This protocol targets a specific presentation of chronic angle-closure glaucoma in which a narrow angle persists because of an anteriorly positioned ciliary body — and in which standard laser peripheral iridotomy (LPI) alone is insufficient to resolve the problem.
Plateau iris syndrome is defined by a narrow angle caused by an anteriorly positioned ciliary body with a relatively deep central anterior chamber. In these eyes, iridotrabecular contact (ITC) persists despite a patent LPI, and recurrent elevated intraocular pressure with a closed anterior chamber angle on gonioscopy continues to occur after laser iridotomy — indicating that the underlying structural cause has not been addressed.
When recurrent high IOP and persistent angle closure continue after LPI, further intervention directed at the ciliary process configuration is indicated. The protocol includes both procedural and surgical options.
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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