Introduction:

Iridoplasty is a surgical procedure used to modify the shape and position of the iris to address angle closure and improve aqueous humor outflow in certain types of glaucoma. This minimally invasive technique is primarily performed in cases of angle closure or plateau iris syndrome, conditions where the drainage angle of the eye is narrowed or occluded, leading to elevated intraocular pressure (IOP). In this article, we explore the indications, techniques, and outcomes of iridoplasty in the management of glaucoma.

Indications for Iridoplasty:

1. Angle Closure Glaucoma: In eyes with a narrow or occludable drainage angle, iridoplasty can help to widen the angle and restore aqueous outflow, reducing IOP.
2. Plateau Iris Syndrome: Plateau iris is characterized by a flat, anteriorly positioned ciliary body, leading to an abnormally configured iris root that can cause angle closure. Iridoplasty can create space between the peripheral iris and the trabecular meshwork, relieving angle crowding.

Techniques of Iridoplasty:

1. Laser Iridoplasty: This is the most common method used for iridoplasty. It involves using a laser, typically an argon or selective laser trabeculoplasty (SLT) laser, to deliver laser spots to the peripheral iris. The laser energy induces thermal changes in the iris stroma, causing localized contraction and bowing of the iris away from the trabecular meshwork.
2. Ultrasound Cycloplasty (UCP): UCP is an emerging technique that uses high-intensity focused ultrasound to coagulate the ciliary body and the peripheral iris. This leads to shrinkage of the ciliary processes and iris, creating more space within the anterior chamber angle.

Outcomes and Complications:

Iridoplasty has demonstrated favorable outcomes in certain cases of angle closure glaucoma and plateau iris syndrome. By opening up the drainage angle, it can effectively reduce IOP and improve aqueous humor outflow. However, like any surgical procedure, iridoplasty is not without potential complications, including:

• IOP Fluctuations: Some patients may experience temporary fluctuations in IOP following iridoplasty. Close monitoring is essential during the postoperative period.
• Iris Tears or Sphincter Damage: In some cases, iridoplasty can cause small iris tears or sphincter damage. These are usually self-limiting and rarely require additional intervention.
• Inflammation and Hyphema: Mild to moderate anterior chamber inflammation and hyphema (blood in the anterior chamber) can occur following the procedure. Adequate postoperative care can help manage these complications.

Conclusion:

Iridoplasty is a valuable surgical technique for managing angle closure glaucoma and plateau iris syndrome. By modifying the iris architecture, this procedure helps to open the drainage angle, improve aqueous outflow, and lower IOP. Although associated with potential complications, iridoplasty, when appropriately indicated and performed, can significantly benefit patients with certain types of glaucoma.

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