Plateau Iris Glaucoma
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Plateau iris is one of the most common angle-closure glaucomas presenting in younger patients. 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.
In plateau iris configuration, the pars plicata may be large and anteriorly positioned, mechanically positioning the peripheral iris against the trabecular meshwork. In addition, the iris root is inserted anteriorly on the ciliary face further crowding the anterior chamber angle. The iris crowding of the angle obstructs aqueous flow via the trabecular meshwork and may lead to angle-closure glaucoma.
Except in the rare younger patients (age 20-30s), some degree of pupillary block also is present. Because a component of pupillary block may exist in patients with plateau iris configuration, laser iridotomy should always be performed as the first intervention. If the angle remains capable of closure despite a patent iridotomy, the condition is termed plateau iris syndrome.
A high prevalence of plateau iris configuration and plateau iris syndrome has been reported in relatives of patients with plateau iris syndrome. An autosomal dominant inheritance pattern with incomplete penetrance has also been suggested. [1]
United States
The exact prevalence of plateau iris is unknown. A 2016 study found that one third of eyes with primary angle-closure glaucoma had plateau iris. [2] In another report, it accounted for more than half of recurrent angle closure cases in young patients. [3] The diagnosis of plateau iris should be suspected when angle closure occurs in patients who are young or myopic and when angle narrowing persists despite iridotomy.
International
In a study from Singapore, plateau iris was found in about a third of primary angle closure suspects older than 50 years of age after laser iridotomy. [4] Another study found that 20% of Japanese patients with primary angle closure after laser iridotomy had plateau iris based on ultrasound biomicroscopy. [5]
Plateau iris is an important cause of angle-closure glaucoma in patients younger than 50 years.
Studies reported no difference in prevalence of plateau iris between whites and Asians. [6, 7]
Plateau iris is seen most commonly in women.
Patients with plateau iris usually are younger than those with primary angle-closure (relative pupillary block) glaucoma.
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Ramakrishnan R, Mitra A, Abdul Kader M, Das S. To Study the Efficacy of Laser Peripheral Iridoplasty in the Treatment of Eyes With Primary Angle Closure and Plateau Iris Syndrome, Unresponsive to Laser Peripheral Iridotomy, Using Anterior-Segment OCT as a Tool. J Glaucoma. 2016 May;25(5):440-6:[Medline].
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Jim C Wang (王崇安), MD Vitreo-Retinal and Cornea/Anterior Segment Subspecialist, Department of Ophthalmology, Kaiser Permanente Fontana Medical Center
Jim C Wang (王崇安), MD is a member of the following medical societies: American Academy of Ophthalmology, American Society of Retina Specialists, American Society of Cataract and Refractive Surgery
Disclosure: Nothing to disclose.
Paul S Lee, MD Clinical Assistant Professor, Department of Ophthalmology, Mount Sinai School of Medicine; Chief of Ophthalmology, James J. Peters Veterans Affairs Medical Center; Associate Adjunct Surgeon, New York Eye and Ear Infirmary
Paul S Lee, MD is a member of the following medical societies: American Academy of Ophthalmology, American Society of Cataract and Refractive Surgery
Disclosure: Nothing to disclose.
Robert Ritch, MD Shelley and Steven Einhorn Distinguished Chair in Ophthalmology, Chief of Glaucoma Service, Surgeon Director, Professor, Department of Ophthalmology, New York Eye and Ear Infirmary, New York Medical College
Robert Ritch, MD is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, American Medical Association, American Ophthalmological Society, Chinese American Medical Society, International College of Surgeons, New York Academy of Medicine, New York Academy of Sciences
Disclosure: Received none from Sensimed for board membership; Received none from iSonic Medical for board membership; Received consulting fee from Aeon Astron for consulting; Received honoraria from Pfizer for speaking and teaching; Received honoraria from Allergan for speaking and teaching; Received honoraria from Ministry of Health of Kuwait for speaking and teaching; Received honoraria from Aeon Astron for speaking and teaching; Received royalty from Ocular Instruments for other.
Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference
Disclosure: Received salary from Medscape for employment. for: Medscape.
Martin B Wax, MD Professor, Department of Ophthalmology, University of Texas Southwestern Medical School; Vice President, Research and Development, Head, Ophthalmology Discovery Research and Preclinical Sciences, Alcon Laboratories, Inc
Martin B Wax, MD is a member of the following medical societies: American Academy of Ophthalmology, American Glaucoma Society, Society for Neuroscience
Disclosure: Nothing to disclose.
Hampton Roy, Sr, MD Associate Clinical Professor, Department of Ophthalmology, University of Arkansas for Medical Sciences
Hampton Roy, Sr, MD is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, Pan-American Association of Ophthalmology
Disclosure: Nothing to disclose.
Bradford Shingleton, MD Assistant Clinical Professor of Ophthalmology, Harvard Medical School; Consulting Staff, Department of Ophthalmology, Massachusetts Eye and Ear Infirmary
Bradford Shingleton, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Ophthalmology
Disclosure: Nothing to disclose.
Celso Tello, MD Clinical Assistant Professor, Department of Ophthalmology, New York Eye and Ear Infirmary
Celso Tello, MD is a member of the following medical societies: American Academy of Ophthalmology, American Medical Association, and New York Academy of Sciences
Disclosure: Nothing to disclose.
Plateau Iris Glaucoma
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