Microsurgery is applied in various operations nowadays. One of the most common cases where the use of microscopic surgery is done is during the operation on malignant glaucoma. Malignant glaucoma is characterized by a low anterior cavity associated with raised intraocular pressure and in the existence of a patent iridotomy. This condition typically goes after intraocular operation and can be clearly seen only through a microscope. The successive analytical outlook for such eyes with malignant glaucoma was normally poor. Thus, the term malignant remains suitable today as the condition persist to be one of the most complicated type glaucoma to manage. Other terms have been used to describe the condition including cilio-lenticular block, ciliary block, and aqueous misdirection glaucoma. Malignant glaucoma stays a situation with a poor result. At the start, analysis may be deferred and as a result there may be setback in doing optimal medical therapy. Many eyes do not respond to medical therapy and the surgical management remains difficult and controversial.

There is a relatively new technique that can be used to achieve correct real time images of anterior section structures, and this technique is called the high frequency ultrasound bio-microscopy. This technique uses 50-100 MHz transducers microscope integrated into a B-mode clinical scanner. The higher frequency transducers microscope are used for viewing of superficial structures in fine resolution, while for deeper infiltration lower frequency transducers are used with some loss of resolution. This technique has a depth of infiltration of 4 mm and resolution of among 20 and 60 µm. The pattern of anterior segment structures has been visualized by using this technique during the malignant glaucoma development. This comprises irido-corneal touch, appositional angle closure, and anterior rotation of the ciliary body with apposition to the iris. Consequently, the positions of anterior segment structures in malignant glaucoma have been well visualized using high frequency ultrasound biomicroscopy, and the images attained sustain the accepted hypotheses regarding its pathogenesis including anterior alternation of the ciliary processes and forward dislocation of the ciliary body and lens. However, while this tool is of use in helping to explain the system of malignant glaucoma it has not yet been discovered to be functional in management of the condition.

In this case surgical intervention may take the form of laser or involve more invasive microsurgery procedures. Direct argon laser through a peripheral iridectomy may be used in an attempt to shrink the ciliary processes and thus relieve cilio-lenticular block to anterior flow of aqueous. In the presence of syncline between the lens capsule and implant such laser therapy may not prove successful. One way of improving the likely outcome of Nd-YAG laser therapy is to make the capsular opening through a dialing hole where present thus allowing a direct passage of aqueous between vitreous cavity and anterior chamber. Filtration surgery can also be modified to minimize the risks by use of releasable sutures to the scleral flap and the anterior chamber depth maintained in the immediate postoperative period by the use of viscoelastics during the microsurgery. The aim of these modifications is to maintain the anatomical position of the lens-iris diaphragm and prevent misdirection of aqueous.