Background

Plateau iris is one of the most common angle-closure glaucomas presenting in younger patients. This condition is characterized by closing of the anterior chamber angle secondary to a large or anteriorly positioned ciliary body that mechanically alters the position of the peripheral iris in relation to the trabecular meshwork.

Pathophysiology

In plateau iris configuration, the pars plicata may be large and anteriorly positioned, mechanically positioning the peripheral iris against the trabecular meshwork. In addition, the iris root is inserted anteriorly on the ciliary face further crowding the anterior chamber angle. The iris crowding of the angle obstructs aqueous flow via the trabecular meshwork and may lead to angle-closure glaucoma.

Except in the rare younger patients (age 20-30s), some degree of pupillary block also is present. Because a component of pupillary block may exist in patients with plateau iris configuration, laser iridotomy should always be performed as the first intervention. If the angle remains capable of closure despite a patent iridotomy, the condition is termed plateau iris syndrome.

A high prevalence of plateau iris configuration and plateau iris syndrome has been reported in relatives of patients with plateau iris syndrome. An autosomal dominant inheritance pattern with incomplete penetrance has also been suggested.^[1]

Frequency

United States

The exact prevalence of plateau iris is unknown. A 2016 study found that one third of eyes with primary angle-closure glaucoma had plateau iris.^[2]In another report, it accounted for more than half of recurrent angle closure cases in young patients.^[3]The diagnosis of plateau iris should be suspected when angle closure occurs in patients who are young or myopic and when angle narrowing persists despite iridotomy.

International

A study from Singapore reported that although plateau iris represents 32% of early-to-moderate primary angle glaucoma, it accounts for 50% of severe primary angle glaucoma.^[4] Another study found that 20% of Japanese patients with primary angle closure after laser iridotomy had plateau iris based on ultrasound biomicroscopy.^[5]

Mortality/Morbidity

Plateau iris is an important cause of angle-closure glaucoma in patients younger than 50 years.

Race

Studies reported no difference in prevalence of plateau iris between whites and Asians.^{[6, 7]}

Sex

Plateau iris is seen most commonly in women.

Age

Patients with plateau iris usually are younger than those with primary angle-closure (relative pupillary block) glaucoma.

Clinical Presentation

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Mansoori T, Sarvepally VK, Balakrishna N. Plateau Iris in Primary Angle Closure Glaucoma: An Ultrasound Biomicroscopy Study. J Glaucoma. 2016 Feb;25(2):e82-6.:[QxMD MEDLINE Link].
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Mochizuki H, Takenaka J, Sugimoto Y, Takamatsu M, Kiuchi Y. Comparison of the prevalence of plateau iris configurations between angle-closure glaucoma and open-angle glaucoma using ultrasound biomicroscopy. J Glaucoma. 2011 Jun-Jul. 20(5):315-8. [QxMD MEDLINE Link].
Diniz Filho A, Cronemberger S, Ferreira DM, Mérula RV, Calixto N. Plateau iris configuration in eyes with narrow-angle: an ultrasound biomicroscopic study. Arq Bras Oftalmol. 2010 Mar-Apr. 73(2):155-60. [QxMD MEDLINE Link].
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Media Gallery

Ultrasound biomicroscopy. (A) In plateau iris, the anterior position of the ciliary body holds the peripheral iris against the trabecular meshwork. (B) The angle is obstructed further in the dark as the peripheral iris thickens with physiologic pupillary dilation.
Ultrasound biomicroscopy, plateau iris syndrome. (A) Appositional anterior chamber angle in dark condition prior to laser iridotomy. (B) After laser iridotomy, the angle remains occludable. (C) After peripheral laser iridoplasty, the peripheral iris is thinned, opening the angle and significantly reducing the risk of closure.

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Author

Jim C Wang (王崇安), MD Vitreo-Retinal and Cornea/Anterior Segment Subspecialist, Department of Ophthalmology, Kaiser Permanente Fontana Medical Center

Jim C Wang (王崇安), MD is a member of the following medical societies: American Academy of Ophthalmology, American Society of Retina Specialists, American Society of Cataract and Refractive Surgery

Disclosure: Nothing to disclose.

Coauthor(s)

Robert Ritch, MD, FACS, FARVO Shelley and Steven Einhorn Distinguished Chair in Ophthalmology, Professor of Ophthalmology, Surgeon Director Emeritus, New York Eye and Ear Infirmary of Mount Sinai

Robert Ritch, MD, FACS, FARVO is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, American Medical Association, American Ophthalmological Society, Chinese American Medical Society, International College of Surgeons, New York Academy of Medicine, New York Academy of Sciences

Disclosure: Received none from Sensimed for board membership; Received none from iSonic Medical for board membership; Received consulting fee from Aeon Astron for consulting; Received honoraria from Pfizer for speaking and teaching; Received honoraria from Allergan for speaking and teaching; Received honoraria from Ministry of Health of Kuwait for speaking and teaching; Received honoraria from Aeon Astron for speaking and teaching; Received royalty from Ocular Instruments for other.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Martin B Wax, MD Professor, Department of Ophthalmology, University of Texas Southwestern Medical School; Vice President, Research and Development, Head, Ophthalmology Discovery Research and Preclinical Sciences, Alcon Laboratories, Inc

Martin B Wax, MD is a member of the following medical societies: American Academy of Ophthalmology, American Glaucoma Society, Society for Neuroscience

Disclosure: Nothing to disclose.

Chief Editor

Hampton Roy, Sr, MD † Associate Clinical Professor, Department of Ophthalmology, University of Arkansas for Medical Sciences

Hampton Roy, Sr, MD is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, Pan-American Association of Ophthalmology

Disclosure: Nothing to disclose.

Additional Contributors

Bradford Shingleton, MD Assistant Clinical Professor of Ophthalmology, Harvard Medical School; Consulting Staff, Department of Ophthalmology, Massachusetts Eye and Ear Infirmary

Bradford Shingleton, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Ophthalmology

Disclosure: Nothing to disclose.

Paul S Lee, MD Clinical Assistant Professor, Department of Ophthalmology, Icahn School of Medicine at Mount Sinai; Chief of Ophthalmology, James J Peters Veterans Affairs Medical Center; Associate Adjunct Surgeon, New York Eye and Ear Infirmary

Paul S Lee, MD is a member of the following medical societies: American Academy of Ophthalmology, American Society of Cataract and Refractive Surgery

Disclosure: Nothing to disclose.

Acknowledgements

Celso Tello, MD Clinical Assistant Professor, Department of Ophthalmology, New York Eye and Ear Infirmary

Celso Tello, MD is a member of the following medical societies: American Academy of Ophthalmology, American Medical Association, and New York Academy of Sciences

Disclosure: Nothing to disclose.