# Case report: a two-step approach in the management of angle-closure glaucoma associated with Plateau iris configuration

## TL;DR

A two-step treatment approach for a patient with advanced angle-closure glaucoma and Plateau iris improved vision and pressure control with fewer complications.

## Contribution

A two-step treatment using cyclophotocoagulation followed by phacoemulsification is proposed as a simpler alternative for managing Plateau iris.

## Key findings

- Both eyes achieved improved visual acuity and intraocular pressure control.
- The two-step approach resulted in fewer medications and no significant complications.
- The method offers more predictable outcomes compared to combined surgeries.

## Abstract

Angle-closure glaucoma is a major cause of visual impairment worldwide, with
Plateau iris syndrome presenting management challenges. We present a case report
of a 58-year-old woman with advanced, uncontrolled angle--closure glaucoma and
Plateau iris. Her history included laser peripheral iridotomy and three glaucoma
medications in both eyes. Different treatments were implemented. For the eye
with lower intraocular pressure, fewer peripheral anterior synechiae, and milder
disease: phacoemulsification with intraocular lens implantation. For the eye
with more advanced disease, a two-step approach was used: slow-coagulation
transscleral cyclophotocoagulation using the double-arc protocol, followed by
phacoemulsification with intraocular lens implantation 2 months later. Both eyes
achieved improved visual acuity and intraocular pressure control with fewer
medications, without significant complications. This case highlights
transscleral cyclophotocoagulation followed by phacoemulsification as an
alternative to combined surgeries in uncontrolled angle-closure glaucoma with
Plateau iris, offering a simpler technique, more predictable refractive and
pressure-control outcomes, and more straightforward postoperative
management.