Pigment dispersion syndrome – A unique presentation with extensive retina pigment deposition

Aims/Purpose: To report a unique presentation of pigment dispersion syndrome (PDS).

Methods: Observational case report.

Results: An 81-year-old woman presented to our department for a routine appointment. Relevant ophthalmologic history comprised prior bilateral cataract surgery in 2009 with single piece in-the-bag intraocular lens (IOL) implantation in right eye (RE) and sulcus implantation in the left eye (LE), due to capsular rupture. Upon examination, best corrected visual acuity was 10/10 in OD and OS. Intra-ocular pressure (IOP) was 9/9 mmHg; there was anisocoria, with OS > OD in photopic conditions. OS slit lamp examination showed IOL positioned in the sulcus, diffuse pigment deposition in the corneal endothelium and uneven extensive 360° iris transillumination defects. Gonioscopy revealed extensive angle pigment deposition in OS; colour fundus photographs displayed extensive retina pigment deposition, mainly in the peripapillary and perivascular areas. No glaucomatous cupping of the optic disc was observed. A diagnosis of left PDS was entertained; given the lack of vision complains, normal visual acuity, IOP, and no glaucomatous damage of the optic nerve, close monitoring of the patient was undertaken.

Conclusions: Pigment dispersion syndrome may arise from the iatrogenic damage to the iris of a single piece sulcus-placed IOL and typically presents with extensive pigment deposition in the structures of the anterior segment, along with iris transillumination defects. To our knowledge, this is the second report of PDS with pigment deposition in the posterior segment. Indeed, although rare, convection currents may carry pigment to the vitreous and retina, which justifies the unusual findings in this patient and warrants a complete ophthalmologic evaluation in such cases.