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Pigmentary Glaucoma Workup

  • Author: Yaniv Barkana, MD; Chief Editor: Hampton Roy, Sr, MD  more...
 
Updated: Oct 13, 2014
 

Imaging Studies

See the list below:

  • Ultrasound biomicroscopy (UBM) has been particularly useful in evaluating the structures surrounding the posterior chamber in patients with pigmentary glaucoma (PG).[12] UBM shows the posterior iris insertion,[13] iris concavity, iridozonular contact, and extensive iridolenticular contact.
  • Slit-lamp optical coherence tomography has been used to assess the parameters of the anterior chamber and angle dimensions in patients with pigmentary glaucoma.[14, 15]
 
 
Contributor Information and Disclosures
Author

Yaniv Barkana, MD Consulting Staff, Glaucoma Unit, Department of Ophthalmology, Assaf Harofe Medical Center

Yaniv Barkana, MD is a member of the following medical societies: Israeli Medical Association

Disclosure: Nothing to disclose.

Coauthor(s)

Robert Ritch, MD Shelley and Steven Einhorn Distinguished Chair in Ophthalmology, Chief of Glaucoma Service, Surgeon Director, Professor, Department of Ophthalmology, New York Eye and Ear Infirmary, New York Medical College

Robert Ritch, MD is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, American Medical Association, American Ophthalmological Society, Chinese American Medical Society, International College of Surgeons, New York Academy of Medicine, New York Academy of Sciences

Disclosure: Received none from Sensimed for board membership; Received none from iSonic Medical for board membership; Received consulting fee from Aeon Astron for consulting; Received honoraria from Pfizer for speaking and teaching; Received honoraria from Allergan for speaking and teaching; Received honoraria from Ministry of Health of Kuwait for speaking and teaching; Received honoraria from Aeon Astron for speaking and teaching; Received royalty from Ocular Instruments for other.

Specialty Editor Board

Simon K Law, MD, PharmD Clinical Professor of Health Sciences, Department of Ophthalmology, Jules Stein Eye Institute, University of California, Los Angeles, David Geffen School of Medicine

Simon K Law, MD, PharmD is a member of the following medical societies: American Academy of Ophthalmology, Association for Research in Vision and Ophthalmology, American Glaucoma Society

Disclosure: Nothing to disclose.

Martin B Wax, MD Professor, Department of Ophthalmology, University of Texas Southwestern Medical School; Vice President, Research and Development, Head, Ophthalmology Discovery Research and Preclinical Sciences, Alcon Laboratories, Inc

Martin B Wax, MD is a member of the following medical societies: American Academy of Ophthalmology, American Glaucoma Society, Society for Neuroscience

Disclosure: Nothing to disclose.

Chief Editor

Hampton Roy, Sr, MD Associate Clinical Professor, Department of Ophthalmology, University of Arkansas for Medical Sciences

Hampton Roy, Sr, MD is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, Pan-American Association of Ophthalmology

Disclosure: Nothing to disclose.

Additional Contributors

Andrew I Rabinowitz, MD Director of Glaucoma Service, Barnet Dulaney Perkins Eye Center

Andrew I Rabinowitz, MD is a member of the following medical societies: Aerospace Medical Association, American Academy of Ophthalmology, American Society for Laser Medicine and Surgery, American Academy of Ophthalmology, American Medical Association

Disclosure: Nothing to disclose.

References
  1. Sugar HS, Barbour FA. Pigmentary glaucoma: a rare clinical entity. Am J Ophthalmol. 1949. 32:90.

  2. Flügel-Koch CM, Tektas OY, Kaufman PL, Paulsen FP, Lütjen-Drecoll E. Morphological alterations within the peripheral fixation of the iris dilator muscle in eyes with pigmentary glaucoma. Invest Ophthalmol Vis Sci. 2014 Jun 17. 55(7):4541-51. [Medline].

  3. Klingenstein A, Kernt M, Seidensticker F, Kampik A, Hirneiss C. Anterior-segment morphology and corneal biomechanical characteristics in pigmentary glaucoma. Clin Ophthalmol. 2014. 8:119-26. [Medline]. [Full Text].

  4. Maidana DE, Sanz S, Lillo J, Arruga J. Serous macular detachment associated with optic nerve head cupping in pigmentary glaucoma. Can J Ophthalmol. 2014 Apr. 49(2):e56-9. [Medline].

  5. [Guideline] U.S. Preventive Services Task Force (USPSTF). Screening for glaucoma: recommendation statement. Rockville (MD): Agency for Healthcare Research and Quality (AHRQ); 2005 Mar.

  6. Roberts DK, Lukic A, Yang Y, Wilensky JT, Wernick MN. Multispectral diagnostic imaging of the iris in pigment dispersion syndrome. J Glaucoma. 2012 Aug. 21(6):351-7. [Medline]. [Full Text].

