Pigment dispersion syndrome and pigmentary glaucoma treatment results

Aim. To assess the pigment dispersion syndrome and pigmentary glaucoma treatment results. Methods. 22 patients (44 eyes) aged 16 to 38 years (male - 12, female - 10) were observed. Pigmentary glaucoma was diagnosed in 12 eyes, pigment dispersion syndrome - in 32 eyes. Visual acuity testing, visual field testing, biomicroscopy, ocular tonometry and tonography, ophthalmoscopy, gonioscopy, scanning laser ophtalmoscopy, computed perimetry were performed. The follow-up period ranged from 6 months to 10 years. All patients underwent laser iridotomy. All patients were treated with anti-glaucoma medications and antioxidants unless intraocular pressure was compensated. Results. Intraocular pressure was lowered to normal in 26 out of 44 eyes. Intraocular pressure was compensated on the rest of 18 eyes using treatment with local pressure-lowering medications and antioxidants. Laser iridotomy allowed to remove the anatomical predisposition (the main pathogenetic link) leading to additional pigment deposition and intraocular pressure increase. Prolonged use of antioxidants has resulted in tear outflow drainage and normalization level of intraocular pressure. Conclusion. Early diagnosis of the pigment dispersion syndrome and proper treatment tactics allows to prevent the pigmentary glaucoma development and to preserve the vision.

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An Iconic Case of Pigmentary Glaucoma: Brief Review of the Literature

Case Reports in Ophthalmology ◽

10.1159/000508605 ◽

2020 ◽

Vol 11 (2) ◽

pp. 377-384

Author(s):

Mariachiara Di Pippo ◽

Chiara Ciancimino ◽

Luca Scuderi ◽

Andrea Perdicchi

Keyword(s):

Intraocular Pressure ◽

Trabecular Meshwork ◽

Corneal Endothelium ◽

Posterior Part ◽

Pigment Dispersion ◽

Pigmentary Glaucoma ◽

Anterior Surface ◽

Review Of The Literature ◽

Pigment Dispersion Syndrome

Pigment dispersion syndrome and pigmentary glaucoma are two conditions characterized by pigment dispersion originating from the posterior part of the iris and its accumulation on the trabecular meshwork, corneal endothelium, and anterior surface of the lens. The pigment on the trabecular meshwork can cause chronic inflammation with a secondary reduction of its function and an increase in intraocular pressure. The case presented represents a typical example of pigmentary glaucoma in a myopic patient in which all the signs, symptoms, and complications typical of these pathologies were present. We report and describe an 8-year-long follow-up period with clinical and instrumental examinations.

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Effect of a YAG Laser Iridotomy on Intraocular Pressure in Pigment Dispersion Syndrome

Ophthalmology ◽

10.1016/s0161-6420(96)30445-4 ◽

1996 ◽

Vol 103 (10) ◽

pp. 1693-1695 ◽

Cited By ~ 30

Author(s):

Stefano A. Gandolfi ◽

Marco Vecchi

Keyword(s):

Intraocular Pressure ◽

Pigment Dispersion ◽

Yag Laser ◽

Laser Iridotomy ◽

Pigment Dispersion Syndrome

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The Role of Dynamic Ultrasound Biomicroscopy in defining Laser Treatment in Pigment Dispersion Syndrome/ Pigmentary Glaucoma. A Case Series

International Archives of BioMedical and Clinical Research ◽

10.21276/iabcr.2016.2.3.16 ◽

2016 ◽

Vol 2 (3) ◽

Author(s):

Atif Anwar ◽

◽

Triputi Nath

Keyword(s):

Laser Treatment ◽

Case Series ◽

Ultrasound Biomicroscopy ◽

Pigment Dispersion ◽

Pigmentary Glaucoma ◽

Pigment Dispersion Syndrome ◽

Dynamic Ultrasound

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Exome-based investigation of the genetic basis of human pigmentary glaucoma

BMC Genomics ◽

10.1186/s12864-021-07782-0 ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Carly van der Heide ◽

Wes Goar ◽

Kacie J. Meyer ◽

Wallace L. M. Alward ◽

Erin A. Boese ◽

...

Keyword(s):

Genetic Basis ◽

Immunohistochemical Analysis ◽

Pigment Dispersion ◽

Pigmentary Glaucoma ◽

Visual Disability ◽

Primary Analysis ◽

Human Donor ◽

Similar Frequency ◽

Pigment Dispersion Syndrome ◽

Rare Mutations

Abstract Background Glaucoma is a leading cause of visual disability and blindness. Release of iris pigment within the eye, pigment dispersion syndrome (PDS), can lead to one type of glaucoma known as pigmentary glaucoma. PDS has a genetic component, however, the genes involved with this condition are largely unknown. We sought to discover genes that cause PDS by testing cohorts of patients and controls for mutations using a tiered analysis of exome data. Results Our primary analysis evaluated melanosome-related genes that cause dispersion of iris pigment in mice (TYRP1, GPNMB, LYST, DCT, and MITF). We identified rare mutations, but they were not statistically enriched in PDS patients. Our secondary analyses examined PMEL (previously linked with PDS), MRAP, and 19 other genes. Four MRAP mutations were identified in PDS cases but not in controls (p = 0.016). Immunohistochemical analysis of human donor eyes revealed abundant MRAP protein in the iris, the source of pigment in PDS. However, analysis of MRAP in additional cohorts (415 cases and 1645 controls) did not support an association with PDS. We also did not confirm a link between PMEL and PDS in our cohorts due to lack of reported mutations and similar frequency of the variants in PDS patients as in control subjects. Conclusions We did not detect a statistical enrichment of mutations in melanosome-related genes in human PDS patients and we found conflicting data about the likely pathogenicity of MRAP mutations. PDS may have a complex genetic basis that is not easily unraveled with exome analyses.

