Retrolental Membrane Research Articles

Endoscopic Surgery for Congenital or Acquired Cataract Associated with Persistent Fetal Vasculature: A Case Series.

Persistent fetal vasculature (PFV) is a congenital malformation caused by a failure in regression of the primary vitreous and hyaloid vessels. An abnormal PFV occurs in the anterior and posterior segments of the eye. Surgery for PFV carries the risk of retinal detachment. We report four cases of cataracts associated with PFV, in which our novel surgical technique with an intraocular endoscope was safely performed. Lensectomy and vitrectomy were performed in cases 1, 3, and 4, while lensectomy, vitrectomy, and intraocular lens implantation using an endoscope were performed in case 2. In all cases, after lens removal, a slit at the posterior lens capsule was created to avoid the retrolental fibrovascular membrane using underwater electric coagulation. Moreover, the endoscope was inserted, by which the intraocular region was observed to determine the treatment method for the fibrovascular membrane and vitreous stalk. No additional surgeries were required for complications before or after any of the surgeries. Using an endoscope during cataract surgery associated with PFV, observing the vitreous stalk at high magnification and ensuring safe treatment were possible. Endoscopic surgery could be considered an effective method for treating PFV-associated cataracts.

RETINAL MANIFESTATIONS OF WALKER-WARBURG SYNDROME IN TWO SIBLINGS WITH RXYLT1 MUTATIONS.

We report two siblings with genetically confirmed Walker-Warburg syndrome (WWS), studied with multimodal imaging, who presented with different retinal manifestations. This is a retrospective report of two WWS cases with ultra-widefield fundus photography, fluorescein angiography, and ultrasound. Molecular diagnosis was achieved using panel testing and targeted variant testing. Two siblings, one male and one female, born 17 months apart with a diagnosis of WWS underwent retinal examination with imaging. The 3-month-old female infant exhibited microphthalmia, persistent hyaloidal arteries, and retrolental membranes with total tractional retinal detachments on ultrasound in both eyes. The 22-day-old male newborn exhibited persistent hyaloidal arteries and extensive peripheral avascular retina on angiography in both eyes. Both were found to be positive for the same two pathogenic variants in the RXYLT1/TMEM5 gene, which accounts for approximately 9% of cases of genetically confirmed WWS. Siblings with genetically confirmed WWS can have variable presentations despite identical genotype. This highlights the phenotypic disease spectrum of WWS, which may be similar to that seen in familial exudative vitreoretinopathy.

Persistent fetal vasculature with vascularized cataract and lens cyst

Persistent fetal vasculature may present as anterior, posterior, or mixed type. Its typical features include microphthalmia, retrolental fibrovascular membrane, stretched ciliary processes, Mittendorf dot, total cataract, and Bergmeister papilla. Atypical features described in literature are axial myopia, platyphakia, lentiglobus, and a normal sized cornea. Platy-phakia (Flat-Lens) is a term commonly used for antero-posteriorly flattened crystalline lens. It is a described but extremely rare finding in Persistent Fetal Vasculature and may represent absorption of the lens with fusion of vestigial lens remnants with retrolental fibrovascular membrane.[1] The spectrum of unusual features may also include unregressed vascular vesicular cataractous lens. The visual prognosis in PFV is generally guarded owing to the developmental anomaly and associated amblyopia, strabismus, glaucoma, and retinal pathologies.

Proliferative Vitreoretinopathy Following Transscleral Diode Cyclophotocoagulation.

Transscleral diode laser cyclophotocoagulation may trigger the development of proliferative vitreoretinopathy. Our article demonstrates one such case leading to tractional macula off retinal detachment in a child with aphakic glaucoma. The purpose of this article is to describe a case of proliferative vitreoretinopathy (PVR) developing subsequent to transscleral diode laser cyclophotocoagulation (cyclodiode) in a pediatric patient with aphakic glaucoma. PVR most commonly occurs following rhegmatogenous retinal detachment (RRD) repair however, to the best of our knowledge, has never been reported to appear after cyclodiode. Retrospective evaluation of case presentation and intraoperative findings. A 13-year-old girl with aphakic glaucoma presented four months after cyclodiode of the right eye with a retrolental fibrovascular membrane and anterior PVR. The PVR extended posteriorly over the next month after which the patient developed a tractional macula off retinal detachment. Pars Plana vitrectomy was performed confirming dense anterior and posterior PVR. Review of the literature suggests an inflammatory cascade, similar to that seen in PVR development following RRD, may occur from the destruction of the ciliary body by cyclodiode. As a result, fibrous transformation may occur, likely accounting for the cause of PVR development in this case. The pathophysiology of PVR development remains unclear. This case demonstrates that PVR may occur following cyclodiode and should be considered during post-operative monitoring after this procedure.

