Francis Brian A, Pouw Andrew, Jenkins Dennis, Babic Kelly, Vakili Ghazal, Tan James, Chopra Vikas, Green Ronald L
*Department of Ophthalmology, Doheny Eye Institute, David Geffen School of Medicine ‡San Francisco Medical Center Department of Ophthalmology-Ultrasound, University of California †Keck School of Medicine, University of Southern California, Los Angeles, CA.
J Glaucoma. 2016 Mar;25(3):e128-33. doi: 10.1097/IJG.0000000000000156.
To describe the anatomic and clinical results of the treatment of severe plateau iris syndrome with lens extraction and endoscopic cycloplasty (ECPL). A secondary aim was to describe 4 novel ultrasound biomicroscopy (UBM) measurements for plateau iris syndrome.
Prospective case series with UBM evaluation.
Included were 12 eyes of 6 patients with plateau iris refractory to laser iridotomy and iridoplasty, miotic and other glaucoma medical treatment, with appositional angle closure in at least 3 quadrants. Treatment consisted of lens extraction and ECPL, an endoscopic diode laser treatment of the ciliary processes in the superior, nasal, and inferior quadrants. UBM measurements were taken in all quadrants before and after surgery. The untreated temporal quadrants were used as controls. Measurement parameters included: anterior chamber depth (ACD), angle opening distance (AOD 500), trabecular ciliary process distance (TCPD), iris ciliary process distance (ICPD), iris depth (ID), iridocorneal angle (ICA), and sulcus angle (SA). Four novel measurements included: ciliary process thickness (CPT), ciliary process width (CPW), ciliary process area (CPA), and iris ciliary process contact length (ICPCL). Visual acuity, intraocular pressure, glaucoma medications, and complications were also followed.
The ACD, AOD 500, and ICA all increased significantly (P<0.001). ICPD, CPT, CPW, CPA, and ICPL all decreased significantly (P<0.01). Parameters remaining unchanged were: TCPD, ID, and SA. The untreated quadrants showed similar measurements to the preoperative measurements. There were no serious complications noted.
Treating the ciliary processes with diode laser using an endoscopic approach (ECPL) and lens extraction, results in opening of the anterior chamber angle and shrinkage of the ciliary processes in the treated areas. This effect seems to be primarily a result of the laser treatment in combination rather than the lens extraction alone. This effectively reverses the anatomic cause and angle closure of plateau iris syndrome.
描述晶状体摘除联合内镜睫状体成形术（ECPL）治疗重度高褶虹膜综合征的解剖学和临床结果。次要目的是描述4种用于高褶虹膜综合征的新型超声生物显微镜（UBM）测量方法。
采用UBM评估的前瞻性病例系列研究。
纳入6例患者的12只眼，这些患者的高褶虹膜对激光虹膜切开术、虹膜成形术、缩瞳及其他青光眼药物治疗均无效，且至少3个象限存在房角关闭。治疗包括晶状体摘除和ECPL，即通过内镜二极管激光对上方、鼻侧和下方象限的睫状体进行治疗。术前和术后对所有象限进行UBM测量。未治疗的颞侧象限用作对照。测量参数包括：前房深度（ACD）、房角开放距离（AOD 500）、小梁睫状体距离（TCPD）、虹膜睫状体距离（ICPD）、虹膜深度（ID）、虹膜角膜角（ICA）和巩膜沟角（SA）。4种新型测量方法包括：睫状体厚度（CPT）、睫状体宽度（CPW）、睫状体面积（CPA）和虹膜睫状体接触长度（ICPCL）。同时随访视力、眼压、青光眼药物使用情况及并发症。
ACD、AOD 500和ICA均显著增加（P<0.001）。ICPD、CPT、CPW、CPA和ICPCL均显著降低（P<0.01）。保持不变的参数为：TCPD、ID和SA。未治疗的象限测量结果与术前测量结果相似。未发现严重并发症。
采用内镜方法（ECPL）用二极管激光治疗睫状体并联合晶状体摘除，可使前房角开放，治疗区域的睫状体缩小。这种效果似乎主要是激光治疗联合作用的结果，而非单纯晶状体摘除的结果。这有效地逆转了高褶虹膜综合征的解剖学病因和房角关闭。
