title: Recurrent acute angle-closure attack due to plateau iris syndrome after cataract extraction with or without argon laser peripheral iridoplasty: a case report.
abstract: BACKGROUND
  We describe two cases of recurrent acute angle-closure attack in patients with plateau iris syndrome after cataract extraction. Argon laser peripheral iridoplasty and cataract extraction have been used to reduce the occurrence of acute angle-closure attack in plateau iris syndrome although the risk cannot be completely eliminated. There is no consensus on the long term management of plateau iris syndrome. This is, as far as we know, the first case report of recurrent acute angle-closure attack in plateau iris syndrome after cataract extraction.
  
  
  METHODS
  We report two cases of recurrent acute angle-closure attack in 2 Chinese patients with plateau iris syndrome. The first patient was a 69 year-old woman who received bilateral argon laser peripheral iridoplasty and cataract extraction 2 years prior to the latest acute angle-closure with right eye intraocular pressure 48 mmHg. The attack was aborted medically. Peripheral iridotomy was patent and argon laser peripheral iridoplasty marks were mostly at peripheral 2/3 of the iris. Anterior segment optical coherence tomography confirmed bilateral plateau iris configuration. Use of long term pilocarpine or repeated argon laser peripheral iridoplasty to prevent recurrent angle-closure attack was discussed but she opted for observation. The second patient was a 64 year-old man presented with acute angle-closure after cataract extraction despite placement of laser peripheral iridotomy. Plateau iris syndrome was confirmed by anterior segment optical coherence tomography and he received argon laser peripheral iridoplasty.
  
  
  CONCLUSIONS
  Acute angle-closure due to plateau iris syndrome can still occur despite previous cataract extraction and argon laser peripheral iridoplasty. These are the first reported cases of recurrent acute angle-closure attack due to plateau iris syndrome following cataract extraction, with or without previous argon laser peripheral iridoplasty. Repeated treatment with argon laser peripheral iridoplasty or pilocarpine could be considered although the long term efficacy is questionable. Argon laser peripheral iridoplasty should be applied as peripheral as possible so as to open up the drainage angle effectively.
authors.affiliation: Department of Ophthalmology, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, Room 301, Block B, Cyberport 4, Hong Kong, People's Republic of China. bonniechoynk@gmail.com.
authors.forename: Bonnie Nga Kwan
authors.initials: BN
authors.lastname: Choy
authors.affiliation: Department of Ophthalmology, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, Room 301, Block B, Cyberport 4, Hong Kong, People's Republic of China.
authors.forename: Jonathan Cheuk Hung
authors.initials: JC
authors.lastname: Chan
authors.affiliation: LKS Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, Hong Kong, People's Republic of China.
authors.forename: Carol Pui Yang
authors.initials: CP
authors.lastname: Chien
authors.affiliation: Department of Ophthalmology, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, Room 301, Block B, Cyberport 4, Hong Kong, People's Republic of China.
authors.forename: Jimmy Shiu Ming
authors.initials: JS
authors.lastname: Lai
mesh_terms: D000208:Acute Disease; D000368:Aged; D001128:Argon / Q000008:administration & dosage; D002387:Cataract Extraction / Q000379:methods*; D005260:Female; D015812:Glaucoma, Angle-Closure / Q000209:etiology*; D006801:Humans; D032801:Iridectomy / Q000379:methods*; D007499:Iris Diseases / Q000150:complications*; D053685:Laser Therapy / Q000379:methods; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D012008:Recurrence
chemical_list: D001128:Argon
keywords: Argon laser peripheral iridoplasty; Cataract extraction; Plateau iris configuration; Plateau iris syndrome; Recurrent acute angle-closure attack