Pupillary Membrane Research Articles

Conservative Management of Persistent Pupillary Membranes in Young Adult

Pupillary membranes are mostly encountered in infants. They present the remnants of anterior tonica vasculosa lentis which nourishes the lens during fetal life, their regression generally begins from the sixth month of gestation. However, in some cases, they may persist and cause a visual impairment .the management of PPM depends on the size of the pupillary aperture, the extent of the membrane, and its visual impact.

Conservative Management of Persistent Pupillary Membranes in Young Adult

Pupillary membranes are mostly encountered in infant. They present the remnants of anterior tonica vasculosa lentis which nourishes the lens during fetal life, their regression generally begins from the sixth month of gestation. However in some cases they may persist and cause a visual impairment .the management of PPM depends on the size of pupillary aperture, the extent of the membrane, and its visual impact.

Anterior Segment OCT Imaging of the Persistent Pupillary Membrane.

Anterior Segment OCT Imaging of the Persistent Pupillary Membrane.

Outcomes after surgical removal of anterior epi-capsular plaque associated with persistent pupillary membranes in children.

Anteriorepi-capsular plaque (ACP) is usually eccentric and is associated with persistent iris strands arising from the collarette. Outcomes of lens preserving ACP peeling along with removal of persistent pupillary membrane (PPM) strands have seldom been reported with only a few cases within some case series appearing in the literature. Herein we aim to report outcome after surgical removal of ACP associated with PPM in children. Research was done in three different Institutes. Charts were reviewed for all children who had undergone ACP removal surgery from 2010. Age at surgery, gender, preoperative best corrected visual acuity (BCVA), preoperative refraction, morphologic details of ACP, intraoperative complications, ophthalmic viscosurgical device use, age at last follow-up, postoperative complications, and postoperative BCVA were reviewed. A total of 16 patients, 10 male and 6 female, were included in study. Age at surgery ranged from 2 to 86 months old. Age at last follow up visit ranged from 2 to 14 years old. Postoperative complications were not observed in any of the 16 patients. Specifically, in all patients the crystalline lens remained clear at the last follow up visit. Congenital ACP of the lens associated with PPM and clear lens can be safely surgically removed with a very low risk of iatrogenic cataract in the early period after surgery.

"A Juvenile Bilateral Persistent Pupillary Membrane with Deprivation Amblyopia and Based Treatment"

"A Juvenile Bilateral Persistent Pupillary Membrane with Deprivation Amblyopia and Based Treatment"

Long term surgical outcome for persistent pupillary membranes with associated ocular abnormalities: a retrospective case series study

BackgroundDeprivation amblyopia is a great concern in hyperplastic persistent pupillary membranes (PPM) which blocked visual axis. Other ocular abnormality may accompany and further hinder the visual development of the infants.We evaluate the long-term visual prognosis and complications in patients with dense PPM and other associated abnormalities treated with early surgical intervention and timely visual rehabilitation.MethodsMedical records of patients with surgical removal of PPM from 2000 to 2020 and also receiving visual rehabilitation were retrospectively reviewed. Besides visual axis blocked PPM, patients combined with other amblyopic risk factors or ocular abnormalities were included.Due to preparation for subsequent lens extraction if an underlying cataract was present, the surgical settings including the instruments and wound direction were similar to cataract surgery. All patients were enrolled in a visual rehabilitation program as soon as possible. The results including sex, age, timing of operation, initial and final visual acuity, refractive errors, and complications were recorded.ResultsSeven cases of five patients were included in this case series. Mean age at surgery was 42.3 ± 21.1 months (range, 5 to 66 months) and the post-operative follow-up period was 4.9 years (range, 1.2 to 8.2 years).The patient age at time of surgery ranged from 2.5 months to 2.5 years (mean, 14 months). Mean postoperative follow-up was 5.3 years (range, 2.5–8 years). There were no intra-operative and post-operative complications. Final BCVA varied with a mean value of 0.29 logMAR (range, 0 to 1 logMAR). An associated ocular abnormality of ametropia and strabismus led to the best visual prognosis.ConclusionsIn patients with PPM, there were no significant complications in any patient using our technique. The surgical settings are easier to handle and more familiar with pediatric surgeons. Besides deprivation with patching, early PPM intervention and timely visual rehabilitation achieve the best visual prognosis in patients associated with risk of ametropic and strabismic amblyopia.Trial registrationThis retrospective, interventional case series study was conducted at China Medical University Hospital between April 1, 2000 and April 31, 2020. (IRB number: CMUH109-REC2–069).

