Visualisation of reverse pupillary block using AC‐OCT in primary pigment dispersion syndrome

Abstract

Abstract Purpose: To describe morphologic characteristics associated with secondary IOP elevation due to pigment release after pupil dilation in primary melanin dispersion syndrome. Methods: The history of a 49 year old male patient with primary pigment dispersion syndrome and secondary ocular hypertension is described. Besides detailed ophthalmologic examination including slit lamp biomicroscopy, gonioscopy as well as IOP and Laser‐Flare measurement (KOWA FC‐1000; Kowa, Tokyo, Japan) before and after pupil dilation, anterior segment optical coherence tomography was performed before and after Nd:YAG laser iridotomy and in medical miosis. Results: After pupil dilatation IOP increased up to 46 mmHg at the right eye but no IOP elevation was recognised at the left eye. Measurement by Laser‐Flare Cell Meter revealed no cells in undilated state but 13.4 cells/ 0.075 μl at the right and 4.0 cells/ 0.075 μl at the left eye after mydriasis. Nd:YAG laser iridotomy was recommended for the right eye to the patient recently. Iris configuration detected by OCT demonstrates a concave shape before iridotomy more pronounced temporal than nasal which resolves after application of pilocarpin as well as after performance of Nd:YAG laser iridotomy. Conclusions: The effect of Nd:YAG laser iridotomy as a prophylactic but potentially causal treatment in pigmentary glaucoma can be easily visualized by OCT as a fast and non‐contact procedure.