Grand Rounds

A patient was referred for post-vitrectomy cataract evaluation in the right eye. BCVA was 20/100 in the right eye and 20/40 in the left eye with pre-dilation IOP of 15 and 16 mmHg. Patient was noted to have a dense AC pigment plume in both eyes after dilation, and IOP was found to be 23 and 32 mmHg. Gonioscopy demonstrated uniformly open angles with dense pigmentation and Sampaolesi line inferiorly in both eyes. Fine radial pigmented lines on the anterior lens capsule in both eyes were seen. The patient was diagnosed with Long Anterior Zonules (LAZ) with Pigment Dispersion Syndrome (PDS)-Variant in both eyes and pigmentary storm.

A second patient was referred for cataract evaluation in the left eye. The right eye had previous complex cataract extraction and IOL implantation with subsequent corectopia and capsular phimosis. BCVA was 20/30 in the right eye and 20/25 in the left eye. IOP was 10 and 11 mmHg. Pre-dilation gonioscopy demonstrated uniformly open angles with a Sampaolesi line inferiorly in the left eye. After dilation, deposits were noted on the peripheral anterior lens capsule in a scalloped pattern, initially thought to reflect pseudoexfoliative (PXF) material. Upon closer inspection,  fine pigmented linear deposits could be seen throughout these portions of the lens capsule with no fibrillar PXF material. The patient was diagnosed with LAZ in a Pseudoexfoliation-like deposition pattern.

A third patient was referred for cataract evaluation with decreased central vision in the right eye. The patient had a past ocular history of bilateral cataracts, and intermittent sub-retinal fluid in the right eye. BCVA was 20/40 in the right eye and 20/25 in the left eye, with an IOP of 19 mmHg in both eyes. Gonioscopy revealed a steep approach with angles open to anterior TM with heavy pigmentation and inferior Sampaolesi line in both eyes. Slit lamp examination disclosed nuclear sclerotic cataracts and fine radially oriented pigmented lines on the anterior lens capsule in both eyes. The patient was diagnosed with LAZ and PDS-Variant.

Presentation Date: 01/29/2026
Issue Date: 03/20/2026