Jaskra barwnikowa – patomechanizm, diagnostyka i leczenie
Pigmentary Glaucoma – Pathomechanism, Diagnostics and Treatment
Monika Udziela, Marta Szymańska-Świderska, Anna Zaleska-Żmijewska, Jacek P. Szaflik
Katedra i Klinika Okulistyki II Wydziału Lekarskiego Warszawskiego Uniwersytetu Medycznego
Samodzielny Publiczny Kliniczny Szpital Okulistyczny w Warszawie
Kierownik: prof. dr hab. n. med. Jerzy Szaflik
Summary: In our article we describe definition, epidemiology, pathogenesis, genetic aspects, symptoms and signs, diagnostic methods, histology, differentiation diagnosis and management of pigmentary glaucoma including pharmacotherapy, laser therapy and surgery. Pigmentary glaucoma (PG) typically develops in young myopic patients with pigment dispersion syndrome (PDS). PDS is characterised by melanin pigment liberation from the iris pigment epithelium due to mechanical disruption by lens zonules. Accomodation plays an important role in this process. Criteria for pigment dispersion syndrome are two out of three signs: Krukenberg spindle, midperipheral radial iris transillumination defects or heavy trabecular meshwork pigmentation. Criteria for pigmentary glaucoma are: pigment dispersion syndrome and two out of three findings: intraocular pressure greater than 21 mmHg, optic nerve damage or visual field loss. Ultrabiomicroscopy Examination (UBM) is especially useful among various diagnostic methods. Optical coherence tomography (OCT for anterior segment) is another new method for anterior segment imaging. Patients suffering from pigmentary glaucoma are treated using pharmacotherapy as well as laser and surgery management. Selective laser trabeculoplasty (SLT) is safe and effective procedure in lowering intraocular pressure and currently it should be the first-choice of PG treatment. However its efficacy depends on stage of the trabecular meshwork pigmentation.
Keywords: pigmentary dispersion syndrome (PDS), pigmentary glaucoma (PG), selective laser trabeculoplasty (SLT).