Purpose: To investigate the role of pigment dispersion and inflammation in the pathogenesis of goniodysgenesis-related glaucoma (GDRG). Procedures: Cases of GDRG were selected when the duration of the disease was specified and there was not any confounding pathology. Cases were grouped into ≤ 7-day (acute), and > 7-day (chronic) durations, based on the time required to effect end-stage retinal damage. Acute cases were further divided into < 4-day and 4-7-day groups to assess peracute changes. Slides were evaluated for four individual signs of pigment dispersion: segmental loss of posterior iris pigment epithelium, clumping of posterior iris pigment epithelium, pigmented cells in the trabecular meshwork or anterior chamber and preferential settling of pigmented cells in the ventral aspect of the iridocorneal angle. Slides were also evaluated for the presence of neutrophils and/or lymphoplasmacytic cells in the trabecular meshwork (TM). Differences between groups were analyzed statistically. Results: Of 100 cases evaluated, 34 were ≤ 7-days (acute) (14 < 4-day and 20 4-7-day) and 66 were > 7-days (chronic) in duration. Of all globes examined, 96% had at least one sign of pigment dispersion, with no significant difference between groups. Two or more signs of pigment dispersion were present in 76% of all globes. The 4-7-day group was significantly more likely than the < 4-day group to have at least two signs. The difference was not significant between ≤ 7- and > 7-day groups. Neutrophils were present in the TM of 86% of < 4-day and 50% of 4-7-day cases. Cases in the ≤ 7-day group were significantly less likely than > 7-day cases to have neutrophils in the TM, with 15 and 65% positive cases, respectively. Lymphoplasmacytic inflammation was present in 53% of all cases, with no significant difference between groups. Cases in the ≤ 7-day group were significantly more likely than > 7-day cases to have both types of inflammation. Conclusions: Our results indicate that both acute inflammation and pigment dispersion may be key factors in the pathogenesis of GDRG. Pigment dispersion is prevalent at all time points and increases during the first 7 days. The finding of iris pigment epithelial loss supports the theory that pupillary block associated with iris-lens touching may be important in the pathogenesis of GDRG.
- Pigment dispersion
ASJC Scopus subject areas