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Marina Syrimi, Michael Griffiths; Trans-scleral Cyclodiode laser for the treatment of plateau iris. Invest. Ophthalmol. Vis. Sci. 2014;55(13):6168.
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The management of plateau iris is currently a challenge. To date, regular pilocarpine 2%, iridoplasty and lensectomy have been proposed for the treatment of plateau iris with variable results. We performed this study to evaluate if trans-scleral cyclodiode laser treatment is effective in reversing the plateau iris configuration and opening the angle.
A retrospective analysis of patients with plateau iris, treated with a single treatment of trans-scleral cyclodiode laser, between January 2012 and January 2013, in our unit was performed. Patients with the classic “double hump” sign evident on gonioscopy in at least two quadrants, in spite of patent peripheral iridotomy, were included. Patients with peripheral anterior synechia were excluded. The medical notes were used to collect information on gonioscopic findings, intraocular pressures (IOP) and number of antiglaucoma agents used to achieve the target IOP before and after treatment. The primary outcome was the resolution of the “double hump” sign on gonioscopy following trans-scleral cyclodiode laser. The secondary outcomes were the presence of adequate IOP control and change in visual acuity.
A total of 8 eyes with plateau iris were treated with trans-scleral cyclophotocoagulation in the study period. Five eyes had visual acuity of 20/20 or better, 2 eyes had visual acuity between 20/25 and 20/32 and one eye had visual acuity of 20/63. The average spherical equivalent pre-treatment was +1.52DS. The average follow up was 6 months (StDev 4 months). Gonioscopic examination following treatment showed resolution of plateau iris configuration in all the eyes. Seven eyes had corrected visual acuity of 20/20 or better at follow up and one eye had visual acuity of 20/25. There was a statistical decrease in the average intraocular pressure following cyclodiode laser treatment (24.75mmHg Vs 14.88mHg, p < 0.05). The mean number of antiglaucoma topical medications before and after treatment were 1.75 and 1.25 respectively (p=0.125).
Trans-scleral cyclophotocoagulation successfully reversed the plateau iris configuration in all the treated eyes in our study with statistically significant reduction in intraocular pressures. All eyes maintained good corrected visual acuities following treatment.
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