Pupillary Membrane Research Articles

Phakic intraocular lens exchange due to severe uveitis/inflammation: case report

Introduction: Phakic intraocular lenses (IOLs) provide excellent visual and refractive outcomes with a high safety profile. This report illustrates a case of a rare episode of severe anterior segment inflammation after iris-claw foldable lens implantation, which required surgical reintervention. Patient and Clinical Findings: A 22-year-old woman was submitted to Artiflex implantation for the correction of myopia. Three months postoperatively, a severe anterior segment inflammation developed with pigment deposition, pupillary membrane formation, and decreased visual acuity in the left eye. Diagnosis, Intervention, and Outcomes: Given the nonresponse to medical treatment (topical and systemic corticosteroid for 3 months), surgical explantation of the IOL with peeling of a pigmentary membrane over the crystalline lens was performed. During a 24-month follow-up period, the patient was monitored to exclude the development of cataract or glaucoma. Afterward, an implantable collamer lens was implanted with an uneventful intraoperative and postoperative period. During the long-term follow-up, no further pigment dispersion, uveitis, or cataract was described. Conclusions: Persistent anterior uveitis with pigmentary membrane formation after iris-claw lens implantation is a rare complication. IOL explantation needs to be considered to prevent further sequelae after severe uveitis when the situation is unresponsive to medical treatment.

Multiple congenital ocular anomalies in three related litters of Jack Russell Terrier puppies.

To describe multiple congenital ocular anomalies in three litters of Jack Russell Terrier puppies. Seven purebred Jack Russell Terrier puppies from three related litters and their four parents. Medical records of the puppies and their parents were evaluated. All dogs underwent a complete ophthalmic examination, followed by bilateral ocular ultrasonography in two of the puppies with complete corneal opacity. One eye from an affected puppy was subjected to histopathology. A complete database of pedigrees was built, and individual inbreeding was evaluated. The most commonly diagnosed ocular anomalies in the puppies were: various anomalies of the fundus (12/14 eyes); microphthalmia (10/14 eyes); sclerocornea (8/14 eyes); and persistent pupillary membranes (7/14 eyes). Six out of seven puppies had at least two ocular abnormalities, and only one puppy was normal. Four out of seven puppies had sclerocornea, a particular corneal opacity to date described only in Spanish Podenco dogs. No ocular abnormalities were found in the parents examined (4/4). Analysis of the pedigrees showed that all the puppies and two parents were inbred, and the individual values of the inbreeding puppies were greater than 6.25% in two litters. Inbreeding with closely related Jack Russell Terriers may result in severe congenital eye abnormalities in puppies.

Surgical approach to and morphology of visually significant persistent pupillary membranes.

To characterize the morphology of persistent pupillary membranes (PPMs) in pediatric patients and explore the corresponding surgical approaches. Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China. Prospective observational study. Consecutive pediatric patients with PPMs who underwent surgery from April 2020 to July 2022 were included. PPM morphology was assessed and categorized according to its anatomic relationship with crystalline lens and distribution of iris strands. The surgical approaches for different morphologies of PPMs were described in detail. The visual outcome and operation-related complications were recorded. 31 eyes from 19 patients were included with the mean age of 7.2 years. 3 morphological variants of PPMs were observed: type I (51.6%, 16/31), a spider-like appearance and no adhesion to the anterior lens capsule (ALC); type II (38.7%, 12/31), a loose central adherence to the ALC and partially thick iris strands attached to the iris collarette; type III (9.7%, 3/31), a tight central adherence to the ALC and only silk-like iris strands. Surgeries were performed with a natural pupil size in type I, while dilated pupil in the other types. The adhesions between PPM and the ALC were separated by viscoelastic injection in type II and by discission needles in type III. The corrected distance visual acuity was significantly improved from 0.34 ± 0.18 logMAR preoperatively to 0.17 ± 0.09 logMAR postoperatively ( P < .001). No operation-related complications were observed during 9.5-month follow-up. PPMs were categorized into 3 types according to their different morphologies, which helped to determine the best surgical strategy.