Intraocular medulloepithelioma clinical features and management of 11 cases

AimsTo describe the clinical features, imaging characteristics, histopathology, treatment and outcomes of intraocular medulloepithelioma.MethodsMedical records of 11 patients with clinically or histopathologically confirmed medulloepithelioma were retrieved and reviewed. Clinical features,...

NONINVASIVE DIAGNOSTIC STRATEGY OF OCULAR TOXOCARIASIS BASED ON CLINICAL FEATURES.

To develop a noninvasive diagnostic strategy based on the clinical manifestations of ocular toxocariasis (OT) and evaluate its sensitivity and specificity. Patients with unilateral OT-like lesions were enrolled retrospectively and classified into OT and non-OT groups according to the immunologic diagnosis criterion of anti-OT immunoglobulin G. Nine clinical manifestations were recorded and compared between the groups. Among them, the retrolental membrane, branch-like vitreous strands, and retinal granulomas were the most common, which were further classified into three categories, including at least 1 of three signs, at least two of three signs, and all three signs positive. Diagnostic sensitivity and specificity were calculated for each strategy. There were 105 immunologically confirmed patients with OT and 70 patients with non-OT uveitis/vitreoretinopathy. Retinal granulomas, retrolental membrane, and branch-like vitreous strands were significantly more frequent in OT patients than in non-OT patients. At least 1 of 3 signs positive strategy showed the highest sensitivity (100.0%) but the lowest specificity (62.0%). At least 2 of 3 signs positive strategies showed 80.0% sensitivity and 94.3% specificity. All 3 signs positive strategies had the lowest sensitivity (46.7%) and the highest specificity (100.0%). The cutoff point of this revealed an area under the curve of 0.85 and a 95% confidence interval of 0.79 to 0.91. A comprehensive strategy based on at least two out of three positive signs showed excellent sensitivity and specificity and could serve as a noninvasive and fast screening strategy for the clinical diagnosis of OT.

Тактика ведения и хирургического лечения задней формы iii и iv степени синдрома первичного персистирующего гиперпластического стекловидного тела у детей

Persistent hyperplastic primary vitreous syndrome (PHPV) is a rare congenital anomaly associated with impaired regression of the primary embryonic vitreous. There is still no unequivocal opinion on the advisability and terms of surgical treatment of the posterior form of severe III and IV stages of PHPV. Objective. To determine the optimal tactics for the treatment of the posterior form III and IV stages of PHPV syndrome in children. Material and methods. During 2017-2021 we examined and performed surgical intervention in 18 children with PHPV syndrome (18 eyes). The first group – children under 2 years with III stage of PHPV, the second group – children under 1 year with IV stage of PHPV, the third group – children from 3 to 6 years with III and IV stage of PHPV not operated and operated at an early age with late complications of PHPV. All children underwent microinvasive lens extraction or extraction of the complicated cataract, separation of the fibrovascular membrane, removal of the retrolental membrane, if presents, vitrectomy (transciliary 3-port surgery 23-25 G). According to indications, reconstruction of the anterior chamber, intraocular lens implantation, scleral buckling, and antiglaucomatous surgery were carried out. Results. In children with III stage of PHPV during the surgery at an early age in 91.0 % of cases the process is stabilized, the traction component is completely eliminated, the retina is fully attached and visual functions are preserved. In children with IV stage of PHPV the restoration of the anterior chamber, complete elimination of the traction component, decrease in the height and area of retinal detachment and increase in the anterior-posterior size of the eyeball were achieved in all cases. While late surgical treatment of PHPV and secondary complications, it was not possible to achieve a positive result in retinal reattachment. Conclusions. 1. In III and IV stages of PHPV it is necessary to perform surgical treatment up to 1 year with an organ-preserving purpose as the disease may progress with the development of complications, which, if left untreated, can lead to complete loss of the eye as an organ. The terms, volume and stages of surgical treatment depend on the degree and clinical picture of the disease. 2. Children with PHPV syndrome should be constantly under the supervision of an ophthalmologist due to high risk of late complications. Keywords: persistent hyperplastic primary vitreous syndrome, fibrovascular membrane, intraocular lens implantation, vitrectomy.