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Clinical Characteristics of Pigment Dispersion Syndrome and Pigmentary Glaucoma Patients: A Cross-sectional Study

JOURNAL FOR CLINICAL AND DIAGNOSTIC RESEARCH ◽

10.7860/jcdr/2020/46939.14383 ◽

2020 ◽

Author(s):

Vijay Pratap Singh Tomar ◽

Sandeep Sharma ◽

Rahul Bhardwaj ◽

Sindhuja Singh ◽

Virendra Kumar Pal ◽

...

Keyword(s):

Visual Field ◽

Optic Disc ◽

Clinical Characteristics ◽

Cross Sectional Study ◽

Pigment Dispersion ◽

Pigmentary Glaucoma ◽

Spherical Equivalent ◽

Sectional Study ◽

Cross Sectional ◽

Pigment Dispersion Syndrome

Introduction: Pigmentary Glaucoma (PG) and Pigment Dispersion Syndrome (PDS) are two different spectrums of a single disease. Since the disease is seen in younger population and is rapidly progressive blinding disease, therefore early diagnosis and treatment will reduce the burden of the disease and improve the quality of life. Aim: To evaluate clinical characteristics of PDS and PG patients in eastern part of Uttar Pradesh. Materials and Methods: This was a two years (1st January 2018 to 31st December 2019) hospital‑based retrospective cross‑sectional study of patients who attended the glaucoma clinic. Diagnosis of PDS was made when they had normal optic disc, normal visual field {with or without increased Intra Ocular Pressure (IOP)} and at least two of the following three signs were found clinically: Krukenberg spindle, homogenous moderate‑to‑heavy (≥Spaeth 2+) Trabecular Meshwork (TM) pigmentation, and any degree of zonular and/or lenticular pigment granule dusting. Patients with PDS were diagnosed with PG, if they had two or more of the following findings: initial IOP >21 mmHg, glaucomatous optic nerve damage or glaucomatous visual field loss. Various parameters such as influence of demographics, IOP, Best‑Corrected Visual Acuity (BCVA), Central Corneal Thickness (CCT), Mean Deviation (MD), Visual Field Index (VFI %), spherical equivalent and clinical finding of anterior segment of study patients were analysed. Mean, standard deviation and percentage were calculated using GraphPad Instat version 3.0. Results: Among 40 patients, nine eyes of the six patients had myopia of ‑0.5D or greater, with mean refractive error of ‑3.55±4.72 spherical equivalent. The average baseline IOP in study patients (PDS+PG), was 30.21±11.42 mmHg. Twenty four (60%) patients, either in one or both eyes had glaucoma, secondary to PDS at the initial diagnosis. Thirty three (82.5%) patients had Krukenberg spindles. Homogeneous TM pigmentation was seen in all patients. Typical spoke‑like radial Iris Transillumination Defects (ITDs) were not observed in any of the patients except in one patient, who had isolated short slit‑like trans‑illumination defects in iris crypts. Conclusion: PDS patients with normal optic disc and visual field and raised IOP, should be started prophylactic treatment and needs to be monitored more closely. Thus, the finding of PDS in Indians should alert the ophthalmologist to look for glaucoma during the initial examination.

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Intraocular pressure elevation precedes a phagocytosis decline in a model of pigmentary glaucoma

F1000Research ◽

10.12688/f1000research.13797.1 ◽

2018 ◽

Vol 7 ◽

pp. 174 ◽

Cited By ~ 7

Author(s):

Yalong Dang ◽

Susannah Waxman ◽

Chao Wang ◽

Priyal Shah ◽

Ralitsa T. Loewen ◽

...

Keyword(s):

Intraocular Pressure ◽

Trabecular Meshwork ◽

Ex Vivo ◽

Pigment Dispersion ◽

Pigmentary Glaucoma ◽

Fluorescent Microspheres ◽

Phagocytic Capacity ◽

Pressure Transducers ◽

Intraocular Pressure Elevation ◽

Iop Elevation

Background: Outflow regulation and phagocytosis are key functions of the trabecular meshwork (TM), but it is not clear how the two are related in secondary open angle glaucomas characterized by an increased particle load. We hypothesized that diminished TM phagocytosis is not the primary cause of early ocular hypertension and recreated pigment dispersion in a porcine ex vivo model. Methods: Sixteen porcine anterior chamber cultures received a continuous infusion of pigment granules (Pg), while 16 additional anterior chambers served as controls (C). Pressure transducers recorded the intraocular pressure (IOP). The phagocytic capacity of the trabecular meshwork was determined by fluorescent microspheres. Results: The baseline IOPs in Pg and C were similar (P=0.82). A significant IOP elevation occurred in Pg at 48, 120, and 180 hours (all P<0.01, compared to baseline). The pigment did not cause a reduction in TM phagocytosis at 48 hours, when the earliest IOP elevation occurred, but at 120 hours onward (P=0.001 compared to C). This reduction did not result in an additional IOP increase at 120 or 180 hours compared to the first IOP elevation at 48 hours (P>0.05). Conclusions: In this porcine model of pigmentary glaucoma, an IOP elevation occurs much earlier than when phagocytosis fails, suggesting that two separate mechanisms might be at work.

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