Purpose: To report a case of pigmentary glaucoma treated with medical therapy, laser treatment, and trabeculotomy.
Case: A 36-year-old man presented with the characteristic Krukenberg spindle on the corneal endothelial surface and heavily pigmented trabecular meshwork. He was diagnosed with pigmentary glaucoma and was initially placed on medical therapy which became less effective over time in controlling intraocular pressure (IOP). Ultrasound biomicroscopy revealing bilateral reverse pupillary block and laser iridotomy was performed in both eyes to eliminate irido-zonular contact causing pigment dispersion. However, argon laser trabeculoplasty (ALT) was subsequently performed in both eyes due to insufficient IOP control. The left eye responded well to ALT, and postoperative IOP has been 14-16 mmHg with medication. On the other hand, the right eye required selective laser trabeculoplasty for uncontrolled IOP after ALT. With little improvement in IOP control after laser treatment, the right eye eventually underwent trabeculotomy which resulted in long-term success in controlling IOP at about 16 mmHg and in preventing the progression of glaucomatous damage.
Conclusion: Improvement in IOP control with trabeculotomy was confirmed in a case of pigmentary glaucoma with heavily pigmented trabecular meshwork. Further studies are needed for evaluation of the management of pigmentary glaucoma.