| Abstract [eng] |
The aim of this study is to evaluate the clinical features of pigment dispersion syndrome (PDS) and pigmentary glaucoma (PG) – including symptoms, diagnosis, disease progression factors, and applied treatment – based on literature review and clinical cases of patients from the Vilnius University Hospital Santaros Klinikos, Center of Eye Diseases. Research material and methods: The clinical cases of two patients diagnosed with PDS and PG were selected and analyzed, assessing their symptoms, intraocular pressure fluctuations, and applied treatment. A literature review was conducted using the PubMed and Google Scholar databases, selecting articles that analyse the epidemiology, genetics, pathophysiology, clinical features, and treatment methods of PDS and PG. Keywords used: pigment dispersion syndrome, pigmentary glaucoma. The selected scientific sources were evaluated through descriptive analysis. Results and conclusions: PDS and PG are closely related conditions that share some clinical features but differ in their progression and damage to the optic nerve. PDS usually does not cause persistent symptoms and can be an incidental finding during ophthalmologic examination. However, in certain cases, it can progress to PG, when pigment accumulation in the trabecular meshwork leads to increased intraocular pressure and optic nerve damage. The analyzed clinical cases confirmed the tendency described in the literature: PDS is more commonly diagnosed in younger patients, while PG occurs at an older age and is associated with more significant optic nerve changes and visual field loss. In both cases, the typical clinical triad of PDS and PG was observed: Krukenberg spindle on the corneal endothelium, iris transillumination defects, and trabecular meshwork pigmentation. The intraocular pressure of the PDS patient was elevated only during active pigment dispersion but later stabilized. In contrast, in the PG patient, despite consistent combined medical treatment, intraocular pressure remained within the higher normal range. The diagnosis of PDS and PG requires a comprehensive examination, including gonioscopy, optic nerve assessment, and visual field testing. Although there is no specific treatment for PDS/PG, the primary focus is on intraocular pressure control. Management includes prostaglandin analogues, β-blockers, carbonic anhydrase inhibitors, α-adrenergic agonists, and pilocarpine, and in some cases, selective laser trabeculoplasty (SLT) or glaucoma surgery may be performed. Considering the pathophysiological mechanisms, progression, and clinical characteristics of PDS and PG, it is essential for patients to undergo regular monitoring. Particular attention should be given to patients with elevated intraocular pressure or optic nerve damage, aiming to prevent disease progression and irreversible vision loss as early as possible. |
