New Migratory Routes Of Pigment In Pigmentary Dispersion Syndrome

To present a retrospective case report of a rare form of pigment accumulation posteriorly to the posterior capsule in a patient proposed for cataract surgery.

Data was collected at Centro Hospitalar Universitário do Porto.

An 80 years-old woman presents with a history of loss of vision on both eyes. Past medical history is notable for a blunt trauma to her left eye when she was 40 years old. Her best corrected visual acuity was 20/80 (-2.00 sphere -0.75x90 cylinder) in the right eye and 20/100 in the left eye (-2.50 sphere -0.50x75 cylinder). Ophthalmological examination was notable for pigment dispersion on the cornea’s endothelium in both eyes and nuclear cataracts. No iris transillumination defects were noted. Intraocular pressure was 11 and 13 mmHg in the right and left eyes, respectively. Gonioscopy revealed a hyperpigmented trabecular meshwork in both eyes. After pupillary dilation, the left eye revealed a vertical column of dense pigment accumulated in the posterior lens capsule. The right eye displayed a nuclear cataract but no pigment was visible. Fundus examination displayed a normal optic disc and retina on both eyes. Ocular coherence tomography (OCT) of the optical nerve revealed a normal retinal nerve fiber layer width.

In PDS, pigmentation of the lens capsule at the level of the ligamentum hyaloideo-capsulare of Wieger, is known as Scheie’s line or Zentmayer’s ring, depending on the pattern of deposition. Retrolental central pigmentation in patients with pigment dispersion syndrome is much less common and a feature, in the few published cases with this characteristic, may include a history of ocular blunt trauma, as in our case.

The deposition of pigment in the retrolental space may be an important sign of PDS. Other causes include trauma and congenital anomalies. When other signs are subtle, this feature may allow us to diagnose PDS and ensure an appropriate follow-up.