Surgical removal of a congenital fibrovascular pupillary membrane

Abstract

F ibrovascular pupillary membranes have been described in the literature by various names, including congenital pupillary-iris-lens membrane with goniodysgenesis and fibrous congenital iris membrane with pupillary distortion. We describe a technique for surgical removal of congenital fibrous pupillary membrane, demonstrated in a newborn girl treated at Stein Eye Institute, University of California, Los Angeles. These fibrous membranes differ from the common hyperplastic persistent pupillary membranes that originate from the iris collarette and do not involve the angle or attach to the lens. Congenital fibrous pupillary membranes variably involve the anterior lens capsule and the anterior chamber angle. They are likely to progress, in which case they may cause complete pupillary obstruction, with secondary iris bombe and angle-closure glaucoma; therefore, surgical removal and enlargement of the pupil has been recommended. Surgery to remove the membranes has been described using a vitrector or small-gauge microforceps and scissors. Our technique uses 23-gauge microforceps to continually grasp the iris, which is pulled away from the membrane. To avoid crossing the pupil and potentially damaging the lens capsule, several paracenteses may be