  7. Campbell DG. Pigmentary dispersion and glaucoma. A new theory. Arch Ophthalmol. 1979 Sep. 97(9):1667-72. [Medline].

  8. Lichter PR, Shaffer RN. Diagnostic and prognostic signs in pigmentary glaucoma. Trans Am Acad Ophthalmol Otolaryngol. 1970 Sep-Oct. 74(5):984-98. [Medline].

  9. Chew SJ, Tello C, Wallman J, Ritch R. Blinking indents the cornea and reduces anterior chamber volume as shown by ultrasound biomicroscopy. Invest Ophthalmol Vis Sci. 1994. 35 (Suppl):1573.

  10. Uy HS, Chan PS. Pigment release and secondary glaucoma after implantation of single-piece acrylic intraocular lenses in the ciliary sulcus. Am J Ophthalmol. 2006 Aug. 142(2):330-2. [Medline].

  11. Gonzalez-Gonzalez LA, Rodríguez-García A, Foster CS. Pigment dispersion syndrome masquerading as acute anterior uveitis. Ocul Immunol Inflamm. 2011 Jun. 19(3):158-66. [Medline].

  12. Mora P, Sangermani C, Ghiradini S, Carta A, Ungaro N, Gandolfi SA. Ultrasound Biomicroscopy and Iris Pigment Dispersion: a Case-Control Study. Br J Ophthalmol. 2009 Oct 12. [Medline].

  13. Kanadani FN, Dorairaj S, Langlieb AM, Shihadeh WA, Tello C, Liebmann JM, et al. Ultrasound biomicroscopy in asymmetric pigment dispersion syndrome and pigmentary glaucoma. Arch Ophthalmol. 2006 Nov. 124(11):1573-6. [Medline].

  14. Dinc UA, Kulacoglu DN, Oncel B, Yalvac IS. Quantitative assessment of anterior chamber parameters in pigmentary glaucoma using slit-lamp optical coherence tomography. Eur J Ophthalmol. 2010 Jan 13. [Medline].

  15. Aptel F, Beccat S, Fortoul V, Denis P. Biometric analysis of pigment dispersion syndrome using anterior segment optical coherence tomography. Ophthalmology. 2011 Aug. 118(8):1563-70. [Medline].

  16. Harasymowycz PJ, Papamatheakis DG, Latina M, De Leon M, Lesk MR, Damji KF. Selective laser trabeculoplasty (SLT) complicated by intraocular pressure elevation in eyes with heavily pigmented trabecular meshworks. Am J Ophthalmol. 2005 Jun. 139(6):1110-3. [Medline].

  17. Cantor L. Section 10: Glaucoma. Basic and Clinical Science Course. American Academy of Ophthalmology: 1996-1997.

  18. Chaudry I, Wong S. Recognizing glaucoma. A Guide for the Primary Care Physician. 1999. Vol 99.: 247-64.

  19. Gupta N, Weinreb RN. New definitions of glaucoma. Curr Opin Ophthalmol. 1997 Apr. 8(2):38-41. [Medline].

  20. Hitchings RA. Glaucoma: current thinking. Br J Hosp Med. 1996 Mar 20-Apr 2. 55(6):312-4. [Medline].

  21. Liesegang TJ. Glaucoma: changing concepts and future directions. Mayo Clin Proc. 1996 Jul. 71(7):689-94. [Medline].

  22. Qureshi IA. Effects of mild, moderate and severe exercise on intraocular pressure of sedentary subjects. Ann Hum Biol. 1995 Nov-Dec. 22(6):545-53. [Medline].

  23. Reistad CE, Shields MB, Campbell DG, Ritch R, Wang JC, Wand M. The influence of peripheral iridotomy on the intraocular pressure course in patients with pigmentary glaucoma. J Glaucoma. 2005 Aug. 14(4):255-9. [Medline].

  24. Shields MB. Textbook of Glaucoma. 4th ed. 1998.

  25. Siddiqui Y, Ten Hulzen RD, Cameron JD, Hodge DO, Johnson DH. What is the risk of developing pigmentary glaucoma from pigment dispersion syndrome?. Am J Ophthalmol. 2003 Jun. 135(6):794-9. [Medline].

  26. Van Buskirk EM. Medicolegal aspects of glaucoma care. Surv Ophthalmol. 1998 Jul-Aug. 43(1):83-6. [Medline].

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To record changes in the pigmentation of the iris, the illumination beam must be directed coaxially through the pupil so that the retinal reflection appears in areas denuded of pigment granules. This transillumination photograph shows the sectoral defects associated with pigmentary glaucoma.
Goniography uses diagnostic mirrored contact lenses to overcome corneal refraction and to permit visualization of the filtration angle. The pigment liberated from the iris in pigmentary glaucoma is shown in the angle, clogging the trabecular meshwork and impeding aqueous outflow.
 
 
 
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