Pupillary Membrane Research Articles

Use of ultrasound biomicroscopy to predict the outcome of anterior segment reconstruction in congenital fibrovascular pupillary membrane with secondary glaucoma

AimsTo evaluate the efficacy and safety of anterior segment reconstruction (ASR) in congenital fibrovascular pupillary membrane-induced secondary glaucoma (CFPMSG) basing ultrasound biomicroscopy (UBM) classification.MethodsThis ambispective cohort study enrolled patients with...

Staged lensectomy and vitrectomy in the management of stage 5C retinopathy of prematurity with corneal opacification: long-term follow up.

To verify the feasibility and safety of staged lensectomy and vitrectomy in stage 5C retinopathy of prematurity (ROP) with corneal opacification. This was a retrospective, interventional, consecutive case series. Twenty-two eyes of 18 stage 5C ROP patients with corneal opacification were included. Regular combined lensectomy and vitrectomy were not prescribed due to the invisible fundus. Staged lensectomy and posterior vitrectomy were performed. The anatomical and visual outcomes were reviewed at the final follow-up visit. The mean gestational age of ROP patients was 29.3±1.6wk (range: 27-32wk), comprising 8 males and 10 females. The average birth weight was 1363.0±300.0 g. All the eyes had corneal opacity and flat or disappeared anterior chambers pre-operatively. Two eyes had complicated cataract and 7 eyes had retrolental fibroplasia. Six eyes had posterior pupillary synechiae or membranes. Seven (31.8%) eyes had vascularly active retinas. The average interval between two procedures was 6.8±4.6mo (2.5-18.5mo). After surgeries, all the patients had normal anterior chambers. Fourteen eyes had clear corneas. The intraocular pressure of 3 eyes with glaucoma was controlled by medication. Two eyes had ocular phthisis. The retina was reattached in 3 eyes and partially attached in 11 eyes. Visual acuity ranged from no light perception to hand motion. Staged lensectomy and vitrectomy are procedures that can halt progression to further complications and preserve some useful eyesight in stage 5C ROP patients with corneal opacification. The earlier the lensectomy is performed, the better the prognosis is.

Hereditary Eye Diseases in German Shepherd Dog

Abstract Hereditary eye diseases occur to varying degrees in all dog breeds. Individual purebred breeds have specific predispositions to various eye disorders. The German Shepherd is diagnosed mainly with chronic superficial keratitis/pannus, but also with: distichiasis, plasmoma/atypical pannus, corneal dystrophy, persistent pupillary membranes, cataract, cone degeneration, retinal dysplasia, optic nerve hypoplasia/micropapilla, and limbal melanoma. Individual ocular abnormalities are manifested by characteristic clinical manifestations and ophthalmological findings. Some eye diseases can lead to blindness, others affect the comfort of life or work use of the dog to varying degrees. A thorough knowledge of individual ocular pathologies in a particular breed leads not only to the identification of the diagnosis but also to the correct assessment of the dog’s breeding usability.

Role of Ultrasound Biomicroscopy in Predicting Intraoperative Surgical Strategies in Penetrating Keratoplasty with Cataract Extraction and IOL Implantation

Background: Penetrating Keratoplasty with cataract extraction and Intraocular Lens (IOL) implantation (Triple procedure) is very challenging procedure because in cases of Opaque cornea, status of anterior segment is difficult to predict that can lead to intraoperative surprises. If not managed properly, these can severely affect visual outcome. To avoid this, we performed Ultrasound Biomicroscopy (UBM) preoperatively for detailed analysis of anterior segment structures and associated pathologies and later compared it with intraoperative findings to judge predictive accuracy of UBM in guiding surgical strategies, decision making and modifications intraoperatively. Methods and findings: 20 eyes of 20 patients with different grades of corneal opacities like simple corneal opacities (6 eyes) or adherent leucoma (7 eyes) or anterior staphyloma (7 eyes) that underwent Triple procedure (Penetrating Keratoplasty+ cataract extraction+ IOL implantation) were evaluated preoperatively by UBM and the findings were compared intraoperatively to find predictive accuracy of UBM. Extent and depth of corneal lesions, corneal thickness, anterior chamber depth, type, position and extent of synechiae, pupillary membrane and status of lens and capsule were assessed. Scan was performed to visualize any posterior segment pathology and to find Axial Length (AL). Keratometry readings of other eye were taken to calculate IOL power for implantation. Preoperative UBM findings when co-related intraoperatively was found to be accurate in 71.42%- 100% parameters and accordingly these cases underwent penetrating Keratoplasty with other modifications like Iridectomy, Membranectomy, Synechiolysis, iris reconstruction, Trabeculectomy, cataract extraction and IOL implantation. Conclusion: In cataract coexisting with corneal pathologies, UBM is Best and reliable guide in predicting and preplanning of surgical strategies for best visual outcomes.

