Pupillary Membrane Research Articles

Findings of Eye Screening Examinations with Wide-Field Digital Imaging System in Healthy Newborns

Purpose: To present the results of eye screening examinations using RetCam in healthy newborns. Methods: Eye screening examinations were performed using the RetCam wide-field digital imaging system (Clarity Medical System, Pleasanton, CA, USA), as requested by parents, on healthy newborns within a week after birth in an obstetrics and gynecology hospital between June 2012 and September 2014. During the examination, photographs were taken showing red reflex and the fundus. The reading was conducted by a pediatric ophthalmologist. Results: The examinations included a total of 10,023 newborn babies, and abnormalities were discovered in 2,916 patients (29.09%). The most commonly found abnormality was retinal hemorrhage, which was discovered in 2,796 babies (27.89%) and 471 patients showed a large amount of bleeding or macular hemorrhage. In 71 patients (0.7%), ophthalmologic examination was recommended after newborns presented with one of the following conditions: congenital cataracts, retinoblastoma, persistent hyperplastic primary vitreous, vitreous hemorrhaging, persistent pupillary membrane, choroidal nevus or albinism. Due to unclear photographs, 85 eyes of 49 patients (0.48%) could not be read. Conclusions: Ophthalmologic screening using RetCam is a safe, simple and useful technique for discovering ophthalmologic abnormalities. Additionally, when abnormalities are suspected, the role of a pediatric ophthalmologist is increasingly important in helping patients receive appropriate ophthalmologic treatment. Furthermore, retinal hemorrhage, which occurred in the majority of all observed abnormalities, requires further investigation to examine the possibilities of amblyopia in cases with a large amount of bleeding or macula involvement. J Korean Ophthalmol Soc 2015;56(10):1617-1623

Konjenital Pinhole Gibi Davranan Persistan Pupiller Membran

Konjenital Pinhole Gibi Davranan Persistan Pupiller Membran

Clinical characteristics and surgical approach to visually significant persistent pupillary membranes

Infants with hyperplastic persistent pupillary membranes (PPM) may be at risk for deprivation amblyopia due to obstructions of the visual axis. We describe the long-term visual and anatomic outcomes of a surgical technique for their removal. The medical records of consecutive patients <3 years of age who underwent surgical removal of PPMs between December 1998 and May 2012 were retrospectively reviewed. Each PPM was judged to be visually significant based on poor visual acuity, poor retinoscopic reflex, or inability to visualize the fundus. The surgical technique included injection of a viscoelastic agent beneath the pupillary strands to bow them anteriorly, careful peeling of residual adherent strands from the anterior lens capsule, and lysis of the strands at the pupillary margin with intraocular scissors. Pre- and postoperative visual and anatomic results were recorded. This case series included 10 eyes of 6 patients: PPMs were bilateral in 4 patients and unilateral in 2. 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). All patients had successful clearance of the visual axis and good visual acuity. No intraoperative complications occurred. All patients in this series had excellent visual and structural outcomes, with no significant complications. The technique described here may be considered for patients with visually significant PPMs to improve visual function and pupil appearance.

A retrospective survey of ocular abnormalities in pugs: 130 cases.

