Pseudophakic malignant glaucoma: Nd:YAG capsulotomy as a primary treatment.

Malignant glaucoma is one of the most serious but rare complications of anterior segment surgery. It is best known following trabeculectomy but has been reported following a wide variety of anterior segment procedures including extracapsular cataract extraction with posterior chamber lens implantation. It is notoriously refractory to medical treatment alone and surgical intervention has had only limited success. An additional treatment option in pseudophakic eyes is that of peripheral Nd:YAG posterior capsulotomy, which is minimally invasive and can re-establish forward flow of posteriorly misdirected aqueous through into the drainage angle of the anterior chamber. We report our experience of seven cases of malignant glaucoma in pseudophakic eyes and of the successful use of Nd:YAG posterior capsulotomy in re-establishing pressure control in five of these eyes, thereby obviating the need for acute surgical intervention.