Comparison of phaco time parameters in eyes with and without glaucoma filtration surgery due to pseudoexfoliation glaucoma.

To compare the phaco time parameters including ultrasound time (UST), effective phaco time (EPT), and average phaco power (APP) in eyes with pseudoexfoliation glaucoma (PEG) and had or had not glaucoma filtration surgery. In this retrospective comparative study, Group 1 was constructed with 84 PEG patients who had not operated previously, and Group 2 was constructed with 49 PEG patients who had glaucoma filtration surgery. The mean values of UST, EPT, and APP were compared. The preoperative clinical characteristics and surgical manipulations were also compared. The mean ages and male-to-female ratios of the groups were similar (p > 0.05, for both). There was no difference in the preoperative clinical characteristics, including biometric values between the groups (p > 0.05, for all). Some surgical manipulations, including pupillary stretching (p = 0.004), pupillary membrane peeling (p = 0.021), iris hook using (p = 0.041), and capsular tension ring implantation (p = 0.041), were significantly performed more commonly in Group 2. Although the mean UST and EPT values were similar (p > 0.05, for both), the mean APP value was significantly lower in Group 2 (p = 0.011). The lower APP parameter was observed in PEG patients having had glaucoma filtration surgery. Needing more surgical manipulation to overcome poor pupillary dilation and weak zonular instability can be a reason for this result.

Surgical membranectomy with modified incision and capsulotomy microscissors for persistent pupillary membrane.

To evaluate the visual outcome and complications of surgical membranectomy with modified incision and capsulotomy microscissors in patients with persistent pupillary membrane (PPM). We enrolled eight eyes with PPM in six patients and performed surgical membranectomy with modified incision located near the limbus and corresponding to the middle of the densest membrane strands. Strands near the collarette of the iris were then cut using capsulotomy microscissors and thick strands were removed with capculorhexis forceps. Complications during or after surgery were evaluated, and uncorrected visual acuity (UCVA) and best corrected visual acuity (BCVA) were compared pre- and post-surgery. The mean age of the patients at surgery was 9.5±3.4 years (range, 5.3 to 13.8 years). Bilateral PPMs were found in two patients, small anterior capsular cataracts not locating on the visual axis in three eyes, and deprivational amblyopia in four eyes. There were no traumatic cataracts, endophthalmitis, corneal opacities, or other complications in patients during or after modified surgical membranectomy. After a mean follow-up period of 5.8±0.4 (range, 5.0 to 6.0) months, UCVA was significantly improved from 0.23±0.14 to 0.36±0.20(P=0.026), and BCVA was also significantly improved from 0.32±0.22 pre-operatively to 0.56±0.25 post-operatively (P=0.006). Surgical membranectomy with modified incision and capsulotomy microscissors may be a safe approach to clear the visual axis of patients with PPM. However further treatments were needed in amblyopic eyes after surgery.

Persistent iris vessels in a case of aniridia

Congenital aniridia is caused by a mutation in the PAX6 gene [1] and is characterized by partial or complete absence of iris tissue. Apart from the hypoplasia of iris tissue, other ocular features such as foveal hypoplasia, nystagmus, aniridia-related keratopathy, Peters anomaly, Axenfeld-Rieger anomaly and glaucoma are seen in these eyes [1,2]. Cases have been reported with persistent pupillary membranes [3] and iris strands [4].

