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Case #73: Atypical Presentation of Pigmentary Dispersion Syndrome – Page 16 of 16

About the Author Dr. Margaret Fernicola is a current ocular disease resident with an emphasis in glaucoma and retina at SUNY College of Optometry and Woodhull Hospital. She received her Doctor of Optometry from SUNY College of Optometry in 2024 and her Bachelor's of Science from the University of Maryland

Case #73: Atypical Presentation of Pigmentary Dispersion Syndrome – Page 16 of 162025-02-04T18:29:55+00:00

Case #73: Atypical Presentation of Pigmentary Dispersion Syndrome – Page 14 of 16

Conclusion Pigment deposition on the posterior lens is an uncommon but easily detectable presentation of PDS.All PDS patients have increased risk of developing pigmentary glaucoma and should be followed as strong glaucoma suspects.Such findings should prompt the examiner to look for more subtle signs of PDS such as iris transillumination defects,

Case #73: Atypical Presentation of Pigmentary Dispersion Syndrome – Page 14 of 162025-02-04T18:26:02+00:00

Case #73: Atypical Presentation of Pigmentary Dispersion Syndrome – Page 13 of 16

Discussion Continued Another hypothesis is a bowed iris configuration could cause mechanical damage to the posterior zonules and eventually a break in the ligament of Weiger.This may explain the decrease in pigment over time, as increasing lens thickness with age may have moved the iris anteriorly and decreased contact between the

Case #73: Atypical Presentation of Pigmentary Dispersion Syndrome – Page 13 of 162025-02-04T18:25:31+00:00

Case #73: Atypical Presentation of Pigmentary Dispersion Syndrome – Page 12 of 16

Discussion The posterior pigment was limited to the space of Berger (The space between the posterior lens and anterior hyaloid face) as there was no pigment cells in the vitreous nor breaks in the retina. This suggests pigment originated from the iris.One explanation for communication between the posterior chamber and the

Case #73: Atypical Presentation of Pigmentary Dispersion Syndrome – Page 12 of 162025-02-04T18:24:47+00:00

Case #73: Atypical Presentation of Pigmentary Dispersion Syndrome – Page 9 of 16

Resolution of Posterior Lens Pigment Over the course of three years, the amount of pigment visualized on the posterior lens capsule showed an initial increase, then subsequent decrease in both eyes.Optos Daytona retinal imaging reveals a shadow cast by the pigment on the posterior lens in both eyes.

Case #73: Atypical Presentation of Pigmentary Dispersion Syndrome – Page 9 of 162025-02-04T18:08:18+00:00

Case #73: Atypical Presentation of Pigmentary Dispersion Syndrome – Page 8 of 16

Diagnosis and Management The patient was diagnosed with optic nerve hypoplasia as an explanation for his longstanding decreased vision since childhood.The patient was diagnosed with PDS and subsequently followed as a glaucoma suspect.Over the course of three years, the patient showed progressive RNFL thinning and correlating visual field defects. His IOP

Case #73: Atypical Presentation of Pigmentary Dispersion Syndrome – Page 8 of 162025-02-04T18:07:02+00:00