ICD-10: H21.82

Plateau iris syndrome (post-iridectomy) is a specific condition classified under the ICD-10 code H21.82. This syndrome is characterized by a unique anatomical configuration of the anterior chamber of the eye, which can lead to increased intraocular pressure and potential glaucoma. Below is a detailed clinical description and relevant information regarding this condition.

Clinical Description of Plateau Iris Syndrome

Definition

Plateau iris syndrome occurs when the peripheral iris is pushed forward, creating a narrow angle between the iris and the cornea. This condition is particularly significant in patients who have undergone an iridectomy, a surgical procedure that involves the removal of a portion of the iris. The removal alters the normal anatomy of the eye, which can lead to the development of this syndrome.

Pathophysiology

In plateau iris syndrome, the anatomical changes following an iridectomy can result in the following:
- Iris Configuration: The remaining iris may become more anteriorly positioned, leading to a plateau-like appearance. This configuration can obstruct the trabecular meshwork, which is responsible for draining aqueous humor from the eye.
- Intraocular Pressure: The obstruction can cause an increase in intraocular pressure (IOP), which is a significant risk factor for glaucoma. Patients may experience symptoms such as blurred vision, eye pain, or headaches due to elevated IOP.

Symptoms

Patients with plateau iris syndrome may present with:
- Visual Disturbances: Blurred vision or halos around lights.
- Ocular Pain: Discomfort or pain in the eye, particularly during episodes of increased IOP.
- Headaches: Often associated with elevated pressure in the eye.

Diagnosis

Diagnosis typically involves:
- Clinical Examination: An ophthalmologist will perform a thorough eye examination, including measuring IOP and assessing the angle of the anterior chamber using gonioscopy.
- Imaging: Optical coherence tomography (OCT) may be used to visualize the anterior segment and confirm the plateau iris configuration.

Management

Management strategies for plateau iris syndrome may include:
- Medications: Topical medications to lower IOP, such as prostaglandin analogs or beta-blockers.
- Laser Treatment: Laser peripheral iridotomy or laser iridoplasty may be performed to create a new drainage pathway for aqueous humor, thereby reducing IOP.
- Surgical Options: In severe cases, surgical intervention may be necessary to manage the condition effectively.

Conclusion

Plateau iris syndrome (post-iridectomy) is a significant condition that can arise following surgical procedures involving the iris. Understanding its clinical presentation, pathophysiology, and management options is crucial for healthcare providers to prevent complications such as glaucoma. Regular monitoring and appropriate treatment are essential for maintaining ocular health in affected patients.

Plateau iris syndrome (post-iridectomy), classified under ICD-10 code H21.82, is a specific condition that arises following an iridectomy, a surgical procedure that involves the removal of a portion of the iris. This syndrome is characterized by a unique set of clinical presentations, signs, symptoms, and patient characteristics that are important for diagnosis and management.

Clinical Presentation

Plateau iris syndrome typically presents in patients who have undergone an iridectomy, particularly those with pre-existing anatomical predispositions. The condition is characterized by a specific configuration of the anterior chamber angle, which can lead to angle-closure glaucoma. The clinical presentation may include:

• Increased Intraocular Pressure (IOP): Patients may experience elevated IOP due to the closure of the angle, which can lead to secondary glaucoma.
• Visual Disturbances: Patients may report blurred vision or halos around lights, particularly in low-light conditions.
• Acute Symptoms: In some cases, patients may present with acute symptoms such as severe eye pain, headache, nausea, and vomiting, which are indicative of an acute glaucoma attack.

Signs and Symptoms

The signs and symptoms of plateau iris syndrome can vary, but they often include:

• Shallow Anterior Chamber: Upon examination, the anterior chamber may appear shallower than normal, which can be assessed using slit-lamp biomicroscopy.
• Narrowing of the Anterior Chamber Angle: Gonioscopy may reveal a narrow or closed angle, particularly in the presence of a plateau configuration of the peripheral iris.
• Iris Configuration: The iris may appear to be pushed forward, creating a plateau-like appearance, which is characteristic of this syndrome.
• Elevated IOP: Measurement of IOP may show elevated levels, indicating potential glaucoma.

