Laser Iridoplasty Techniques for Narrow Angles and Plateau Iris Syndrome

  • Baseer U. Khan


The apparent mechanism of intraocular pressure (IOP) elevation in primary angle closure (PAC) is straightforward: the obstruction of aqueous to the trabecular meshwork (TM) by the peripheral iris, usually interacting with the lens, which is therefore termed papillary block. With age, the crystalline lens increases in diameter, moving the peripheral iris forward and/or increasing pupil block, thus narrowing the angle. The conundrum that arises is determining when the threshold of occludability has been reached. Most epidemiological studies have chosen to define this point as when 270° or more of the posterior (pigmented) trabecular meshwork is not visible on gonioscopy; however, this threshold is arbitrary and has not been validated. The issue of angle compression has not been addressed. Nevertheless, at this time, the literature does not purport any other definition to be of greater accuracy and thus this is the operational definition used in this chapter.


Trabecular Meshwork Angle Closure Anterior Segment Optical Coherence Tomography Plateau Iris Primary Angle Closure 
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  1. 1.
    Foster PJ. The epidemiology of primary angle closure and associated glaucomatous optic neuropathy. Semin Ophthalmol. 2002;17(2): 50-58. Review.CrossRefPubMedGoogle Scholar
  2. 2.
    Friedman DS, Gazzard G, Foster P, et al. Ultrasonographic biomicroscopy, Scheimpflug photography, and novel provocative tests in contralateral eyes of Chinese patients initially seen with acute angle closure. Arch Ophthalmol. 2003;121(5):633–642.CrossRefPubMedGoogle Scholar
  3. 3.
    Markowitz SN, Morin JD. The clinical course in primary angle-closure glaucoma: a reassessment. Can J Ophthalmol. 1986;21(4): 130–133.PubMedGoogle Scholar
  4. 4.
    Wojciechowski R, Congdon N, Anninger W, Teo Broman A. Age, gender, biometry, refractive error, and the anterior chamber angle among Alaskan Eskimos. Ophthalmology. 2003;110(2):365–375.CrossRefPubMedGoogle Scholar
  5. 5.
    Foster PJ, Buhrmann R, Quigley HA, Johnson GJ. The definition and classification of glaucoma in prevalence surveys. Br J Ophthalmol. 2002;86(2):238-242, Review.CrossRefPubMedGoogle Scholar
  6. 6.
    He M, Friedman DS, Ge J, et al. Laser peripheral iridotomy in primary angle-closure suspects: biometric and gonioscopic outcomes: the Liwan Eye Study. Ophthalmology. 2007;114(3):494–500.CrossRefPubMedGoogle Scholar
  7. 7.
    Ritch R, Liebmann JM, Tellow C. A construct for understanding angle closure glaucoma: the role of ultrasound biomicroscopy. Ophthalmol Clin North Am. 1995;8:281–293.Google Scholar
  8. 8.
    Pavlin CJ, Harasiewicz K, Foster FS. An ultrasound biomicroscopic dark-room provocative test. Ophthalmic Surg. 1995;26(3):253–255.PubMedGoogle Scholar
  9. 9.
    American Academy of Ophthalmology. Laser peripheral iridotomy for pupillary-block glaucoma. Ophthalmology. 1994;101(10):1749-1758, Review, No abstract available.Google Scholar
  10. 10.
    Fleck BW, Dhillon B, Khanna V, Fairley E, McGlynn C. A randomised, prospective comparison of Nd:YAG laser iridotomy and operative peripheral iridectomy in fellow eyes. Eye. 1991;5(Pt 3): 315–321.PubMedGoogle Scholar
  11. 11.
    Pavlin CJ, Ritch R, Foster FS. Ultrasound biomicroscopy in plateau iris syndrome. Am J Ophthalmol. 1992;113(4):390–395.PubMedGoogle Scholar
  12. 12.
    Ritch R. Plateau Iris is caused by abnormally positioned ciliary processes. J Glaucoma. 1992;1:23–26.CrossRefGoogle Scholar
