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Plateau iris syndrome indication for endocycloplasty
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NEW ORLEANS — Plateau iris syndrome is an indication for improving angle architecture with endocycloplasty, which shrinks the ciliary processes, Ramesh S. Ayyala, MD, told colleagues at Glaucoma Day preceding the American Society of Cataract and Refractive Surgery meeting.
“Endocycloplasty has been used primarily as an adjunct with phacoemulsification cataract extraction and may be indicated for plateau iris if ciliary processes are directed anteriorly,” Ayyala said.
Ramesh S. Ayyala
Plateau iris syndrome is associated with anterior iris insertion, and angle closure is most often caused by anteriorly positioned ciliary processes. Diagnosis is made only by gonioscopy or ultrasound.
In performing endocycloplasty, laser energy is directed at the posterior portion of the ciliary process to cause shrinkage and concurrent retraction of the process and iris root posteriorly, thereby opening the angle, Ayyala said.
Ayyala said he uses the E2 diode laser endoscope system (Endo Optiks/Beaver-Visitec) at 0.3 W power on a continuous setting using a spray painting technique to paint the processes starting at the posterior or middle portion of the ciliary processes and “shooting away from the iris root,” treating as much of the ciliary processes as possible and following with an anterior chamber washout.
“I like to inject diluted Kenalog (triamcinolone acetonide, Bristol-Myers Squibb) into the ciliary space to reduce the postoperative inflammation, which can be substantial, especially in the African-American population,” Ayyala said. – by Patricia Nale, ELS
Reference:
Ayyala RS. Opening the angle with ECP: When is it necessary? Presented at: American Society of Cataract and Refractive Surgery meeting; May 6-10, 2016. New Orleans, Louisiana.
Disclosure: Ayyala reports relative financial disclosures.