Atlas of Ophthalmology

Melanin Granules on Corneal Endothelium (Krukenberg Spindle), (Colour Photography, OCT)

角膜 -> Degenerations, Aquired Keratopathies
Patient: 47 years of age, female, BCVA 1.0 at OD, 1.0 at OS, IOP OD 15 mmHg, OS 16 mmHg, Pachmetry OD 485 µm, OS 487 µm, autorefraction OD -3.0 D -0.25/169°, OS -2.75 D -0.5/167°. General Medical History: empty Ocular Medical History: routine check, never increased IOP-values, regular visual fields, regular optic nerve head. Methods: Colour photography, OCT. Findings: (1) Colour photography: Deposition of melanin granules on the corneal endothelium, no deep anterior chamber, no concave anterior iris configuration. (2) OCT: no reduction of retinal nerve fiber thickness. Discussion: Deposition of melanin granules on the corneal endothelium (Krukenberg spindle) is risk factor for glaucoma. Primary pigment dispersion syndrome (PDS) is a condition usually seen in younger myopic males that is characterized by radial defects of the iris pigment epithelium visible on retroillumination, with liberation and deposition of melanin granules on the corneal endothelium (Krukenberg spindle), on the posterior lens capsule, and in the trabecular meshwork and it is frequently associated with secondary open-angle glaucoma, and also referred to as pigmentary glaucoma, which is believed to be caused by melanin granules that, after being released from the iris pigment epithelium into the aqueous humor, lead to obstruction of the aqueous outflow pathways. The degree of retrocorneal Krukenberg spindle, are graded semiquantitatively by means of the following scale: not present, trace, mild, moderate, and marked. Extensive dispersion of melanin granules, sometimes associated with a marked rise of intraocular pressure, has been described after medical pupillary dilation Literature: (1) Küchle M, Mardin CY, Nguyen NX, Martus P, Naumann GO. Quantification of aqueous melanin granules in primary pigment dispersion syndrome. Am J Ophthalmol. 1998 Sep;126(3):425-31.

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