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Robert Ritch - One of the best experts on this subject based on the ideXlab platform.

  • Plateau Iris Syndrome and angle closure glaucoma in a patient with nail patella Syndrome
    American Journal of Ophthalmology Case Reports, 2020
    Co-Authors: Margot A Gardin, Chiea Chuen Khor, Luis Silva, Einar A Krefting, Robert Ritch
    Abstract:

    Abstract Purpose To describe a case of Plateau Iris Syndrome (PIS) and angle-closure glaucoma (ACG) in a patient with nail-patella Syndrome (NPS). Observation A 33 year-old woman of Slovakian ancestry from Norway with a history of NPS presented with angle-closure secondary to Plateau Iris. At the time of her NPS diagnosis, she had no ocular pathology. Genetic testing revealed a rare de novo mutation in LMX1B [c.668G>C (p.Arg223Pro)]. Two years later, she experienced acute bilateral ocular pain and blurred vision in the setting of one year of reported visual loss. Subsequent ophthalmic examinations revealed closed angles and Plateau Iris OU with ACG OD and angle-closure OS. Perimetry showed superonasal visual field defects OD and no defects OS. Ocular coherence tomography (OCT) revealed thinning of the inferior pole of the optic nerve OD. Medical management proved ineffective. A laser peripheral iridotomy (LPI) OD was performed, without resolution of the angle-closure, and a diagnosis of Plateau Iris Syndrome (PIS) was made. She was then treated with an argon laser peripheral iridoplasty (ALPI) and clear lens extraction with a posterior chamber intraocular lens (PCIOL) and goniosynechialysis OD, but her IOP remained elevated OU. She was referred to New York Eye and Ear Infirmary of Mount Sinai, where an LPI OS was performed, but angle-closure persisted, consistent with PIS. An ALPI OS with touch-up was performed, and her IOP normalized with dark-room gonioscopy revealing open angles OU. Conclusions And importance NPS has been associated with ocular hypertension (OHTN) and open-angle glaucoma (OAG); however, to our knowledge, no association between NPS and angle-closure has previously been reported. The case described here, of a patient with a rare de novo mutation and ocular findings of PIS with associated ACG, represents a novel genetic and clinical presentation of NPS.

  • Argon laser peripheral iridoplasty (ALPI): an update.
    Survey of Ophthalmology, 2007
    Co-Authors: Robert Ritch, Clement C Y Tham
    Abstract:

    Argon laser peripheral iridoplasty is a useful procedure to eliminate appositional angle closure resulting from mechanisms other than pupillary block. For those eyes with angle closure originating at an anatomic level posterior to the Iris, such as Plateau Iris, lens-induced angle closure, or posterior segment processes (malignant glaucoma, central retinal vein occlusion, etc.), laser iridotomy by itself may be insufficient to treat the underlying disease mechanism. Argon laser peripheral iridoplasty is often useful in these cases to further open the angle. It can be used to break an acute attack of angle-closure glaucoma and relieve appositional angle closure secondary to Plateau Iris Syndrome, or lens-related angle closure, and to widen the angle prior to argon laser trabeculoplasty. Peripheral location of long-duration, low-power, large spot size laser burns is essential for optimal success.

  • long term success of argon laser peripheral iridoplasty in the management of Plateau Iris Syndrome
    Ophthalmology, 2004
    Co-Authors: Robert Ritch, Clement C Y Tham
    Abstract:

    OBJECTIVE: To document the long-term effect of argon laser peripheral iridoplasty (ALPI) in eyes with Plateau Iris Syndrome. DESIGN: Retrospective, noncomparative, interventional case series. SETTING: New York Eye and Ear Infirmary. METHODS: The charts of all patients with Plateau Iris Syndrome treated with ALPI from 1982 to 1991 and subsequently followed for 6 or more years were retrospectively reviewed. Patients with lens-related mechanisms contributing to angle closure (e.g., phacomorphic or malignant glaucoma) were excluded. MAIN OUTCOME MEASURES: Necessity for repeat ALPI and/or any additional means of intervention. RESULTS: A total of 26 ALPI procedures were performed in 23 eyes of 14 patients (4 men, 10 women). The mean age was 61+/-8.7 years. The mean follow-up was 78.9+/-8.0 months (range, 72-188 months). The angle in 20 of 23 (87.0%) eyes remained open throughout the entire follow-up period after only 1 treatment with ALPI. In 3 eyes, there was gradual reclosure of the angle 5 to 9 years after initial ALPI, but they were readily reopened and maintained open by a single repeat treatment. No filtration surgery was necessary in any eye during follow-up. CONCLUSIONS: ALPI is highly effective in eliminating residual appositional closure after laser iridotomy caused by Plateau Iris Syndrome. The effect is maintained for years, although a small proportion of patients might require retreatment.