ASSESSMENT OF VISUAL ACUITY AND COMPLICATIONS POST CATARACT SURGERY IN PATIENTS WITH UVEITIS IN TERTIARY CARE HOSPITAL

Aim and Objectives Aim:To study the visual acuity and operative complications after cataract surgery in patients with uveitis in tertiary care hospital Objectives: 1.To study factors affecting visual acuity. 2.To study surgical complications post cataract surgery in uveitis patients. Materials and Methods:A total of 18 patients were taken, data was collected from all the selected patients using a structured proforma meeting the objectives of the study. • Inclusion Criteria:1.All complicated cataract patients attending ophthalmology OPD 2.A quite eye (without inflammation) for atleast 3 months • Exclusion Criteria: 1.Cataract due to causes other than uveitis 2.Patients with posterior segment pathology Patients were scheduled for follow up on post op day 1, day 3 , day 7 , day 15, day 30, day 60, day 90. Results: The prevalance was more common in males compared to females. Out of 18 patients, 14 (77%) underwent SICS with PCIOL implantation and 4 (22%) underwent phacoemulsification with PCIOL. Intra-operative complications were noted as small non-dilating pupil, peripheral anterior synechiae, pupillary membrane, incomplete capsulorhexis, iris prolapse. In 7 (38%) patients sphincterectomy was done and in 4 (22%) patients stretch pupilloplasty was done. Immediate post-op complications that were noted were anterior chamber reaction and pigment dispersion. Late post-op complications that were noted were posterior capsular opacification Dense posterior synechiae were encountered in 12 (66%) patients and excessive conjunctival bleeding in 6(33%) patients. There was improvement in visual outcomes as follows 8 patients had 6/6 vision, 6 patients had 6/18 vision where as remaining 4 patients had 6/36 vision due to early development of posterior capsular opacification. Conclusion: Cataract development is a very common occurrence in any form of anterior and intermediate uveitis because of chronic intraocular inflammation, long term use of corticosteroids. Reported incidence of cataract in uveitic patients is about 25% in juvenile rheumatoid arthritis and 75% in chronic anterior uveitis. It is possible to achieve successful visual outcomes following cataract surgery in uveitis by proper management of pre-operative inflammation and close post-operative observation. Management of uveitic cataract requires careful case selection, proper timing of surgery, and close monitoring with appropriate handling of complications that may occur.

Profile of Unilateral Cataract in Pediatric Patients: A 3 Year Retrospective Study

Abstract&#x0D; Introduction &amp; Objectives : Unilateral cataract presents from 19.6% to 55.5% of pediatric cataract in children by many previous reported studies. This condition is treatable, but delayed treatment may cause visual impairment. This study aims to understand characteristic and treatment of unilateral cataract in children.&#x0D; Methods : The study involved a retrospective review of medical records of patients aged 0-17 years with unilateral cataract who presented to Dr. Kariadi Hospital Semarang from 2019 to 2022. Cases of cataract secondary to causes such as trauma or uveitis were excluded.&#x0D; Results : Thirty-five patient was included in this study, 51% of whom were male and 49% female. The mean age at presentation is 60.49  48.23 months and mean age of onset is 36.77  45.94 months. The most common presenting complaint was whitish eye (81%) while others presented with blurred vision. All the patients had leukocoria, 28% have microcornea, 3% have persistent pupillary membrane. Half of patient (51%) have strabismus, with exotropia being the most common type (34.17%). Eight patients had congenital rubella syndrome, one patient had cytomegalovirus infection while others did not have any systemic condition related to cataract. Majority of patient (17%) treated with phacoaspiration, primary posterior capsulotomy, anterior vitrectomy and intraocular lens implantation. Intraocular lens was implanted in 71% patient and 54% patients given spectacles.&#x0D; Conclusion : Unilateral cataract is disease with isolated and sporadic incident. The majority of patients did not have systemic condition related to unilateral cataract. The most common treatment is phacoaspiration, primary posterior capsulotomy, anterior vitrectomy and intraocular lens implantation.

