Clinical associations for the development of malignant glaucoma following intraocular surgery.

Abstract

Purpose: To assess the factors associated with malignant glaucoma (MG) following intraocular surgery.

Design: Retrospective case-control study.

Setting: Institutional.

Study population: A total of 40 eyes with MG and 80 controls were included.

Methods: A total of 40 patients who developed malignant glaucoma following intraocular surgery between January 1995 and December 2013 were compared with 80 age- and gender-matched controls who underwent surgery during the study period.

Main outcome measures: The associated factors for the development of malignant glaucoma following intraocular surgery.

Results: Diagnosis in cases included primary angle closure glaucoma (PACG: 31 [77.5%]), primary open-angle glaucoma (POAG: 2 [5%]), pseudoexfoliation glaucoma (PXFG: 4 [10%]); in controls included PACG 44 (55%) and POAG 36 (45%), (P < 0.001). Trabeculectomy was performed in 24 cases (50%) and 28 (35%) controls, phaco-trabeculectomy in 14 cases (35%) and 52 eyes (65%) in controls, and cataract surgery in 2 cases (5%) (P = 0.004). Factors associated on univariate analysis included PACG (odds ratio [OR]: 12.68, 95% confidence interval [CI]; 2.84, 56.62, P < 0.001, synechial angle closure > 180° (OR: 10.1, 95% CI: 2.87, 35.44, P < 0.001, higher preoperative IOP > 22 mmHg (OR: 5.32, 95% CI: 2.64, 10.73, P < 0.001), trabeculectomy (OR: 3.05, 95% CI: 1.36, 6.83, P = 0.007) and axial length < 22 mm (OR: 6.80, 95% CI: 2.51, 18.46, P < 0.001. The use of postoperative cycloplegics was protective on univariate analysis (OR: 0.268, 95% CI: 0.12, 0.596), P < 0.001). Preoperative IOP > 22 mmHg (2.85, 95% CI: 1.11, 7.31, P = 0.02), and trabeculectomy (OR: 4.09, 95% CI: 1.48, 11.3, P = 0.007) remained significant on multivariate analysis.

Conclusion: PACG eyes with higher preoperative IOP and eyes undergoing trabeculectomy surgery alone, increased the likelihood of developing MG.