To determine the types and frequency of ophthalmic findings in pugs. Retrospective analysis of case records of pugs presented to an ophthalmology unit between 2001 and 2012. Ophthalmological findings were correlated with age, gender, presenting signs and time of onset of disease. In total, 130 pugs (258 eyes) with a mean (±sd) age of 2 · 8 (±2 · 87) years were examined. Ocular abnormalities identified included keratoconjunctivitis sicca (n = 39 eyes), macroblepharon (n = 258 eyes), entropion (n = 258 eyes), distichiasis (n = 56 eyes), ectopic cilia (n = 8 eyes), conjunctivitis (n = 88 eyes), corneal pigmentation (n = 101 eyes), opacity (n = 63 eyes), ulceration (n = 46 eyes), vascularisation (n = 35 eyes), iris-to-iris persistent pupillary membranes (n = 21 eyes) and cataract (n = 18). Keratoconjunctivitis sicca was significantly associated with the presence of corneal pigmentation (P = 0 · 007 for left eyes; P = 0 · 043 for right eyes). However corneal pigmentation was also identified in pugs (n = 61) without keratoconjunctivitis sicca. There was a significant influence of ectopic cilia on corneal ulceration (P < 0 · 001). Younger dogs (mean age, 1 · 28 (±0 · 45) years) were significantly more affected by distichiasis. The high number of cases of corneal pigmentation without keratoconjunctivitis sicca suggests that there may be additional yet undetermined factors involved in the development of corneal pigmentation in pugs.

PETERS ANOMALY IN A RED KANGAROO (MACROPUS RUFUS)

A 10-mo-old female red kangaroo (Macropus rufus) presented with a unilateral congenital corneal opacity OD. Complete ophthalmic examination revealed a shallow anterior chamber and a focal area of corneal edema with multiple persistent pupillary membranes extending from the iris colarette to the corneal endothelium adjacent to the edematous area of cornea. High-resolution B-scan ultrasound of the anterior segment showed an area consistent with thinning of Descemet's membrane in the area of corneal edema. Ophthalmic examination and ultrasound findings are consistent with a diagnosis of Peters anomaly, a form of anterior segment dysgenesis. An electroretinogram performed on the affected animal did not reveal any specific abnormalities. Karyotype analyses revealed a normal diploid number (2n = 20, -XX), with an abnormal pericentric inversion in the second largest chromosomal pair. The kangaroo exhibits mild compensated vision deficits in the affected eye. The maternal and paternal adult pairing has been discontinued in an effort to prevent future offspring anomalies.

Remnants of the Anterior Tunica Vasculosa Lentis and Long Anterior Lens Zonules

To investigate presence of remnants of the tunica vasculosa lentis, a possible indication of anterior segment dysgenesis, in subjects with the long anterior zonule (LAZ) trait. Retroillumination photographs of the pupil region had been collected in earlier study of the LAZ trait in African Americans. Secondary image analysis was performed to assess the frequency of intact persistent pupillary membrane iris strands (PPMIS). The analysis included 148 subjects, comprised of 74 LAZ subjects (median age=70 y; range, 50 to 91 y; 64 females) and 74 controls (68 y; 50 to 83 y; 64 females). While controlling for age and sex, analysis showed that LAZ subjects were 3.1 times more likely than controls (odds ratio=3.1; 95% confidence interval, 1.4-6.7; P=0.004) to exhibit PPMIS in at least one of their eyes. The LAZ trait, which is being studied as a potential risk factor for glaucoma, was associated with presence of PPMIS in our study population.

Anterior segment ischemia following diode laser photocoagulation for aggressive posterior retinopathy of prematurity.

To describe the clinical and demographical characteristics and treatment outcomes of the premature infants who were presented with the signs of anterior segment ischemia (ASI) following transpupillary diode laser photocoagulation for aggressive posterior retinopathy of prematurity (APROP). The records of the premature infants who developed ASI following bilateral laser photocoagulation between November 2010 and December 2013 in a single institution for the treatment of APROP were retrospectively reviewed. The clinical and demographical characteristics, laser parameters, anterior segment complications, and structural outcomes were evaluated. Nine eyes of five infants (three males, two females) were recruited for the study. Mean gestational age (GA), birth weight (BW), and postmenstrual age (PMA) at the time of laser ablation were 28.2 ± 2.5 weeks, 1,287.0 ± 483.4 g and 34.8 ± 2.2 weeks, respectively. All eyes were treated with a near-confluent pattern of laser ablation. Several anterior segment complications were observed including corneal edema (nine eyes), posterior synechia (nine eyes), pupillary membranes (five eyes), shallow anterior chamber (three eyes), hyphema (three eyes), and focal lens opacities (two eyes), of all resolved completely. Permanent dense cataracts observed in two eyes of two infants who were scheduled for lensectomy and anterior vitrectomy. None of the eyes progressed to phthisis bulbi. Anterior segment ischemia after laser treatment of APROP is a rarely encountered clinical entity. Mild and transient cases may resolve without any long-term sequelae but severe ones may progress to permanent cataract requiring further surgery.

