A case of dense pigment deposition of the posterior lens capsule
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CASE REPORT
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A case of dense pigment deposition of the posterior lens capsule Igor Šivec Trampuž Abstract Background: Pigment dispersion syndrome (PDS) is a well-known entity which can lead to pigmentary glaucoma (PG). This case report presents a rare presentation of PG with bilateral dense pigment deposits of the posterior lens capsule. Case presentation: A 72-year-old male came for his first appointment due to an asymmetric worsening of visual acuity. The examination showed unilaterally severely increased intraocular pressure, bilateral dense pigment deposition of the posterior lens capsule, and a shallow unilateral optic disk excavation. Gonioscopy revealed moderate pigmentation of the angle and a concave configuration of the peripheral iris in both eyes. The standard slit lamp examination showed no transillumination defects of either iris. Optical coherence tomography showed retinal nerve fiber layer (RNFL) thinning in the peripapillary and macular regions. An antiglaucoma medication was prescribed with a good lowering effect. Conclusion: Pigment deposition of the posterior lens capsule, which has been rarely reported, is a possible important sign of PDS or PG. Keywords: Pigmentary dispersion syndrome, Pigmentary glaucoma, Retinal nerve fiber layer, Intraocular pressure, Deposits, Posterior lens capsule, Optic neuropathy
Background Pigment dispersion syndrome (PDS) is a relatively rare and peculiar entity that can lead to a secondary elevation of intraocular pressure (IOP) and cause pigmentary glaucoma (PG). PDS is characterized by dispersion of pigment of the anterior segment, including Krukenberg’s spindles, iris transillumination defects, diffuse trabecular meshwork pigmentation, and a backward bowing of the iris [1–3]. It is hypothesized that the posterior bowing of the iris causes rubbing of the pigmented iris epithelium against lens structures, which in turn causes the liberation of pigment that reduces the outflow of the aqueous in the trabecular meshwork [4–7]. The majority of patients with PDS are asymptomatic; however, episodes of blurred vision, halos around light sources, and headaches Correspondence: [email protected] Morela Okulisti in Optika, Center for Eye Refractive Surgery, Tehnološki Park 21, 1000 Ljubljana, Slovenia
have been described [2, 8]. PDS typically affects myopic patients between 20 and 40 years of age and can be seen equally distributed between men and women [2, 9, 10]. It is reported that it affects Caucasians more often than other races [1, 9, 11]. Many cases are sporadic; however, there are families with apparent autosomal dominant inheritance [12, 13]. Unlike PDS, PG is more prevalent in men [1]. The features are similar to PDS with an additional elevated IOP and glaucomatous optic neuropathy. PG tends to be a high-tension type of glaucoma with 12.5% of patients having an IOP over 39 mmHg at the time of the diagnosis [10, 14]. The probability of conversion from PDS to PG is 10% at 5 years and 15% at 15 years. A lifetime risk of PDS progressing to PG has been es
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