EC Ophthalmology

Purpose: To share initial experiences in the early diagnosis and management of pigment dispersion syndrome (PDS) and pigmentary glaucoma (PG) using optical coherence tomography (OCT) and to demonstrate the effectiveness of laser iridotomy in altering the iris configuration as a preventive measure against the progression of PDS to PG.

Observations: In this study, optical coherence tomography (OCT) was instrumental for the early diagnosis and monitoring of treatment efficacy in pigment dispersion syndrome (PDS) and pigmentary glaucoma (PG). Pre- and post-laser iridotomy OCT images demonstrated significant changes in iris configuration from concave to a more flattened profile, alongside a reduction in pigment dispersion. These findings highlight the effectiveness of laser iridotomy in modifying the anatomical contributors to PDS and PG and suggest its potential in preventing the progression from PDS to PG. The ability of OCT to visualize these changes emphasizes its value not only in diagnosing but also in guiding the management of these conditions, reinforcing the importance of early intervention.

Conclusion and Importance: The findings suggest that OCT is a valuable tool for the early detection of PDS and PG. Laser iridotomy proves to be an effective intervention for altering iris configuration, thereby reducing pigment dispersion and potentially preventing the progression of PDS to PG. Further studies are recommended to validate these results and explore the long-term benefits of early diagnosis and intervention in PDS/PG management. Anterior segment optical coherence tomography has the potential to assist in the diagnostic enhancement of individuals with suspected or diagnosed glaucoma, serving as an adjunct to gonioscopy. This tool is especially valuable for young suspects and patients, and can be used in patient education by displaying the shape of the chamber angle through an image.

 Keywords: Glaucoma; Pigmentary Glaucoma; AS-OCT; Secondary Glaucoma; Anterior Chamber Angle; Juvenile Open‑Angle Glaucoma

1. Tham YC., et al. “Global prevalence of glaucoma and projections of glaucoma burden through 2040: A systematic review and meta-analysis”. Ophthalmology11 (2014): 2081-2090.
2. Bourne RRA., et al. “Number of people blind or visually impaired by glaucoma worldwide and in world regions 1990 - 2010: A meta-analysis”. PLoS One10 (2016): e0162229.
3. Harwerth RS and Quigley HA. “Visual field defects and retinal ganglion cell losses in patients with glaucoma”. Archives of Ophthalmology6 (2006): 853-859.
4. Sommer A. “Glaucoma risk factors observed in the Baltimore Eye Survey”. Current Opinion in Ophthalmology2 (1996): 93-98.
5. Wang Y., et al. “Application of optical coherence tomography in clinical diagnosis”. Journal of X-Ray Science and Technology 6 (2020): 995-1006.
6. Scuderi G., et al. “Pigment dispersion syndrome and pigmentary glaucoma: a review and update”. International Ophthalmology7 (2019): 1651-1662.
7. Gacina DL., et al. “Assessment of effect of peripheral laser iridotomy on biometric parameters of anterior eye segment in pigmentary glaucoma”. Lijecnicki Vjesnik 12 (2020): 389-394.
8. Niyadurupola N and Broadway DC. “Pigment dispersion syndrome and pigmentary glaucoma - A major review”. Clinical and Experimental Ophthalmology9 (2008): 868-882.
9. Campbell DG and Schertzer RM. “Pathophysiology of pigment dispersion syndrome and pigmentary glaucoma”. Current Opinion in Ophthalmology2 (1995): 96-101.
10. Krishnadas R and Ramakrishnan R. “Secondary glaucomas: The tasks ahead”. Journal of Community Eye Health 39 (2001): 40-42.
11. Ramanarao S and Jain D. “A clinical study of secondary glaucoma”. Indian Journal of Clinical and Experimental Ophthalmology1 (2020): 5-8.
12. Mora P., et al. “Ultrasound biomicroscopy and iris pigment dispersion: A case-control study”. British Journal of Ophthalmology4 (2010): 428-432.
13. Campbell DG. “Pigmentary dispersion and glaucoma: a new theory”. Archives of Ophthalmology9 (1979): 1667-1672.
14. Potash SD., et al. “Ultrasound biomicroscopy in pigment dispersion syndrome”. Ophthalmology2 (1994): 332-339.
15. Fabrikantov OL., et al. “Diagnostic value of modern methods of ocular anterior segment visualization in intumescent cataract”. Oftalmologiya3 (2019): 350-354.
16. Lehto I and Vesti E. “Diagnosis and management of pigmentary glaucoma”. Current Opinion in Ophthalmology2 (1998): 61-64.
17. Pavlin CJ., et al. “Accommodation and iridotomy in the pigment dispersion syndrome”. Ophthalmic Surgery, Lasers and Imaging Retina2 (1996): 113-120.
18. Abdolrahimzadeh S., et al. “Optical coherence tomography evidence on the correlation of choroidal thickness and age with vascularized retinal layers in normal eyes”. Retina12 (2016): 2329-2338.
19. Abdolrahimzadeh S., et al. “Spectral domain optical coherence tomography evidence of retinal nerve fiber layer and ganglion cell loss in adult patients with neurofibromatosis Type 1”. Retina1 (2016): 75-81.
20. Esporcatte BLB., et al. “The estimates of retinal ganglion cell counts performed better than isolated structure and functional tests for glaucoma diagnosis”. Journal of Ophthalmology (2017): 2724312.
21. Gu S., et al. “Ganglion cell layer-inner plexiform layer thickness and vision loss in young children with optic pathway gliomas”. Investigative Ophthalmology and Visual Science 3 (2014): 1402-1408.
22. Pomorska M., et al. “Application of optical coherence tomography in glaucoma suspect eyes”. Clinical and Experimental Optometry1 (2012): 78-88.
23. Farrar SM and Shields MB. “Current concepts in pigmentary glaucoma”. Survey of Ophthalmology4 (1993): 233-252.
24. Roberts DK., et al. “Clinical signs of the pigment dispersion syndrome in blacks”. Optometry and Vision Science12 (1997): 993-1006.
25. Costa VP., et al. “O efeito da iridectomia periférica em pacientes com glaucoma pigmentar”. Arquivos Brasileiros de Oftalmologia 1 (1994).
26. , et al. “Pathophysiology of pigment dispersion syndrome and pigmentary glaucoma: Editorial review”. Current Opinion in Ophthalmology 6.2 (1995): 96-101.
27. Nolan W. “Anterior segment imaging: Ultrasound biomicroscopy and anterior segment optical coherence tomography”. Current Opinion in Ophthalmology2 (2008): 115-121.
28. Guedes V., et al. “Optical coherence tomography measurement of macular and nerve fiber layer thickness in normal and glaucomatous human eyes”. Ophthalmology1 (2003): 177-189.
29. Diniz Filho A., et al. “Plateau iris configuration in eyes with narrow-angle: an ultrasound biomicroscopic study”. Arquivos Brasileiros de Oftalmologia 2 (2010): 155-160.
30. Sampaolesi R. “[Retinal detachment and pigment dispersion syndrome]”. Klinische Monatsblätter für Augenheilkunde 1 (1995): 29-32.
31. Desmond T., et al. “Diagnostic accuracy of AS-OCT vs gonioscopy for detecting angle closure: a systematic review and meta-analysis”. Graefe’s Archive for Clinical and Experimental Ophthalmology1 (2022): 1-23.
32. Sakata LM., et al. “Comparison of Visante and slit-lamp anterior segment optical coherence tomography in imaging the anterior chamber angle”. Eye 4 (2010): 578-587.