Laser section for treatment of congenital persistent pupillary membrane

Objective To evaluate the clinical effects of Nd∶ YAG laser section for serious congenital persistent pupillary membranes.Methods The contact lens was placed on the cornea under topical anesthesia.The Nd ∶ YAG laser was used in single-pulse mode with energy ranged from 0.4 to 0.8 mJ.The operation was carried out under the slit lamp microscope.The total energy was ranged from 5 to 10 mJ in each treatment time,mainly (2 ±0.18) mJ.Results 5 eyes were cured by once treatment,accounting for 16.13％.12 eyes (38.71％)were implemented by two or three times of treatment.And 14 eyes(45.16％) had four or five times of treatments.The best corrected visual acuities were 0.1-0.25 in 5 eyes(16.13％),0.3-0.5 in 7 eyes(22.58％),0.6-0.8 in 8 eyes (25.81％),and no less than 1.0 in 11 eyes (35.48％).The complications,such as lens opacity,retinal damage or continuous ocular hypertension was not observed during the follow-up.Conclusion The Nd∶YAG laser section for serious congennital persistent pupillary membranes is an easy,safe and effective method,which can be performed under surface anaesthesia without special surgical instruments,and can improve visual acuities. Key words: Membrane, pupillary , persistent ; Laser, Nd ∶ YAG ; Section

Comparison of Contact Lens and Intraocular Lens Correction of Monocular Aphakia During Infancy

The efficacy and safety of primary intraocular lens (IOL) implantation during early infancy is unknown. To compare the visual outcomes of patients optically corrected with contact lenses vs IOLs following unilateral cataract surgery during early infancy. The Infant Aphakia Treatment Study is a randomized clinical trial with 5 years of follow-up that involved 114 infants with unilateral congenital cataracts at 12 sites. A traveling examiner assessed visual acuity at age 4.5 years. Cataract surgery with or without primary IOL implantation. Contact lenses were used to correct aphakia in patients who did not receive IOLs. Treatment was determined through random assignment. HOTV optotype visual acuity at 4.5 years of age. The median logMAR visual acuity was not significantly different between the treated eyes in the 2 treatment groups (both, 0.90 [20/159]; P = .54). About 50% of treated eyes in both groups had visual acuity less than or equal to 20/200. Significantly more patients in the IOL group had at least 1 adverse event after cataract surgery (contact lens, 56%; IOL, 81%; P = .02). The most common adverse events in the IOL group were lens reproliferation into the visual axis, pupillary membranes, and corectopia. Glaucoma/glaucoma suspect occurred in 35% of treated eyes in the contact lens group vs 28% of eyes in the IOL group (P = .55). Since the initial cataract surgery, significantly more patients in the IOL group have had at least 1 additional intraocular surgery (contact lens, 21%; IOL, 72%; P < .001). There was no significant difference between the median visual acuity of operated eyes in children who underwent primary IOL implantation and those left aphakic. However, there were significantly more adverse events and additional intraoperative procedures in the IOL group. When operating on an infant younger than 7 months of age with a unilateral cataract, we recommend leaving the eye aphakic and focusing the eye with a contact lens. Primary IOL implantation should be reserved for those infants where, in the opinion of the surgeon, the cost and handling of a contact lens would be so burdensome as to result in significant periods of uncorrected aphakia. clinicaltrials.gov Identifier: NCT00212134

Rare case of exogenous Candida dubliniensis endophthalmitis: a case report and brief review of the literature.

