The purpose of this study was to evaluate the long-term outcomes of plateau iris syndrome (PIS) patients treated with argon laser peripheral iridoplasty (ALPI) following YAG laser peripheral iridotomy (LPI). Typical ALPI settings were a spot size of 200 to 400μm with a power of 250 to 500mW per shot for 0.2 seconds, titrated until a visible contraction of the iris was noted. No lens was used during the procedure. ALPI involves the application of argon laser to the peripheral iris, resulting in immediate shrinkage due to coagulation of collagen, followed by the long-term formation of fibroblastic membranes that contract the iris, ultimately pulling it away from the irido-corneal drainage angle. Although ALPI is sometimes used to help break acute attacks of primary angle closure (PAC), it is often utilised to treat PIS after iridotomy fails to deepen the angle. Additionally, ALPI may reduce the need for filtration surgery in PAC glaucoma eyes with a patent iridotomy. The authors conducted a retrospective chart review on all patients with plateau iris syndrome treated with ALPI from 1996 to 2007. In total, 30 patients with 49 eyes that underwent ALPI were identified. The primary outcome measure was the incidence of intraocular pressure (IOP) lowering medications and/or surgery (either a filtering procedure or phaco-emulsification). The overall mean follow-up was 76 months. Only 2 (9%) eyes maintained an IOP <21mmHg without requiring medication or surgery. Seventeen (77%) eyes underwent surgery at an average of 50 months after ALPI. Eight (36%) eyes underwent filtering surgery, and 9 (41%) eyes underwent phacoemulsification. Three months after cataract extraction, none of those eyes required any IOP-lowering medication. In their study, the authors demonstrated that while ALPI is effective in the short term, the majority of eyes required surgical intervention to manage progressive angle narrowing and control IOP. Their further findings also suggest that phacoemulsification alone may be a successful treatment for patients with PIS. They conclude that the beneficial effects of ALPI last for less than 4 years, with the majority of patients (77%) requiring surgery. Phacoemulsification alone was a successful treatment for plateau iris in their patient population.

Long-term outcome of argon laser peripheral iridoplasty in the management of plateau iris syndrome eyes.
Peterson JR, Jeffrey R, Anderson JW, et al.
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Chrysostomos D Dimitriou

Essex County Hospital, Colchester, Essex, UK.

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