Hypotonous malignant glaucoma: Aqueous misdirection with low intraocular pressure

Two patients who underwent trabeculectomy and post-operatively manifested axially shallow anterior chamber associated with hypotony but without choroidal effusion are described. The first patient was treated conservatively with topical cycloplegics. The second patient was treated with pars plana anterior vitrectomy. The interventions resulted in deepening of the anterior chamber and posterior rotation of the ciliary body to a natural position as observed by ultrasound biomicroscopy. Intraocular pressure remained low in both cases. These cases demonstrate that hypotony and axial shallowing of the anterior chamber after trabeculectomy can result in a malignant glaucoma-like appearance.