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Endoscopic Cycloplasty With Phacoemulsification Effective in Treating Recalcitrant Angle Closure Secondary to Plateau Iris: Presented at COS By Louise Gagnon TORONTO -- June 24, 2009 -- Endoscopic cycloplasty (ECPL) can be used in conjunction with phacoemulsification to treat recalcitrant angle closure secondary to plateau iris, according to research presented here at the 72nd Annual Meeting and Exhibition of the Canadian Ophthalmological Society (COS). “Normally patients with plateau-iris configurations have a glaucomatous angle of closure,” said Dominik Podbielski, MD, University of Toronto, Toronto, Ontario, on June 22. “They are recalcitrant to any previous treatment with glaucoma medications.” Treatments such as laser peripheral iridotomy or lens removal do not address the angle closure that plateau-iris syndrome creates, noted Dr. Podbielski. During ECPL, laser is applied to the posterior part of the ciliary body as opposed to the entire ciliary body. “We wanted to see if the ciliary processes would contract back and open up the angle in patients,” said Dr. Podbielski. The researchers retrospectively reviewed 31 consecutive eyes that were treated with phacoemulsification and 270 degrees of ECPL for recalcitrant angle closure that was secondary to plateau iris. They collected demographic data about the patients such as ocular history, indications for surgery, and the presence of intraoperative and postoperative complications. At 3 months postoperation, mean intraocular pressure fell from 18.0 to 13.3 mm Hg. The average number of glaucoma medications also fell from 1.7 to 0.8, and the mean nasal angle widened from 0.96 to 2.77 on gonioscopy (P < .005 for all). In addition, investigators used ultrasound biomicroscopy to capture the ciliary processes and view changes in the anterior chamber. The analysis showed few complications with ECPL, and the complications that did occur were not significant, according to Dr. Podbielski. “There were cases of some oedema and inflammation, but there were no cases of hypotony,” he noted. Dr. Podbielski and colleagues plan to conduct a prospective trial that will likely compare the outcome of phacoemulsification alone with combination treatment of phacoemulsification and ECPL. [Presentation title: Endoscopic Cycloplasty (ECPL) in Angle Closure Glaucoma Secondary to Plateau Iris. Abstract 4] E-mail this page to a friend or colleague! To print, use this version