BILATERAL CONGENITAL MYDRIASIS WITH ACCOMPANYING MIXED DEVELOPMENTAL DELAY

Introduction: Congenital bilateral mydriasis is a rare condition characterized by fixed dilated pupils unresponsive to light. It may occur associated with cardiovascular syndrome, gastrointestinal malformation, or developmental delay. Referred causes in comprehensive differential diagnosis for congenital mydriasis include alterations in ocular structures, ocular innervation alterations and others secondary to trauma, infection, or topical medication. Case Illustration: A 10 months-old boy presented to the hospital with large pupils in both eyes since birth. He has a persistent pupillary membrane with 9 mm diameter of pupil and unable to respond to light in both eyes. The pupillary response test using pilocarpine solution 0.1% showed no difference in diameter of pupils. Comprehensive pediatric examination revealed developmental delay. Computed tomography and laboratory result (laboratory blood count, toxoplasmosis, and cytomegalovirus) within normal limit. After eight months follow up, no significant change in pupil size or light responsiveness was found. Discussion: Comprehensive examination of anterior to posterior segments of the eyes is imperative on the lookout for underdiagnosed diseases. Clinical assessment remains vital for guiding investigations. Observation is required to detect the presence of certain systemic abnormalities that frequently do not manifest at birth. Conclusion: Congenital mydriasis can be diagnosed quickly in ordinary conditions, but it can be quite challenging when it presents as a coincidental finding of other spectrum diseases. It is important to perform a comprehensive general and eye examination to rule out any serious condition related to it. Keyword: Bilateral congenital mydriasis, dilated pupil, mixed developmental delay, pediatric ophthalmology

PROFILE OF UNILATERAL CATARACT IN PEDIATRIC PATIENTS: A 3 YEAR RETROSPECTIVE STUDY

Introduction and Objective: Unilateral cataract presents from 19.6% to 55.5% of pediatric cataract. This condition is treatable, but delayed treatment may cause visual impairment. This study aims to understand characteristic of unilateral cataract in children. Methods: This study was descriptive review of patients aged 0-17 years old with unilateral cataract at Dr. Kariadi Hospital, Semarang. Data were collected from medical record of patients from January 2019 to December 2022. Results: Sixty patients were included in this study, 56.7% of whom were male and 43.3% were female. The mean age at presentation is 71.50 ± 48.34 months with whitish eye being the most common main complaint (65%), followed by blurred vision (35%) and squinting of eye (5%). Most of patients had congenital or infantile cataract (60%), followed by traumatic (36.6%), uveitis (1.7%) and iatrogenic (1.7%). Some of patients had microcornea (21.7%), persistent pupillary membrane (8.3%), retinopathy of prematurity (3.3%), persistent fetal vasculature (8.3%), nystagmus (8.3%), amblyopia (20%) and strabismus (40%), with exotropia being the most common type (33.3%). Most of patients did not have systemic disease (93.3%), but we found two patients had congenital rubella syndrome, one had congenital cytomegalovirus, one had down syndrome. Conclusion: Etiology of unilateral pediatric cataract mostly idiopathic followed by traumatic. Leukocoria was the most common complaint, followed by blurred vision and strabismus. In unilateral cataract, exotropia was more common type of strabismus.

Persistent pupillary membrane and accessory iris membrane in cataract surgery

Abstract: Incomplete involution of the anterior tunica vasculosa lentis is observed in most newborns, including persistent pupillary membrane (PPM) and accessory iris membrane (AIM). PPM is a common congenital ocular anomaly characterized by delicate iris strands along the pupil. AIM is a rare congenital ocular anomaly characterized by iris tissue strands arising from the iris collarette, forming a pseudopupil. Although most of these membranes do not lead to visual impairment, they can pose challenges during cataract surgery. Our case highlights a unique scenario involving the concurrent presence of PPM and AIM in cataract surgery. The surgeries were performed uneventfully without postoperative complications. To prevent unnecessary interventions and potential disappointment, it is essential to individually assess and plan strategies for patients with either PPM or AIM.

