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J. Ueda, Y. Tanaka, T. Fukuchi, K. Suda, A. Ohta, K. Yaoeda, H. Hara, M. Shirakashi, H. Abe; Effects of Nocturnal Low-dose Pilocarpine Administration against Plateau Iris Configuration after Laser Iridotomy . Invest. Ophthalmol. Vis. Sci. 2003;44(13):2206.
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Purpose: Plateau iris configuration is a major element of angle-closure mechanism, frequently coexisting with relative pupillary block. Since narrowing of chamber angle is retained after laser iridotomy (LI), optimal management is yet to be established how we can prevent the formation of peripheral anterior synechia in these eyes. This study was performed to evaluate the effects of nocturnal low-dose pilocarpine administration for widening of chamber angle in the eyes of plateau iris configuration after LI. Methods: Ultrasound biomicroscopy (UBM) demonstrated plateau iris configuration in 14 eyes of 7 patients with narrow chamber angle after LI. Either 0.5 or 1.0% pilocarpine was applied once a day at 10 pm, or twice a day, 6 and 10pm. Period of the observation ranged from 2 months to 12 months. Angle opening distance 500 (AOD 500), trabecular-iris angle (TIA) and corneo-sulcus angle (CSA) were measured by diurnal UBM examination before and after the usage of pilocarpine. Intraocular pressure (IOP) was measured concurrently. Results: In these eyes, mean value of AOD 500 and TIA were much smaller than those of normal eyes as previously reported. 4 weeks after the application of pilocarpine, diurnal UBM examination revealed significant opening of chamber angle in all cases. AOD 500 increased from 0.07±0.06 to 0.15±0.08 mm, and TIA increased from 8.3±7.5 to 16.6±9.1 degree. Mean IOP level changed from 17.8±5.4 to 14.2±4.3 mmHg. CSA did not show a statistically significant change. Posterior synechia due to prolonged myosis was not found in any cases during the period of observation. Conclusions: This treatment effectively widened the chamber angle of plateau iris configuration after LI. These preliminary data may provide a clue for the optimal management for these eyes.
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