Elsevier

Ophthalmology

Volume 111, Issue 1, January 2004, Pages 104-108
Ophthalmology

Long-term success of argon laser peripheral iridoplasty in the management of plateau iris syndrome

Presented in part at: Congress of the European Glaucoma Society, June, 2000; London, and the Third International Symposium of Ophthalmology on “The Challenges and Controversies in Ophthalmology in the New Millenium,” February, 2001; Hong Kong.
https://doi.org/10.1016/j.ophtha.2003.05.001Get rights and content

Abstract

Objective

To document the long-term effect of argon laser peripheral iridoplasty (ALPI) in eyes with plateau iris syndrome.

Design

Retrospective, noncomparative, interventional case series.

Setting

New York Eye and Ear Infirmary.

Methods

The charts of all patients with plateau iris syndrome treated with ALPI from 1982 to 1991 and subsequently followed for 6 or more years were retrospectively reviewed. Patients with lens-related mechanisms contributing to angle closure (e.g., phacomorphic or malignant glaucoma) were excluded.

Main outcome measures

Necessity for repeat ALPI and/or any additional means of intervention.

Results

A total of 26 ALPI procedures were performed in 23 eyes of 14 patients (4 men, 10 women). The mean age was 61±8.7 years. The mean follow-up was 78.9±8.0 months (range, 72–188 months). The angle in 20 of 23 (87.0%) eyes remained open throughout the entire follow-up period after only 1 treatment with ALPI. In 3 eyes, there was gradual reclosure of the angle 5 to 9 years after initial ALPI, but they were readily reopened and maintained open by a single repeat treatment. No filtration surgery was necessary in any eye during follow-up.

Conclusions

ALPI is highly effective in eliminating residual appositional closure after laser iridotomy caused by plateau iris syndrome. The effect is maintained for years, although a small proportion of patients might require retreatment.

Section snippets

Materials and methods

We reviewed the charts of all patients with plateau iris syndrome who were treated with ALPI at the New York Eye and Ear Infirmary from 1983 to 1991 and who were followed continuously for at least 6 years afterward. Patients with less than 6 years of follow-up or who were followed elsewhere were excluded from analysis.

Plateau iris syndrome was diagnosed by the presence of spontaneous appositional angle closure on darkroom indentation gonioscopy to at least the upper border of the pigmented band

Results

A total of 26 ALPI procedures were performed in 23 eyes (10 right eyes, 13 left eyes) of 14 patients (4 men, 10 women). Mean age of the 14 patients was 61±8.7 years (range, 45–76 years). Only 1 Filipino patient was not Caucasian. Mean follow-up time was 78.9±8.0 months (range, 72–188 months). Of the 5 untreated eyes, 4 were judged sufficiently open so as not to require ALPI, and 1 was prephthisical with no light perception vision. All patients with plateau iris and appositional closure to the

Discussion

Gradle and Sugar11 observed angle-closure glaucoma in a number of eyes with normal anterior chamber depths. In 1955 Higgett and Smith12 described 2 cases of angle-closure glaucoma in younger patients who had a flat iris and a narrow angle secondary to an abrupt angulation at the root of the iris. Chandler described a 37-year-old woman with recurring intermittent angle-closure glaucoma despite a patent iridectomy who was successfully treated with pilocarpine.7 Tornquist1 was the first to use the

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    Manuscript no. 220740.

    Supported in part by the Steven and Shelley Einhorn Research Fund of the New York Glaucoma Research Institute, New York, New York.

    The authors have no financial interest in any device or technique described in this manuscript.

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