Angle Closure with Patent Laser Peripheral Iridotomy - An Unusual Complication

Area of Science:

• Ophthalmology
• Glaucoma Research

Background:

• Angle-closure glaucoma (ACG) is a significant cause of vision loss.
• Primary angle closure (PAC) and primary angle-closure glaucoma (PACG) require prompt management to prevent optic nerve damage.

Observation:

• A 41-year-old female presented with symptoms suggestive of ACG and PAC.
• Initial treatment included anti-glaucoma medications and bilateral laser peripheral iridotomy (LPI).
• Despite patent LPIs, the patient experienced recurrent angle closure, particularly in the right eye, and developed significant optic nerve cupping in the left eye.

Findings:

• The patient's recurrent angle closure was attributed to plateau iris configuration, an anatomical variant.
• Even with patent LPIs, plateau iris configuration can predispose individuals to angle closure and elevated intraocular pressure (IOP).
• Surgical intervention (trabeculectomy with cataract surgery) was required for the right eye to restore vision and control IOP.

Implications:

• Patent LPI is not a guaranteed preventative measure against angle closure, especially in anatomically predisposed individuals.
• Clinicians must remain aware of anatomical variants like plateau iris configuration and their implications for glaucoma management.
• Comprehensive management strategies are crucial, considering potential complications beyond standard LPI efficacy.