Introduction <p>Malignant glaucoma is an uncommon but serious complication of intraocular surgery, including filtration surgery and phacoemulsification, with an incidence of 2–4%. It arises from an obstruction in aqueous humor flow, leading to elevated posterior pressure and subsequent complications. Delayed or insufficient treatment can result in irreversible vision loss. This case highlights the importance of early surgical intervention and anti-inflammatory management for preventing complications and achieving improved outcomes.</p> Case presentation <p>A 56-year-old Chinese woman presented with bilateral malignant glaucoma. The initial treatment of the right eye involved medications for 3 months, followed by yttrium aluminium garnet laser posterior capsulotomy, which offered limited success. Irido-zonulo-hyaloid-vitrectomy was eventually performed, successfully normalizing her intraocular pressure but resulting in macular cystoid edema 6 months later. Her left eye, diagnosed with malignant glaucoma 2 months after the right eye’s presentation, received early intervention with cataract extraction, intraocular lens implantation, and irido-zonulo-hyaloid-vitrectomy. This approach yielded excellent outcomes, with optimal intraocular pressure control and preserved vision without complications.</p> Conclusion <p>This case underscores the importance of early surgical intervention, particularly irido-zonulo-hyaloid-vitrectomy, in managing malignant glaucoma. Early intervention can prevent postoperative complications such as macular edema and ensure superior visual outcomes. Tailored anti-inflammatory approaches further mitigate associated risks and enhance long-term prognosis in cases of bilateral involvement.</p>