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Editors Selection IGR 13-4

Clinical Forms of Glaucoma: Pigment dyspersion syndrome in Chinese

Comment by Nathan Radcliffe on:

24148 Clinical characteristics of pigment dispersion syndrome in Chinese patients, Qing G; Wang N; Tang X et al., Eye, 2009; 23: 1641-1646

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In an extension of their previous retrospective study¹ of pigment dispersion syndrome (PDS) in a Chinese population, Qing et al.² (1158) present the first prospective, single-examiner clinical case series of PDS in a Chinese population. The classic triad of PDS includes corneal endothelial pigmentation (Krukenberg spindle), slitlike, radial, mid-peripheral iris transillumination defects (TIDs) and dense homogeneous pigmentation of the trabecular meshwork. The authors show that iris TIDs are frequently absent in Chinese, a finding that has also been reported in blacks.³ Qing and coauthors acknowledge that iris TIDs in their patients may have been visible with infrared pupillography, a technique that has been shown to identify occult iris TIDs in blacks with PDS.⁴

Iris transillumination defects are frequently absent in Chinese with pigmentary dispersion

The presence of pigmented long anterior zonules is an important mimicker of PDS and has been identified in black patients with endothelial and trabecular pigmention who do not exhibit iris TIDs or other classic features of PDS, such as iris concavity.⁵ Although pigmented long anterior zonules are not mentioned in this study, the presence of moderate myopia and posterior iris bowing as well as the provided photographs of peripheral lenticular and zonular pigmentation are most consistent with classic PDS. Finally, the high prevalence of visual field damage (83.3%) along with the severity of IOP elevation and optic nerve cupping could indicate a greater susceptibility to pigmentary glaucoma in this population. Alternatively this could reflect a selection or referral bias or it could indicate that PDS is under recognized in Chinese and goes undiagnosed unless glaucomatous damage develops. This publication should increase awareness of PDS in the Chinese population and may assist in earlier detection of this condition.

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