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Editor,—Pigment deposits on the anterior lens capsule may be seen in a variety of conditions. In this case report, we describe unusual bilateral pigmentation of the anterior lens surface in a young woman. Recognition of this benign condition should diminish the clinician’s concern that other potentially progressive disorders such as pigmentary glaucoma are likely.
A 21 year old white woman with myopia was referred for evaluation of pigmentary dispersion syndrome. There was no previous history of ocular inflammation, trauma, or use of topical or systemic medications. There were no visual complaints.
On examination, her best corrected visual acuity was 20/15 right eye and 20/20 left eye with −1.25 D sph both eyes and J1+ for near. Slit lamp examination revealed clear corneas bilaterally with no pigment deposits over the posterior corneal surfaces. The anterior chambers were deep and quiet. No iris transillumination defects were noted. Intraocular pressures were 15 mm Hg before and after pupillary dilatation. On pupillary dilatation, the anterior surface of the lens in the right eye demonstrated clumps of pigmented cells. The cells were paraxial in location, closely packed with a few isolated cells in the pupillary axis (Fig 1). The cells were rounded, fusiform or stellate in shape (Fig 2). In the left eye, similar stellate pigmented cells were seen in the pupillary axis. The zonular attachments in the right eye were prominent. However, no pigment deposits were noted in the peripheral capsule, zonules, or on the posterior lens capsule. On gonioscopy, the angles were wide open with ciliary body visible 360° both eyes (E 40 q, Spaeth classification). No pigment deposits were noted in the angle structures. Fundus examination revealed a clear vitreous, cup to disc ratios of 0.5 right eye and 0.6 left eye, an unremarkable posterior pole, and periphery.
This case represents an unusual asymmetric pigmentation of the anterior capsule of the lens. The closely packed fusiform pigmented cells resembled iris pigment epithelial cells or pigmented ciliary epithelial cells in culture.1 In the absence of signs of intraocular inflammation, and other causes of primary and secondary of pigmentary dispersion, it is likely that the pigmented cells were implanted on the lens surface in utero from the developing iris pigment epithelium. It is possible that there was migration of some of these implanted cells into the visual axis but at present appear non-progressive and do not impair the patient’s vision. The paraxial location of congenital lenticular pigmentation is unusual. Previously described cases of congenital pigmentation showed a radial distribution of the pigmentation in the mid and peripheral portions of the anterior lens capsule.2 3 These radial pigmented lines were pathologically confirmed to be melanin pigment granules incorporated within the lens zonules.2 Pigmentation of the anterior lens surface may be seen in many conditions including anterior segment inflammation with posterior synechiae, pigmentary dispersion syndrome, siderosis, the aging eye,2 pseudoexfoliation syndrome,2 antipsychotic medication usage,4and remnants of the tunica vasculosa lentis.3 These must be differentiated from congenital lenticular pigmentation as seen in this case.
This work is supported by an unrestricted grant to Washington University from Research to Prevent Blindness, and EY 02687 Core Grant for Vision Research.