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Editors Selection IGR 17-3
Gonioscopy: Double hump sign in plateau iris
Comment by Robert Ritch & Syril Dorairaj on:
22702 Double hump sign in indentation gonioscopy is correlated with presence of plateau iris configuration regardless of patent iridotomy, Kiuchi Y; Kanamoto T; Nakamura T, Journal of Glaucoma, 2009; 18: 161-164
Kiuchi et al. (265) conclude that the double hump sign observed on indentation gonioscopy strongly correlates with the presence of plateau iris and is thus a useful indicator of plateau iris configuration regardless of the patency of a laser iridotomy. It should be remembered that plateau iris configuration is an anatomic diagnosis and that plateau iris syndrome can be diagnosed only after laser iridotomy has been performed to eliminate any element of pupillary block. Plateau iris syndrome indicates spontaneous or pharmacologically induced iridotrabecular contact after pupillary block has been eliminated. Also, in eyes with plateau iris, the ciliary processes are not actually rotated anteriorly, as one would find in malignant glaucoma, in which a supraciliary effusion causes this to happen, but are large and/or anteriorly and centrally positioned.
A double hump sign on indentation gonioscopy is pathognomonic for plateau irisThe double hump sign results from the fact that the large ciliary processes resist displacement during indentation gonioscopy, so that the deepest point of indentation seen using the slit beam occurs at the periphery of the lens, where the iris is displaced into the small posterior chamber, and then the beam climbs again over the ciliary processes, causing the second hump. The authors are correct that plateau iris configuration can be detected without resorting to UBM and have adequately proven this in this series of patients. A double hump sign is pathognomonic for plateau iris and is commonly associated with deep central anterior chambers in younger patients, in whom plateau iris classically occurs, but may not be in older patients who also have pupillary block.
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