title: Management of plateau iris syndrome with cataract extraction and endoscopic cyclophotocoagulation.
abstract: Plateau iris configuration describes an anatomic abnormality in which large or anteriorly positioned pars plicata push the iris root forward, thereby narrowing the anterior chamber angle. Plateau iris syndrome (PIS) is diagnosed if the angle remains occludable, either spontaneously or pharmacologically, after iridotomy. PIS has traditionally been treated with chronic pilocarpine or laser peripheral iridoplasty. A series of 9 eyes of 6 patients with PIS, diagnosed by dark room provocative testing and ultrasound biomicroscopy (UBM) following iridotomy, underwent cataract extraction and endoscopic cyclophotocoagulation (ECP). The ciliary body was treated for a median of 180° (range of 120-360°). Post-ECP, the angles in areas treated with ECP were open with corresponding flattened ciliary processes on UBM, while the angles remained occludable in quadrants untreated by ECP despite lens extraction. The mean follow-up time post-ECP was 73.7 ± 34 months (range 11-122 months). The mean IOP was reduced from a baseline of 25.2 ± 10.9 mm Hg on 3.4 ± 1.0 IOP lowering medications to a mean IOP of 17.1 ± 5.3 mm Hg (p < 0.05) on 1.9 ± 1.5, (p < 0.01) medications at last visit. There were no cases of chronic inflammation, eye pain, decreased vision, retinal detachment, or hypotony. Lens extraction and ECP offers an alternative treatment option for patients with PIS, which may directly address the underlying anatomic abnormality leading to angle closure in PIS.
authors.affiliation: Glaucoma Research Laboratory, Department of Ophthalmology, University of California, San Francisco, USA.
authors.forename: David A
authors.initials: DA
authors.lastname: Hollander
authors.affiliation: Glaucoma Research Laboratory, Department of Ophthalmology, University of California, San Francisco, USA.
authors.forename: Mark E
authors.initials: ME
authors.lastname: Pennesi
authors.affiliation: Glaucoma Research Laboratory, Department of Ophthalmology, University of California, San Francisco, USA. Electronic address: jorge.alvarado@ucsf.edu.
authors.forename: Jorge A
authors.initials: JA
authors.lastname: Alvarado
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002387:Cataract Extraction; D002924:Ciliary Body / Q000000981:diagnostic imaging / Q000601:surgery*; D004724:Endoscopy; D005260:Female; D015812:Glaucoma, Angle-Closure / Q000601:surgery*; D006801:Humans; D007429:Intraocular Pressure / Q000502:physiology; D007499:Iris Diseases / Q000000981:diagnostic imaging / Q000601:surgery*; D017075:Laser Coagulation / Q000379:methods*; D054020:Lasers, Gas / Q000627:therapeutic use; D008297:Male; D033401:Microscopy, Acoustic; D008875:Middle Aged; D014065:Tonometry, Ocular
keywords: Angle closure; ECP; Endoscopic cyclophotocoagulation; Endoscopic cycloplasty; Glaucoma; Iridoplasty; Plateau iris; Plateau iris configuration; Plateau iris syndrome; Ultrasound biomicroscopy