A case of dense pigment deposition of the posterior lens cap
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Pigment dispersion syndrome (PDS) is a well-known entity which can lead to pigmentary glaucoma (PG). This case report presents a rare presentation of PG with bilateral dense pigment deposits of the posterior lens capsule.

A 72-year-old male came for his first appointment due to an asymmetric worsening of visual acuity. The examination showed unilaterally severely increased intraocular pressure, bilateral dense pigment deposition of the posterior lens capsule, and a shallow unilateral optic disk excavation. Gonioscopy revealed moderate pigmentation of the angle and a concave configuration of the peripheral iris in both eyes. The standard slit lamp examination showed no transillumination defects of either iris.

Due to a severely elevated IOP we decided to prescribe the patient with a prostaglandin analogue (latanoprost once daily) for both eyes and a combination of an 2 adrenergic agonist and a adrenergic antagonist (brimonidine tartrate/timolol maleate twice daily) for his right eye. The patient had a good response to topical medication. At his last follow-up examination 6 months after the presentation, his VA was 0.5–0.6 and 1.0 and IOP 9 mmHg and 10 mmHg in his right and left eye respectively. OCT showed no additional RNFL thinning; also the visual fields defects were unchanged.

Due to a severely elevated IOP we decided to prescribe the patient with a prostaglandin analogue (latanoprost once daily) for both eyes and a combination of an 2 adrenergic agonist and a adrenergic antagonist (brimonidine tartrate/timolol maleate twice daily) for his right eye. The patient had a good response to topical medication. At his last follow-up examination 6 months after the presentation, his VA was 0.5–0.6 and 1.0 and IOP 9 mmHg and 10 mmHg in his right and left eye respectively. OCT showed no additional RNFL thinning; also the visual fields defects were unchanged.

Pigment deposition of the posterior lens capsule, which has been rarely reported, is a possible important sign of PDS or PG.

Source:https://bmcophthalmol.biomedcentral.com/articles/10.1186/s12886-020-01728-y
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