Hollander David A, Pennesi Mark E, Alvarado Jorge A
Glaucoma Research Laboratory, Department of Ophthalmology, University of California, San Francisco, USA.
Glaucoma Research Laboratory, Department of Ophthalmology, University of California, San Francisco, USA.
Exp Eye Res. 2017 May;158:190-194. doi: 10.1016/j.exer.2016.07.018. Epub 2016 Jul 28.
Plateau iris configuration describes an anatomic abnormality in which large or anteriorly positioned pars plicata push the iris root forward, thereby narrowing the anterior chamber angle. Plateau iris syndrome (PIS) is diagnosed if the angle remains occludable, either spontaneously or pharmacologically, after iridotomy. PIS has traditionally been treated with chronic pilocarpine or laser peripheral iridoplasty. A series of 9 eyes of 6 patients with PIS, diagnosed by dark room provocative testing and ultrasound biomicroscopy (UBM) following iridotomy, underwent cataract extraction and endoscopic cyclophotocoagulation (ECP). The ciliary body was treated for a median of 180° (range of 120-360°). Post-ECP, the angles in areas treated with ECP were open with corresponding flattened ciliary processes on UBM, while the angles remained occludable in quadrants untreated by ECP despite lens extraction. The mean follow-up time post-ECP was 73.7 ± 34 months (range 11-122 months). The mean IOP was reduced from a baseline of 25.2 ± 10.9 mm Hg on 3.4 ± 1.0 IOP lowering medications to a mean IOP of 17.1 ± 5.3 mm Hg (p < 0.05) on 1.9 ± 1.5, (p < 0.01) medications at last visit. There were no cases of chronic inflammation, eye pain, decreased vision, retinal detachment, or hypotony. Lens extraction and ECP offers an alternative treatment option for patients with PIS, which may directly address the underlying anatomic abnormality leading to angle closure in PIS.
高褶虹膜形态描述了一种解剖学异常，即大的或靠前位置的睫状突将虹膜根部向前推，从而使前房角变窄。如果在虹膜切开术后，房角无论是自发地还是经药物作用后仍可发生闭合，则诊断为高褶虹膜综合征（PIS）。传统上，PIS采用长期毛果芸香碱治疗或激光周边虹膜成形术。对6例经虹膜切开术后通过暗室激发试验和超声生物显微镜（UBM）诊断为PIS的患者的9只眼进行了白内障摘除和内镜睫状体光凝术（ECP）。睫状体治疗的角度中位数为180°（范围为120 - 360°）。ECP术后，接受ECP治疗区域的房角开放，UBM显示相应的睫状突变平，而尽管进行了晶状体摘除，但未接受ECP治疗象限的房角仍可发生闭合。ECP术后的平均随访时间为73.7±34个月（范围为11 - 122个月）。平均眼压从使用3.4±1.0种降眼压药物时的基线值25.2±10.9 mmHg降至末次随访时使用1.9±1.5种（p<0.01）药物时的平均眼压17.1±5.3 mmHg（p<0.05）。没有慢性炎症、眼痛、视力下降、视网膜脱离或低眼压的病例。晶状体摘除和ECP为PIS患者提供了一种替代治疗选择，这可能直接解决导致PIS房角关闭的潜在解剖学异常。
