Recurrent acute angle closure attack due to plateau iris syndrome after cataract extraction and argon laser peripheral iridoplasty

Abstract

PURPOSE: To report 2 cases of recurrent acute angle closure attack in patients with plateau iris syndrome after cataract extraction. Treatment of plateau iris syndrome is reviewed as there is no consensus on the long term management of plateau iris syndrome. METHOD: We describe 2 cases of recurrent acute angle closure attack in patients with plateau iris syndrome after cataract extraction. RESULTS: We report 2 cases of recurrent acute angle closure attack in 2 Chinese patients with plateau iris syndrome. The first patient was a 69 year-old woman who received bilateral argon laser peripheral iridoplasty and cataract extraction 2 years prior to the latest acute angle closure with right eye intraocular pressure 48 mmHg. The attack was aborted medically. Peripheral iridotomy was patent and argon laser peripheral iridoplasty marks were mostly at peripheral 2/3 of the iris. Anterior segment optical coherence tomography confirmed bilateral plateau iris configuration. Use of long term pilocarpine or repeated argon laser peripheral iridoplasty to prevent recurrent angle closure attack was discussed but she opted for ob¬servation. The second patient was a 64 year-old man presented with acute angle closure after cataract ex¬traction and laser peripheral iridotomy. Plateau iris syndrome was confirmed by anterior segment optical coherence tomography and he received argon laser peripheral iridoplasty. CONCLUSIONS: Acute angle closure due to plateau iris syndrome can still occur despite previous cataract ex-traction and argon laser peripheral iridoplasty. These are the first reported cases of recurrent acute angle closure attack following cataract extraction, with or without previous argon laser peripheral iridoplasty. Repeated treatment with argon laser peripheral iridoplasty or pilocarpine could be considered although the long term efficacy is questionable. Argon laser peripheral iridoplasty should be applied as peripheral as possible so as to open up the drainage angle effectively.