Optic Nerve Aplasia.

Optic nerve aplasia (ONA) is a rare ocular anomaly. We report ophthalmologic, systemic, and genetic findings in ONA. Patients were identified through an International Pediatric Ophthalmology listserv and from the practice of the senior author. Participating Listserv physicians completed a data collection sheet. Children of all ages were included. Neuroimaging findings were also recorded. Nine cases of ONA are reported. Patients' ages ranged from 10 days to 2 years (median 9 months). Seven cases were bilateral. All patients had absence of the optic nerve and retinal vessels in the affected eye or eyes. Ophthalmologic findings included glaucoma, microcornea, persistent pupillary membrane, iris coloboma, aniridia, retinal dysplasia, retinal atrophy, chorioretinal coloboma, and persistent fetal vasculature. Systemic findings included facial dysmorphism, cardiac, genitourinary, skeletal, and developmental defects. A BCOR mutation was found in one patient. One patient had rudimentary optic nerves and chiasm on imaging. ONA is a unilateral or bilateral condition that may be associated with anomalies of the anterior or posterior segment with or without systemic findings. Rudimentary optic nerve on neuroimaging in one case suggests that ONA is on the continuum of optic nerve hypoplasia.

Congenital Microcoria

A 22-year-old woman has had very small pupils since birth. Vision was 20/20 in each eye, pupillary size was 1 mm (Fig A) and did not change after administration of dilating drops, including 1% atropine (Fig B). On ultrasound biomicroscopy, both iris dilator muscles were very thin (Fig C-D, arrow), and persistent pupillary membrane was visible (Fig C-D, arrowhead). Diagnosis of microcoria was made and full microsomal micro-essay screen for mutations on chromosome 13, previously associated with microcoria, was negative.

Clinical and Histopathological Features of Congenital Fibrovascular Pupillary Membranes in a Chinese Case Series.

To investigate the clinical and histopathological features of congenital fibrovascular pupillary membrane (CFPM) in Chinese patients. This retrospective study reviewed CFPM cases treated at Beijing Children's Hospital. The clinical manifestations, approaches of treatment, outcomes, and histopathological findings were collected and analyzed. A total of 33 patients with CFPM were reviewed. All patients had unilateral eye involvement. A total of 21 eyes (63.64%) had a white membrane that partially covered the pupil and 12 eyes (36.36%) had a membrane that completely covered the pupil. Of the 12 eyes with a complete pupillary membrane, 6 (50%) had glaucoma. For eyes with a partial pupillary membrane, 11 eyes (52.38%) were followed up at the outpatient clinic without surgery and 10 eyes (47.62%) underwent membranectomy and pupilloplasty due to visual axis blockage. For the 12 eyes with a complete pupillary membrane, 6 eyes (50%) with normal intraocular pressure (IOP) received membranectomy and pupilloplasty combined with iridectomy, and 1 (16.67%) of these 6 eyes underwent a reoperation after 5 months due to a recurrent membrane. Furthermore, 6 eyes (50%) with glaucoma had membranectomy, pupilloplasty, iridectomy, and goniosynechialysis. Among these 6 eyes, 2 eyes (33.33%) underwent a reoperation due to the recurrence of a membrane and 4 eyes (66.67%) had a pale optic disc. The histopathological findings revealed that these membranes were mainly composed of fibrous tissue, lymphocytes, pigment epithelial cells, and vascular tissues. CFPM has diverse manifestations, including a partial pupillary membrane, a complete pupillary membrane with normal IOP, and a complete pupillary membrane with glaucoma. Timely diagnosis and treatment are critical when the visual axis is blocked and/or the IOP is high. [J Pediatr Ophthalmol Strabismus. 2021;58(2):105-111.].