  • iridociliary apposition in Plateau Iris Syndrome persists after cataract extraction
    American Journal of Ophthalmology, 2003
    Co-Authors: Viet H Tran, Jeffrey M. Liebmann, Robert Ritch
    Abstract:

    Abstract Purpose To evaluate the ultrasound biomicroscopic appearance of the anterior segment before and after cataract extraction in eyes with Plateau Iris Syndrome and to determine the effect of postoperative zonular relaxation on ciliary body position. Design Interventional case series. Methods Eyes with Plateau Iris Syndrome scanned before and after cataract extraction between January 1994 and September 2001 were enrolled. The iridociliary relationship and the anterior chamber depth at a distance of 3 mm from the scleral spur were assessed. Results We examined six eyes of six patients. Mean patient age was 74.2 ± 6.4 years (standard deviation [SD]) (range, 65–81 years). Mean refractive error was + 1.0 ± 3.9 diopters [D] (range, −5.75–+5.50), and mean axial length was 21.85 ± 0.77 mm (range, 20.90–22.95 mm). All eyes had undergone laser iridotomy and argon laser peripheral iridoplasty before cataract extraction. Ultrasound biomicroscopy examination revealed a narrow angle and absence of a ciliary body sulcus in all eyes with focal areas of iridotrabecular apposition in three eyes. Following cataract extraction, the anterior chamber depth increased ( P = .0006, paired t test), while the iridociliary contact remained unchanged. Conclusions Iridociliary apposition persists after cataract extraction in Plateau Iris Syndrome. Whether the cause is congenital or acquired, or both, remains to be determined.

  • ultrasound biomicroscopy in Plateau Iris Syndrome
    American Journal of Ophthalmology, 1992
    Co-Authors: Charles J. Pavlin, Robert Ritch, Stuart F Foster
    Abstract:

    Ultrasound biomicroscopy is a new technique that uses high-frequency ultrasound (50 to 100 MHz) to produce images of the entire anterior segment at high resolution (20 to 50 μm). The iridocorneal angle, Iris, ciliary body, and posterior chamber can be imaged in detail and the dimensions and anatomic relationships of these structures determined. Plateau Iris Syndrome is a condition in which the angle remains appositionally closed or occludable after iridectomy for angle-closure glaucoma. How the Iris remains in a position that allows it to occlude the angle has been uncertain. We performed ultrasound biomicroscopy eye examinations on eight patients with clinically diagnosed Plateau Iris Syndrome. In all the patients, ciliary processes were situated anteriorly compared to the position in normal subjects and in patients with angle closure caused by pupillary block. The ciliary processes provide structural support beneath the peripheral Iris, preventing the Iris root from falling away from the trabecular meshwork after iridectomy.

Clement C Y Tham - One of the best experts on this subject based on the ideXlab platform.

  • Argon laser peripheral iridoplasty (ALPI): an update.
    Survey of Ophthalmology, 2007
    Co-Authors: Robert Ritch, Clement C Y Tham
    Abstract:

    Argon laser peripheral iridoplasty is a useful procedure to eliminate appositional angle closure resulting from mechanisms other than pupillary block. For those eyes with angle closure originating at an anatomic level posterior to the Iris, such as Plateau Iris, lens-induced angle closure, or posterior segment processes (malignant glaucoma, central retinal vein occlusion, etc.), laser iridotomy by itself may be insufficient to treat the underlying disease mechanism. Argon laser peripheral iridoplasty is often useful in these cases to further open the angle. It can be used to break an acute attack of angle-closure glaucoma and relieve appositional angle closure secondary to Plateau Iris Syndrome, or lens-related angle closure, and to widen the angle prior to argon laser trabeculoplasty. Peripheral location of long-duration, low-power, large spot size laser burns is essential for optimal success.

  • long term success of argon laser peripheral iridoplasty in the management of Plateau Iris Syndrome
    Ophthalmology, 2004
    Co-Authors: Robert Ritch, Clement C Y Tham
    Abstract:

