Krukenberg’s Spindles Strongly Suggest Long Anterior Zonule Associated Pigment Dispersion Mechanism in Older Patients

Abstract

The purpose of this study was to further investigate factors associated with Krukenberg's spindle (KS) presence in a primary eye care setting. METHODS. As part of a larger investigation, several practitioners in an academic eye care facility in Chicago, IL, USA evaluated patients for the long anterior zonule (LAZ) trait during 2011 to 2018, and data were collected on ocular/systemic health, lifestyle, and demographic variables, including the presence of a KS. Multivariate regression was used to assess relationships to KS presence. RESULTS. Analysis included 3501 subjects with mean age of 51 ± 15 years (18-98 years; 65% women; and 84% African American). Among the right eyes, 57 (1.6%) had a KS, with this group having a mean age of 62 ± 13 years (25-86 years; 75% women; and 82% African American). There were 120 subjects (3.4%) with right eye LAZ, with mean age of 64 ± 11 years (36-91 years; 77% women; and 92% African American). There were 19 of 57 (33.3%) KS eyes that also had LAZ. Controlling for other factors, variables with the strongest relationship to KS presence were the LAZ trait (odds ratio [OR] = 12.2, 95% confidence interval [CI] = 6.5 to 22.8, P < 0.0001) and advancing age (OR = 1.3 per decade, 95% CI = 1.3 to 1.9, P < 0.0001). CONCLUSIONS. In the population studied, KS presence had its strongest relationship to the LAZ trait and advancing age. The KS-LAZ relationship may not be well-known, but these data strongly suggest that pigment dispersion signs, such as a KS, should prompt the clinician to consider the LAZ trait as a potential etiology, especially because LAZ is associated with higher IOP and possibly glaucoma.

Time-of-Year Variation in Intraocular Pressure

“…We used 3 different datasets for the analyses described herein. Our primary dataset (A), from which our interest in the IOP to time-of-year relationship developed, was recently described in separate reports that addressed IOP among people with the LAZ trait 37,38. This study excluded patients that had greater than trace LAZ.…”

“…We considered a Krukenberg spindle present when there was any degree of “fine pigment dusting” of the central region of the posterior cornea when it was not possible to “count” individual pigment granules because they were too small, numerous, and coalesced. We did not consider larger, coarse pigment flecks representative of a Krukenberg spindle, even when somewhat central 38…”

“…the IOP to time-of-year relationship developed, was recently described in separate reports that addressed IOP among people with the LAZ trait. 37,38 This study excluded patients that had greater than trace LAZ. Subsequent to exploration on that dataset, we used the other 2 datasets (B, C) to check for certain consistencies and to perform additional analyses afforded by greater numbers of subjects.…”

“…We did not consider larger, coarse pigment flecks representative of a Krukenberg spindle, even when somewhat central. 38 Data on other variables (Table 1) relied on information extracted from the medical record and/or the questionnaire which was completed by patients without assistance. We constructed race categorization based on medical record and questionnaire information, with final assignment to one of the following categories: (1) Black/African American, (2) Asian, (3) Hispanic, Black or White, (4) Non-Hispanic White, (5) other.…”

Long anterior lens zonules with retinal stripes: a case report

“…It sometimes causing a marked reduction in the ZFZ diameter. The estimated prevalence is from 1–2% and is associated with age > 50 years, female sex, and most binocular diseases [ 1 , 2 ]. But previous studies were mostly conducted among African Americans.…”