title: Endoscopic Cycloplasty (ECPL) and Lens Extraction in the Treatment of Severe Plateau Iris Syndrome.
abstract: OBJECTIVE
  To describe the anatomic and clinical results of the treatment of severe plateau iris syndrome with lens extraction and endoscopic cycloplasty (ECPL). A secondary aim was to describe 4 novel ultrasound biomicroscopy (UBM) measurements for plateau iris syndrome.
  
  
  METHODS
  Prospective case series with UBM evaluation.
  
  
  METHODS
  Included were 12 eyes of 6 patients with plateau iris refractory to laser iridotomy and iridoplasty, miotic and other glaucoma medical treatment, with appositional angle closure in at least 3 quadrants. Treatment consisted of lens extraction and ECPL, an endoscopic diode laser treatment of the ciliary processes in the superior, nasal, and inferior quadrants. UBM measurements were taken in all quadrants before and after surgery. The untreated temporal quadrants were used as controls. Measurement parameters included: anterior chamber depth (ACD), angle opening distance (AOD 500), trabecular ciliary process distance (TCPD), iris ciliary process distance (ICPD), iris depth (ID), iridocorneal angle (ICA), and sulcus angle (SA). Four novel measurements included: ciliary process thickness (CPT), ciliary process width (CPW), ciliary process area (CPA), and iris ciliary process contact length (ICPCL). Visual acuity, intraocular pressure, glaucoma medications, and complications were also followed.
  
  
  RESULTS
  The ACD, AOD 500, and ICA all increased significantly (P<0.001). ICPD, CPT, CPW, CPA, and ICPL all decreased significantly (P<0.01). Parameters remaining unchanged were: TCPD, ID, and SA. The untreated quadrants showed similar measurements to the preoperative measurements. There were no serious complications noted.
  
  
  CONCLUSIONS
  Treating the ciliary processes with diode laser using an endoscopic approach (ECPL) and lens extraction, results in opening of the anterior chamber angle and shrinkage of the ciliary processes in the treated areas. This effect seems to be primarily a result of the laser treatment in combination rather than the lens extraction alone. This effectively reverses the anatomic cause and angle closure of plateau iris syndrome.
authors: *Department of Ophthalmology, Doheny Eye Institute, David Geffen School of Medicine ‡San Francisco Medical Center Department of Ophthalmology-Ultrasound, University of California †Keck School of Medicine, University of Southern California, Los Angeles, CA.
authors: Brian A
authors: BA
authors: Francis
authors: Andrew
authors: A
authors: Pouw
authors: Dennis
authors: D
authors: Jenkins
authors: Kelly
authors: K
authors: Babic
authors: Ghazal
authors: G
authors: Vakili
authors: James
authors: J
authors: Tan
authors: Vikas
authors: V
authors: Chopra
authors: Ronald L
authors: RL
authors: Green
mesh_terms: D000368:Aged; D000867:Anterior Chamber / Q000000981:diagnostic imaging; D002924:Ciliary Body / Q000601:surgery*; D004724:Endoscopy; D005260:Female; D015812:Glaucoma, Angle-Closure / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D007429:Intraocular Pressure / Q000502:physiology; D007499:Iris Diseases / Q000503:physiopathology / Q000601:surgery*; D017075:Laser Coagulation / Q000379:methods*; D054023:Lasers, Semiconductor / Q000627:therapeutic use; D007908:Lens, Crystalline / Q000601:surgery*; D008297:Male; D033401:Microscopy, Acoustic; D008875:Middle Aged; D011446:Prospective Studies; D014065:Tonometry, Ocular; D014792:Visual Acuity