Pigmentary Glaucoma refractory to medical therapy (Clinical Image)

Abstract

Pigmentary glaucoma (PG) a type of secondary open angle glaucoma is characterized by classic diagnostic triad of Krukenberg's spindle; mid peripheral iris transillumination defects and dense Trabecular pigmentation. Treatment consists of medical management followed by laser iridotomy/ laser trabeculoplasty and trabeculectomy in recalcitrant cases; trabeculectomy is challenging with a higher risk of bleb failure and Hypotony Maculopathy.We report the case of a 43-year-old one-eyed male with BCVA 6/9 OS (log MAR 0.2); intraocular pressure (IOP) 34mmHg, oedematous cornea, prominent Krukenberg spindle and a very prominent Eggers line. He had advanced glaucomatous cupping (CDR 0.7:1); gonioscopy showed widely open angles, with "queer" iris configuration, and heavily pigmented PTM (Gd IV) with advanced damage on perimetry. As patient couldn't be weaned off systemic anti-glaucoma medications, trabeculectomy with antifibrotic augmentation was done. The surgery was uneventful and resulted in stabilizing IOP at 12-14 mmHg over a 6 month follow up till date.