Plateau Iris Syndrome
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Video: https://youtu.be/uJgl4Rf_WxY
Plateau Iris Syndrome
•A form of angle closure more common in younger female patients.
•Classic teaching: Anteriorly positioned ciliary processes push the peripheral iris forward leading to angle closure.
•The anatomical findings in plateau iris syndrome might be caused by a more anterior junction of the iris dilator muscle and ciliary epithelium which may contribute to bunching of the iris and occlusion of the angle at the time of dilation. This is commonly described in textbooks as an anterior displacement of the iris insertion on the ciliary body.
•Plateau Iris Configuration (PIC): Appositional or narrow angle is confirmed by gonioscopy prior to LPI with a deep anterior chamber and flat iris.
•Plateau Iris Syndrome (PIS): Patent iridotomy has eliminated the relative pupillary block but evidence of angle-closure persists with a deep central AC.
•On exam, the central anterior chamber is deep while the drainage angle is occluded, a distinguishing feature compared to primary angle closure.
•A double hump sign is seen on indentation gonioscopy and UBM.
•PAS often form in reverse from Schwalbe’s line to the spur compared to classic pupillary block angle closure where PAS form from posterior to anterior.
•Management includes LPI, however angle closure is still possible despite a patent PI and other steps (cataract extraction, iridoplasty) are needed to further deepen the angle.
•Our choice is to perform cataract extraction with endocyclophotocoagulation which appears to be a more definitive treatment of the root cause of this disease process.
