Zentmayer ring and stretched zonules

To the Editor,

A 28-year-old male was referred for refractive surgery opinion. On examination, his best-corrected distance visual acuity was 20/20 with a − 3 diopter sphere in both the eyes (BE). Slit-lamp examination of BE showed fine pigments on the corneal endothelium, deep central and peripheral anterior chamber depth [Van Herick grade 4] iris showed peripheral concavity toward its insertion and mild iridodonesis was noted. Intraocular pressure was 10 mmHg in BE. Gonioscopy showed open angles till ciliary body band, sampaolesi line, Grade 3, dense, homogeneous trabecular meshwork pigmentation, and peripheral iris concavity.

Postdilatation examination showed a clear lens, and the lens equator with stretched zonules was visible 360° in the extremes of gaze, though not seen in the patient’s primary gaze in BE. An annular 1 mm ring of fine brown pigmentation was seen at the zonular insertion on the posterior lens capsule [Figure 1a and b]. Fundus examination showed a medium size disc, 0.5 cup–disc ratio, and healthy neuroretinal rim. The retinal periphery was noted to be normal with no treatable lesions.

Figure 1.

Slit-lamp photograph of the right eye shows an annular 1 mm ring of fine brown pigmentation at the zonular insertion on the posterior lens capsule on the temporal (a) and nasal (b) side and stretched zonules

A probable diagnosis of congenital anomaly of stretched zonules, rubbing against the iris pigment epithelium leading to pigment dispersion, and Zentmayer ring on posterior lens capsule was made. The risk of pigmentary glaucoma was explained to the patient. As there was no evidence of lens subluxation or evidence of pigmentary glaucoma, the patient was advised to go ahead with the refractive surgery.

In 1938, Zentmayer[1] described a circular segment of pigment accumulation in the Wieger’s ligament, known as the Zentmayer ring. The pigments are released due to iris–lens friction, which pass through the zonules and can accumulate in the form of line or ring known as Scheie’s line or Zentmayer ring respectively. Although it has been described in patients with pigment dispersion, this is the first reported case of elongated and visible zonules with Zentmayer ring.

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