Ultrasound Biomicroscopy in Pigment Dispersion Syndrome

Purpose: To examine the positional relations of the iris, lens, ciliary processes, and zonules in eyes with the pigment dispersion syndrome (PDS). Methods: High-resolution, anterior segment ultrasound biomicroscopy was performed on 16 untreated eyes of 11 patients with PDS. Scanning was repeated on four eyes after miotic treatment and four eyes after laser iridotomy. Results: Mid-peripheral iris concavity could be demonstrated in 56%, irido-zonular contact in 25%, and irido-ciliary process contact in 75% of untreated eyes with PDS. Repeat scanning after laser iridotomy or pilocarpine therapy showed resolution of the iris concavity and irido-zonular contact in all eyes receiving these therapies. Irido-ciliary process contact persisted in some eyes. Conclusion: The authors' findings demonstrate the structural relations among the iris, lens, zonules, and ciliary processes in vivo that characterize the PDS. Miotic therapy and laser iridotomy eliminate the iris concavity in all patients with this finding, supporting the hypothesis of reverse pupillary block. Irido-ciliary process contact may be another mechanism causing release of pigment. This issue merits further clinical and histologic study.