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Peripheral laser iridoplasty opens angle in plateau iris by thinning the cross-sectional tissues

Authors Liu J, Lamba T, Belyea DA

Received 27 April 2013

Accepted for publication 25 June 2013

Published 23 September 2013 Volume 2013:7 Pages 1895—1897

DOI https://doi.org/10.2147/OPTH.S47297

Checked for plagiarism Yes

Review by Single-blind

Peer reviewer comments 2

Ji Liu,1,2 Tania Lamba,1 David A Belyea1

1Department of Ophthalmology, The George Washington University, Washington DC, USA; 2Yale Eye Center, Yale University, New Haven, CT, USA

Abstract: Plateau iris syndrome has been described as persistent angle narrowing or occlusion with intraocular pressure elevation after peripheral iridotomy due to the abnormal plateau iris configuration. Argon laser peripheral iridoplasty (ALPI) is an effective adjunct procedure to treat plateau iris syndrome. Classic theory suggests that the laser causes the contraction of the far peripheral iris stroma, "pulls" the iris away from the angle, and relieves the iris-angle apposition. We report a case of plateau iris syndrome that was successfully treated with ALPI. Spectral domain optical coherence tomography confirmed the angle was open at areas with laser treatment but remained appositionally closed at untreated areas. Further analysis suggested significant cross-sectional thinning of the iris at laser-treated areas in comparison with untreated areas. The findings indicate that APLI opens the angle, not only by contracting the iris stroma, but also by thinning the iris tissue at the crowded angle. This is consistent with the ALPI technique to aim at the iris as far peripheral as possible. This case also suggests that spectral domain optical coherence tomography is a useful adjunct imaging tool to gonioscopy in assessing the angle condition.

Keywords: plateau iris, optic coherence tomography, argon laser peripheral iridoplasty, angle-closure glaucoma

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