Ophthalmic involvement in PHACES syndrome: prevalence, spectrum of anomalies, and outcomes

To highlight prevalence, spectrum of anomalies, and outcome of ophthalmic involvement in PHACES syndrome (posterior fossa malformations, infantile hemangiomas, arterial, cardiac, eye, and sternal anomalies). A retrospective, noncomparative, single-institution observational case series of children with PHACES was conducted from 2000 to 2019. Data on ocular presentations, interventions and visual outcomes were collected. Primary outcome measures were the frequency and spectrum of ocular involvement. Secondary outcomes were final visual acuity, long-term ocular sequelae, and frequency of surgical interventions. A total of 43 infants had PHACES, of whom 29 (67%) had periocular infantile facial hemangiomas (IFH) and 6 (14%) had primary ocular anomalies that were always ipsilateral to the IFH. Five patients (12%) met ocular PHACES-specific diagnostic criteria, including optic nerve (3), retinal vascular (1) and lenticular (2) anomalies. Non-PHACES-specific abnormalities were Peters anomaly (1), persistent pupillary membranes (2), dysmorphic optic nerves (1), and iris/choroidal hemangiomas (2). IFH-related periocular abnormalities were frequent: ptosis (29), proptosis (9), strabismus (6). Surgery was required in 8 of the 29 children: (strabismus [6], entropion [2], ptosis [2], and optical iridectomy [1]), all of whom had orbital/conjunctival hemangioma (P = 0.03). Final visual acuity (follow-up, 8.7 years) ranged between 20/20 and 20/80 in 26 of 29 patients. All patients with visual acuity worse than 20/200 (3/29 [10%]) had structural anomalies. Two-thirds of infants with PHACES have periocular IFH causing vision compromising complications of amblyopia and strabismus. Structural ocular anomalies exist in 1 of 7 patients and are always ipsilateral to the IFH. Long-term ophthalmic monitoring and management is required, and the majority of patients obtain good visual outcomes.

Congenital fibrovascular pupillary membranes: case series with pathological correlation and surgical treatment.

Congenital fibrovascular pupillary membranes: case series with pathological correlation and surgical treatment.

Epidemiology and clinical presentation of feline presumed hereditary or breed-related ocular diseases in France: retrospective study of 129 cats.

This study aimed to describe the epidemiology and clinical presentation of presumed hereditary or presumed breed-related ocular diseases in a population of cats in France. Medical records from between September 2013 and August 2017 were reviewed to identify cats with at least one presumed hereditary or breed-related ocular disease. Cats with concurrent, or a history of, ocular or systemic infectious diseases were excluded. Signalment, history and clinical findings were recorded. Of the 1161 cats that presented to our institution during the study period, 129 were diagnosed with at least one presumed hereditary or presumed breed-related ocular disease (11.1%, 95% confidence interval [CI] 9.3-12.9). Five ocular abnormalities had a prevalence of >1%: entropion, corneal sequestration, persistent pupillary membrane, cataract and retinal dysplasia. The prevalence of entropion was 2.2% (95% CI 1.3-3.0), with Persians (P = 0.03), Maine Coons (P <0.01) and male cats (P <0.01) being over-represented. The prevalence of corneal sequestration was 2.4% (95% CI 1.5-3.3), with Persians (P <0.01) and Exotic Shorthairs (P = 0.02) being over-represented. Persistent pupillary membranes and cataracts had the same prevalence of 2.3% (95% CI 1.5-3.2), with no particular sex or breed significantly over-represented. Retinal dysplasia had a prevalence of 1.6% (95% CI 0.8-2.3) and Persian cats were over-represented (P = 0.04). Anterior segment dysgenesis had a low prevalence (0.9%, 95% CI 0.4-1.5), with all affected cats being domestic shorthairs and this breed therefore was over-represented (P = 0.04). In a French population of cats, presumed hereditary or breed-related ocular diseases accounted for 11.1% of all ocular diseases. Cataracts, corneal sequestration, persistent pupillary membrane, entropion and retinal dysplasia were the most common conditions. Statistical breed over-representation was observed for entropion, corneal sequestration and retinal dysplasia. We recommend that more systematic screening of feline species is conducted.

