PMC3968079_01
Before the second laser iridotomy. (A) The initial laser iridotomy appears open, although the opening is small with white collagen strands in the stroma. Myosis is observed due to the preoperative application of topical pilocarpine. (B) A cross-sectional image obtained by anterior-segment optical coherence tomography. A thin membrane with an anterior bowing configuration is seen at the base of the iridotomy (arrow). The intensity of the membrane is not equal to that of the iris stroma. The anterior chamber angle is crowded. Magnified images are also shown.
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Despite its small size, the previous laser iridotomy was observed at the 10 o'clock position in the iris (Figure 1A). The images showed a membrane that was not observed by slit-lamp examination, with an anterior bowing configuration at the base of the iridotomy (Figure 1B), suggesting increased fluid pressure in the posterior chamber. This observation indicated that pupillary block was the causative mechanism of the increased IOP in our patient, and retreatment with Nd:YAG laser iridotomy was performed at the same site.
After the second laser iridotomy. (A) The iridotomy is completely penetrated. The anterior lens capsule is seen through the opening. (B) Cross-sectional images obtained by anterior-segment optical coherence tomography. The iridotomy is completely penetrated (arrow). Widening of the anterior chamber angle and straightening of the iris are also seen. (C) The plateau iris configuration is seen by gonioscopy. Magnified images are also shown.
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The anterior lens capsule was observed through the opening by slit-lamp examination (Figure 2A). A cross-sectional image showed a completely penetrated iridotomy with widening of the anterior chamber angle and straightening of the iris (Figure 2B).