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by Marc P. Japitana MDCLMMRH - Ophthalmology
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PIGMENT DISPERSION SYNDROME & PIGMENTARY
GLAUCOMA
MARC P. JAPITANA MDDepartment of Ophthalmology
CLMMRH
OVERVIEW
PIGMENT DISPERSION SYNDROME
– abnormal amounts of pigment are liberated from the posterior surface of the iris
– pigments are deposited all throughout the anterior and posterior chambers of the eye
PIGMENTARY GLAUCOMA
– a secondary glaucoma that develops among patients with PDS
PATHOPHYSIOLOGY
The Mechanical Abrasion Theory
Abiotrophy Theory
MECHANICAL ABRASION THEORY
proposed by D.G. Campbell
proposed that people with PDS often exhibits iris transillumination defects
iris transillumination defects (slitlike defects) – there was a corresponding packet of zonules attached to it.
MECHANICAL ABRASION THEORY
MECHANICAL ABRASION THEORY
MECHANICAL ABRASION THEORY
ABIOTROPHY THEORY
Abiotrophy is the premature degeneration of cells or tissues, especially when it is due to genetic defects
PDS might have a heritable component – GPDS1 gene mapped in chromosome 7
microscopic findings of iris tissue
EPIDEMIOLOGY
Diagnosed on second and third decade of life
PDS is equally prevalent among men and female, PG is more common among males
More common among whites
More common on myopic patients
Genetic association is under study
SYMPTOMS
EARLY: usually no symptoms; some may have blurred vision with jarring exercise
LATER: loss of peripheral vision
VERY LATE: loss of central vision
SIGNS
CORNEA
– KRUKENBERG SPINDLE – pigment deposited on the corneal endothelium and phagocytosed in the endothelial cells
– pigments do not cause visual symptoms– pigments do not harm the endothelium
SIGNS
IRIS
– develops defects in pigment epithelium of the iris that can be seen through transillumination
– pigments deposited on the anterior surface can cause iris to appear darker
SIGNS
PUPILS
– change in the function of the pupil– in asymmetric disease, larger pupil is found in the affected
eye
ANTERIOR CHAMBER
– anterior chamber is usually deep
SIGNS
IRIDOCORNEAL ANGLE
– open angle – densed trabecular pigment – backbowed iris
* gonioscopy is of importance to visualize the angle
SIGNS
POSTERIOR CHAMBER
– pigments can accumulate at the junction of the lens and posterior zonules
– SCHEIE STRIPE or ZENTMEYER LINES– best examined in dilated pupils– gonioscopy in of benefit
In Summary ...
Classic triad of clinical signs of PDS
– Krukenberg spindle– slitlike, radial, midperipheral iris transillumination
defects– pigment deposition on the trabecular meshwork
TREATMENT
Treated like POAG
Cholinergic agonist drugs (Pilocarpine) – induces miosis and lifts iris from the zonules
– not well tolerated by myopics– may increase risk for developing retinal detachment– pilocarpine Ocusert can be used to lessen side effects
TREATMENT
Laser Trabeculoplasty may be beneficial in PG
Laser Iridotomy – in PG patients with iris backbowing
Not an ideal choice in the following patients 1. Patients with PDS with no Ocular Hypertension and may never
develop optic nerve damage
2. Patients with advanced glaucomatous damage taking multiple medications
TREATMENT
Trabeculectomy – if medical and laser therapy fails
– increased risk for failure– antimetabolites should be used with caution– myopic males is at increased risk to develop hypotony
maculopathy
PROGNOSIS
25 to 50% of patients with PDS will progress to Pigmentary Glaucoma (PG)
6 to 8% of patients with PDS & PG will develop retinal detachment
THANK YOU!