EQUATORIAL LENS PIGMENTATION, MYOPIA, AND RETINAL DETACHMENT WILLIAM V. DELANEY, JR., Syracuse, New
Pigment at the lens equator is found in uveitis, pigmentary glaucoma,1 and as a con genital malformation.2 This report describes five myopic patients (Table) of 448 consecutive retinal detach ment patients who had distinct pigmentation of the lens equator.
M.D.
York
berg's spindles (Case 1) and his lens pig mentation has increased. His intraocular pressure by applanation tonometry has not been above 23 mm Hg.
CASE REPORT A 46-year-old white man was seen on July 15, 1968, with floaters and visual field loss in his right eye. His past history and family history were noncontributory. His visual acuity was 6/7.S in both eyes with —8.50 + 0.50 X 180° in the right eye and —7.25 + 0.50 X 10° in the left eye. His intraocular pressure was 15.6 mm H g in the right eye and 13.1 mm H g in the left eye by Schiotz tonometry. His right retina was detached clockwise from 12 to 9 o'clock with a questionable retinal break at 12 o'clock. The ora serrata could be seen by scierai depression with slight difficulty due to pigment on the lens equator (Figure). The left lens had a similar pigment deposit. No Krükenberg's spindles were present. The macular retina was still attached. "High water" n r r k s could be seen in the superior nasal quadrant. The left retina was intact and normal. On July 18, an encircling silicone band was placed after transcleral cryopexy with an indirect ophthalmoscope. Transient diplopia was present postoperativcly. Four and a half years after surgery, visual acuity was 6/7.5 in the right eye and 6/6 in the left. Krükenberg's spindles had developed. The intra ocular pressure by applanation tonometry was 23 mm H g in the right eye, 19 mm H g in the left eye. No cupping was visible in either optic nerve. The angle was heavily pigmented and some pigment was visible on the peripheral corneal endothelium of both eyes. The pigment on the lens equator had increased. COMMENT
One patient has been lost to follow-up. None of the remaining patients have devel oped glaucoma. One patient now has KrükenFrom Crouse-Irving Memorial Hospital, Syra cuse, New York. Reprint requests to William V. Delaney, Jr., M.D., 400 State Tower Bldg., Syracuse, N Y 13202.
Figure (Delaney). Equatorial lens pigmentation ( a r r o w ) , myopia, and retinal detachment (Case 1). 194
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EQUATORIAL LENS PIGMENTATION
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TABLE SUMMARY OF PATIENT DATA
Visual Acuity Patient, (sph) Age (yrs) R. E. L. E. 1. 46
-8.25
-7.00
2* 36
-4.50
-4.25
3,
32
-4.00
-3.75
4, 37
-3.62
-4.00
J,
-4.75
-7.00
44
Diagnosis
Preoperative Intraocular Pressure (mm Hg)
Lens Pigment
R. E.
L. E.
Retinal detachment Lattice with hole Lattice with hole Retinal detachment Lattice with hole
—
26
19
Both eyes
Retinal detachment Retinal detachment Lattice with hole Retinal detachment
17
17
Both eyes
15
6
Both eyes
20
20
Both eyes
23
17
Both eyes
Gonioscopy
Holes and Detachment
Open angle with pigment
12 o'clock superior nasal quadrant Superior temporal quad rant 12 o'clock superior tem poral quadrant Superior temporal quad rant All quadrants
R. E. L. E.
—' ■ —
Open angle with pigment
* Family history of glaucoma and amblyopia. The other patients had noncontributory histories.
