Surgeon: Consider peripheral iridectomy in early pigmentary glaucoma

LAS VEGAS — Patients with early pigmentary glaucoma (a secondary form of open angle glaucoma) should be considered candidates for iridectomy, a surgeon said here at the First Annual Ocular Surgery News Symposium — Glaucoma: Improving Your Odds.

"We are aware of descriptions that suggest with pigmentary glaucoma the concave posterior bowing of the iris is characteristic of pigmentary glaucoma and may revert to a more planar confirmation following iridectomy," Louis B. Cantor, MD, co-course director, said.

Also, research suggests that "reverse pupillary block" exists in eyes with an abnormal iris that acts like a valve, Dr. Cantor said.

Ultrasound biomicroscopy can be used to confirm the concave bowing of the iris and thus diagnosis, Dr. Cantor said.

"What is the role of iridectomy in this syndrome? The evidence and the science are not there," he said. However, he noted, "I consider a peripheral iridectomy in early pigmentary glaucoma or in eyes with ocular hypertension and pigment dispersion syndrome. In eyes with firmly established pigmentary glaucoma and significant damage we are probably too late.

He noted that eyes with pigmentary dispersion syndrome and normal IOP should not be considered candidates for iridectomy.