A case report of bilateral uveitis with meningococcal septicaemia resulting to blindness and adjustment disorder

To report the rare case of a patient with bilateral uveitis with meningococcal septicaemia from Neisseria meningitides, resulting to blindness and adjustment disorder. A 9-years-old boy presented to the Emergency paediatric unit of a hospital with complaints of fever, and neck stiffness of one week duration. There was associated sudden decreased vision, pain and photophobia of both eyes. Neck was stiff and retracted with positive Kernig’s and Brudzinski’s signs. Neisseria meningitidis was isolated from both the turbid CSF and the blood. Visual Acuity (VA) was Perception of Light (PL) and Counting Finger (CF) in right and left eyes (RE and LE) respectively, with 360 degrees posterior synechiae and pupillary membrane. Diagnosis of meningococcal septicaemia with bilateral uveitis was made. Patient was treated with IV ceftriaxone, sub-conjunctival dexamethasone, dexamethasone, atropine and moxifloxacin eye drops and other supporting medications. Although he showed improvement of VA to RE-6/36, LE- 6/24, he absconded from follow- up and later relapsed with subsequent blindness (VA of Perception of Light in Both eyes) and symptoms of adjustment disorder. Although ocular involvement is rare in meningococcal septicaemia, patients should always have detailed ophthalmological examination as prompt diagnosis and management could improve the visual outcome.

Genetic and phenotypic analysis of a patient with phosphogylcerate dehydrogenase deficiency

To explore the genetic basis for a child with ocular anomaly, microcephaly, growth retardation and intrauterine growth restriction. The patient underwent ophthalmologic examinations including anterior segment photography, fundus color photography, and fundus fluorescein angiography. The patient and her parents were subjected to whole exome sequencing. Candidate variants were verified by Sanger sequencing and bioinformatic analysis. The patient was found to have bilateral persistent pupillary membrane and coloboma of inferior iris, in addition with macular dysplasia and radial pigmentation near the hemal arch of the temporal retina. She was found to have carried compound heterozygous missense variants of the PHGDH gene, namely c.196G>A and c.1177G>A, which were respectively inherited from her father and mother. Bioinformatic analysis suggested both variants to be pathogenic. The patient was diagnosed with phosphoglycerate dehydrogenase deficiency. Above finding has enriched the phenotypic spectrum of the disease with ocular manifestations.

The enigma of subnormal vision in persistent pupillary membrane

Persistent pupillary membrane (PPM) is a common congenital anomaly of the eye, representing the remnants of tunica vasculosa lentis. It is often detected as an incidental finding upon examination. The presentation may vary from being an insignificant strand of iris to a hyperplastic dense membrane, with or without adhesions to the surrounding structures, which notably obscures the visual axis. When present as an isolated pathology, these patients are often asymptomatic. However, some patients with isolated PPM do present with poor visual acuity or subnormal quality of vision. The severity of their disability does not always correlate to the extent of the anomaly present in the eye. The rationale as to why only some patients with significant PPM experience this visual handicap while others don’t is one of the baffling conundrums in ophthalmology at present. Hence, we attempt to elaborate on the possible mechanisms that explain the unpredictable and variable clinical manifestation of persistent pupillary membranes.

Visual rehabilitation in pediatric cataract with primary intraocular lens implantation

Aim: The aim of this study was to show visual rehabilitation in pediatric cataract with primary intraocular lens implantation. Materials and Methods: 106 eyes of 91 pediatric patients between 2 to 20 years of age who underwent cataract surgery with primary IOL implantation from June 2018 to January 2020 were included in the study. All the surgeries were performed by a single experienced pediatric ophthalmologist. Phacoemulsification, anterior vitrectomy, and primary posterior capsulorhexis with primary IOL implantation were done in all patients. Patients were reviewed 1 week, 1 month, and 6 months postoperatively. Results: Visual acuity improved from 1.7 logarithm of the minimum angle of resolution (logMAR) before the surgery to 0.74 logMAR at the last follow-up. Twelve eyes had postoperative complications which included posterior capsule opacification in 12 eyes, pupillary fibrin membranes in 17 eyes, and corneal edema in 2 eyes. Conclusion: The current study suggests that primary IOL implantation is safe when in an experienced hand for pediatric age group.