Unilateral isolated type 3 persistent pupillary membrane

We report a 65-year-old male with unilateral type 3 persistent pupillary membrane, which was an incidental finding and was not a contributing factor for his presented symptom of diminished vision. Persistent pupillary membrane is a frequently encountered congenital anomaly of iris in routine ophthalmological practice. Different clinical types of persistent pupillary membrane do exist. However, this clinical variety is a rare one to be reported so far in the existing literature.

Surgical outcomes of primary intraocular lens implantation for the treatment of aphakia in pediatric cataracts in the Brazilian public health system.

To evaluate primary intraocular lens implantation in the treatment of children's aphakia in the Brazilian public health system and compare the outcomes among different age groups. Children aged 0-12 years old with unilateral or bilateral congenital/developmental cataracts and underwent primary intraocular lens implantation were included. A total of 108 eyes from 68 children were evaluated, and the children were divided into four age groups (<7 months [mo]; 7 mo-2 years old [y/o]; 2-5 y/o, and >5 y/o) were evaluated. Nineteen eyes (17.59%) presented visual axis opacification as a postoperative complication, which was more frequently observed in the <7 mo age group (37.93%). The difference was significant between the <7 mo and >5 y/o age groups (p=0.002). Visual axis opacification was divided into two categories: pupillary membrane and lens cell proliferation. Eight eyes presented pupillary membrane, whereas 14 showed lens cell proliferation. Out of eight eyes with pupillary membrane, seven occurred in the <7 mo age group. The difference between the <7 mo age group and the 2-5 y/o or >5 y/o age group was significant (p=0.01). Lens cell proliferation was more frequent in the <7 mo and 2-5 y/o age groups, but the difference was significant only between the < 7 mo age group and >5 y/o age group (p=0.040). Glaucoma and glaucoma suspect cases were not observed during the follow-up period. The main complication found in the study was visual axis opacification, which had a higher incidence in children operated on or before the age of 7 months.

Urrets-Zavalia syndrome: report of 2 cases

Urrets-Zavalia syndrome characterized by areflexic mydriasis followed by progressive atrophy of the iris can occur afterfull thickness cornea transplant (penetrating keratoplasty). This is often associated with ocular hypertonia. We here report two cases. A 14-year-old girl with bilateral stage IV keratoconus, who underwent penetrating keratoplasty in the right eye. Immediate postoperative outcome was marked by the appearance of an inflammatory reaction of the anterior chamber with double-cross tyndall effect and pupillary fibrin membrane formation characterized by a tone of 23 mm hg at day21.

Bilateral hyperplastic persistent pupillary membrane: A case-based approach

Bilateral hyperplastic persistent pupillary membrane: A case-based approach

Persistent pupillary membrane masquerading as a foreign body

Persistent pupillary membrane masquerading as a foreign body

The Zonular Stripes

Long anterior zonules [LAZ] are zonules having anomalous anterior insertion on the lens capsule, thus reducing the size of zonule-free zone. This article describes a diabetic elderly female who presented to us for cataract surgery. Examination showed presence of bilateral persistent pupillary membrane [PPM] along with long anterior zonules. Association of PPM with LAZ has been established in literature but bilateral PPM-LAZ association is a unique finding. The article also illustrates different phenotypes of LAZ and their clinical associations. LAZ eyes have propensity for sight threatening diseases like glaucoma, retinal diseases etc. Hence, a thorough ocular examination is warranted.

