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M. H. Wong, R. S. Kumar, D. T. Quek, V. T. Koh, L. S. MohanRam, K. Y. Lee, T. Aung; Clinical Course of Primary Angle Closure Glaucoma Eyes With Plateau Iris. Invest. Ophthalmol. Vis. Sci. 2009;50(13):2452.
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To compare the clinical course of primary angle closure glaucoma (PACG) eyes with and without plateau iris.
We retrospectively analyzed the natural history of the disease in subjects with PACG over the age of 40 years, who had a patent laser iridotomy (LI) and had at least 6 months follow-up. Plateau iris in a quadrant was defined by the following ultrasound biomicroscopy (UBM) findings: anteriorly directed ciliary body, absent ciliary sulcus, steep iris root from its point of insertion followed by downward angulation from the corneoscleral wall, flat iris plane and irido-angle contact. Factors analyzed included history of previous acute primary angle closure (APAC), presence of peripheral anterior synechiae (PAS), intraocular pressure (IOP) during the follow up period, IOP lowering medical treatment and/or surgery required during follow-up. A rise in IOP was defined as follows: IOP> 21 mm Hg (on at least 2 occasions) and requiring treatment.
Forty-two subjects were recruited with 13 (31%) eyes having plateau iris based on UBM. The mean age was 68.4 ± 7.1 years; the majority were women (64.3%) and Chinese (92.8%). Mean follow-up period was 32.7 ± 24.3 months (range 7-93 months). PAS was significantly more common in PACG eyes without plateau iris (75.9%) compared to those with plateau iris (30.8%, p=0.01). Although a higher proportion of PACG eyes with plateau iris (100%) required IOP lowering medical treatment compared with those without plateau iris (86.2%), this was not statistically significant (p=0.29). There was no difference found for proportion of eyes requiring surgery or for percentage of eyes with previous history of APAC.
In this sample of Asian subjects with PACG, PAS was more common in PACG eyes without plateau iris compared to those with plateau iris. The proportion of cases requiring further medical or surgical intervention or having previous APAC was similar in the 2 groups.
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