A Case of Plateau Iris Syndrome: A Diagnosis and Management Dilemma

This is a case report of primary angle-closure glaucoma (PACG) with persistent high intraocular pressure (IOP) despite patent laser peripheral iridotomy (LPI) and treated with argon laser peripheral iridoplasty (ALPI) possibly due to plateau iris syndrome. A 49-year-old gentleman with underlying hypertension, subclinical hypothyroidism, seizure, and ocular history of bilateral normotensive glaucoma (NTG) on topical latanoprost 0.005% every night (ON) presented with acute onset of left eye pain and redness. His IOP was found to be high with shallow anterior chamber depth and the presence of mild cataract. He was initially diagnosed with bilateral eye PACG and started with four topical antiglaucoma medications; subsequently, LPI was commenced. At subsequent follow-up, the patient reported persistent occipital headache. The IOP remained high despite compliance with all topical medications and having the enlarged patent PI over both eyes. Ultrasound biomicroscopy (UBM) was done and showed the possibility of plateau iris syndrome. He was treated with ALPI, and the IOP was reducing in trend; however, it still did not reach the optimum level. He subsequently underwent left eye phacoemulsification with intraocular lens (IOL) implantation. IOP of both eyes subsequently was able to reach the optimum level with a reduction in the number of antiglaucoma eyedrops used. Managing plateau iris syndrome may require a combination of therapies to effectively lower the IOP. ALPI may not solely be as effective as its combination with cataract removal surgery in managing plateau iris syndrome.