CLINICAL AND HISTOPATHOLOGIC OCULAR FINDINGS IN AQUARIUM-HOUSED COWNOSE RAYS (RHINOPTERA BONASUS).

Cownose rays (Rhinoptera bonasus) are susceptible to ocular disease with their prominent globes, but despite being popular animals housed in aquaria, there is little published information about their normal ocular anatomy and common pathologic ocular findings. A total of 63 live cownose rays (CNR) from three unrelated, separately housed groups had ocular examinations, and 5 adult rays were selected for ocular ultrasound. All examinations were performed out of the water, and most without anesthesia. Clinical findings were described, categorized, and scored by severity. Sixty-two of 63 rays (123 eyes) had clinical abnormalities, including 110 eyes with corneal pathology (mild = 76, moderate/severe = 34) and 74 eyes with intraocular pathology (mild = 44, moderate/severe = 30). Grey-to-white corneal opacities were the most common pathology (n = 58 rays/100 eyes) followed by cataracts (n = 41 rays/58 eyes), then persistent (or dysplastic) pupillary membranes (n = 14 rays/15 eyes). Most pathologic findings appeared inactive, but one aquarium had several CNR with active ocular pathology. There was a significant association between the diagnosis of moderate/severe corneal and intraocular pathology with age (P = 0.008 and P = 0.014, respectively) and weight (P = 0.001 and P = 0.039, respectively), as well as moderate/severe corneal pathology and group sampled (P = 0.03). There were no other significant variables identified. Additionally, histopathology of 14 eyes (11 rays) from two different facilities were examined, with keratitis (n = 8) and uveitis (n = 2) as the most common lesions. This study shows a high prevalence of pathologic ocular findings in cownose ray eyes with heavier adults more likely to be affected than lighter juveniles. Comprehensive ocular evaluation is important in this species and serial ocular exams and future studies should be pursued to monitor ocular disease progression and better understand possible etiologies.

A rare presentation of pupillary block glaucoma and persistent tunica vasculosa lentis in Klippel–Trenaunay syndrome

Phacomatoses are a group of neurocutaneous disorders characterized by vascular and pigmentary birthmarks, often involving multiple organ systems. Klippel–Trenaunay syndrome (KTS), a rare phacomatosis, is characterized by the classical triad of cutaneous capillary hemangiomas, venous malformations, and soft tissue overgrowth. Glaucoma secondary to angle dysgenesis, raised episcleral venous pressure, or excess angle pigmentation is observed. We report a case of KTS that presented with cutaneous capillary hemangiomas and limb hypertrophy along with unilateral buphthalmos. This eye was noted to have persistent tunica vasculosa lentis and persistent pupillary membrane with pupillary block glaucoma that was treated with pupilloplasty. To the best of our knowledge, this mechanism of glaucoma in KTS has not been reported before. The purpose of this article is to document this rare presentation as well as highlight the importance of detecting the underlying mechanism for appropriate management.

Early Postoperative Complications of Trabeculectomy and Their Management: A Hospital Based Study

