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Plateau Iris Glaucoma Medication

  • Author: Jim C Wang (王崇安), MD; Chief Editor: Hampton Roy, Sr, MD  more...
 
Updated: May 06, 2016
 

Medication Summary

Treatment of plateau iris is primarily surgical. However, in patients whose anterior chamber angles remain occludable after properly performed iridotomy and laser peripheral iridoplasty, miotic therapy may be used to prevent angle closure.

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Miotics

Class Summary

Miotic agents cause the pupillary sphincter to contract, mechanically pulling the iris away from the trabecular meshwork and opening the anterior chamber angle. In addition, these agents also have an IOP-lowering effect by stimulating contraction of the ciliary muscle and thereby increasing trabecular outflow of aqueous humor. Induced myopia, pupillary constriction, brow ache, and retinal detachment are potential adverse effects of this therapy.

Pilocarpine ophthalmic (Pilocar, Piloptic, Pilostat, Akarpine, Ocusert Pilo-40)

 

Commercially available as an ophthalmic solution, daily dosing gel, and sustained-release membranes (Ocusert). The symptoms of induced myopia and miosis are best tolerated with the sustained-release Ocusert.

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Contributor Information and Disclosures
Author

Jim C Wang (王崇安), MD Vitreo-Retinal and Cornea/Anterior Segment Subspecialist, Department of Ophthalmology, Kaiser Permanente Fontana Medical Center

Jim C Wang (王崇安), MD is a member of the following medical societies: American Academy of Ophthalmology, American Society of Retina Specialists, American Society of Cataract and Refractive Surgery

Disclosure: Nothing to disclose.

Coauthor(s)

Robert Ritch, MD Shelley and Steven Einhorn Distinguished Chair in Ophthalmology, Chief of Glaucoma Service, Surgeon Director, Professor, Department of Ophthalmology, New York Eye and Ear Infirmary, New York Medical College

Robert Ritch, MD is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, American Medical Association, American Ophthalmological Society, Chinese American Medical Society, International College of Surgeons, New York Academy of Medicine, New York Academy of Sciences

Disclosure: Received none from Sensimed for board membership; Received none from iSonic Medical for board membership; Received consulting fee from Aeon Astron for consulting; Received honoraria from Pfizer for speaking and teaching; Received honoraria from Allergan for speaking and teaching; Received honoraria from Ministry of Health of Kuwait for speaking and teaching; Received honoraria from Aeon Astron for speaking and teaching; Received royalty from Ocular Instruments for other.

Paul S Lee, MD Clinical Assistant Professor, Department of Ophthalmology, Mount Sinai School of Medicine; Chief of Ophthalmology, James J. Peters Veterans Affairs Medical Center; Associate Adjunct Surgeon, New York Eye and Ear Infirmary

Paul S Lee, MD is a member of the following medical societies: American Academy of Ophthalmology, American Society of Cataract and Refractive Surgery

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Martin B Wax, MD Professor, Department of Ophthalmology, University of Texas Southwestern Medical School; Vice President, Research and Development, Head, Ophthalmology Discovery Research and Preclinical Sciences, Alcon Laboratories, Inc

Martin B Wax, MD is a member of the following medical societies: American Academy of Ophthalmology, American Glaucoma Society, Society for Neuroscience

Disclosure: Nothing to disclose.

Chief Editor

Hampton Roy, Sr, MD Associate Clinical Professor, Department of Ophthalmology, University of Arkansas for Medical Sciences

Hampton Roy, Sr, MD is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, Pan-American Association of Ophthalmology

Disclosure: Nothing to disclose.

Additional Contributors

Bradford Shingleton, MD Assistant Clinical Professor of Ophthalmology, Harvard Medical School; Consulting Staff, Department of Ophthalmology, Massachusetts Eye and Ear Infirmary

Bradford Shingleton, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Ophthalmology

Disclosure: Nothing to disclose.

Acknowledgements

Celso Tello, MD Clinical Assistant Professor, Department of Ophthalmology, New York Eye and Ear Infirmary

Celso Tello, MD is a member of the following medical societies: American Academy of Ophthalmology, American Medical Association, and New York Academy of Sciences

Disclosure: Nothing to disclose.

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Ultrasound biomicroscopy. (A) In plateau iris, the anterior position of the ciliary body holds the peripheral iris against the trabecular meshwork. (B) The angle is obstructed further in the dark as the peripheral iris thickens with physiologic pupillary dilation.
Ultrasound biomicroscopy, plateau iris syndrome. (A) Appositional anterior chamber angle in dark condition prior to laser iridotomy. (B) After laser iridotomy, the angle remains occludable. (C) After peripheral laser iridoplasty, the peripheral iris is thinned, opening the angle and significantly reducing the risk of closure.
 
 
 
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