All of the patients had bilateral vitreoretinal disease and one was already blind from retinal detachment in one eye when first examined. Two patients had prophylac tic cryopexy of retinal breaks in the second eye. No patient has developed retinal detach ment in the second eye. DISCUSSION
Lens pigmentation has been described as located at the hyaloideocapsular ligament (Wieger's line) and at spacia zonularia (Petit's canal). 3 Earlier reports4"6 consid ered the pigmentation to be depositional rather than of developmental origin. Congenital pigmentation of the lens equa tor has been described2 and is attributable to delayed development of the ciliary ring with prolonged apposition of the ciliary pro cesses to the lens. If valid, such a delay in development during accelerated axial growth would undoubtedly have a considerable effect on the vitreous base and development of the peripheral retina. Our patients fit both the age and sex anal ysis of pigmentary glaucoma patients7 and the myopic retinal detachment population.8 The tendency for male myopic retinal de tachment patients to have paraoral retinal breaks rather than equatorial ones is con firmed by this group. Whether lens pigmentation is related to an increased incidence of retinal detachment re
mains unanswered. To date, all patients with this combination of findings have been myo pic men and, in my estimation, pigmentary glaucoma suspects. Their vitreoretinal disease did not present serious surgical difficulty other than obscur ing the view of the ora serrata. Additional reports by other observers will undoubtedly clarify the incidence of retinal detachment, sex, and refractive relationship of patients with equatorial lens pigmentation. This com bination of findings is probably more than coincidental. SUMMARY
Five myopic male retinal detachment pa tients had pigmentation of the lens equator that mildly obscured the view of the ora serrata. It may be related to a prepigmentary glaucoma state or to development of the ciliary ring predisposing to retinal detach ment, or both. ACKNOWLEDGMENTS
Mark Elias, M.D., Richard Gillis, M.D, Anthony LaTessa, M.D., and Thomas Stapleton, M.D., referred these patients to me. REFERENCES
1. Becker, B., and Shaffer, R. : Diagnosis and Therapy of the Glaucomas. St. Louis, C. V. Mosby, 1961, p. 186. 2. Mann, I.: Developmental Abnormalities of the Eye. Montreal, J. B. Lippincott, 1957, p. 340. 3. Cibis, P. A. : Vitreoretinal Pathology and Sur-
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gery in Retinal Detachment. St. Louis, C. V. Mosby, 1965, pp. 21-23. 4. Zentmayer, W. : Association of an annular band of pigment on the posterior capsule of the lens with a Kriikenberg spindle. Arch. Ophthal mol. 20:52, 1938. 5. Bellows, J. G. : Kriikenberg's spindle and its relation to annular pigmented band on the pe riphery of the lens. Arch. Ophthalmol. 32:480, 1944.
FEBRUARY, 197S
6. Scheie, H. G., and Fleishhauer, H. W. : Idiopathic atrophy of the epithelial layers of the iris and ciliary body. Arch. Ophthalmol. 59:216, 1958. 7. Sugar, H. S. : Pigmentary glaucoma. Am. J. Ophthalmol. 62:499, 1966. 8. Schepens, C. L., and Marden, D. : Data on the natural history of retinal detachment. Am. J. Ophthalmol. 61:213, 1966.
OPHTHALMIC MINIATURE
It is probable that when, as happens in some parts of Scotland, a sufferer from a stye seeks a cure by the application of a decoction of barley, someone will explain the custom in terms of the appropriate vitamin, and it would surprise no one if an enterprising business man took advantage of the occasion to bring out a new patent eyewash. When, however, a Russian peasant, similarly afflicted, rubs the eye with a barleycorn which he then throws to the fowls (my own Russian informant said a cock) to eat, or when a Magyar places a barleycorn on the edge of a well in the belief that the stye will last until the seed is carried away by birds, the opportunities for scientific and commercial exploitation are not so apparent. The association of styes with barley is of great antiquity. In Greek the word krithe means both stye and barley, whilst the Latin name for a stye, hordeolum, is derived from hordeum, barley. Professor· Sir John Myres, an authority on such matters, tells me that the classical passages in which the words occur are from authors of the later Greek and Graeco-Roman centuries, roughly 300 B.C. to A.D. 300. W. S. Inman, Styes and Wedding Rings London, Churchill Livingstone, 1973