BackgroundCandida dubliniensis is a recently described opportunistic fungal pathogen that rarely infects the eye. Reported cases of C. dubliniensis endophthalmitis have been of endogenous etiology and demonstrated recovery of visual acuity with timely treatment. We herein report an unusual case of severe C. dubliniensis endophthalmitis requiring enucleation.FindingsThis is a retrospective, descriptive case report with a brief literature review. A 41-year-old Caucasian man, with a history of blunt trauma 8 months prior, presented to the emergency department with left eye pain and loss of vision 2 days after complicated cataract surgery. He was first evaluated by an outside ophthalmologist 3 months after trauma for left eye pain and progressive vision loss. He was found to have light perception vision with non-granulomatous anterior uveitis but no sign of ruptured globe. A dense cataract developed while he was treated with topical and subtenon's corticosteroids for which he underwent cataract surgery. Our examination revealed no light perception vision with a relative afferent pupillary defect, elevated intraocular pressure, moderate anterior chamber reaction, pupillary membrane, vitritis, and choroidal thickening on B-scan ultrasonography. Diagnostic vitrectomy revealed purulent vitreal debris, retinal detachment with severe retinal necrosis, and choroidal infiltrates. Operative fungal cultures grew C. dubliniensis. Despite intravitreal and systemic anti-fungal treatment, vision and pain did not improve, resulting in subsequent enucleation.ConclusionC. dubliniensis endophthalmitis is uncommonly encountered and typically has reasonable visual outcomes. This is the first reported case of C. dubliniensis, likely exogenous endophthalmitis, resulting in enucleation, illustrating the potential virulence of this newly described organism.

Микроинвазивные вмешательства с сохранением прозрачного хрусталика при обскурационных зрачковых мембранах

<p style="text-align: justify;"><span style="color: #800000;"><span style="font-size: 13.0080003738403px; line-height: 1.538em;"><span style="color: #800000;">https://doi.org/10.31288/oftalmolzh201411217</span></span></span> <p style="text-align: justify;"><span style="color: #800000;"><strong><span style="font-size: 13.0080003738403px; line-height: 1.538em;">Microinvasive interventions with preservation of the transparent lens in obscure pupillary membranes</span></strong></span>

Bilateral persistent pupillary membrane with tetralogy of fallot: a case report and review of the literature.

Case Report. A 15-year-old boy presented to the Fatih Sultan Mehmet Education and Research Hospital with the complain of bilateral vision blurring associated with severe glare and photophobia. On ophthalmological examination, uncorrected visual acuity was 20/200 in the right eye and 20/100 in the left eye, and there was no improvement with pinhole testing. The slit-lamp examination showed persistent pupillary membranes (PPM) in both eyes. According to the history obtained from his parents, he had received cardiac surgery for tetralogy of Fallot (TOF) 8 years ago. Conclusion. This patient is unique because this is the first reported case of bilateral PPM with congenital heart anomaly in the literature. Bilaterality of the eye anomaly strengthens the possibility of an uncommon association between PPM and TOF, rather than local failure in embryonic development.

