CASE REPORT Simultaneous Spontaneous Bilateral Malignant Glaucoma Attack in a Young Patient With Bilateral Posterior Polar Cataract A case of posterior polar cataract developed sudden-onset ocular pain and blurred vision. Because of high intraocular pressure and shallow anterior chamber, iridotomy was done and anti-glaucoma medication was started without effect. Subsequently, right-eye vitrectomy was performed after postoperative malignant glaucoma developed. Left- eye intraocular pressure stabilized after accidental use of cycloplegic agent. This therapy was continued. ABSTRACT ANN OPHTHALMOL. 2005; 37 (4) ..................................................285 HEYDAR AMINI, MD, NASRIN FEKRAT, MD, MOHAMMAD REZA RAZEGHINEJAD, MD REPRINTS Dr. Mohammad Reza Razeghinejad, Glaucoma Services, Department of Ophthalmology, Khalili Hospital, Khalili Street, Shiraz, Iran. E-mail: razeghinejad @yahoo.com. Dr. Amini is an Associate Professor of Ophthalmology at the Farabi Hospital, Tehran University of Medical Sciences, Tehran, Iran. Dr. Fekrat is an ophthal- mologist at the Razi Eye Clinic, Tehran, Iran. Dr. Razeghinejad is an Assistant Professor of Ophthalmology at the Khalili Hospital, Shiraz University of Med- ical Sciences, Shiraz, Iran. The authors have stated that they do not have a significant financial interest or other relationship with any product manufacturer or provider of services discussed in this article. The authors also do not discuss the use of off-label products, which includes unlabeled, unapproved, or investigative products or devices. Submitted for publication: 8/1/05. Accepted: 8/20/05. Annals of Ophthalmology, vol. 37, no. 4, Winter 2005 © Copyright 2005 by ASCO All rights of any nature whatsoever reserved. 1530-4086/05/37:285–288/$30.00. INTRODUCTION Malignant glaucoma was first described by von Graefe in 1869 as a form of postoperative glaucoma, which usually results in blindness ( 1 ) . Although malignant glaucoma may occur after many types of ocular surgeries, it has been suggested that the periph- eral lens and anterior ciliary body may become appo- sitional in certain predisposed eyes, producing a ciliary block (2–4). Blocking of the forward flow of aqueous at the level of corona ciliaris in conjugation with a dense anterior hyaloid membrane may result in misdirection of aqueous flow in the vitreous cavity, which displaces the lens–iris diaphragm anteriorly and, consequently, the intraocular pressure (IOP) rises. Such an event can occur in previously unoperat- ed, predisposed eyes (5–9). Although there are several individual case reports of spontaneous occurrence of malignant glaucoma, to the best of our knowledge, this is the first report of bilateral spontaneous malig- nant glaucoma with the presence of posterior polar cataract. CASE REPORT A 37-year-old woman with sudden-onset blurred vision and pain of both eyes was referred in January 1998. She had no previous ocular surgery and her general medical history did not show any relevant findings. An initial ocular examination revealed visual acuity of 20/200 in