Fig. 2

Ultrasound biomicroscopy images of the anterior segments in the patients with primary angle-closure glaucoma (PACG). In a patient without malignant glaucoma indicated as PACG-1, the depth of the anterior chamber (ACD, the distance between central inner corneal surface and anterior surface of the lens or artificial lens) was 1.42 mm with an extremely occluded angle (arrows) before phacoemulsification (Phaco). But the lens extraction with implantation of an artificial intraocular lens (IOL) significantly increased the ACD to 3.50 mm and widened the angle (arrows in After Phaco). A dotted line between the scleral spurs (SS) served as the base line of reference for the position of the IOL. Normally, the IOL was located below the dotted line and the iris tilted toward but without touching the IOL. However, in PACG-2 and PACG-3 with onset of malignant glaucoma, lens extraction did not significantly increase the ACD (2.06 mm before Phaco vs. 2.25 after Phaco in PACG-2, 1.78 mm before Phaco vs. 1.83 after Phaco in PACG-3) and open the angle. The iris of these two patients touched the IOL’s surface and were pushed forward exceeding the dotted line. After zonulo-hyaloido-vitrectomy (ZHV), the iris-IOL diaphragm was shifted backward, substantially deepening the ACD (3.30 mm in PACG-2 and 3.66 mm in PACG-3) and reopening the angle