Nd-YAG laser hyaloidotomy for malignant glaucoma following one-piece 7 mm intraocular lens implantation

Three cases of malignant glaucoma following extracapsular cataract extraction with 7 mm one-piece posterior chamber intraocular lens implantation are presented. Nd-YAG laser hyaloidotomy was successfully performed in all eyes, but was difficult and required several sessions in two eyes. In the third eye, which had a sector iridectomy, laser hyaloidotomy applied over the edge of the lens optic through the iridectomy resulted in brisk deepening of the anterior chamber and reduction of intraocular pressure. We propose that the one-piece 7 mm optic posterior chamber intraocular lens may constitute an obstacle to successful hyaloidotomy, mainly owing to its large size, as it may block aqueous percolation from the vitreous into the anterior chamber. Eyes prone to develop malignant glaucoma after surgery should have a sector or large peripheral iridectomy to facilitate postoperative Nd- YAG laser hyaloidotomy if required.