Patient Characteristics

Certain patient characteristics are commonly associated with plateau iris syndrome:

• Demographics: This condition is more frequently observed in individuals with a history of angle-closure glaucoma, particularly in older adults and those of Asian descent, who may have anatomical predispositions.
• Previous Eye Surgery: Patients who have undergone iridectomy or other anterior segment surgeries are at higher risk for developing plateau iris syndrome.
• Anatomical Features: Individuals with a thick peripheral iris or a shallow anterior chamber are more likely to develop this condition post-surgery.

Conclusion

Plateau iris syndrome (post-iridectomy) is a significant condition that can lead to complications such as angle-closure glaucoma. Understanding its clinical presentation, signs, symptoms, and patient characteristics is crucial for timely diagnosis and management. Regular monitoring of intraocular pressure and thorough examination of the anterior chamber angle are essential for patients with a history of iridectomy to prevent potential vision loss associated with this syndrome.

Plateau iris syndrome (post-iridectomy) is a specific condition that can be classified under the ICD-10 code H21.82. This syndrome is characterized by a particular anatomical configuration of the iris that can lead to increased intraocular pressure and potential glaucoma, especially following surgical procedures like iridectomy. Below are alternative names and related terms associated with this condition.

Alternative Names for Plateau Iris Syndrome

1. Post-Iridectomy Plateau Iris Syndrome: This term emphasizes the condition's association with prior iridectomy surgery.
2. Plateau Iris Configuration: Refers to the anatomical arrangement of the iris that is characteristic of this syndrome.
3. Plateau Iris Phenomenon: A term that may be used interchangeably to describe the same anatomical and functional issues.
4. Secondary Plateau Iris Syndrome: This term can be used to indicate that the syndrome developed as a result of another condition or procedure, such as iridectomy.

Related Terms

1. Glaucoma: While not synonymous, plateau iris syndrome can lead to secondary glaucoma due to the anatomical changes in the eye.
2. Iris and Ciliary Body Disorders: This broader category includes various conditions affecting the iris, including plateau iris syndrome.
3. Postprocedural Complications: This term encompasses complications that arise following surgical interventions, including those related to the iris.
4. Angle-Closure Glaucoma: A potential outcome of plateau iris syndrome, where the angle between the iris and cornea becomes narrowed, leading to increased intraocular pressure.

Clinical Context

Understanding these alternative names and related terms is crucial for healthcare professionals involved in ophthalmology and coding, as they can impact diagnosis, treatment, and billing processes. Accurate coding and terminology ensure proper patient management and facilitate communication among healthcare providers.

In summary, plateau iris syndrome (post-iridectomy) is recognized by various names and related terms that reflect its clinical significance and implications for patient care. Proper identification and understanding of these terms are essential for effective diagnosis and treatment planning.

Plateau iris syndrome (post-iridectomy) is a specific condition classified under the ICD-10 code H21.82. This syndrome is characterized by a particular anatomical configuration of the anterior chamber of the eye, which can lead to angle-closure glaucoma. Understanding the diagnostic criteria for this condition is essential for accurate coding and effective management.

Diagnostic Criteria for Plateau Iris Syndrome

1. Clinical History

• Previous Iridectomy: A history of surgical iridectomy is crucial, as plateau iris syndrome typically occurs following this procedure. The iridectomy may have been performed to treat other forms of glaucoma or for other ocular conditions.
• Symptoms of Glaucoma: Patients may present with symptoms such as eye pain, headache, blurred vision, or halos around lights, which are indicative of increased intraocular pressure.

2. Ocular Examination

• Slit-Lamp Examination: This examination is vital for assessing the anterior segment of the eye. The presence of a plateau iris configuration can be observed, where the peripheral iris is flat or slightly elevated, leading to a narrow angle between the iris and the cornea.
• Gonioscopy: This is a critical diagnostic tool for evaluating the angle of the anterior chamber. In plateau iris syndrome, gonioscopy will typically reveal a closed or narrow angle despite the presence of an iridectomy, indicating that the angle closure is not due to pupillary block but rather due to the anatomical configuration of the iris.

3. Intraocular Pressure Measurement

• Tonometry: Measurement of intraocular pressure (IOP) is essential. Elevated IOP can be a sign of angle-closure glaucoma, which may occur in patients with plateau iris syndrome.

