**9. Prognosis**

the pigment epithelium and accompanying vessels. Deep coagulative necrosis of the pig‐ ment epithelium, pathological reconstruction of collagen fibers in the stroma, and intra‐ vascular coagulation in the blood vessels of the ciliary body take place [43]. Significant complications include postoperative inflammation, pain, cystoid macular edema, and phthisis. Thus, indications for cyclophotocoagulation are generally limited to patients whose glaucoma has been resistant to medical and surgical therapies, with no potential

The indication for surgical intervention is a lack of effectiveness of conservative and laser treatment [11,36]. An operative procedure should not be conducted too late due to the de‐

**Figure 5.** A,B: Advanced stage of malignant glaucoma - shallow anterior chamber, corneal oedema and posterior syn‐

Currently used methods of surgical treatment were introduced when the role of the patholo‐ gy of the anterior segment and the vitreous body in the pathogenesis of the malignant proc‐ ess were discovered. As of now, surgical intervention in malignant glaucoma is directed towards lowering IOP, achieving correct anatomical relationships between the vitreous body, lens, and ciliary body, and additionally enabling correct flow of aqueous humour from the posterior segment to the anterior chamber of the eye. Achievement of communica‐ tion seems to be necessary, because the disruption of aqueous humour flow in malignant glaucoma can last even after PPV [54]. The concept of such a procedure is based on the ob‐ servation of regression of the symptoms of malignant glaucoma in the case of direct commu‐ nication between the vitreous cavity and anterior chamber being ensured [25]. The iridectomy may be performed using Vannas scissors or a vitrectomy tip, whereas the poste‐ rior capsulotomy and hyaloidotomy may be done with a vitrectomy tip. The anterior cham‐ ber may be reformed with air. All of these procedures should be performed in one setting through the same location. Additionally synechiolysis may be performed if the iridocorneal angle is completely closed using a spatula or a viscoelastic agent. The performance of all

velopment of complications resulting from the persistence of the malignant process.

for improvement in visual acuity.

*8.2.2. Surgical treatment*

432 Glaucoma - Basic and Clinical Aspects

echiae in pseudophakic eye.

Malignant glaucoma remains a difficult clinical problem that results in irreversible blindness if treatment is delayed and not adequate. The surgeon should be aware preoperatively of eyes at risk and observe them closely during follow-up visits. Early recognition is the most important step to prevent irreversible loss of vision. The prognosis depends on the duration and the severity of the malignant glaucoma attack. In patients with glaucoma in its early stage, the prognosis can be good if the attack is discontinued and IOP is well controlled. The problem is that malignant glaucoma is often resistant to conservative treatment, and laser procedures are not always effective as well. Partial pars plana vitrectomy combined with capsulotomy communicating the anterior chamber and vitreous cavity in such cases is an ef‐ ficacious method of intervention when it comes to IOP control, postoperative BCVA, and re‐ duction of the number of antiglaucoma medications. The prognosis after laser and surgical treatment depends on the occurence of complications after performed procedures. Compli‐ cations after malignant glaucoma surgery observed in own material included: increased IOP during the early post-operative period (above 21 mmHg) [5%), inflammatory effusion [5%), hyphema [10%), occurrence of posterior adhesions [5%), no effectiveness of filtration sur‐ gery preceding the occurrence of malignant glaucoma [55%), macular edema [10%), and reti‐ nal detachment [5%). Recurrence of malignant glaucoma with the full range of symptoms was observed in 15% of eyes subjected to surgery. In the case of post-operative shallowing of the anterior chamber, it is possible to conduct a capsulotomy through iridectomy, and the use of an Nd-YAG laser for this purpose is a safe and effective method in most cases.

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