Long-term success of argon laser peripheral iridoplasty in the management of plateau iris syndrome

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.