Diffuse Posterior Capsule Pigmentation In Pigment Dispersion Syndrome Mimicking Posterior Subcapsular Cataract: A Diagnostic And Functional Masquerade

To describe diffuse posterior capsule pigmentation in Pigment Dispersion Syndrome mimicking posterior subcapsular cataract and producing significant visual symptoms despite normal intraocular pressure.

Tertiary eye care center, India.

A 42-year-old male presented with progressive dimness of vision, glare, and night driving difficulty in the left eye. Detailed clinical evaluation included visual acuity assessment, slit-lamp examination, Goldmann applanation tonometry, gonioscopy, and optic nerve evaluation.

Uncorrected visual acuity was 6/6 in the right eye and 6/18 in the left eye, improving to 6/9 with correction. Slit-lamp examination showed Krukenberg spindle in both eyes. The left eye demonstrated Zentmayer ring, Scheie line, and extensive diffuse pigment deposition over the posterior capsule involving the visual axis, clinically simulating posterior subcapsular cataract. Gonioscopy revealed dense trabecular meshwork pigmentation, more marked in the left eye. Intraocular pressure remained normal in both eyes. Optic nerve examination was normal. Visual symptoms correlated with central posterior capsule pigment deposition.

Diffuse posterior capsule pigmentation in Pigment Dispersion Syndrome can mimic posterior subcapsular cataract both structurally and functionally. Recognition of this diagnostic masquerade is essential to avoid misdiagnosis and unnecessary surgical intervention.