Peripheral Iris Cerclage in Angle Closure Glaucoma: A Retrospective Pilot Study

To describe a novel surgical technique using peripheral iris cerclage (PIC) and evaluate clinical and anatomical outcomes in eyes with angle-closure glaucoma (ACG).

Single-center retrospective pilot study of 8 consecutive eyes (7 patients) with ACG at high risk of recurrence undergoing peripheral iris cerclage (2010-2025), with adjunctive procedures. Primary outcomes were postoperative Shaffer angle grade and peripheral anterior synechiae (PAS). Secondary outcomes included surgical success, intraocular pressure (IOP), and glaucoma medication use. Surgical success was defined as IOP ≤18 mmHg with ≥20% reduction from baseline, without clinical hypotony (IOP <6 mmHg accompanied by ≥2-line loss of visual acuity from baseline). Eyes that underwent surgical revision, reoperation or developed no light perception vision were classified as failures. Complete success required no glaucoma medications; qualified success permitted glaucoma medications.

Median Shaffer angle grading (interquartile range [IQR]) increased significantly from 0 (0-0) to 3 (3-3) (P=0.01), and PAS also significantly decreased in all eyes (P=0.03), with 6 eyes (75%) demonstrating no PAS. Postoperative imaging demonstrated relative thinning of the peripheral iris and widening of the angle. Median IOP decreased from 33.5 (31.2-43.5) mmHg to 12.0 (10-15) mmHg (p=0.01) and medication classes decreased from 4 (4-4) to 2 (1-3) (p=0.04). Two eyes (25.0%) achieved complete success, while 7 eyes (87.5%) achieved qualified success. No intraoperative complications occurred. One patient required secondary glaucoma surgery.

Peripheral iris cerclage was associated with sustained angle widening, favorable PAS outcomes, and substantial IOP reduction in this pilot series. This technique may serve as a useful adjunct in the surgical management of glaucoma, particularly in ACG eyes with flaccid iris tone, a high or thick iris insertion, and risk of recurrent synechiae.