Purpose: To study the early post operative complications of trabeculectomy, Phaco trabeculectomy and their management in a tertiary care center. Study Design: Interventional case series. Place and Duration of Study: Al-Ehsan Welfare Eye Hospital from 1st November 2020 to 30th January 2022. Methods: One hundred and two patients who underwent glaucoma filtration surgery were selected through convenient sampling. The patients were followed up for 12 weeks and early post-operative complications, if any, were noted and managed. Results: There were 58 (56.86%) males and 44 (43.14%) females. The age ranged from 35 to 70 years. There were 48 (47.06%) pseudophakic and 54 (52.94%) phakic patients. Mean pre-operative IOP was (31.99 ± 5.66 mm Hg) which reduced to 12.35 ± 4.30 mm Hg one month after surgery. Trabeculectomy with 5-Fluorouracil (5-FU) was performed in 48 patients (47.06%) while trabeculectomy combined with phacoemulsification and IOL implantation was performed in 54 patients (52.94%). Primary open angle glaucoma (POAG) was present in 94 patients (92.16%) while 8 patients (7.84%) had chronic angle closure glaucoma. The early postoperative complications were shallow anterior chamber in 17.6%, pupillary membrane in 2.9% and choroidal detachment in 2.9%. Six patients (5.9%) were steroid responder and these patients were shifted to topical Loteprednol from topical prednisolone. Conclusion: Majority of early post operative complications of trabeculectomy are transient and settled in first two to three weeks without any surgical intervention. Anticipation, timely diagnosis and early intervention is the key to success in management of complications of trabeculectomy.

Transient vacuolar changes of the crystalline lens in patients using a dispersive ophthalmic viscosurgical device.

To report the clinical prognosis and pathological findings of accidental lens vacuolar changes in eyes with intraoperative exposure to a dispersive ophthalmic viscosurgical device (OVD). Two patients who developed transient lens vacuolar changes during uneventful persistent pupillary membrane (PPM) removal surgery were presented and followed up. This event was speculated to be associated with an intraoperative dispersive OVD DisCoVisc (hyaluronic acid 1.6%-chondroitin sulfate 4.0%) exposure. Then, to provide the pathological basis for our speculation, another four cataract patients were randomly exposed to different OVDs, and their anterior lens capsules were investigated with transmission electron microscopy (TEM). After months, the subcapsular vacuoles in both PPM cases were gradually disappeared without visual deterioration. For the cataract patients, similar lens changes were observed intraoperatively in those exposed to a dispersive DisCoVisc but not a cohesive OVD IVIZ (sodium hyaluronate gel 1.0%). In addition, marked ultrastructural changes, including chromatin condensation, extensive cytoplasmic vacuoles, and obvious intercellular space between lens epithelial cells in the anterior lens capsules of all eyes exposed to DisCoVisc, were observed by TEM. The lens vacuolar changes may be associated with a dispersive OVD exposure. Therefore, it is not preferable to use dispersive OVDs in patients with transparent lenses or without the intention of lens extraction. In addition, close follow-ups instead of immediate lens extraction are recommended for the occurrence of similar lens lesions.

Hypertrophic persistent pupillary membrane: From fish mouth to spider web

We describe a clinical picture of a hypertrophic persistent pupillary membrane causing sensory deprivation amblyopia.

Wide-field digital imaging system for assessing ocular anterior segment development in very preterm infants.

This study aims to longitudinally investigate developments of the anterior segment in very preterm infants who exhibit normal retinal development outcomes by utilizing a wide-field digital imaging system. Between June 2021 and June 2022, neonates with a birth weight of <1500 g and/or a gestational age (GA) of less than 32 weeks were included in this study. The participants underwent regular ocular examinations, including sequential evaluations of the anterior segment and the retina, at intervals of 2-5 weeks, starting from birth and continuing until they reached a corrected GA of 48 weeks. Term neonates were selected as normal controls for the study. The study recorded the weight and GA of subjects at the time of examination, as well as indicators of abnormal development in the anterior segment. A total of 48 very preterm infants with normal retinal developmental outcomes were enrolled. The control group included 59 full-term infants. Common anterior segment eye abnormalities such as persistent hyperplasia of primary vitreous, persistent pupillary membranes, iris vessels, and anterior chamber angle vessels gradually subsided with the period in very preterm infants. The vascularity of the iris was substantially higher than in term controls (P < 0.05) at term gestation. The imaging of iris vessels and anterior chamber angle vessels in very preterm infants exhibited a decline at 46 and 47 weeks, respectively, which occurred slightly later compared to term infants. In very preterm infant s with normal outcomes, although the developmental process is delayed, they may form a normal anterior segment structure similar to that of full-term infants in the late stages, which is followed up by the wide-field digital imaging system.