Corrective Surgery for Palpebral Coloboma in a Feline Using the Technique of Transposition of the Lip Commissure

Background: Eyelid coloboma is considered a disease caused by failure in eye development during the first semester of pregnancy. In felines, its prevalence occurs in the upper eyelids, temporal region, and bilaterally. Coloboma, whether to a large or small extent, can lead to keratoconjunctivitis sicca and trichiasis, situations that can give rise to secondary ulcerative keratitis. The only corrective method is blepharoplasty. The current work aims to report the case of corrective surgery for eyelid coloboma in a feline with a successful postoperative period, in order to corroborate the effectiveness of the technique. We also report a finding of persistent pupillary membrane.Case: A 7-month-old male feline, no defined breed, was analyzed with a purulent mucus secretion and signs of discomfort in the right eye. After the ophthalmic screening, the presence of a coloboma was identified, which occupied approximately 50% of the size of the upper eyelid, in the temporal-dorsal region of the right eye. The cat had already undergone an enucleation of the left eye due to a perforation arising from ulcerative keratitis. Together with coloboma, the presence of blepharospasm, trichiasis, keratoconjunctivitis sicca, and secondary ulcerative keratitis were diagnosed. The presence of persistent pupillary membrane was also observed, a rare condition in the feline species. To confirm the ulcer, the fluorescein test was applied and treatment with antibiotic eye drops and lacrimomimetics (tear film replacements) drops was administered until the day of surgery, one week later. Concomitant with the institution of treatment prior to surgery, blood was collected for complementary pre-surgical tests such as blood count and biochemistry, which demonstrated satisfactory results. Corrective surgery was then instituted by the technique of transposing the labial commissure, described in 2010, which consists of replacing the colobomatous tissue with a flap from the oral region. To ensure quality in the postoperative period, the use of the Elizabethan collar, oral antibiotics, analgesics, anti-inflammatory drugs, and cleaning with 0.9% saline solution around the sutures were prescribed. The first return appointment occurred on the day after the operation and further appointments were made weekly for one month. As the animal did not present any complications in the healing process, the spacing between the follow-up appointments was increased. After 2 months, the animal demonstrated a palpebral reflex and a pleasant appearance.Discussion: The results were similar to those described by the author of the technique, as there was no recurrence of hair in contact with the cornea, the flap mucosa became efficient in terms of the quality in lubricating the fibrous tunic, and an appearance acceptable to the owner was achieved. It is also reported that, different from previous studies, the technique was able to correct palpebral coloboma without any complications during the post-surgical process. In all previously published works, some type of setback was reported, such as dehiscence of the suture of the oral region, dehiscence of the transposed suture, superficial necrosis of the flap, deformation of facial folds, excessive graft retraction, and return of trichiasis in the pre-existing medial region. It is inferred, then, that the use of this technique for correction of eyelid coloboma longer than 1/3 should be indicated.

Congenital ocular malformations in dogs and cats: 123 cases.

