Issue 7/2024
Vassileva, P., Georgieva, A.
Specialized Eye Hospital “Acad. Pashev”, Sofia
The anatomic interactions in the anterior ocular segment tissues, аssociated with the origin and the drainage of the anterior chamber fluid, can lead to closure of the anterior chamber angle (ACA) and development of glaucoma. One of the most common cause for the primary closure of ACA in young patients is plateau iris configuration (PIC). This anomaly is due to a larger ciliary body, which is positioned anteriorly so the peripheral iris is displaced in opposition to the trabeculum meshwork and causes iridotrabecular apposition and needs to persistently narrowing angle. When after functioning laser peripheral iridotomy (LPI) the ACA remains narrow capable of closure plateau iris syndrome (PIS) develops. Purpose: In order to improve the diagnosis and management of PIC/PIS we demonstrate our experience with these sight-threatening glaucomas observed mostly in young patients, and discuss current opinions on pathogenesis and proposed treatment methods of this form of angle-closure glaucoma. Material and Methods: Our study includes patients diagnosed with PIC for a six-month period. In all 31 patients, we observed symptoms and signs of angle closure with a deep anterior chamber centrally. Treatment was performed with antiglaucomatous drops, laser peripheral iridotomy (LPI), argon laser peripheral iridoplasty (ALPI) and trabeculectomy (TE). Results: Mean age of treated patients is 45,5 predominantly females – 19 (61,3%). Data on inheritance of PIC was stated in 10 patients (32,36%). Main complain for the visit was problems with vision in 17 patients (54,83%). Increased intraocular pressure above 21 mmHg had 18 patients (58,06%). We received promising results with LPI and ALPI in different succession according to the clinical picture. Conclusion: Patients with closed angle in PIC present a specific diagnostic puzzle consisting of various pathogenesis and mechanisms leading to the development of glaucoma damages and vision loss. Unfortunately this form of glaucoma common in young people is often not diagnosed on time.
Key words: primary angle closure glaucoma; plateau iris configuration; plateau iris syndrome; laser peripheral iridotomy; argon laser peripheral iridoplasty
Аddress for correspondation:
Vasileva, Р.
Specialized Eye Hospital for Active Treatment
“Acad. Pashev”
51, Em. Vaskidovich str.
1517, Sofia
e-mail: centersight@sobalpashev.com