A 73-year-old male patient diagnosed with advanced ACCA was referred to our centre. He had undergone two trabeculectomies that had failed early. Given the stage of the glaucoma and the existence of a nuclear cataract, it was decided to perform a combined procedure of phacoemulsification and valve implantation. Twenty-four hours after surgery, the intraocular pressure was 48 mmHg and the anterior chamber was flattened with peripheral iridoendothelial contact. The iridectomies were patent and pupillary block was ruled out. Fundus examination and ultrasound were normal, and malignant glaucoma was diagnosed. An Nd-YAG laser capsulotomy and hyaloidotomy was performed through the pupil, and a slight deepening of the anterior chamber was observed when the anterior hyaloid was perforated, which progressively increased over the following hours. Three hours after treatment, the intraocular pressure was 14 mmHg and the iridoendothelial contact had disappeared. One year after surgery, intraocular pressure (IOP) was 16 mmHg with brinzolamide 0.1% (Azopt®, Laboratorios Alcon-Cusi SA, El Masnou, Barcelona).
