We read the recent article in which Thompson et al. analyzed the factors associated with successful management of malignant glaucoma (MG). Nevertheless, we believe that some discussion is required.

The authors stated that anterior chamber (AC) reformation performed in the clinic treated 42.2% cases of MG. However, surgical intervention was still required in 87.5% of cases. Thus, we would like to ask if AC reformation was performed during anterior or posterior vitrectomy, or was it a separate procedure? How was it performed technically? Furthermore, what was the definition of resolution, as in such a case one cannot consider AC reformation as a fully successful treatment. Notably, some studies do not consider AC reformation as the treatment for MG, because this intervention treats only a symptom but not the underlying cause of AC shallowing. ^,

The study concludes that, in phakic eyes, vitrectomy combined with lensectomy is recommended to improve the likelihood of complete MG resolution. However, it is not clear what the preferred surgical approach was in phakic patients, and based on what results was this conclusion drawn? The methods section asserts that pars plana vitrectomy (PPV) with cataract extraction (CE) was successful in 5 of 5 eyes, and PPV without CE in 4 of 6 eyes, whereas AC reformation with cataract extraction was performed in 5 of 6 eyes. On the other hand, CE is not mentioned as a surgical treatment method in Table 1, and the lens status was not predictive of vitrectomy success. Moreover, we would like to ask how was CE performed, and if the surgery was combined with PPV. Importantly, performing CE in eyes with MG is challenging due to high posterior vitreous pressure. Thus, Sharma and associates recommended an initial limited core vitrectomy to “debulk” the vitreous, followed by phacoemulsification and residual PPV. It is also known that the recurrence rate for MG is higher in phakic eyes treated solely with PPV. ^, Moreover, other defined risk factors for MG, including hyperopia, history of angle closure, iris plateau configuration, or shallow anterior chamber after surgery should be analyzed in terms of the main outcome measures. We believe that all of these detailed issues are important to better understand the results of the study.

Finally, we believe that the term chronic fluid misdirection syndrome should replace malignant glaucoma . ^, The mechanism of this entity involves inappropriate movement of fluid through the zonular fibers posteriorly into or beside the vitreous gel, thus fluid misdirection syndrome more appropriately defines the pathophysiology than the historic term malignant glaucoma . Moreover, the current term leads to misunderstanding; often it is necessary to explain to patients with MG that the term does not indicate a neoplastic process.