Ocular Phenotype ofFbn2-Null Mice

Fibrillin-2 (Fbn2) is the dominant fibrillin isoform expressed during development of the mouse eye. To test its role in morphogenesis, we examined the ocular phenotype of Fbn2(-/-) mice.Ocular morphology was assessed by confocal microscopy using antibodies against microfibril components.Fbn2(-/-) mice had a high incidence of anterior segment dysgenesis. The iris was the most commonly affected tissue. Complete iridal coloboma was present in 37% of eyes. Dyscoria, corectopia and pseudopolycoria were also common (43% combined incidence). In wild-type (WT) mice, fibrillin-2-rich microfibrils are prominent in the pupillary membrane (PM) during development. In Fbn2-null mice, the absence of Fbn2 was partially compensated for by increased expression of fibrillin-1, although the resulting PM microfibrils were disorganized, compared with WTs. In colobomatous adult Fbn2(-/-) eyes, the PM failed to regress normally, especially beneath the notched region of the iris. Segments of the ciliary body were hypoplastic, and zonular fibers, although relatively plentiful, were unevenly distributed around the lens equator. In regions where the zonular fibers were particularly disturbed, the synchronous differentiation of the underlying lens fiber cells was affected.Fbn2 has an indispensable role in ocular morphogenesis in mice. The high incidence of iris coloboma in Fbn2-null animals implies a previously unsuspected role in optic fissure closure. The observation that fiber cell differentiation was disturbed in Fbn2(-/-) mice raises the possibility that the attachment of zonular fibers to the lens surface may help specify the equatorial margin of the lens epithelium.

Characteristics of, prevalence of, and risk factors for corneal pigmentation (pigmentary keratopathy) in Pugs

To determine the characteristics of, prevalence of, and risk factors for corneal pigmentation (CP) in Pugs. Prospective cross-sectional study. 295 Pugs > 16 weeks old. Ophthalmic examination of the anterior segment of each eye was performed, including determination of tear film characteristics (Schirmer tear test and tear film breakup time) and corneal sensitivity. Digital photographs of the head and each eye were obtained. Corneal pigmentation of eyes was graded as absent, very mild, mild, moderate, or severe. Signalment and medical history information and American Kennel Club registration status were recorded. Results-CP was detected in at least 1 eye of 243 of the 295 (82.4%) Pugs; CP was typically very mild or mild. Detection of CP was not significantly associated with coat color, age, eyelid conformation, or tear film characteristics but was significantly associated with sex of dogs. The severity of CP was not significantly associated with American Kennel Club registration status or age, but was significantly associated with sex, tear film characteristics, and coat color. Iris hypoplasia was detected in 72.1% of the Pugs. Iris-to-iris persistent pupillary membranes were detected in 85.3% of the Pugs. Prevalence of CP in Pugs in this study was high. Unexpectedly high prevalences of iris hypoplasia and persistent pupillary membranes were also identified. The condition identified in these Pugs was a pigmentary keratopathy, rather than pigmentary keratitis or corneal melanosis. This condition may have a genetic basis, and further studies are warranted to determine etiology.

Persistent fetal vasculature: ocular features, management of cataract and outcomes

To describe ocular features, management of cataract and functional outcomes in patients with persistent fetal vasculature. Retrospective, descriptive case series of patients with persistent fetal vasculature. Data were recorded from the Congenital Cataract Section of Federal University of São Paulo, Brazil from 2001 to 2012. All patients were evaluated for sex, age at diagnosis, systemic findings, laterality, age at surgery, and initial and final follow-up visual acuities. Follow-up and complications after cataract surgery were recorded. Ultrasound was performed in all cases and ocular eco-Doppler was performed in most. The study comprised 53 eyes from 46 patients. Age at diagnosis ranged from 5 days of life to 10 years-old (mean 22.7 months). Twenty-seven patients were male (58.7%). Persistent fetal vasculature was bilateral in 7 patients (15.2%). Forty-two eyes (79.2%) had combined (anterior and posterior forms) PFV presentation, 5 eyes (9.4%) had only anterior persistent fetal vasculature presentation and 6 eyes (11.3%) had posterior persistent fetal vasculature presentation. Thirty-eight eyes (71.7%) were submitted to cataract surgery. Lensectomy combined with anterior vitrectomy was performed in 18 eyes (47.4%). Phacoaspiration with intraocular lens implantation was performed in 15 eyes (39.5%), and without lens implantation in 5 eyes (13.2%). Mean follow-up after surgery was 44 months. Postoperative complications were posterior synechiae (3 cases), retinal detachment (2 cases), phthisis (3 cases), posterior capsular opacification (8 cases), inflammatory pupillary membrane (5 cases), glaucoma (4 cases), intraocular lens implantation displacement (1 case) and vitreous hemorrhage (2 cases). Complications were identified in 19 (50%) of the 38 operated eyes. Visual acuity improved after cataract surgery in 83% of the eyes. Patients with persistent fetal vasculature have variable clinical presentation. There is an association of persistent fetal vasculature with congenital cataract. Severe complications are related to cataract surgery in patients with persistent fetal vasculature, but 83% of the operated eyes improved visual acuity.

