Diapositiva 1

1
IRIS BEHAVIOUR AFTER YAG LASER IRIDOTOMY IN
A CASE OF PIGMENTARY DISPERSION
SINDROME PHOTODOCUMENTED WITH ARTEMIS
ULTRALINK SCAN
Barcelona-Spain
Jairo Hoyos-Chacón, MD Melania Cigales, MD
Jairo E. Hoyos, MD PhD
info_at_iohoyos.com
The Pigmentary Dispersion Syndrom (PDS) is
characterized by the pigment release of the iris
pigmentary epithelium and its deposition in all
the anterior segment. Normally it is bilateral
that affects mainly a white people and it can be
inherited with a dominant autosomic feature. The
clinical signs of PDS are shown in table 1.
Different research has suggested that patients
with PDS have a risk of 25-50 to develop
glaucoma. The Pigmentary Glaucoma (PG) affects
mainly young miopic male (relation 21). The
clinical PG features can be observed in table
2. The PDS and the PG are considered as different
stages of the same pathology, according to
Richardsons theory (1982). At the first stage
pigment is accumulated in the trabecular meshwork
and they are phagocytized by the endothelial
cells. At this point transitory episode of ocular
hypertension after exercise or pupillary
dilatation can exist. At the second stage , the
massive pigment phagocytosis can cause the
autolysis or the collapse or the trabecular
meshwork with the posterior pigment accumulation,
setting up the intraocular pressure (IOP)
alteration. Pigmentary dispersion causes In
1979 Campbell puts forward that PDS is due to
purely mechanical reason the rubbing of the
anterior zonular with the posterior iris surface,
which frequently presents a posterior bowing. The
tendency of the pathology to improve with the
passing of the years can be due to the normal
lens axial growth, that pushes iris periphery
away from the zonula, reducing the rubbing. In
these eyes the iris posterior bowing and the lens
would behave as a kind of valve that would stop
the aqueous humor retrograde flowing from the
anterior chamber to the posterior chamber,
causing a reverse pupillary block. This block
would produce the pressure elevation in the
anterior chamber, forming a pressure gradient
between the anterior and the posterior chamber.
This situation would mean a posterior iris
movement as well as its contact and rubbing with
zonula and with the cilliary body. The iris
posterior bowing with reverse papillary block has
been noticed in many eyes suffering from
pigmentary glaucoma. In 1992, Karickhoff put
forward the realization of a laser iridotomy to
treat the reverse pupillary block. The laser
iridotomy would let us eliminate the pressure
gradient between the anterior and the posterior
chambers, eliminating the reverse pupillary
block, thus reducing iris concavity and
diminishing the contact between iris and zonula.

• Richardson TM. Pigmentary glaucoma. In Ritch R,
  Shields MB, Krupin T (eds). The Glaucomas. St.
  Louis CV Mosby, 1989vol 2981-5.
• Campbell DG. Pigmentary dispersion syndrome a
  new theory. Arch Ophthalmol 1979 971667-72.
• Campbell DG, Schertzer RM. Pathophysiology of
  pigment dispersion syndrome and pigmentary
  glaucoma. Curr Opin Ophthalmol 19956(2)96-101.
• Karickhoff JR. Pigmentary dispersion syndrome and
  pigmentary glaucoma a new mechanism concept, a
  new treatment, and a new technique. Ophthalmic
  Surg 199223(4)269-77.

The authors have not commercial or proprietary
interest in the equipment or medications used in
this study.