Biometric Analysis of Pigment Dispersion Syndrome Using Anterior Segment Optical Coherence Tomography

Purpose: To compare anterior chamber volume (ACV), iris volume, and iridolenticular contact (ILC) area before and after laser peripheral iridotomy (LPI) in eyes with pigment dispersion syndrome (PDS) using anterior segment optical coherence tomography (AS OCT) and image processing software. Design: Cross-sectional study. Participants: Eighteen eyes of 18 patients with PDS; 30 eyes of 30 controls matched for age, gender, and refraction. Methods: Anterior segment OCT imaging was performed in all eyes before LPI and 1, 4, and 12 weeks after LPI. At each visit, 12 cross-sectional images of the AS were taken: 4 in bright conditions with accommodation (accommodation), 4 in bright conditions without accommodation (physiological miosis), and 4 under dark conditions (physiologic mydriasis). Biometric parameters were estimated using AS OCT radial sections and customized image-processing software. Main Outcome Measures: Anterior chamber volume, iris volume-to-length ratio, ILC area, AS OCT anterior chamber depth, and A-scan ultrasonography axial length. Results: Before LPI, PDS eyes had a significantly greater ACV and ILC area than control eyes (P < 0.01) and a significantly smaller iris volume-to-length ratio than the controls (P < 0.05). After LPI, ACV and ILC area decreased significantly in PDS eyes, but iris volume-to-length ratio increased significantly (P < 0.02) and was not significantly different from that of controls. These biometric changes were stable over time. Iris volume-to-length ratio decreased significantly from accommodation to mydriasis and from miosis to mydriasis, both in PDS and control eyes (P < 0.01). In PDS eyes, ILC area decreased significantly from accommodation to mydriasis, both before and after LPI (P < 0.01). On multivariate analysis, greater anterior chamber (AC) volume (P < 0.02) and larger AC depth (P < 0.05) before LPI were significant predictors of a larger ILC area. Conclusions: Pigment dispersion syndrome eyes do not have an iris that is abnormally large, relative to the AS size, but have a weakly resistant iris that is stretched and pushed against the lens when there is a pressure difference across the iris. Financial Disclosure(s): The author(s) have no proprietary or commercial interest in any materials discussed in this article. Ophthalmology 2011; 118: 1563-1570 (C) 2011 by the American Academy of Ophthalmology.