The ocular anterior segment examination of perinatal newborns by wide-field digital imaging system: a cross-sectional study

PurposeThe aim of this study was to evaluate and summarize the developmental rules of the ocular anterior segment of neonates by means of wild-field digital imaging system.MethodsWe used the wide-field digital imaging system to sequentially capture images of the neonates’ eyes within 42 days after delivery, including the ocular surface, anterior segment, and fundus. At the same time, basic information at the time of birth and examination was collected.ResultsAmong 248 newborns, 51.21% were male. Abnormalities of the anterior segment such as visualization of anterior chamber angle vessels (79.03%) and iris vessels (51.21%), iris process (42.34%), persistent pupillary membranes (19.35%), albinism, congenital cataracts, corneal leucoma, and subconjunctival hemorrhage were observed in this study. There were significant differences in the appearance of iris vessels among different sex, gestational age and birth weight, postmenstrual age and weight at the time of examination and iris color groups. The iris vessels were more visualized in males relative to females (OR = 6.313, 95% CI 2.529–15.759). The greater the postmenstrual age at the time of examination, the lower the visualization of iris vessels (OR = 0.377, 95% CI 0.247–0.575). In addition, although visualization of anterior chamber angle vessels differed within the birth gestation age and weight at examination groups, there was no significant correlation by regression analysis.ConclusionsThe anterior segment of perinatal neonates can be visualized by the wide-field digital imaging system. The neonatal iris and anterior chamber angle are immature, and the visible vessels at the anterior chamber angle that vanish later than the surface of the iris are characteristic structures.

Bilateral dense persistent pupillary membrane - A rare case

A persistent pupillary membrane (PPM) is a congenital eye condition characterized by the presence of remnants of tissue in the eye that normally regresses during fetal development. A 37-year-old male patient complained of bilateral blurred vision for distance that had been present from childhood and was accompanied by glare and photophobia. On examination, uncorrected distance visual acuity was 20/30 in the right eye and 20/40 in the left eye, and there was no improvement with pinhole. The slit-lamp examination showed PPM with covering pupil partially in both eyes. The management of PPM depends on the severity of the condition and its impact on vision and ocular health.

Corneal Diseases in Cats: A Retrospective Study of 477 Cases (2015-2020)

Corneal diseases are common in cats. If not diagnosed and treated in time, they can cause vision loss or even eye loss.This retrospective study aimed to introduce corneal disorders in cats, briefly explaining the therapeutic management of these disorders, and exploring the possibility of breed, age, and sex predisposition. In the study, a total of 477 cats, referred to the clinics of Istanbul University-Cerrahpasa, Faculty of Veterinary Medicine, and Department of Surgery between 2015-2020 with ophthalmological complaints and diagnosed with and treated for corneal disorders, were retrospectively evaluated. The most commonly encountered corneal disease was corneal ulcers (n=208, 43.60%), followed in descending order by corneal sequestrum (n=71, 14.8%), and corneal opacities (n=57, 11.9%) due to infection-associated symblepharon. Overall prevalence rates of ulcerative keratitis and non-ulcerative keratitis were 59.6% and 35.9%, respectively, in the study’s entire cat population. The congenital corneal diseases, such as persistent pupillary membrane (PPM) and corneal opacity due to endothelial dystrophy and acquired corneal disorders, such as corneal degeneration, scarring, and endothelial degeneration, were less frequently monitored conditions. In this study, it was seen that some corneal diseases in cats are more common in cats of certain breeds and ages, and corneal diseases are diseases that can be treated with early diagnosis. It has been noted that certain diseases are of infectious origin and are more likely to be treatable conditions.