    OBJECTIVE: To document the long-term effect of argon laser peripheral iridoplasty (ALPI) in eyes with Plateau Iris Syndrome. DESIGN: Retrospective, noncomparative, interventional case series. SETTING: New York Eye and Ear Infirmary. METHODS: The charts of all patients with Plateau Iris Syndrome treated with ALPI from 1982 to 1991 and subsequently followed for 6 or more years were retrospectively reviewed. Patients with lens-related mechanisms contributing to angle closure (e.g., phacomorphic or malignant glaucoma) were excluded. MAIN OUTCOME MEASURES: Necessity for repeat ALPI and/or any additional means of intervention. RESULTS: A total of 26 ALPI procedures were performed in 23 eyes of 14 patients (4 men, 10 women). The mean age was 61+/-8.7 years. The mean follow-up was 78.9+/-8.0 months (range, 72-188 months). The angle in 20 of 23 (87.0%) eyes remained open throughout the entire follow-up period after only 1 treatment with ALPI. In 3 eyes, there was gradual reclosure of the angle 5 to 9 years after initial ALPI, but they were readily reopened and maintained open by a single repeat treatment. No filtration surgery was necessary in any eye during follow-up. CONCLUSIONS: ALPI is highly effective in eliminating residual appositional closure after laser iridotomy caused by Plateau Iris Syndrome. The effect is maintained for years, although a small proportion of patients might require retreatment.

Nicholas P Bell - One of the best experts on this subject based on the ideXlab platform.

Charles J. Pavlin - One of the best experts on this subject based on the ideXlab platform.

  • anterior chamber depth in Plateau Iris Syndrome and pupillary block as measured by ultrasound biomicroscopy
    American Journal of Ophthalmology, 2003
    Co-Authors: Michael A. Mandell, Daniel J. Weisbrod, Charles J. Pavlin, Rand E Simpson
    Abstract:

    PURPOSE: To quantitatively analyze the anterior chamber depth (ACD) in patients with pupillary block and Plateau Iris Syndrome. DESIGN: Retrospective, consecutive, observational case series. METHODS: We measured the ACD in 318 eyes of 318 patients who had been diagnosed by ultrasound biomicroscopy as having either pupillary block or Plateau Iris Syndrome. Pupillary block patients were all preiridotomy and Plateau Iris patients were all postiridotomy. Anterior chamber depth was measured axially from the internal corneal surface to the lens surface using the ultrasound instrument's internal measuring capability. RESULTS: The mean ACD in patients with Plateau Iris Syndrome (n = 181) was significantly smaller than the hypothesized normal ACD (2.04 +/- 0.30 mm vs 3.0 mm, P =.0001). The mean ACD in patients with pupillary block (n = 137) was also significantly smaller than the hypothesized normal ACD (2.17 +/- 0.30 mm vs 3.0 mm, P =.0001). The mean ACD in patients with Plateau Iris Syndrome was significantly smaller than the ACD in patients with pupillary block (2.04 +/- 0.30 mm vs 2.17 +/- 0.30 mm, P =.001). CONCLUSIONS: Review of the literature suggests that patients with Plateau Iris have a normal or deeper axial ACD compared with pupillary block. This study found that the ACD associated with Plateau Iris Syndrome is shallower than normal and also shallower than in pupillary block.

  • Plateau Iris Syndrome changes in angle opening associated with dark light and pilocarpine administration
    American Journal of Ophthalmology, 1999
    Co-Authors: Charles J. Pavlin, Stuart F Foster
    Abstract:

    Abstract PURPOSE: To report changes in angle configuration associated with dark, light, and pilocarpine administration in Plateau Iris Syndrome. METHOD: In 10 eyes of 10 patients with Plateau Iris Syndrome and persistent narrow angles after patent peripheral Nd:YAG laser iridotomy, ultrasound biomicroscopy was used to image variations in angle opening, Iris thickness, and trabecular-ciliary process distance. Measurements were taken in the dark, in full room light, and after administration of pilocarpine 2%. RESULTS: Average angle opening distance increased in the light compared with the dark (113 ± 34 μm vs 22 ± 34 μm, P = .0001) and increased further after pilocarpine administration (171 ± 52 μm vs 113 ± 34 μm, P = .0034). Average Iris thickness decreased in the light compared with the dark (338 ± 34 μm vs 436 ± 58 μm, P = .0009) and decreased further after pilocarpine administration (253 ± 48 μm vs 338 ± 34 μm, P = .0002). Average trabecular meshwork–ciliary process distance measurements were smaller than normal and did not change significantly in the light compared with the dark (481 ± 42 μm vs 464 ± 44 μm, P = .4001) or after pilocarpine administration compared with light (451 ± 67 μm vs 481 ± 42 μm, P = .1304). CONCLUSIONS: In Plateau Iris Syndrome, anteriorly located ciliary processes support the peripheral Iris. Changes in angle opening in dark and light are solely related to changes in Iris thickness. Pilocarpine produces Iris thinning and is an effective method of opening the angle. Ultrasound biomicroscopy can be used to perform a darkroom provocative test, which provides information on whether the angle anatomically closes in the dark.