  13. 13.
    Jain IS, Gupta A, Dogra MR, Gangwar DN, Dhir SP. Phacomorphic glaucoma - management and visual prognosis. Indian J Ophthalmol. 1983;31(5):648–653.PubMedGoogle Scholar
  14. 14.
    Epstein DL. Diagnosis and management of lens-induced glaucoma. Ophthalmology. 1982;89(3):227–230.PubMedGoogle Scholar
  15. 15.
    Kimbrough RL, Trempe CS, Brockhurst RJ, Simmons RJ. Angle-closure glaucoma in nanophthalmos. Am J Ophthalmol. 1979;88(3 Pt 2):572–579.PubMedGoogle Scholar
  16. 16.
    Ritch R. Argon laser treatment for medically unresponsive attacks of angle-closure glaucoma. Am J Ophthalmol. 1982;94(2):197–204.PubMedGoogle Scholar
  17. 17.
    Ritch R. Argon laser peripherl iridoplasty: an overview. J Glaucoma. 1992;1:206–213.CrossRefGoogle Scholar
  18. 18.
    York K, Ritch R, Szmyd LJ. Argon laser peripheral iridotoplasty: indications, techniques and results. Invest Ophthalmol Vis Sci. 1984;25(suppl):94.Google Scholar
  19. 19.
    Ritch R, Tham CC, Lam DS. Long-term success of argon laser peripheral iridoplasty in the management of plateau iris syndrome. Ophthalmology. 2004;111(1):104–108.CrossRefPubMedGoogle Scholar
  20. 20.
    Yip PP, Leung WY, Hon CY, Ho CK. Argon laser peripheral iridoplasty in the management of phacomorphic glaucoma. Ophthalmic Surg Lasers Imaging. 2005;36(4):286–291PubMedGoogle Scholar
  21. 21.
    Tham CC, Lai JS, Poon AS, et al. Immediate argon laser peripheral iridoplasty (ALPI) as initial treatment for acute phacomorphic angle-closure (phacomorphic glaucoma) before cataract extraction: a preliminary study. Eye. 2005;19(7):778–783.CrossRefPubMedGoogle Scholar
  22. 22.
    Chew P, Chee C, Lim A, et al. Laser treatment of severe acute angle-closure glaucoma in dark Asian irides: the role of iridoplasty. Lasers Light Ophthalmol. 1991;4:41–42.Google Scholar
  23. 23.
    Lim AS, Tan A, Chew P, et al. Laser iridoplasty in the treatment of severe acute angle closure glaucoma. Int Ophthalmol. 1993;17:33–36.CrossRefPubMedGoogle Scholar
  24. 24.
    Matai A, Consul S. Argon laser iridoplasty. Indian J Ophthalmol. 1987;35(5-6):290–292.PubMedGoogle Scholar
  25. 25.
    Lai JS, Tham CC, Chua JK, et al. To compare argon laser peripheral iridoplasty (ALPI) against systemic medications in treatment of acute primary angle-closure: mid-term results. Eye. 2006;20(3):309–314.CrossRefPubMedGoogle Scholar
  26. 26.
    Lai JS, Tham CC, Chua JK, Lam DS. Immediate diode laser peripheral iridoplasty as treatment of acute attack of primary angle closure glaucoma: a preliminary study. J Glaucoma. 2001;10(2):89–94.CrossRefPubMedGoogle Scholar
  27. 27.
    Lai JS, Tham CC, Chua JK, Poon AS, Lam DS. Laser peripheral iridoplasty as initial treatment of acute attack of primary angle-closure: a long-term follow-up study. J Glaucoma. 2002;11(6):484–487.CrossRefPubMedGoogle Scholar
  28. 28.
    Lam DS, Lai JS, Tham CC, Chua JK, Poon AS. Argon laser peripheral iridoplasty versus conventional systemic medical therapy in treatment of acute primary angle-closure glaucoma: a prospective, randomized, controlled trial. Ophthalmology. 2002;109(9):1591–1596.CrossRefPubMedGoogle Scholar
  29. 29.
    Sassani JW, Ritch R, McCormick S, et al. Histopathology of argon laser peripheral iridoplasty. Ophthalmic Surg. 1993;24(11):740–745.PubMedGoogle Scholar
  30. 30.
    Wand M, Grant WM, Simmons RJ, Hutchinson BT. Plateau iris syndrome. Trans Sect Ophthalmol Am Acad Ophthalmol Otola­ryngol. 1977;83(1):122–130.Google Scholar
  31. 31.
