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Laser Surgery in the Treatment of Glaucoma
Published in Neil T. Choplin, Carlo E. Traverso, Atlas of Glaucoma, 2014
Selected narrow angles may be widened by peripheral iridoplasty, particularly if the configuration is one of plateau iris and the narrowing is not due to pupillary block. In current practice, iridoplasty is performed by inducing a deep thermal contraction burn in iris stroma, causing mechanical retraction from the filtering angle by flattening of the peripheral iris contour and increased space secondary to tissue atrophy (Figure 15.15). The laser parameters chosen to facilitate this type of laser–tissue interaction are long burns (0.5 s), large spot size (500 μm), and low power (200–350 mW). If bubble formation occurs, the operator should stop energy application in mid-pulse and decrease continuous-wave power. The laser energy can be delivered through a laser peripheral iridectomy lens to the most peripheral portion of the iris that is accessible with pilocarpine pretreatment. Six to seven spots are placed per quadrant with 500 μm (one laser spot) spacing. In cases of plateau iris or nanophthalmos, the laser light may need to be delivered even more peripherally, and a goniolens will facilitate this. In this case, the spot size should be reduced to 200 μm. In general, eyes with more chromophore (dark irides) will require less continuous-wave power than lighter irides. Iridoplasty is also a useful adjunct for cases that retain an appositional closure of the filtering angle after iridectomy or in cases in which an iridectomy cannot be initially created. Iridoplasty may also be useful to facilitate the performance of laser trabeculoplasty in eyes with a plateau iris configuration.
The treatment of refractory angle-closure glaucoma in a patient with X-linked juvenile retinoschisis
Published in Ophthalmic Genetics, 2018
Sancy Low, Ryian Mohamed, Michelle Ting, Andrew R. Webster, David F. Garway-Heath
According to Ritch’s anatomical classification of angle-closure (pupil block, plateau iris/non-pupil block, lens-induced angle-closure, and retrolenticular causes) (2), this patient is unusual as his mixed-mechanism angle-closure glaucoma included all four levels of block (Figure 1). Our patient underwent systematic investigation and treatment to exclude each of these levels of angle-closure. After failure of initial medical treatment, he underwent a laser peripheral iridotomy to relieve any pupil block component. An anterior segment optical coherence tomography scan was able to rule out plateau iris configuration and confirmed the clinical finding that the crystalline lens was bulging anteriorly. The B-scan ultrasound showed heavy calcification in the area of chronic exudative retinal detachment.
Urrets-Zavalia Like Syndrome, as a Complication of Sickle Cell Disease
Published in Ocular Immunology and Inflammation, 2019
Seyed Ali Tabatabaei, Mirataollah Salabati, Mohammad Soleimani
Since the first introduction of UZS, more than 110 cases of this syndrome have been reported with a mean age of approximately 46 years old. The most common surgical intervention associated with UZS was PK with 51.8% of these cases followed by DALK (18.1%), ALPI (8.2%), DSAEK (8.2%), cataract surgery (8.2%), phakic IOL implantation (2.7%), Trabx (1.9%), goniotomy (0.9%), and after injection of C3F8 into the anterior chamber for treating acute corneal hydrops (0.9%).2 Most patients were diagnosed with keratoconus (45.2%) followed by stromal dystrophies (23.7%), Fuchs’ dystrophy (9.4%), senile cataract (8.5%), plateau iris syndrome (8.5%), high myopia (1.9%), primary open-angle glaucoma (1.9%), and congenital glaucoma (0.9%).2 Mydriatic drops were used during or after surgery in 26% of cases and IOP was found to be increased in 59.1% of the subjects within the first post-operative day.2 The presented patient was preciously diagnosed as sickle cell thalassemia with recurrent crises. On examination the patient had bilateral fixed dilated pupils that warranted further evaluation, upon which, an increased IOP and peripheral anterior synechiae in both eyes and ischemia of the iris in the right eye were appreciated. Although Sickle cell disease can cause microvascular occlusions leading to iris ischemia and secondary pupillary sphincter atrophy resulting in mydriasis, anterior chamber inflammation and secondary glaucoma3, there were not any peripheral retinal changes in wide-field fundus fluorescein angiography; therefore, we could correlate these symptoms to a Urrets-Zavalia like syndrome.
Imaging of the Ciliary Body: A Major Review
Published in Seminars in Ophthalmology, 2022
Gazella Bruce Warjri, Sirisha Senthil
PubMed, Science Direct, Cochrane Library and Google Scholar were searched for relevant keywords. The search string included one or a combination of the following terms: ultrasound biomicroscopy, ciliary body, ciliary processes, ciliary muscle, anterior chamber angle, ciliary body imaging, ciliary body glaucoma, angle closure glaucoma, normal ciliary body, secondary glaucoma, laser peripheral iridotomy, plateau iris syndrome, malignant glaucoma, ciliary body diabetic retinopathy, ciliary body myopia, ciliary body accommodation, ciliary body hypermetropia, ciliary body transscleral cyclophotocoagulation, anterior segment optical coherence tomography ciliary body, ASOCT ciliary body, spectral domain ASOCT ciliary body and ICL vault ciliary body.