after topical atropine was very supportive of the diagnosis of malignant glaucoma. Successful management with trabeculectomy and limited vitrectomy also affirmed the diagnosis of malignant glaucoma.
Conclusion: This is a very rare case of bilateral malignant glaucoma in a young adult without any prior eye conditions; only one similar case has been reported in the literature. We propose our own theory regarding this simultaneous occurrence of the pathology based on previously published studies about the presence of communication between the two eyes along the ­cerebrospinal fluid pathways.

Keywords: intraocular pressure, iridotomy, malignant glaucoma, young adult

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