Glaucoma secondary to congenital fibrovascular pupillary membrane: a single tertiary center experience

We report the clinical features, treatments, and outcomes of 9 infants with glaucoma secondary to congenital fibrovascular pupillary membrane. The clinical features included unilateral low vision, high intraocular pressure (IOP), enlarged and cloudy cornea, loss of anterior chamber, and pupillary membrane. All patients underwent membranectomy, peripheral iridectomy, pupilloplasty, and goniosynechialysis as primary treatment. The membranes were posterior to the iris in all 9 eyes. In 5 eyes, the membrane covered the ciliary processes, and in 1 eye the membrane reached the posterior lens capsule. Following primary surgery, 3 patients developed membrane recurrence, 4 had refractory elevated IOP, and 2 developed lens opacities. All 4 eyes with poor postoperative IOP control had iris root insertion anterior to the scleral spur. Five patients received additional surgeries including membranectomy, pupilloplasty, goniosynechialysis, cyclocryotherapy, ciliary photocoagulation, Amhed valve implantation, and lensectomy. One patient had refractory elevated IOP at last follow-up. IOP in the other 8 eyes was well controlled. None of the affected eyes was able to fix and follow at last follow-up.

Membrana pupilar persistente en un felino: Reporte de caso

The persistent pupillary membrane (PPM) is a rare congenital disorder, characterized by thin bands that cross the iris and usually does not affect the visual ability. This disease does not necessarily need therapeutic intervention, however, the place of attachment of this membrane can generate corneal or cataract opacity. The etiology has not been well elucidated; however, it is believed to have a hereditary background and this disease has already been reported in humans, dogs, rats, and felines. A feline, female, unsterilized, crossbreed, 2 years old, weighing 3.2 kg, was referred for preoperative evaluation of elective ovariohysterectomy, in which the left unilateral ocular alteration was observed, compatible with persistent pupillary membrane. The objective of this study was to present a case of PPM in a feline, a species with a rare incidence of this anomaly, making the case relevant for a better understanding of the epidemiology of this condition. As much as the disease does not have significant ocular repercussions, medical follow-up is recommended.

Ocular dermoids in 13 cats: a multicentre retrospective study.

The aim of this multicentre retrospective study was to review the clinical data, outcomes and histopathological features of cats that had been treated for ocular surface dermoids. Thirteen cats from various private practices in France with a clinical diagnosis of ocular surface dermoid were included in the study. The mean age of the study population at the time of diagnosis was 5 months. There were nine males and four females. Three different breeds were domestic shorthair (n = 7), Birman (n = 4) and Havana Brown (n = 2). Two of the four Birmans were related (same sire). The two Havana Browns were also related (same sire). All of the dermoids were unilateral. Five of the dermoids were strictly conjunctival. Four affected both the conjunctiva and the cornea. Three affected both the conjunctiva and the eyelid, and one was strictly corneal. They were located in various positions: temporal (n = 9), inferonasal (n = 1), dorsonasal (n = 1) and dorsotemporal (n = 1). The last dermoid was heterogeneous and involved the nasal, dorsal and temporal quadrants. Concurrent eye diseases were observed in five patients: four cats exhibited associated eyelid agenesis and one cat exhibited persistent iris-to-iris pupillary membranes. Ten dermoids were surgically excised with no recurrences. Surgery was not performed for three cats: one cat died a few days after diagnosis and two cats were lost to follow-up after initial presentation. Ocular surface dermoids are a rare condition in cats that can be treated successfully by surgical excision. Although our study reports only a small number of cases, the observation of ocular surface dermoids in two related cats in two different breeds indicates that genetic transmission is likely.

