Cataract surgery in patients with Pigment Dispersion Syndrome can be challenging due to the anatomic changes which have happened over the course of many years. These patients can have an unusual iris configuration which allows contact between the anterior lens capsule and the posterior surface of the iris. This can lead to dispersion of pigment throughout the eye, often seen in the angle on gonioscopic view and also on the corneal endothelium in the Krukenberg spindle pattern.
Due to the configuration and extensive loss of pigment, this iris behaves much like floppy iris syndrome or IFIS (intra-operative floppy iris syndrome). IFIS is usually associated with use of prostate medications such as Flomax (tamsulosin), but this patient is female and has never used such agents.
Care is taken during surgery to avoid prolapse and damage of the iris. The case progresses nicely and the patient achieves a great result. While the cataract surgery will tend to lower the IOP and should help prevent further contact between the anterior lens capsule and the back of the iris, this patient is still at a lifelong risk for glaucoma issues and should be monitored closely.
Click below to see the technique of cataract surgery in pigment dispersion syndrome: