**5. Objective symptoms**

Myopic shift in refraction related to the anterior dislocation of the iris-lens diaphragm with secondary improvement of near vision [38].

anterior chamber, resulting in increased pressure in the posterior chamber and forward bowing of the peripheral iris. This closes the anterior chamber angle, obstructing the trabec‐ ular meshwork and the outflow channels with subsequent elevation of the IOP. Laser pe‐ ripheral iridotomy is the treatment of choice [45] and should be performed in all cases of pupillary block glaucoma. In pupillary block, there should not exist axial shallowing of the anterior chamber (movement of the IOL toward the cornea). The anterior chamber usually remains deeper in the center than on its circumference, in contrast to malignant glaucoma, where axial chamber shallowing also occurs. If there is axial shallowing, then fluid has

Malignant Glaucoma

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somehow moved posteriorly and the vitreous is acting to shallow the chamber [46].

predisposition.

ma may develop [48].

of the abdominal press.

accompanying the occurrence of malignant glaucoma

**7. Testing**

Angle closure glaucoma – shallowing of the anterior chamber occurs symmetrically in both eyes. In the affected eye, the filtration angle is closed, there is a sudden increase in IOP, and microcystic edema of the cornea. Conjunctival injection and a medium size pupil may ac‐ company these symptoms [47]. It occurs regardless of surgery and is caused by anatomical

Choroidal effusion - a static condition which is observed independently of operation and has inflammatory (trauma and intraocular surgery, scleritis, following cryocoagulation and photocoagulation, chronic uveitis, Vogt-Koyanagi-Harada disease) or hydrostatic causes (hypotony and wound leak, dural arteriovenous fistula, abnormally thick sclera in nanophthalmos, possibly in emmetropic or myopic eyes or associated with Hunter's syn‐ drome). Uveal effusion should not be considered to be a distinct clinical entity but rather a state characterized by abnormal amounts of fluid in the choroid resulting in thickening of the choroid, accumulation of fluid in the suprachoroidal space resulting in choroidal detachment, and in some cases, accumulation of fluid in the subretinal space, resulting in nonrhegmatogenous retinal detachment. IOP may be normal but is often reduced in uveal effusion secondary to inflammatory factors. An exception occurs in nanophthalmic uveal effusion wherein IOP is normal or frequently elevated and chronic angle closure glauco‐

Suprachoroidal hemorrhage – shallowing of the anterior chamber coexists with increased IOP, sudden pain, and the presence of a haemorrhagic, non-serous detachment of the cho‐ roid in biomicroscopic and ultrasonographic examination. It occurs most often within 1 week after surgery, rarely later [6]. Suprachoroidal hemorrhage may be caused by bleeding diathesis, anti-coagulants, paranasal sinusitis, or may occur spontaneously. Small supra‐ choroidal hemorrhages occurring during surgery are usually absorbed extemporaneously. Suprachoroidal hemorrhage may be also related to postoperative hypotony, and in the late postoperative period, may be connected to increased venous pressure or increased tension

Medical history – determination of predisposing factors and early statement of symptoms

Narrowing or shallowing of the circumferential and central part of the anterior chamber even if patent iridotomy or iridectomy is present. Shallowing of the anterior chamber is related to ante‐ rior dislocation of the iris-lens diaphragm [39,40] and iris-hyaloid diaphragm with coexistence of increased IOP [40]. Persistent symptoms of malignant glaucoma lead to the formation of in‐ tensified anterior adhesions due to the long-lasting shallowing of the anterior chamber [41].

**Figure 2.** Axial shallowing of the anterior chamber in an eye with malignant glaucoma.

Increased IOP – intraocular pressure may increase slowly with simultaneously intensifying shallowing of the anterior chamber [42]. It is characteristic that in the presence of an active, well functioning filtering bleb, the increase in intraocular pressure can be moderate [43].

No decrease of IOP in response to conventional antiglaucoma treatment [4].

In many cases, a decrease of IOP or curing as a result of mydriatic-cycloplegic therapy [44].

Reaction to surgical treatment of the vitreous body [6].
