Plateau iris is a medical condition of the eye resulting from anterior displacement of the peripheral iris by the ciliary body causing angle closure glaucoma. Case presentation a 32yearold white female presented to her community er with an 8week complaint of pain in her left eye, headache, and subsequent nausea. To assess and describe the prevalence and clinical features associated with plateau iris syndrome pis in young individuals with recurrent angle closure despite initial therapy. If the glaucoma persists even after iridectomy then it is called plateau iris syndrome and subsequently. Plateau iris syndrome symptoms, diagnosis, treatments and. Conclusions plateau iris syndrome is a form of primary angle closure glaucoma caused by a large or anteriorly positioned. This is the video that accompanies a case presentation of plateau iris found at rogers gm, alward, wlm, fingert jh. Argon laser peripheral iridoplasty alpi has been proposed in pis to widen the. A peripheral iridotomy may also be appropriate for the patient with plateau iris who has never had an angle closure attack. Plateau iris syndrome exacerbated by lensangle crowding in a hyperopic patient.
Plateau iris syndrome occurs when angle closure with raised iop develops in an eye with plateau iris configuration despite a patent iridotomy. Pdf on oct 1, 2016, haithamhilal al mahrouqi and others published plateau. Angle closure in plateau iris is most often caused by anteriorly positioned ciliary processes that critically narrow the anterior chamber recess by pushing the peripheral iris. This is, as far as we know, the first case report of recurrent acute angleclosure attack in plateau iris syndrome after cataract extraction. Request pdf on jan 1, 2009, tetsuya baba and others published plateau iris syndrome associated with cysts and nocturnal elevation of intraocular pressure find, read and cite all the research. Twelve eyes of 8 patients that completed 1year followup were analyzed. To describe plateau iris syndrome associated with multiple neuroepithelial cysts of the pars plicata. Plateau iris syndrome associated with cysts and nocturnal. Sep 22, 2019 plateau iris syndrome pis is a frequent cause of angle closure. Eisenbergers case, she doesnt recall a family member having it. However, plateau iris syndrome is normally diagnosed after laser iridotomy.
Plateau iris syndrome and acute angle closure glaucoma. Recurrent acute angleclosure attack due to plateau iris. Plateau iris is characterized by anteriorly rotated ciliary processes, which push the peripheral iris forward resulting in a deep chamber centrally and flat iris contour with a sharp dropoff peripherally. Patients can come at the hospital presenting angle closure, either spontaneously or after pupillary dilation as one of the cases presented here case 2, but more commonly, patients are asymptomatic and the. The term plateau iris was first coined in 1958 to describe the iris configuration of a patient. Often confused with a narrow angle secondary to papillary block described above, one should be suspicious of a plateau iris in. Plateau iris syndrome exacerbated by lensangle crowding. Plateau iris syndrome american academy of ophthalmology. This patient is included both under techniques for difficult angles and plateau iris. Angle widening was noted in 46% of treated quadrants by at. Endocycloplasty shows promise for treating plateau iris. Eisenberger had a more aggressive and ever rarer form of glaucoma called plateau iris syndrome. Plateau iris configuration refers to an iris with a flat central surface and angulated sharp dropoff of the peripheral portion next to the angle wall. Plateau iris syndrome an overview sciencedirect topics.
Plateau iris syndrome pis is a frequent cause of angle closure. Plateau iris syndrome is associated with anterior iris insertion, and angle closure is most often caused by anteriorly positioned ciliary processes. Primary and secondary outcome measures were angle widening on gonioscopy and magnitude of intraocular pressure iop reduction, respectively. Jan 25, 2008 plateau iris is an angle appearance in which a short iris root angulates forward and centrally, and the iris surface is flat. Plateau iris syndrome pis is defined as the development of angle closure in an eye with pic despite the presence of a patent laser iridotomy. The level of the iris stroma in relation to the angle structures, referred to as the height of the plateau, differentiates the 2 subtypes of plateau iris syndrome. Plateau iris is characterized by closing the anterior chamber angle due to a large ciliary body or due to its anterior insertion that alters the position of iris. Plateau iris syndrome is a condition in which the angle remains appositionally closed or occludable after iridectomy for angleclosure glaucoma. Argon laser peripheral iridoplasty alpi has been proposed in pis to widen the iridocorneal angle.