GAPO syndrome: Four new patients with congenital glaucoma and myelinated retinal nerve fiber layer

This article reports on the ophthalmological features of four Turkish children with GAPO syndrome, a very rare autosomal recessive condition characterized by growth retardation (G), alopecia (A), pseudoanodontia (P) (failure of tooth eruption), and optic atrophy (O). The children were from two unrelated families born to consanguineous parents. They had the characteristic facial appearance of alopecia, rarefaction of eyebrows and eyelashes, frontal bossing, high forehead, midfacial hypoplasia, hypertelorism, and thickened eyelids and lips. Two children had severe end-stage glaucoma in both eyes and unilateral corneal opacity, whereas other two children had myelinated retinal nerve fiber layer; one with bilateral optic atrophy and the other one with persistent pupillary membrane in the left eye.

Findings of perinatal ocular examination performed on 3573, healthy full-term newborns

ObjectiveTo document the findings of a newborn eye examination programme for detecting ocular pathology in the healthy full-term newborn.MethodsThis is a cross-sectional study of the majority of newborns born in...

Laser photocoagulation of an avulsed persistent pupillary membrane vessel causing recurrent hyphaema

Clinical & Experimental OphthalmologyVolume 41, Issue 5 p. 513-515 Letter to the Editor Laser photocoagulation of an avulsed persistent pupillary membrane vessel causing recurrent hyphaema Kapil G Kapoor MD, Kapil G Kapoor MD The Mayo Clinic Department of Ophthalmology, Rochester, Minnesota, USASearch for more papers by this authorKeith H Baratz MD, Keith H Baratz MD The Mayo Clinic Department of Ophthalmology, Rochester, Minnesota, USASearch for more papers by this authorAndrew J Barkmeier MD, Andrew J Barkmeier MD The Mayo Clinic Department of Ophthalmology, Rochester, Minnesota, USASearch for more papers by this author Kapil G Kapoor MD, Kapil G Kapoor MD The Mayo Clinic Department of Ophthalmology, Rochester, Minnesota, USASearch for more papers by this authorKeith H Baratz MD, Keith H Baratz MD The Mayo Clinic Department of Ophthalmology, Rochester, Minnesota, USASearch for more papers by this authorAndrew J Barkmeier MD, Andrew J Barkmeier MD The Mayo Clinic Department of Ophthalmology, Rochester, Minnesota, USASearch for more papers by this author First published: 10 December 2012 https://doi.org/10.1111/ceo.12049Citations: 1 Competing/conflicts of interest: No stated conflict of interest. Funding sources: No stated funding sources. Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Citing Literature Volume41, Issue5July 2013Pages 513-515 RelatedInformation

Surgical management in patient with uveitis

Surgery in the management of uveitis can be divided based on indication: either for therapeutic or can be for diagnostic purposes or to manage complications. The commonest indications include: Visual rehabilitation: surgery for removal of cataract, band keratopathy, corneal scars, pupillary membranes, removal of dense vitreous membranes, management of complications: anti-glaucoma surgery, vitreous hemorrhage, retinal detachment and chronic hypotony and diagnostic: aqueous tap, vitreous biopsy, tissue biopsy (iris, choroid). In this review, we shall describe the surgical technique for visual rehabilitation and for management of complications.

Poor Vision, Deafness, Hypotonia. . .With Pupillary Membranes

Poor Vision, Deafness, Hypotonia. . .With Pupillary Membranes