Curvilinear, symmetrical, and profound pigment deposition on the posterior lens capsule in a patient with bilateral pigmentary dispersion syndrome

Abstract

IntroductionThe classic presentation of pigmentary dispersion syndrome (PDS) often consists of midperipheral iris transillumination defects, Krukenberg’s spindle, and dense homogeneous trabecular pigmentation. Other subtle, sometimes overlooked features include pigment on the lens zonules, pigment on the anterior lens capsule and pigment along the equator of the posterior lens capsule.CaseThis unique presentation of PDS presented with bilateral, dense, oblique, and symmetrical pigment deposition along the posterior lens capsule that changed in shape, density, and extent over the span of 3 years.DiscussionThere have been few reports in the literature that describe a central accumulation of pigment along the posterior lens capsule associated with PDS. There are reported cases of pigment deposition along the central aspect of the posterior lens capsule, some changing over time, although none were bilateral and symmetrical. There are suggestions that perhaps this central pigment deposition is related to a break in the ligament of Weiger, allowing communication between the posterior chamber and posterior lens capsule. This is a case in which curvilinear, symmetrical, and changing pigment deposition on the posterior lens capsule is suggestive of perhaps another key features of PDS.

Pigment deposits in the retrolental space of Berger: a rare feature of pigment dispersion syndrome?

“…(11) Canestrano et al described a case of bilateral pigment deposits in a patient with PDS with no history of trauma in whom the morphology of the deposits were seen to change over time. (12) This feature had already been emphasized by Nagarajaiah et al, demonstrating a unilateral case in which the central aspect of the deposit cleared to accumulate more peripherally, after 14 years of follow-up. (13) The deposition of pigment in the retrolental space may be an important sign of PDS.…”

A case of dense pigment deposition of the posterior lens capsule

“…Al-Mezaine [22] described a case of pigment deposition after blunt ocular trauma. There is only one documented case of bilateral pigment deposition of the posterior lens capsule published by Canestraro et al [23]. The patient presented in this latter case study had optic nerve hypoplasia which made the assessment of the damage done by the glaucoma difficult.…”

“…This means that an anatomical anomaly or a defect in Wiegers ligament would have to be present and for the aqueous from the posterior chamber to be able to flow into the retrolental space [18][19][20]22]. Canestraro et al [23] proposed that anatomical changes due to the proximity of the posterior zonulae insertions and Wieger's ligament are to be blamed.…”

Posterior Capsular Pigment Deposition: A Rare Presentation of Pigment Dispersion Syndrome

“…There have been reports of unilateral and bilateral pigment deposition on the posterior lens capsule without a history of trauma. [5][6][7][8][9][10][11] In the classic presentation of PDS, pigmentation of the lens capsule is seen in the periphery of the lens, known as Scheie's or Zentmayer's line. 2,4 To detect more central posterior capsular pigmentation there must be an anatomical anomaly or a defect in the ligament of Wieger to allow aqueous flow from the posterior chamber to the retrolental space.…”