4. Imaging Studies

• Anterior Segment Imaging: Techniques such as ultrasound biomicroscopy (UBM) or optical coherence tomography (OCT) can provide detailed images of the anterior segment, helping to confirm the diagnosis by visualizing the iris configuration and the angle anatomy.

5. Differential Diagnosis

• It is important to rule out other causes of angle closure, such as pupillary block or other forms of secondary glaucoma. This may involve a comprehensive assessment of the patient's ocular history and current symptoms.

Conclusion

The diagnosis of plateau iris syndrome (post-iridectomy) under ICD-10 code H21.82 relies on a combination of clinical history, thorough ocular examination, intraocular pressure measurements, and possibly imaging studies. Recognizing the unique anatomical features associated with this syndrome is crucial for effective management and treatment, particularly in preventing complications such as acute angle-closure glaucoma. Proper coding and documentation are essential for ensuring appropriate patient care and reimbursement for services rendered.

Plateau iris syndrome (post-iridectomy), classified under ICD-10 code H21.82, is a condition characterized by a specific anatomical configuration of the anterior chamber of the eye that can lead to angle-closure glaucoma. This syndrome often occurs after surgical procedures such as iridectomy, where a portion of the iris is removed to treat conditions like glaucoma. Understanding the standard treatment approaches for this syndrome is crucial for effective management and prevention of complications.

Understanding Plateau Iris Syndrome

Plateau iris syndrome is defined by a situation where the peripheral iris is pushed forward, leading to a narrow or closed angle between the iris and the cornea. This can result in increased intraocular pressure (IOP) and potential damage to the optic nerve if not managed appropriately. The condition is particularly significant in patients who have undergone iridectomy, as the surgical alteration of the iris can contribute to this anatomical change.

Standard Treatment Approaches

1. Medical Management

• Topical Medications: The first line of treatment often involves the use of topical medications to lower intraocular pressure. Commonly prescribed medications include:
• Prostaglandin analogs (e.g., latanoprost) to increase aqueous humor outflow.
• Beta-blockers (e.g., timolol) to reduce aqueous humor production.
• Alpha agonists (e.g., brimonidine) to decrease aqueous humor production and increase outflow.

• Carbonic anhydrase inhibitors (e.g., dorzolamide) to reduce aqueous humor secretion.

• Oral Medications: In some cases, oral carbonic anhydrase inhibitors (e.g., acetazolamide) may be used to further reduce IOP, especially in acute situations.

2. Laser Treatment

• Laser Peripheral Iridotomy (LPI): This procedure is often performed to create a new drainage pathway for aqueous humor, thereby relieving pressure in the eye. LPI can be particularly effective in cases where the angle is closed or narrow due to plateau iris configuration.

• Laser Iridoplasty: In cases where LPI is not sufficient, laser iridoplasty may be considered. This technique involves applying laser energy to the peripheral iris to induce contraction and pull the iris away from the angle, thereby widening it.

3. Surgical Interventions

• Goniotomy or Trabeculotomy: In more severe cases or when medical and laser treatments fail, surgical options such as goniotomy (surgical opening of the anterior chamber angle) or trabeculotomy (creating a new drainage pathway) may be necessary to manage IOP effectively.

• Filtering Surgery: For patients with chronic angle-closure glaucoma secondary to plateau iris syndrome, filtering surgeries such as trabeculectomy may be indicated to create a new drainage route for aqueous humor.

4. Monitoring and Follow-Up

Regular follow-up is essential for patients diagnosed with plateau iris syndrome. Monitoring IOP and assessing the anatomical configuration of the anterior chamber can help in adjusting treatment plans as necessary. Patients should be educated about the signs of acute glaucoma, such as sudden eye pain, headache, nausea, and visual disturbances, which require immediate medical attention.

Conclusion

The management of plateau iris syndrome (post-iridectomy) involves a combination of medical, laser, and surgical approaches tailored to the individual patient's needs. Early recognition and appropriate treatment are vital to prevent complications such as permanent vision loss due to glaucoma. Regular monitoring and patient education play crucial roles in the long-term management of this condition. If you suspect you or someone you know may be experiencing symptoms related to this syndrome, consulting an ophthalmologist is essential for timely intervention.