Risk of visual axis opacification in infants with and without primary IOL implantation after congenital cataract surgery performed during the first 4 months of age

PurposeThe study evaluates the rate of postoperative formation of a pupillary membrane (PM) and posterior visual axis opacification (PVAO) in infants with and without primary IOL implantation during the first 4 months of infancy.MethodsMedical records for 144 eyes (101 infants) operated between 2005 and 2014 were evaluated. A posterior capsulectomy and anterior vitrectomy were performed. Primary IOL implantation was performed in 68 eyes, while 76 eyes were left aphakic. There were 16 bilateral cases in the pseudophakic group and 27 in the aphakic group. The follow-up period was 54.3 ± 21.05 months and 49.1 ± 18.60 months, respectively. Fisher’s exact test was used for statistical analysis. The two-sample t-test with equal variance was used to compare surgery age, follow-up period and time intervals of complications.ResultsThe mean age of surgery was 2.1 ± 0.85 months in the pseudophakic and 2.2 ± 1.01 months in the aphakic group. PM was diagnosed in 40% pseudophakic and 7% aphakic eyes. A second surgery for PVAO was performed in 72% pseudophakic and 16% aphakic eyes. Both were significantly higher in the pseudophakic group. In the pseudophakic group, the number of PVAO was significantly higher in infants operated before 8 weeks of age compared to surgery age 9–16 weeks. The frequency of PM was not age-dependent.ConclusionAlthough it remains feasible to implant an IOL during the primary surgery, even in very young infants, there should always be solid arguments for this decision since it puts the child at higher risk of repeated surgeries under general anaesthesia.

Treatment of visual axis opacification and secondary membranes with Nd:YAG laser after pediatric cataract surgery under intranasal sedation.

To describe neodymium-doped yttrium-aluminum-garnet (Nd:YAG) laser treatment of visual axis opacification and secondary membranes in pediatric patients with cataracts under intranasal dexmedetomidine sedation. Twenty eyes of 17 patients with secondary membrane formation after cataract extraction were enrolled in this study. Intranasal dexmedetomidine sedation (3 ug/kg) was administered, and Nd:YAG laser (Ellex Super Q, Adelaide, Australia) procedures were performed with children in the sitting position with their chin supported on a laser delivery slit lamp. Preoperative and postoperative visual acuities were documented, and medical records were reviewed. The age of the patients ranged from 5 to 83 months (31.82 ± 27.73). Nineteen (95.0%) eyes had congenital cataracts and one (5.0%) had a traumatic cataract. Nd:YAG laser treatment of VAO with ten (50.0%) eyes, pupillary membranes with three (15.0%) eyes, pupillary cortical proliferation with six (30.0%) eyes, and anterior capsule contraction with one (5.0%) eye. Five (25.0%) eyes demonstrated visual acuity improvement, whereas six (30.0%) eyes remained unchanged after laser treatment. The recurrence rate was 30.0% and four eyes underwent a second Nd:YAG membranectomy. No side effects or tolerances due to sedative drugs were observed. Nd:YAG laser membranectomy under intranasal dexmedetomidine sedation was safely performed in children as young as 5 months old in a sitting position. This approach facilitates patient convenience, doctor proficiency, and cost reductions. Patients with recurrence can be treated by repeating the procedure.

Persistent pupillary membrane: a rare case and its surgical management

Aim: To discuss the surgical outcome of the persistent pupillary membrane (PPM), which is a rare entity. Case report: A female child aged seven and a half years has been reported to have had reduced vision in her right eye since birth. Her vision was counting fingers; after pupillary dilation, her vision improved to 6/24. A supranasal incision in the cornea was constructed under general anesthesia with a keratome of 3.2 mm size. A dispersive viscoelastic substance was introduced into the anterior chamber. The strands were excised with an iris scissor from their junction at the collarette. The viscoelastic material was removed, and a suture was placed. The post-operative patient was treated with cycloplegic, moxifloxacin, and dexamethasone eye drops. The pre- and post-operative periods were uneventful. After one and a half months, the patient’s vision improved to 6/9 with a refraction +0.50 DS with +1.00 Cyl at 1100. Conclusion: Pupilloplasty with excision of iris strands of PPM is relatively a safe procedure and might improve visual acuity.