Pigment dispersion syndrome and pigmentary glaucoma: overview and racial disparities

Pang, Ruiqi; Labisi, Siloka Arthur; Wang, Ning Li

doi:10.1007/s00417-022-05817-0

Cited by 6 publications

(3 citation statements)

References 108 publications

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“…This constant iris chafing could lead over time to an increased eye pressure via constant inflammation, iris depigmentation, pigment dispersion (see Figure 3) and subsequent pigment dispersion glaucoma. 30 One major limitation of the study is that all patients underwent full pars plana vitrectomy, which may have contributed to the frequency of RPB. However, in the cohort studied by Bang et al, only two out of eight patients with RPB had undergone prior full pars plana vitrectomy, while the remaining six had only undergone anterior vitrectomy.…”

Section: Discussionmentioning

confidence: 99%

Reverse pupillary block, in contemporary scleral intraocular lens procedures

Schranz,

Schartmüller,

Lisy

et al. 2024

Clinical Exper Ophthalmology

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BackgroundTo evaluate the frequency and anterior segment optical coherence tomography parameters of patients with scleral fixated intraocular lenses (IOL) and reverse pupillary block (RPB).MethodsRetrospective analysis at a tertiary care centre (Department for Ophthalmology and Optometry, Medical University of Vienna, Austria).We researched our records for patients who underwent scleral fixated IOL implantation from January 2018 till February 2023.Patients were included only if there was at least one adequate post‐operative scan of anterior segment optical coherence tomography (AS‐OCT) available.Initially, AS‐OCT scans were assessed for IOL tilt and decentration employing a 3D scan and then later for anterior chamber angle (ACA), aqueous anterior chamber depth (AQD), pupil diameter and iris‐IOL distance using the 2D scan at a 0° angle. Both an iris‐IOL distance of 0 or less and an ACA of more than 70° were required to define an RPB.ResultsA total of 110 patients met the inclusion criteria, 41 were treated using the Carlevale, 33 the four flanged, 24 the Yamane and 12 the Scharioth technique, respectively. RPB was found in 32 patients (29%). Twenty patients with RPB were treated using YAG peripheral iridotomy, mean ACA decreased from 91.91° ± 13.77 to 61.02° ± 8.52, (p < 0.001), mean AQD decreased from 4.67 mm ± 0.47 to 4.31 ± 0.36 mm (p < 0.001) and mean iris‐IOL distance increased from −0.09 ± 0.04 to 0.33 ± 0.30 (p < 0.001).ConclusionsRPB is found in a third of eyes who have undergone scleral fixated IOL implantation without iridectomy. YAG peripheral iridotomy is a potent option to treat RPB, and subsequently reduce the risk of iris chafing and secondary inflammation or glaucoma.

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Section: Discussionmentioning

confidence: 99%

Reverse pupillary block, in contemporary scleral intraocular lens procedures

Schranz,

Schartmüller,

Lisy

et al. 2024

Clinical Exper Ophthalmology

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“…The prevalence of these two types of secondary glaucoma varies geographically and across different ethnic groups, suggesting a multifactorial basis of pathogenesis (Gaton et al, 1998; Pang et al, 2022; Pasquale et al, 2018; Schlötzer‐Schrehardt & Zenkel, 2019; Tarkkanen, 1986; Thorleifsson et al, 2007). There are currently no disease‐specific treatment options for these conditions (European Glaucoma Society Terminology and Guidelines for Glaucoma, 2021).…”

