Effectiveness of Argon Laser Peripheral Iridoplasty in Plateau Iris Syndrome Patients after Laser Peripheral Iridotomy

Objective: There is controversy surrounding the next best step in treating plateau iris syndrome (PIS) patients with persistent angle dysfunction despite a patent laser peripheral iridotomy (LPI). The aim of this study was to examine the effectiveness of argon laser peripheral iridoplasty (ALPI) in PIS patients with a patent LPI. Methods: Retrospective review of medical records in consecutive patients that underwent ALPI to treat persistently narrow angles due to underlying PIS after a patent LPI. Patients in whom angle configuration could not be ascertained by review of medical records, those with less than 12 months follow-up at our institution, or those younger than 18 years of age were excluded. Kaplan-Meier survival analysis was used to determine treatment survival time. Paired t-tests were used to compare intraocular pressure (IOP), number of glaucoma medications, and bestcorrected visual acuity (BCVA) 12 months post-ALPI and at the last follow-up visit. Results: Fifty-one eyes of 51 patients were included in the analysis. The median survival time for a successful ALPI procedure was 1023 days (34.1 months). The majority of failure events were attributed to cataract extraction to open a persistently narrow angle, performed at approximately 934 (± 694) days (31.1 months) after ALPI. No changes in IOP, number of glaucoma medications, or BCVA from baseline were observed after 12 months or at last follow-up. Conclusion: ALPI is a potentially effective treatment for PIS following LPI. While angle dysfunction may re-emerge over time, ALPI can potentially delay the need for lensectomy in patients without visually significant cataracts.