In a patient with primary angle-closure glaucoma undergoing laser peripheral iridotomy, the procedure fails to deepen the anterior chamber angle. Subsequent gonioscopy reveals plateau iris syndrome. The most appropriate next management step is:

• A Trabeculectomy
• B Phacoemulsification and IOL implantation
• C Long-term miotic therapy with pilocarpine 4%
• D Argon laser peripheral iridoplasty ✓

Explanation

In plateau iris syndrome, the peripheral iris rests against the trabecular meshwork due to anteriorly positioned ciliary processes, even after patent iridotomy. Argon laser peripheral iridoplasty (ALPI) contracts the peripheral iris stroma, pulling it away from the angle and opening the drainage pathway. It is the specific treatment for plateau iris syndrome when LPI fails. Pilocarpine can temporarily help but is not the definitive treatment; trabeculectomy is reserved for IOP non-response to laser.

Reference: Khurana Comprehensive Ophthalmology, 7th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.