Provide epidemiological data regarding the prevalence of congenital ocular malformations in dogs and cats. A population of 32974 dogs and 13977 cats that presented for consultation at the veterinary teaching hospital. Medical records from 2011 to 2018 were reviewed. A retrospective and prospective epidemiological clinical study addressing congenital ocular malformations was conducted. Signalment, medical history, reason for presentation, clinical findings, vision impairment, and treatment options were analyzed. From the total of cases analyzed, 103 dogs (0.3%) and 20 cats (0.1%) met the inclusion criteria. The majority of dogs were mixed breed, the most common breed being the French Bulldog, while the majority of cats were European domestic shorthair. The median age of diagnosis was 12months for dogs and 6months for cats. Sex predisposition was not found. The most frequently identified abnormalities were as follows: congenital cataract (dogs: 31.1%; cats: 30.0%), microphthalmia (dogs: 35.0%, cats: 25.0%), and persistent pupillary membrane (dogs: 27.2%, cats: 40.0%). Some of the concurrently observed malformations were significantly associated. A statistically significant association was found between ocular dermoids and the French Bulldog breed (P<.001). Even though congenital ocular malformations are uncommon, knowledge about their prevalence is important, since they can cause vision impairment or even blindness. Moreover, some human ocular disease phenotypes are similar to the ones presented by dogs and cats, so they can be used as models to investigate pathophysiology and therapeutic approaches.

Safety of piggyback intraocular lenses (polypseudophakia) in children: long-term outcomes of a 15-year, single-surgeon study

To report the outcomes of piggyback (PB) intraocular lens (IOL) implantation, or temporary polypseudophakia, in children who have undergone cataract surgery and to assess their safety in pediatric patients. The medical records of consecutive patients who underwent PB IOL implantation at a single institution over a period of 15years were reviewed retrospectively. Outcome measures were reoperation rate, complications, and outcome of planned explantation. A total of 48 eyes of 38 children received PB IOL implantation: 40 eyes at the time of cataract surgery and 8 eyes as a later secondary procedure. Of these, 38 eyes of 31 patients with primary PB IOL implantation had follow-up of >3years and were included in the present analysis. Median age at cataract surgery with PB IOL implantation was 6.5months (0.5months to 2.4years). Median follow-up was 12.5years (range, 3.0-20.7). Four eyes required reoperation for adverse events related to PB IOL implantation (1 each for IOL tilt, pupillary capture, pupillary block glaucoma, and pupillary membrane). All 4 of these eyes were operated for cataract before 3months of age. The sulcus-fixated PB IOL underwent a planned explantation in 33/38 eyes. Eight eyes needed intraocular pressure-lowering topical medications. Planned PB IOL explantation was uncomplicated in our series. Early complications occurred in 4 eyes, but late complications were not noted, and glaucoma developed at predictable rates for this population. Piggyback IOL placement in our cohort of young children appears to have an acceptable safety profile.

Cataract surgery in treated retinoblastoma eyes: A study of 29 eyes.

To study the outcomes of cataract surgery in treated retinoblastoma (RB) eyes. Retrospective study of 29 eyes of 27 patients. Based on International Classification of Intraocular Retinoblastoma, tumors belonged to group B (n = 3, 10%), C (n = 1, 4%), D (n = 10, 34%), and E (n = 3, 10%). The remaining 12 eyes (41%) had regressed tumors on presentation due to prior treatment. The RB treatment details included intravenous chemotherapy (n = 24, 83%), external beam radiotherapy (n = 14, 48%), and others. The mean time interval between tumor regression and cataract surgery was 51 months (median, 26 months; range, 6-245 months). The post-operative visual acuity was 20/200 or better in 12 (41%) eyes. Overall, 16 (55%) eyes displayed improvement of vision post-cataract surgery, while 13 (45%) eyes had no improvement in vision. The complications of cataract surgery included visual axis opacification (n = 15, 52%), pupillary membrane (n = 4, 14%), hyphema (n = 1, 3%), and extraocular tumor extension (n = 1, 3%). Clearer fundus view post-surgery revealed underlying tumor edge recurrence in 1 (3%) eye, and two (7%) patients had tumor recurrence at a mean interval of 8 months (median, 8 months; range, 7-8 months) following cataract extraction. Globe salvage was achieved in 26 (90%) eyes over a mean follow-up period of 103 months (median, 91 months; range, 19-267 months). Cataract surgery in treated RB is safe with vision salvage in 55% eyes and globe salvage in 90% eyes. Though there is a risk of extraocular tumor extension, its occurrence is rare (3%).