Eyeworld

FALL 2025 | EYEWORLD | 67 G by Liz Hillman Editorial Co-Director About the physicians Jonathan Eisengart, MD Clinical Assistant Professor of Ophthalmology Cleveland Clinic Cole Eye Institute Cleveland, Ohio Davinder Grover, MD, MPH Glaucoma Associates of Texas Dallas-Fort Worth, Texas Kateki Vinod, MD Associate Professor of Ophthalmology Icahn School of Medicine at Mount Sinai New York Eye and Ear Infirmary of Mount Sinai New York, New York I n the last few issues of EyeWorld, specialists have gone deeper into different types of glaucoma, such as steroid-induced glauco- ma and pseudoexfoliation glaucoma. In this issue, Jonathan Eisengart, MD, Davinder Grover, MD, MPH, and Kateki Vinod, MD, discuss pigment dispersion syndrome (PDS) and related pigmentary glaucoma (PG) from diagnosis to treatment and monitoring, and what they want anterior segment surgeons who are not necessarily glaucoma specialists to know about it. What is PDS and PG? Dr. Vinod said in an email to EyeWorld that pig- ment dispersion syndrome is thought to result from posterior iris bowing that causes friction between the iris and the zonules, liberating pigment that is then deposited onto various structures in the eye. Dr. Eisengart said many patients with PDS have concave iris configura- tion that brings the iris into contact with the zonules. "This concave iris configuration is thought to be caused by reverse pupillary block in which there is higher pressure anterior to the iris than posterior to it," he said. "As the iris dilates and constricts in response to changes in ambient light, the posterior iris surface rubs against the zonules and releases pigment. Some people ar- gue that PDS isn't purely mechanical, and there could be a component of iris pigment epitheli- opathy as well." Clinical findings, cited by all the doctors in this article, include pigment on the corneal en- dothelium (Krukenberg spindle), mid-peripheral iris transillumination defects, and a homoge- nously and heavily pigmented trabecular mesh- work viewed on gonioscopy. Dr. Vinod said that pigment deposition can also occur circumferen- tially on the posterior lens capsule near zonular attachment. Dr. Eisengart commented that this pigment deposition (called a Scheie stripe) is usually best seen inferiorly. He additionally not- ed that in light colored eyes a pigment dusting can be seen on the anterior iris surface. PG is defined by the clinical findings de- scribed above in addition to glaucomatous optic neuropathy. Dr. Eisengart said PG is thought to occur due to elevated IOP caused by the pig- ment cells that clog the trabecular meshwork. However, Dr. Eisengart said he has seen patients with PG who never had an elevated eye pres- sure recorded in office. Dr. Vinod said that both PDS and PG are usually bilateral, though they can sometimes be asymmetric. These conditions are most common in younger (30–50 years old), myopic male patients. "Sometimes, the clinical signs of PDS/PG can be subtle, so it's essential to have a high degree of vigilance and perform a thorough anterior segment exam, including gonioscopy, in younger patients with high IOP," Dr. Vinod said. "When assessing a patient for PDS/PG, it's also important to consider other forms of secondary glaucoma associated with pigment dispersion in the differential diagnosis, such as uveitis-glau- coma-hyphema (UGH) syndrome, uveitis, and intraocular tumors." Dr. Grover said the patient presentation for PDS and PG depends on various factors, such as how acute the presentation is, disease stage, and the patient's healthcare access. Pigment dispersion syndrome and pigmentary glaucoma: the basics continued on page 68 Krukenberg spindle, pigment deposition on the corneal endothelium Source: Jonathan Eisengart, MD

• Blank Page
• Blank Page (1)