Kingsley Okafor1, Kateki Vinod, Steven J Gedde. 1. aBascom Palmer Eye Institute, University of Miami, Miller School of Medicine, Miami, FL bNew York Eye and Ear Infirmary of Mount Sinai and Icahn School of Medicine at Mount Sinai, New York, NY, USA.
Abstract
PURPOSE OF REVIEW: The present article reviews the clinical features and pathogenesis of pigment dispersion syndrome and pigmentary glaucoma and provides an update regarding their diagnosis and management. RECENT FINDINGS: Newer imaging modalities including ultrasound biomicroscopy and anterior segment optical coherence tomography facilitate visualization of the iris concavity characteristic of eyes with pigment dispersion syndrome and pigmentary glaucoma. Patients with pigmentary glaucoma may be distinguished from those with other glaucoma types by the presence of typical symptoms, personality type, and patterns of diurnal intraocular pressure fluctuation. Although laser iridotomy has been shown to alter iris anatomy in pigmentary glaucoma, it is not proven to slow visual field progression. Multiple trials have validated the safety and efficacy of filtering surgery in treating pigmentary glaucoma, with fewer studies published on the role of micro-invasive glaucoma surgery. SUMMARY: Literature from the review period has further defined the unique clinical characteristics of pigment dispersion syndrome and pigmentary glaucoma. Laser surgery has a limited role in the management of these entities, whereas trabeculectomy remains an acceptable first-line surgical treatment. Further studies are needed to define the potential application of the newer micro-invasive glaucoma procedures in pigmentary glaucoma.
PURPOSE OF REVIEW: The present article reviews the clinical features and pathogenesis of pigment dispersion syndrome and pigmentary glaucoma and provides an update regarding their diagnosis and management. RECENT FINDINGS: Newer imaging modalities including ultrasound biomicroscopy and anterior segment optical coherence tomography facilitate visualization of the iris concavity characteristic of eyes with pigment dispersion syndrome and pigmentary glaucoma. Patients with pigmentary glaucoma may be distinguished from those with other glaucoma types by the presence of typical symptoms, personality type, and patterns of diurnal intraocular pressure fluctuation. Although laser iridotomy has been shown to alter iris anatomy in pigmentary glaucoma, it is not proven to slow visual field progression. Multiple trials have validated the safety and efficacy of filtering surgery in treating pigmentary glaucoma, with fewer studies published on the role of micro-invasive glaucoma surgery. SUMMARY: Literature from the review period has further defined the unique clinical characteristics of pigment dispersion syndrome and pigmentary glaucoma. Laser surgery has a limited role in the management of these entities, whereas trabeculectomy remains an acceptable first-line surgical treatment. Further studies are needed to define the potential application of the newer micro-invasive glaucoma procedures in pigmentary glaucoma.
Authors: Adrian A Lahola-Chomiak; Tim Footz; Kim Nguyen-Phuoc; Gavin J Neil; Baojian Fan; Keri F Allen; David S Greenfield; Richard K Parrish; Kevin Linkroum; Louis R Pasquale; Ralf M Leonhardt; Robert Ritch; Shari Javadiyan; Jamie E Craig; W T Allison; Ordan J Lehmann; Michael A Walter; Janey L Wiggs Journal: Hum Mol Genet Date: 2019-04-15 Impact factor: 6.150