    Tran HV, Liebmann JM, Ritch R. Iridociliary apposition in plateau iris syndrome persists after cataract extraction. Am J Ophthalmol. 2003;135(1):40–43.CrossRefPubMedGoogle Scholar
  32. 32.
    Azuara-Blanco A. Iridociliary apposition in plateau iris syndrome persists after cataract extraction. Am J Ophthalmol. 2003;136(2): 395.CrossRefPubMedGoogle Scholar
  33. 33.
    Crowston JG, Medeiros FA, Mosaed S, Weinreb RN. Argon laser iridoplasty in the treatment of plateau-like iris configuration as result of numerous ciliary body cysts. Am J Ophthalmol. 2005;139(2):381–383.CrossRefPubMedGoogle Scholar
  34. 34.
    Teekhasaenee C, Ritch R. Combined phacoemulsification and goniosynechialysis for uncontrolled chronic angle-closure glaucoma after acute angle-closure glaucoma. Ophthalmology. 1999;106(4):669–674.CrossRefPubMedGoogle Scholar
  35. 35.
    Harasymowycz PJ, Papamatheakis DG, Ahmed I, et al. Phacoemulsification and goniosynechialysis in the management of unresponsive primary angle closure. J Glaucoma. 2005;14(3):186–189.CrossRefPubMedGoogle Scholar
  36. 36.
    Lai JS, Tham CC, Lam DS. The efficacy and safety of combined phacoemulsification, intraocular lens implantation, and limited goniosynechialysis, followed by diode laser peripheral iridoplasty, in the treatment of cataract and chronic angle-closure glaucoma. J Glaucoma. 2001;10(4):309–315.CrossRefPubMedGoogle Scholar
  37. 37.
    Ritch R, Tham CC, Lam DS. Argon laser peripheral iridoplasty (ALPI): an update. Surv Ophthalmol. 2007;52(3):279-288, Review.CrossRefPubMedGoogle Scholar
  38. 38.
    Wand M. Argon laser gonioplasty for synechial angle closure. Arch Ophthalmol. 1992;110(3):363–367.PubMedGoogle Scholar
  39. 39.
    Kiuchi Y, Kanamoto T, Nakamura T. Double hump sign in indentation gonioscopy is correlated with presence of plateau iris configuration regardless of patent iridotomy. J Glaucoma. 2009;18(2): 161–164.CrossRefPubMedGoogle Scholar
  40. 40.
    Friedman Z, Neumann E. Comparison of prone-position, dark-room, and mydriatic tests for angle-closure glaucoma before and after peripheral iridectomy. Am J Ophthalmol. 1972;74(1):24–27.PubMedGoogle Scholar
  41. 41.
    Epstein DL, Allingham RR, Schuman JS, eds. In: Chandler and Grant’s Glaucoma. 4th ed. Baltimore: Lippincott Williams & Wilkins, 1997;279–280.Google Scholar
  42. 42.
    Dada T, Sihota R, Gadia R, Aggarwal A, Mandal S, Gupta V. Comparison of anterior segment optical coherence tomography and ultrasound biomicroscopy for assessment of the anterior segment. J Cataract Refract Surg. 2007;33(5):837–840.CrossRefPubMedGoogle Scholar
  43. 43.
    Radhakrishnan S, Goldsmith J, Huang D, et al. Comparison of optical coherence tomography and ultrasound biomicroscopy for detection of narrow anterior chamber angles. Arch Ophthalmol. 2005;123(8):1053–1059.CrossRefPubMedGoogle Scholar
  44. 44.
    Böker T, Sheqem J, Rauwolf M, Wegener A. Anterior chamber angle biometry: a comparison of Scheimpflug photography and ultrasound biomicroscopy. Ophthalmic Res. 1995;27(Suppl 1):104–109.CrossRefPubMedGoogle Scholar
  45. 45.
    Espana EM, Ioannidis A, Tello C, Liebmann JM, Foster P, Ritch R. Urrets-Zavalia syndrome as a complication of argon laser peripheral iridoplasty. Br J Ophthalmol. 2007;91(4):427–429.CrossRefPubMedGoogle Scholar

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© Springer Science+Business Media, LLC 2010

Authors and Affiliations

  • Baseer U. Khan
    • 1
  1. 1.Department of OphthalmologyUniversity of TorontoTorontoCanada

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