Sir,

The term malignant glaucoma describes a form of secondary angle closure glaucoma with raised intraocular pressure (IOP), shallow or flat anterior chamber (AC), in the presence of a patent peripheral iridectomy (PI). Although the exact pathophysiology of malignant glaucoma remains an enigma, the postulated mechanism is an abnormal anatomical interaction between the ciliary processes, lens and anterior vitreous face associated with misdirection of the aqueous posteriorly.1 It is theorized that this anterior displacement of the lens-Iris diaphragm (due to sudden shallowing of anterior chamber or slack lens zonules) results in forward rotation of the ciliary body and apposition of ciliary processes to the lens equator. This leads to misdirection of the aqueous posteriorly. Further evidence is supplied by Epstein et al2 who, based on experimental perfusion studies on enucleated eyes, proposed that a thickened anterior hyaloid face and impedance to aqueous flow across the intact anterior hyaloid leads to sequestration of aqueous within the posterior segment. This results in a forward displacement of the vitreous into apposition with lens and ciliary body, directing the aqueous posteriorly.

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