Section: Introductionmentioning

confidence: 99%

Secondary glaucoma: Toward interventions based on molecular underpinnings

Mueller,

Lam,

Kishor

et al. 2023

WIREs Mechanisms of Disease

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Glaucoma is a heterogeneous group of progressive diseases that leads to irreversible blindness. Secondary glaucoma refers to glaucoma caused by a known underlying condition. Pseudoexfoliation and pigment dispersion syndromes are common causes of secondary glaucoma. Their respective deposits may obstruct the trabecular meshwork, leading to aqueous humor outflow resistance, ocular hypertension, and optic neuropathy. There are no disease‐specific interventions available for either. Pseudoexfoliation syndrome is characterized by fibrillar deposits (pseudoexfoliative material) on anterior segment structures. Over a decade of multiomics analyses taken together with the current knowledge on pseudoexfoliative glaucoma warrant a re‐think of mechanistic possibilities. We propose that the presence of nucleation centers (e.g., vitamin D binding protein), crosslinking enzymes (e.g., transglutaminase 2), aberrant extracellular matrix, flawed endocytosis, and abnormal aqueous‐blood barrier contribute to the formation of proteolytically resistant pseudoexfoliative material. Pigment dispersion syndrome is characterized by abnormal iridolenticular contact that disrupts iris pigment epithelium and liberates melanin granules. Iris melanogenesis is aberrant in this condition. Cytotoxic melanogenesis intermediates leak out of melanosomes and cause iris melanocyte and pigment epithelium cell death. Targeting melanogenesis can likely decrease the risk of pigmentary glaucoma. Skin and melanoma research provides insights into potential therapeutics. We propose that specific prostanoid agonists and fenofibrates may reduce melanogenesis by inhibiting cholesterol internalization and de novo synthesis. Additionally, melatonin is a potent melanogenesis suppressor, antioxidant, and hypotensive agent, rendering it a valuable agent for pigmentary glaucoma. In pseudoexfoliative glaucoma, where environmental insults drive pseudoexfoliative material formation, melatonin's antioxidant and hypotensive properties may offer adjunct therapeutic benefits.This article is categorized under: Neurological Diseases > Molecular and Cellular Physiology

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“…However, it significantly impacts vision and can be easily misdiagnosed as other types of open-angle glaucoma during clinical diagnosis. 11 Therefore, studying the pathogenesis of PDS/PG is clinically important for early diagnosis and treatment. The progression of PDS to PG involves a complex interplay of several etiologic factors.…”

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confidence: 99%

Pigment Dispersion Contributes to Ocular Immune Privilege in a DBA/2J Mouse Model of Pigmentary Glaucoma

Li,

Pu,

Cheng

et al. 2024

Invest. Ophthalmol. Vis. Sci.

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Purpose To investigate the effects of anterior chamber pigment dispersion on ocular immune privilege and the possible mechanisms involved in a DBA/2J mouse model of pigmentary glaucoma. Methods DBA/2J mice were utilized as a pigment dispersion model, and age-matched C57BL/6J mice were used as the control group in this study. Proteins in the aqueous humor (AH) and serum were quantified using the bicinchoninic acid assay. Immune cells in the AH were detected using hematoxylin and eosin staining and immunocytochemistry. The expression of TGF-β2 in the AH and cytokine levels (IL-10, IFN-γ) in serum were measured using ELISA. Anterior chamber-associated immune deviation (ACAID) was induced in DBA/2J mice by injecting antigens into the anterior chamber. Delayed-type hypersensitivity (DTH) assays were used to assess the induction of ACAID. In DBA/2J mice, before and after pigment dispersion, following anterior chamber injection of pigment particles, and after ACAID modeling, the expression of regulatory T cells (Tregs) was detected using flow cytometry. Results Compared to C57BL/6J mice, the protein concentration, immune cell count, and TGF-β2 levels in the AH were elevated in DBA/2J mice. Protein concentration and IL-10 levels in serum were increased, while IFN-γ levels were decreased in DBA/2J. Additionally, the expression of Treg cells in the spleen of DBA/2J mice was significantly increased after pigment dispersion and anterior chamber injection of pigment particles. At 3 and 6 months, DTH responses in DBA/2J mice were not inhibited, thus preventing ACAID induction. However, the opposite was observed at 9 months in DBA/2J mice. Furthermore, the ACAID group exhibited an augmented expression of Treg cells. Conclusions Dispersion of pigment particles in the anterior chamber of the eye enhances the state of ocular immune privilege by influencing the immunosuppressive microenvironment and inducing more Treg cells to reestablish ACAID.

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Pigment dispersion syndrome and pigmentary glaucoma: overview and racial disparities

Cited by 6 publications

References 108 publications

Reverse pupillary block, in contemporary scleral intraocular lens procedures

Reverse pupillary block, in contemporary scleral intraocular lens procedures

Secondary glaucoma: Toward interventions based on molecular underpinnings

Pigment Dispersion Contributes to Ocular Immune Privilege in a DBA/2J Mouse Model of Pigmentary Glaucoma

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