  • ultrasound biomicroscopy in Plateau Iris Syndrome
    American Journal of Ophthalmology, 1992
    Co-Authors: Charles J. Pavlin, Robert Ritch, Stuart F Foster
    Abstract:

    Ultrasound biomicroscopy is a new technique that uses high-frequency ultrasound (50 to 100 MHz) to produce images of the entire anterior segment at high resolution (20 to 50 μm). The iridocorneal angle, Iris, ciliary body, and posterior chamber can be imaged in detail and the dimensions and anatomic relationships of these structures determined. Plateau Iris Syndrome is a condition in which the angle remains appositionally closed or occludable after iridectomy for angle-closure glaucoma. How the Iris remains in a position that allows it to occlude the angle has been uncertain. We performed ultrasound biomicroscopy eye examinations on eight patients with clinically diagnosed Plateau Iris Syndrome. In all the patients, ciliary processes were situated anteriorly compared to the position in normal subjects and in patients with angle closure caused by pupillary block. The ciliary processes provide structural support beneath the peripheral Iris, preventing the Iris root from falling away from the trabecular meshwork after iridectomy.

Kaweh Mansouri - One of the best experts on this subject based on the ideXlab platform.

  • pattern scanning laser pascal for peripheral iridoplasty in eyes with Plateau Iris Syndrome a novel application
    Journal of Glaucoma, 2018
    Co-Authors: Neha Midha, Kirsten Hoskens, Kaweh Mansouri
    Abstract:

    PURPOSE: The purpose of this study was to evaluate safety and efficacy of pattern scanning laser (PASCAL) for peripheral iridoplasty in eyes with Plateau Iris Syndrome. MATERIALS AND METHODS: This study was a retrospective review of cases that underwent PASCAL laser peripheral iridoplasty. Eyes with Plateau Iris Syndrome confirmed on gonioscopy and ultrasound biomicroscopy were included in the study. Primary and secondary outcome measures were angle widening on gonioscopy and magnitude of intraocular pressure (IOP) reduction, respectively. RESULTS: Twelve eyes of 8 patients that completed 1-year follow-up were analyzed. Angle widening was noted in 46% of treated quadrants by at least 1 grade (Shaffer classification) at 1-month follow-up. A statistically significant IOP reduction was noted at 1 year from 20.6±4.8 to 17.8±3.8 mm Hg (P=0.01). At 1 month, 8 of 12 eyes (66.6%) achieved gonioscopic success (widening of the angle by at least 1 grade in 2 of 4 quadrants). At 1 year, 6 of 12 eyes (50%) achieved tonometric success (20% reduction or 3 mm Hg IOP reduction from the baseline without addition of new antiglaucoma medications). No adverse effects associated with PASCAL laser peripheral iridoplasty were observed. CONCLUSIONS: PASCAL laser iridoplasty can be a safe and effective alternative to argon laser peripheral iridoplasty in the management of eyes with Plateau Iris Syndrome. Our findings need to be further validated on larger sample size and in different ethnicities.

  • pattern scanning laser pascal for peripheral iridoplasty in eyes with Plateau Iris Syndrome a novel application
    Journal of Glaucoma, 2018
    Co-Authors: Neha Midha, Kirsten Hoskens, Kaweh Mansouri
    Abstract:

    PURPOSE: The purpose of this study was to evaluate safety and efficacy of pattern scanning laser (PASCAL) for peripheral iridoplasty in eyes with Plateau Iris Syndrome. MATERIALS AND METHODS: This study was a retrospective review of cases that underwent PASCAL laser peripheral iridoplasty. Eyes with Plateau Iris Syndrome confirmed on gonioscopy and ultrasound biomicroscopy were included in the study. Primary and secondary outcome measures were angle widening on gonioscopy and magnitude of intraocular pressure (IOP) reduction, respectively. RESULTS: Twelve eyes of 8 patients that completed 1-year follow-up were analyzed. Angle widening was noted in 46% of treated quadrants by at least 1 grade (Shaffer classification) at 1-month follow-up. A statistically significant IOP reduction was noted at 1 year from 20.6±4.8 to 17.8±3.8 mm Hg (P=0.01). At 1 month, 8 of 12 eyes (66.6%) achieved gonioscopic success (widening of the angle by at least 1 grade in 2 of 4 quadrants). At 1 year, 6 of 12 eyes (50%) achieved tonometric success (20% reduction or 3 mm Hg IOP reduction from the baseline without addition of new antiglaucoma medications). No adverse effects associated with PASCAL laser peripheral iridoplasty were observed. CONCLUSIONS: PASCAL laser iridoplasty can be a safe and effective alternative to argon laser peripheral iridoplasty in the management of eyes with Plateau Iris Syndrome. Our findings need to be further validated on larger sample size and in different ethnicities.