Introduction: Plateau iris is recognised as an important cause of primary angle closure glaucoma. The management of this condition generally comprises laser peripheral iridotomy and iridoplasty, to remove any component of relative pupillary block and to widen the iridotrabecular drainage angle respectively. However, plateau iris may be associated with multiple iris cysts at the iridociliary junction, which then presents diagnostic and management problems.
Case presentation: We present a fifty-three year old Caucasian gentleman with plateau iris associated with peripheral iris cysts, in which the iridotrabecular angle did not widen despite having had both laser peripheral iridotomy and iridoplasty. The patient has remained asymptomatic over 12 months, and is under close follow-up to monitor for signs of glaucoma.
Conclusion: Plateau iris with iridociliary cysts can be difficult to diagnose and manage. Ultrasound biomicroscopy should be performed on patients with appositional iridotrabecular angle closure on gonioscopy, especially if the angle closure is not relieved with either laser peripheral iridotomy or iridoplasty. Question marks can be raised as to the benefit of laser iridotomy when plateau iris without pupillary block has already been conclusively diagnosed on ultrasound biomicroscopy.