Malignant glaucoma in a case of nanophthalmos

A 24-year-old male presented with chronic closed-angle glaucoma in his right eye associated with nanophthalmos in both eyes. We performed phacoemulsification-aspiration, intraocular lens implantation and goniosynechialysis. Pilocarpine instillation the next day induced malignant glaucoma. Atropine instillation induced normalization of intraocular pressure but the anterior chamber remained shallow due to pupil capture. It appeared that miosis led to cilio-vitreo-lenticular block in the eye implanted with a soft acrylic 3-piece lens. His left eye was treated by the same procedure using a polymethylmethacrylate one-piece lens resulting in uneventful outcome. This case illustrates that the proper choice of intraocular lens is advocated when planning cataract surgery in high-risk eyes for malignant glaucoma.