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Angle closure associated with a cobblestone iris configuration: clinical and imaging description.
Tiago S Prata1, Luis G Biteli, Syril Dorairaj
1*Department of Ophthalmology, Glaucoma Service, Federal University of São Paulo †Glaucoma Service, Hospital Medicina dos Olhos, São Paulo, Brazil ‡Department of Ophthalmology, Glaucoma Service, Mayo Clinic, Jacksonville, FL.
Journal of Glaucoma
|November 19, 2013
Summary
This case report describes a unique peripheral iris anatomy causing primary angle closure glaucoma. The abnormally thick iris, resembling a cobblestone, can obstruct aqueous outflow despite patent iridotomies.
Area of Science:
- Ophthalmology
- Anatomy
- Glaucoma Research
Background:
- Primary angle closure glaucoma (PACG) is a significant cause of vision loss.
- Understanding the diverse mechanisms of PACG is crucial for effective management.
Observation:
- A case report detailing a patient with primary angle closure.
- The patient presented with an unusually thick peripheral iris, exhibiting a cobblestone-like cross-sectional shape.
- Anterior segment optical coherence tomography (AS-OCT) visualized this unique iris morphology.
Findings:
- Despite patent laser peripheral iridotomies, the patient exhibited 360-degree narrow angles and occludable angles on gonioscopy.
- AS-OCT and ultrasound biomicroscopy (UBM) confirmed an abnormally thick peripheral iris with a rectangular cross-section, distinct from typical thick peripheral iris rolls.
- Laser peripheral iridoplasty successfully relieved the angle closure.
Implications:
- This distinct peripheral iris anatomy represents a non-pupillary block mechanism contributing to PACG.
- Awareness of this cobblestone iris morphology is vital for clinicians managing angle closure, even with patent iridotomies.
- Further research into this anatomical variant may elucidate novel therapeutic strategies for PACG.
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