Plateau iris represents an atypical configuration of the anterior chamber angle that may result in acute or chronic angleclosure glaucoma. Gonioscopic examination revealed a closedangle with a doublehump iris. Plateau iris configuration can be diagnosed before iridotomy. Plateau iris syndrome refers to a post laser iridotomy condition in which a patent iridotomy has removed the relative pupillary block, but goniscopically confirmed angle closure recurs without central shallowing of the anterior chamber. Ultrasound biomicroscopy revealed classic features of plateau iris syndrome in each patient but also.
B the angle is obstructed further in the dark as the peripheral iris. If the glaucoma persists even after iridectomy then it is called plateau iris syndrome and subsequently managed either medically miotics or surgically laser. Challenging cases plateau iris syndrome exacerbated by. This configuration is usually corrected surgically, for example by iridectomy. The height to which the plateau iris rises determinates two subtypes of plateau iris syndrome and whether or not the angle will close completely. Patients with plateau iris configuration must not be assumed to be cured and plateau iris syndrome may develop years later 16.
Often confused with a narrow angle secondary to papillary block described above, one should be suspicious of a plateau iris. A, plateau iris syndrome with a flat iris plane but shallow angle recess arrow. Tornquist et al5 first described the plateau iris configuration in 1958 on a young woman with high iop and a flat iris surface. May 06, 2016 plateau iris is one of the most common angleclosure glaucomas presenting in younger patients. On the other hand, the plateau iris syndrome was defined as an acute glaucoma crisis in one eye with a relative normal central anterior chamber depth and patent. In 1977, the plateau iris configuration was classically defined as presurgical changes of an eye with a relative normal central anterior chamber depth, flat iris by conventional biomicroscopy, but displaying an extremely narrow or closed angle on gonioscopic examination. The prevalence of angle closure attack in plateau iris syndrome is not known. For claims with a date of service on or after october 1, 2015, use an. This form of primary angleclosure glaucoma is caused by an anteriorly positioned ciliary body, which displaces the peripheral iris forward. Note that the midperipheral angle appears deeper double arrow than the narrow angles associated with pupillary block.
It is caused by large or anteriorly positioned ciliary processes that push the peripheral iris forward. Her iop measured 50 mm hg os, and the visual acuity in that eye was. Primary angle closure glaucoma is characterized by apposition of the peripheral iris to the trabecular meshwork as a result of abnormal size and position of anterior segment structures or posterior segment pressure forces that alter the anterior segment anatomy. Plateau iris syndromeassociated with multipleciliarybodycysts reportof3 cases augustoazuarablanco, md, phd. In this issue, norman et al1 report a favorable longterm outcome of peripheral iridoplasty in plateau iris syndrome in 48 eyes, in agreement with a prior report. Iris thickness, choroidal expansion, and vitreous conductivity have been implicated as potential etiologic factors of acg. In 1977, the plateau iris configuration was classically defined as presurgical changes of an. B, plateau iris syndrome, with a much deeper angle recess arrow following laser peripheral iridoplasty. Dec 20, 2011 this is the video that accompanies a case presentation of plateau iris found at rogers gm, alward, wlm, fingert jh.
In plateau iris syndrome, a large or anteriorly placed ciliary process pushes the peripheral iris tissue forward against the trabecular meshwork, crowds the angle and blocks aqueous outflow. Plateau iris syndrome is rare compared to the configuration, which itself is not common. As laser iridotomy only relieves pupil block, laser iridoplasty has been suggested as the treatment of choice for plateau iris. Plateau iris syndrome associated with multiple ciliary body. Rhee had discovered that this syndrome is an inherited disease, although in ms. Plateau iris syndrome is characterized by persistent angle occludability spontaneous, in the dark, or after dilation in an eye with a patent iridotomy. A in plateau iris, the anterior position of the ciliary body holds the peripheral iris against the trabecular meshwork. Plateau iris syndrome pis is one cause of acute angle closure glaucoma. Plateau iris syndrome associated with multiple ciliary. Review careful and frequent follow up is mandatory. We hereby present two case reports of plateau iris syndrome in young patients who came to an ophthalmologic consult by chance. Dilation causes the peripheral iris to fold into the angle and occlude the trabecular meshwork. Plateau iris configuration is defined as an angle appearance in which the iris root is pushed forward and centrally.
