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Jonathan M Schulhof, Janet B Serle; Long term outcome of patients with Plateau Iris Configuration. Invest. Ophthalmol. Vis. Sci. 2014;55(13):6151.
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To examine the long term outcome of patients with Plateau Iris Configuration
A retrospective chart review was performed of all patients presenting for glaucoma follow-up over a one year period. Inclusion criteria were a minimum of 24 months follow-up, and a diagnosis of Plateau Iris Configuration as determined by JBS via clinical gonioscopic exam and/or ultrasound biomicroscopy. The charts were then reviewed for exam on presentation, subsequent visual acuity, intraocular pressure (IOP), need for laser iridotomy (LI) and/or laser iridoplasty, need for glaucoma surgery, need for IOP lowering and/or miotic eyedrops, progression of optic nerve cupping, and development of peripheral anterior synechiae (PAS).
26 eyes of 13 patients satisfied the criteria and were included in the study. Mean follow-up time was 6.4 years (2.1 - 16.0). 22 eyes of 11 patients were still phakic at the time of our study, and all maintained vision within 1 line or better compared with initial presentation. 100% of eyes underwent LI at least once, with 1/26 (3.8%) requiring a repeat LI due to iridotomy closure. 5/26 eyes (19.2%) of 3 patients progressed to Plateau Iris Syndrome defined as elevated IOP with narrow or closed angles despite LI, and all 5 underwent peripheral iridoplasty. Only 4/26 eyes (15.4%) of 2 patients required IOP lowering eyedrops to maintain IOP <21. While 8/26 phakic eyes (30.8%) were treated with pilocarpine, 4 of those 8 eyes subsequently underwent cataract extraction, and were successfully tapered off miotics. 0/26 eyes required filtration or drainage implant surgery, and 26/26 showed stable cup to disc ratio within 0.1 from initial exam. 3/26 eyes (2 patients) showed presence of PAS on initial exam, and only 2/24 remaining eyes (8.3%, 1 patient) showed development of PAS over the course of treatment.
Our current series demonstrates that a majority of patients Plateau Iris Configuration treated with LI alone were able to maintain normal IOP while avoiding sequelae of chronic angle-closure. Eyedrops and iridoplasty were only required in a minority of patients, and in all cases excellent vision was maintained without significant structural or glaucomatous damage.
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