Angle-closure glaucoma
ICD-10 H40.2 · ICD-11 9C61.3

Treatment of Angle-Closure Glaucoma When ITC Persists After Laser Peripheral Iridotomy

A subset of patients with narrow or closed-angle glaucoma continues to have iridotrabecular contact (ITC) and recurrent intraocular pressure (IOP) elevation even after a patent laser peripheral iridotomy (LPI). This specific presentation requires a distinct management approach beyond standard iridotomy.

Clinical scenario
The angle is narrow or closed due to an anteriorly positioned ciliary body with a relatively deep central anterior chamber. Despite a patent LPI, ITC persists on gonioscopy and the patient experiences recurrent elevated IOP with a closed angle. Eyes with this configuration that develop recurrent high IOP associated with a closed angle after LPI should undergo further therapy.
Treatment direction
Further management involves procedural or surgical options targeting the underlying ciliary body configuration. The full structured regimen — including the specific sequence, selection criteria, and complete list of interventions — is available via the link below.
Instant Access to Structured Evidence-Based Regimens

References

DOI: 10.1016/j.ophtha.2025.12.030

Plateau iris syndrome: narrow angle due to an anteriorly positioned ciliary body with a relatively deep central anterior chamber and ITC persisting after patent laser peripheral iridotomy surgery (LPI).

Eyes with plateau iris syndrome that experience recurrent high IOP associated with a closed angle on gonioscopy after LPI should undergo further therapy.

Additional treatment options may include iridoplasty, chronic parasympathomimetic therapy, or other surgical procedures, such as lens extraction.

Two small case series indicate that phacoemulsification combined with ECP can address the ciliary process configuration and may improve IOP control in patients with plateau iris.

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