Congenital Cataracts and Microphakia with Retinal Dysplasia and Optic Nerve Hypoplasia in a Calf

Case Description. A two-month-old, female, Aberdeen-Angus calf was presented for congenital cataracts and blindness in both eyes (OU). The dam had a reported history of visual defects (not specified) and had produced other affected calves (per owner history). Ophthalmic examination revealed mature bilateral cataracts, attenuation of the iridic granules, persistent pupillary membranes, and dyscoric pupils. Additionally, the calf had a poor body condition, prognathism, dome-shaped head, excessive nasal drainage, limb contracture, and fever. Histopathology of both eyes revealed lenticular degeneration (congenital cataracts), retinal dysplasia, and optic nerve hypoplasia. BVDV IHC detected antigen within only the left eye (OS), consisting of intrahistiocytic and endothelial immunoreactivity within the ciliary body, iris, and choroid. No BVDV immunoreactivity could be detected in the right eye (OD). This case highlights the unique ocular changes present in in utero BVDV infection of cattle with a different immunohistochemical staining profile than previously described.

Лечение последствий длительной тампонады силиконовым маслом при рецидивирующей отслойке сетчатки у пациента с ретинопатией недоношенных

Objective. To present the clinical and functional results of combined treatment of the complications of long-term silicone oil tamponade in a patient with retinopathy of premature. Materials and methods. A 24-year-old patient diagnosed with stage 4b retinopathy of premature in a single seeing right eye. Between 2011 and 2020 underwent 5 microinvasive revisions of the vitreous cavity with replacement of silicone oil and median duration of silicone oil tamponade of 19+25.5 months over this entire period. Because of the constant migration of emulsified silicone oil to anterior chamber due to weakness of iridolenticular ligaments, band keratopathy developed in the right eye, opacity of the IOL due to the adhesion of precipitates on its anterior and posterior surfaces, pupillary membrane, and aggravation of the proliferative membrane on the ocular surface. UCVA was proectio incerta and IOP was 17 mmHg. The median thickness of the cornea was 853 μm, the average thickness of the corneal calcifications is 57 μm. The patient underwent revision of the vitreous cavity with removal of the pupillary membrane, the next steps were to install bandage sutures in the anterior chamber parallel to iris in two mutually perpendicular surfaces to create additional barriers to silicone oil migration. Then we used 27 mg of K3-EDTA to produce 0.1% chelating solution and to remove corneal calcium deposits. Final stage was YAG – laser discision of precipitates from the IOL surfaces. Results. Postoperatively UCVA of the right eye in 1-month was 0.05, IOP was 17 mmHg and endothelial cell density was 1200 cells / mm2. According to OCT data the median corneal thickness was 640 μm, the thickness of the epithelial layer was 39 μm. Biomicroscopically, cornea was transparent, a single silicone oil vesicle in the lower segment of anterior chamver, the bandage sutures are consistent, the IOL is centered with a transparent optical zone, silicone oil visualized on the fundus, epi- and subretinal proliferates were delimited by laser coagulates, epiretinal membrane was in the macular region. Key words: retinopathy of prematurity, silicone oil, emulsification, ribbon-like keratopathy, bandage threads, EDTA.

A curious case of unilateral buphthalmos

Unilateral secondary angle-closure glaucoma due to uveitis is a rare presentation in a neonate. While the congenital pupillary membranes present predominantly with iris and pupillary changes, glaucoma being a late presentation in a milder form. We report an unusual presentation of a few weeks old baby, having unilateral buphthalmos, normal iris, flat anterior chamber, and elevated intraocular pressure with a pupillary membrane, causing secondary angle-closure glaucoma. There was indirect evidence of maternal infection during the antenatal period with raised IgG titers. The case was managed with anterior chamber reformation, iridectomy along with membranectomy, and did not require trabeculectomy.

Persistent pupillary membranes and cataract

A 58-year-old man with hemochromatosis experienced decreasing vision in his right eye and was referred for cataract surgery. His best-corrected visual acuity at presentation (Snellen) was 20/400 in the right eye and 20/20 in the left eye. He had hypermetropia and astigmatism, and a known amblyopia in his right eye since childhood. The eye examination showed iris strands extending centrally, with a spider-like appearance. This was consistent with persistent pupillary membranes in both eyes (A and B) –most pronounced in the right eye (A), which also had a pronounced cataract.