The Significance of Pigment of the Anterior Part of Eye for Glaucoma

Abstract

The significance of proliferation of pigment in the anterior part of the eye expressly gained ground after voluminous search-work of Koeppe in the sense of ascertaining of pathogenesis of primary glaucoma. Attention was paid not only to corneal spotty pigmentation of the behind surface in the form of a spindle, but also to such phenomena on anterior part of the iris and the chamber angle.

The latest research work about the connection between pigmentation in the region of trabecula comeoscleral and o'-her fixed pigment formations in the region of the anterior part of the eye led to ascertainment of clinical picture of pigment glaucoma (Sugar), already earlier found by Koeppe and Jess. In this search-work we paid special attention to clinical picture of pigment glaucoma. Those cases containing pigment formations in the anterior part of the eye were treated with special care in that sense. It was thus that 25 patients were analysed in the first group, four of which were patient younger in age i. e. being in the second or third decade of their lives, and 21 patients in the age of praesenium or else senium stage including the eldest patient od 82 years of age. Pigmentations on the behind surface of cornea, as well as pigmentations of trabecula at times weaklier or strongly expressed, have been ascertained in these cases. Moreover, atrophy of iris matter was found in the majority of cases and more rarely of ciliary body which fact was ascertained by the method of anteriotransillumination and posteriotransillumination. Eye pressure was increased and in thirleen cases there existed signs of glaucoma simplex with an open chamber angle, and an increased eye pressure was found in cases by means of provocative test application. Normal eye pressure was found in seven cases. The second group consisted of eleven patients. namely of four patients with megalocomea, hydrophthalmus, two patients with ectopia lentis congenita and one patient with dysostosis mandibulofacialis and microcornea on both eves. In all these cases pigmentations were found in the anterior part of the eve as well as an increased eye pressure excepting one case with monocular hydrophthalmus where ablatio patina” (detachment of the retina) existed on the same eye.

A new clinical form of heterochrony of iris with hypertrcphy of pigment layer in the darker eye is described and found in the third group of patients. Scleral pigmentation of the behind surface of comea and trabecuia were found at the same time. In these three cases glaucoma was found, while it was not so in one case for the present. Furthermore, in two cases of glaucoma secundarium intense pigment layers on the anterior part of the iris as well as on the behind surface of cornea and in the region of chamber angle were found and described.

These pigment layers or gathering in anterior part of the eye with increased intraocular pressure individua! authors like Sugar, Malbran and Etienne considered as a separate and unique clinical picture i. e. glaucoma pigmentosum. It is here exposed, however, that one cannot asipeak about a form of glaucoma, owing to the mentioned pigment gathering on layers especially so in the chamber angle where glaucoma begins to develop. Proliferation of pigment in the anterior part of the eye is an accidental phenomenon which can develop in every clinical type of glaucoma. It is for this reason that we gave and suggested clinical name of "pigmentiforme" as a general notion for such pigment formations found in any clinilac form as e. g. glaucoma simplex, congestivum, congenital, secundarium “pigmentiforme”, therewith subordinating the phenomenon of pigmentation to the general pathogenesis of glaucoma. According to that, the discovery of pigment in itself in the anterior part of the eye cannot be considered as a sole factor for glaucoma development, but that pigment among other more important etiogenetic factors, helps to develop glaucoina.