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Editors Selection IGR 17-4

Clinical forms of glaucoma: UBM for (pseudo) plateau iris

Comment by Celso Tello & Pat-Michael Palmiero on:

20780 Clinical features distinguishing angle closure from pseudoplateau versus plateau iris, Shukla S; Damji KF; Harasymowycz P et al., British Journal of Ophthalmology, 2008; 92: 340-344

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In 1958, Törnquist coined the term plateau iris (PI) in a young patient with angle-closure and elevated intraocular pressure. Plateau iris syndrome is a common cause of anatomic narrow angles in patients under 50 years old and results from a large or anteriorly positioned ciliary body that maintains the iris root in proximity to the trabecular meshwork causing iridotrabecular apposition that is not alleviated by a peripheral iridotomy. Clinically on indentation gonioscopy a 'double-hump' sign is present, where the iris follows the convexity of the anterior lens capsule, dips posteriorly into the posterior chamber and rises over the anteriorly positioned ciliary processes. Pseudoplateau iris (PPI) is a rare entity classified by lesions that cause enlargement of the iridociliary junction producing a similar clinical appearance as PI. Although iridociliary cysts are more common, other etiologies of PPI may arise from ciliary body tumors or inflammation. In their retrospective cohort study, Shukla et al. (257) evaluated the clinical aspects of 76 patients with the diagnosis of PI (n = 55) or PPI (n = 21) made by ultrasound biomicroscopy (UBM) to determine if there were any clinical factors that can help differentiate between these two entities. They found no clinical factors that appeared to discriminate between the two except, concluded that younger males with a bumpy peripheral iris have a higher likelihood of having a diagnosis of PPI than PI. They also concluded that UBM still remains an extremely helpful tool in confirming the diagnosis. This is an interesting article where the authors attempted to clinically differentiate between PI and PPI. However, a prospective population-based study with a larger sample size can help confirm an increased male preponderance in PPI compared to PI patients. It would be interesting to note the classification (primary vs. secondary cysts), location, size and number of cysts.

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