Weightlifters with Pigment Dispersion Syndrome or Pigmentary Glaucoma: A Case Study
Shakun Gupta *
Indira Gandhi Eye Hospital and Research Centre, Lucknow, Uttar Pradesh, India.
Alka Gupta
Indira Gandhi Eye Hospital and Research Centre, Lucknow, Uttar Pradesh, India.
*Author to whom correspondence should be addressed.
Abstract
Pigmentary glaucoma affects the younger population and has a predilection for Caucasian males with myopia. A weightlifter developed a sudden diminution of vision after exercise with visual acuity in the right eye (RE) HM, and in the left eye (LE) CF 1foot. Intraocular pressure (IOP) with Goldmann applanation tonometer (GAT) in both eyes was 34 mmHg with antiglaucoma medications. The patient was having similar episodes in the past from 6 months to 1 year, which aggravated after exercise and improved after taking rest, along with the instillation of topical eyedrops (records were not available). The patient was a weightlifter by profession. Slit lamp examination of both eyes showed an edematous cornea, the concave configuration of the iris, semi-dilated pupil, sluggishly reacting to light and iris pigment on corneal endothelium and on the clear lens in RE; LE lens was clear. The gonioscopy showed an open angle with increased pigmentation. Fundus examination showed a cup-disc ratio of 0.8 in RE and 0.85 in LE. Anterior segment optical coherence tomography (ASOCT) confirmed the concave configuration of the iris.
The patient was treated with antiglaucoma medications and a peripheral iridotomy done with Nd: YAG in BE, which decreased the concave configuration of the iris. Visual acuity improved to 6/6 in RE & 6/9 in LE. BE IOP with GAT 14 mmHg, Humphery visual field (HVF) 10-2 showed advanced field defects, Central corneal thickness 598µ, OCT showed retinal nerve fibre layer thickness in RE 75µ and 64µ in LE. Planned for trabeculectomy with MMC subsequently in BE. Pigmentary glaucoma affects the younger population and has a predilection for Caucasian males with myopia. The pigment is released due to irido-zonular contact owing to reverse pupillary block and blockage of the filtering trabecular meshwork, leading to decreased outflow and a rise in IOP. Weightlifters need to remain cautious, especially having Pigment dispersion syndrome or pigmentary glaucoma and should undergo regular ophthalmic checkups.
Keywords: Pigmentary glaucoma, Pigment Dispersion Syndrome (PDS)