In the syndrome, angle closure usually occurs in the early postoperative period but may occur long after iridectomy when the pupil dilates spontaneously or in response to mydriatic agents. Plateau iris syndrome is defined by persistent occludable angle after patent iridotomy. Longterm success of argon laser peripheral iridoplasty in the management of plateau iris syndrome. Pattern scanning laser pascal for peripheral iridoplasty i. Plateau iris is an angle appearance in which a short iris root angulates forward and centrally, and the iris surface is flat.
Following the iridotomy she continued to have narrow angles and plateau iris syndrome was diagnosed. There is no consensus on the long term management of plateau iris syndrome. Cataract fragments in left eye following cataract surgery h59. Plateau iris syndrome is defined as a persistently narrow angle capable of closure in spite of a patent iridotomy. Conclusions plateau iris syndrome is a form of primary angle closure glaucoma caused by a large or anteriorly positioned ciliary body that. Plateau iris has been considered to be an anatomic variant of iris structure in which the iris root angulates sharply forward from its insertion point and then again angulates sharply centrally. Some patients with an acute angleclosure attack not only have pupillary block but often may have some severe ischemia of the iris that will cause swelling of the ciliary body and a pseudo plateau iris. On the other hand, the plateau iris syndrome was defined as an.
Isolated plateau iris syndrome is rare compared to plateau iris configuration. Iris plateau configuration exhibits a flat iris plane with an anterior chamber that is not shallow axially. Adjunctive testing, such as ultrasound biomicroscopy ubm, can aid in diagnosis and ultimately guide an appropriate therapeutic strategy. An anteriorly rotated or abnormally oversized ciliary body occludes the ciliary sulcus.
This article shares pearls on the clinical spectrum of presentations and treatment options for patients with plateau iris syndrome. Prevalence of plateau iris syndrome in young patients with. Two years later the concept of plateau iris was published. Preexisting infections in individuals with iris may have been. Plateau iris syndrome postiridectomy postprocedural 2016 2017 2018 2019 2020 billablespecific code. Endocycloplasty shows promise for treating plateau iris syndrome.
Less than 10 % of all patients with primary angle closure are considered to have plateau iris syndrome. Plateau iris is one of the most common angleclosure glaucomas presenting in younger patients. She had developed narrow iridocorneal angles and had undergone a laser iridotomy in both eyes. Pdf plateau iris syndrome pis is a frequent cause of angle closure. Argon laser peripheral iridoplasty for plateau iris syndrome. Plateau iris syndrome case series europe pmc article. The term immune reconstitution inflammatory syndrome iris describes a collection of inflammatory disorders associated with paradoxical worsening of preexisting infectious processes following the initiation of antiretroviral therapy art in hivinfected individuals 16. Immune reconstitution inflammatory syndrome uptodate. Plateau iris syndrome indication for endocycloplasty.
Plateau iris syndrome is a relatively uncommon form of primary angle closure glaucoma that is seen more often in younger adults than pupillary block angleclosure glaucoma. Then plateau iris was classified by wand et al6 in 1977, differentiating plateau iris syndrome from plateau iris configuration. Plateau iris syndrome the plateau iris configuration refers to an anterior chamber of normal depth centrally with a flat iris plane, but a narrow angle on gonioscopic examination. We report two cases of recurrent acute angleclosure attack in 2 chinese patients with plateau iris syndrome. Plateau iris syndrome refers to the condition in which angle closure is still present confirmed by gonioscopy, despite a patent peripheral iridotomy that has. This condition is characterized by closing of the anterior chamber angle secondary to a large or anteriorly positioned ciliary body that mechanically alters the position of the peripheral iris in relation to the trabecular meshwork. The truth about mobile phone and wireless radiation dr devra davis duration. Case reports of 3 patients with plateau iris syndrome who were found to have multiple bilateral ciliary body cysts on ultrasound biomicroscopic examination.
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