Ophthalmology Times revisits plateau iris

Ophthalmology Times has revisited plateau iris as a source of persistent angle crowding and unexpected intraocular pressure behavior after peripheral iridotomy, drawing attention to a diagnosis that can remain hidden in routine angle-closure workups. The publication’s article, “An eye toward plateau iris and its implications,” recounts case-based teaching from Sayoko E. Moroi of The Ohio State University Wexner Medical Center. The piece says plateau iris can account for narrow angles, postoperative surprises and drug-related pressure events even when a laser peripheral iridotomy is patent. The article was originally published in 2021 and remains available on the site. ### Why does a patent iridotomy not always settle the angle question? Plateau iris syndrome is defined by a persistently narrow angle capable of closure despite a patent iridotomy, according to the American Academy of Ophthalmology’s EyeWiki and a 2023 review indexed by PubMed. Those sources describe a non-pupillary-block mechanism in which an anteriorly positioned or rotated ciliary body pushes the peripheral iris into the trabecular meshwork. (ophthalmologytimes.com) The AAO’s EyeNet article says the condition is typically diagnosed when a narrow angle persists after laser peripheral iridotomy, and it characterizes plateau iris configuration as an anatomic variant that can increase the risk of primary angle-closure glaucoma. Ophthalmology Times framed the same point through clinical cases in which prior assumptions about angle closure did not fully explain what happened next. (pubmed.ncbi.nlm.nih.gov) ### What clues did Moroi tell clinicians to watch for? Sayoko E. Moroi said plateau iris can be missed when it has an atypical appearance, according to the Ophthalmology Times report and its European edition counterpart. The article points to a persistently crowded angle after iridotomy, a flat or only moderately shallow central anterior chamber with a narrow peripheral chamber, and gonioscopic findings including a steep iris root approach and a double-hump sign. (aao.org) Ultrasound biomicroscopy was described in the article as Moroi’s preferred imaging method because it can visualize the lens and ciliary body, while anterior-segment optical coherence tomography has more limited ability to show the ciliary body. The 2023 review on PubMed likewise says diagnosis relies on gonioscopy and imaging modalities such as ultrasound biomicroscopy. (ophthalmologytimes.com) ### Which cases made the warning concrete? One Ophthalmology Times case involved a 60-year-old man with baseline visual acuity of 20/15 in both eyes, intraocular pressure of 14 mm Hg in the right eye and 11 mm Hg in the left, and angles that initially appeared open. The day after oral acetazolamide was given in a study, the article said, his visual acuity fell to 20/25 bilaterally, intraocular pressure rose to 36 and 35 mm Hg, and the angles were closed on examination. (europe.ophthalmologytimes.com) A second case in the same report involved a myopic shift after cataract surgery, which Moroi said should prompt consideration of plateau iris in some patients. The article linked that possibility to ciliochoroidal effusion mechanisms that may resemble topiramate-related events. ### How does this fit with other guidance on angle-closure management? A 2024 Review of Ophthalmology article said patients with plateau iris configuration can remain at risk of angle-closure attack after successful laser iridotomy, particularly with dilation. (ophthalmologytimes.com) That article described plateau iris and narrow angles as part of a clinical spectrum and said gonioscopy can help distinguish the different iris contour patterns. The BMJ Open Ophthalmology systematic review drew the same distinction between plateau iris configuration and plateau iris syndrome, reserving the syndrome label for persistent occludable angles after patent iridotomy. That nomenclature matters because the underlying mechanism is not fully removed by relieving pupillary block alone. ### Where can clinicians look next? The Ophthalmology Times article remains posted on the publication’s website, and the site’s journal archive lists current 2026 issues separately from older web features. (reviewofophthalmology.com) The American Academy of Ophthalmology also maintains EyeNet and EyeWiki guidance on diagnosis and management, including the role of gonioscopy and imaging after iridotomy when the angle still appears crowded. (ophthalmologytimes.com) (bmjophth.bmj.com)