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BLOG: Single-pass four-throw pupilloplasty for angle closure glaucoma
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There are various laser and surgical treatments that guide the management of angle closure glaucoma.
In select cases of angle closure glaucoma such as plateau iris, Urrets-Zavalia syndrome and chronic angle closures with peripheral anterior synechiae (PAS), surgical pupilloplasty can be performed with good results. Performing a surgical pupilloplasty prevents the iris from falling back into the periphery, and the constant stretch induced by the mechanical pull helps to break the PAS, as documented in our study in which single-pass four-throw pupilloplasty (SFT) was performed with good results. However, surgical pupilloplasty cannot be performed in a phakic eye due to the potential of inducing damage to the lens. Nevertheless, lens extraction is in itself one of the modalities for treatment of angle closure glaucoma, and when the lens removal is planned, a surgical pupilloplasty can be performed.
The video demonstrates a case of intumescent cataract with closed peripheral anterior chamber angles that had PAS on gonioscopy. After lens removal and IOL placement, SFT was performed for this case and the angles opened up that were detected on OCT as well as on gonioscopy.