Pigment Dispersion Syndrome and Pigmentary Glaucoma: New Clinical Gradation and Current Therapeutic Strategies

The classic triad of clinical findings in pigment dispersion syndrome was described decades ago. It consists of radial, spoke-like iris transillumination defects, pigment deposits on the corneal endothelium known as the Krukenberg spindle, and a densely and homogenously pigmented trabecular meshwork. PDS occurs approximately three times more frequently in young myopic men than in women and is most often identified between 30 and 50 years of age. The diagnostic evaluation does not differ from the standard examination performed in patients with suspected glaucomatous optic neuropathy. However, it must additionally incorporate examinations specific to PDS. The possible therapeutic approaches varying by disease stage will be discussed, including pharmacologic treatment, laser procedures (iridotomy and trabeculoplasty), and surgical approaches such as canaloplasty, trabeculectomy, and other glaucoma surgeries. In order to better identify patients requiring an optimal therapeutic strategy, we propose a division into five stages of PDS: (1) preclinical PDS, (2) visible PDS, (3) PDS converting to pigmentary glaucoma, (4) pigmentary glaucoma, and (5) inactive PDS. Therapeutic strategies of each stage are described below.