Postvitrectomy endophthalmitis caused by Morganella morganii: a case report and literature review

BackgroundPostvitrectomy endophthalmitis is a rare and serious complication following vitreoretinal surgeries. Morganella morganii, an emerging gram-negative, facultative anaerobic rod, is related to severe nosocomial infections in various organs and thus has gained importance in recent decades. Morganella morganii infection following intraocular surgery is rarely reported.Case presentationWe report an immunocompetent patient with Morganella morganii-related endophthalmitis after vitrectomy for retinal detachment who presented with hand motion visual acuity, hypopyon and a unique retrolental exudative membrane. Initially, the patient was unresponsive to empirical intravitreal ceftazidime and vancomycin but recovered with vision preservation (20/63) after surgical removal of the membrane and silicone oil tamponade.ConclusionsMorganella morganii intraocular infection is often devastating, likely due to its high multidrug-resistance rate via intrinsic ß-lactamase production, multiple acquired traits related to additional genetic mechanisms, and fimbrial adhesion, urease production, and type III secretion system-associated biofilm formation. The above characteristics of M. morganii may lead to an inadequate response to empirical intravitreal antibiotics, and early surgical intervention should be considered.

Surgery for stage 5 retinopathy of prematurity.

Our understanding of the pathogenesis and surgical management of stage 5 retinopathy of prematurity has come a long way. Despite of new technologies in retinal surgical devices, the dissection of thick membranes is still a challenge. We use a capsulotomy 'plug on tip' 0.05 mm designed for capsular fimosis. This diathermy instrument is used to cut the lens capsule by low power waves transmitted from the tip of an active incising electrode and make incisions in the tissue. We tested this technique with 226 infants of which all 226 eyes retrolental membrane were removed. In 6-46 months follow-up, light perception or better visual function was achieved in 92%. Despite of new technologies in retinal surgical devices, the dissection of thick membranes is still a challenge. Sometimes, we need to use tools that were made for another purpose and adapt it to our current techniques. Achieving at least a vision of light perception in eyes that were considered untreatable is a good outcome as light perception maintains the circadian circle and helps in the brain development. http://links.lww.com/COOP/A47.

Intraocular lens implantation in combination with lensectomy and vitrectomy for persistent fetal vasculature.

To present surgical outcomes following intraocular lens (IOL) implantation in combination with lensectomy and vitrectomy for the treatment of persistent fetal vasculature (PFV). This interventional case series included 19 eyes from 19 patients with unilateral combined PFV. Limbal lensectomy, capsulotomy, anterior vitrectomy, dissection of the retrolental membrane and stalk, and in-the-bag or in-the-sulcus IOL implantation were performed for the treatment of visually significant lenticular opacity with the presence of a retrolental fibrovascular membrane and stalk, in an eye with sufficient capsular support. Postoperative anatomical and visual outcomes were evaluated. After 22 to 50months of follow-up, IOLs were well positioned in 18 (95%) of 19 eyes. Retinal dragging was reversed in all 8 eyes with preexisting peripapillary tractional retinopathy. Major complications occurred in 2 eyes (11%): one eye (5.5%) of vitreous hemorrhage and posterior capsular opacity and one eye (5.5%) of IOL dislocation. Nine (47%) of 19 eyes achieved best-corrected visual acuity (BCVA) above 20/200. Myopic shift after IOL implantation ranged from 0.75 to 4.17 D. Compared with eyes with poorer BCVA, eyes with BCVA above 20/200 had a better preoperative BCVA (mean 20/400 vs. 20/4000, P = 0.004) and were less likely to have preexisting peripapillary tractional retinopathies (11% vs. 70%, P = 0.002). Primary IOL implantation in combination with lensectomy and vitrectomy is an alternative to treat eyes with combined PFV. Prospects for rehabilitation may be limited by poor preoperative visual function and the presence of tractional retinopathies preoperatively. Postoperative refractive status requires long-term monitoring.

Use of an Iris Speculum for Retrolental Membrane Dissection for Stage 5 Prematurity of Retinopathy Complicated With Pupillary Adhesion.

To report a novel use of an iris speculum to assist with membrane dissection and trough separation for stage 5 retinopathy of prematurity-related funnel-shaped tractional retinal detachment complicated with pupillary adhesion. Limbus-based closed vitrectomy and membrane dissection were performed in 10 eyes (9 patients) with stage 5 retinopathy of prematurity-related tractional retinal detachment and pupillary adhesion. After synechiolysis, an iris speculum was positioned to enlarge the pupil for surgical visualization and maintain a neutral iris plane. The retrolental membrane was dissected bimanually and circumferentially along the peripheral trough and then toward the central retina with vertical scissors and end-gripping forceps. In all 10 eyes, retrolental membranes were entirely removed and troughs were circumferentially unraveled. Follow-up examinations performed 6 to 18 months postoperatively showed reattachment of the retina in 3 eyes with an open-narrow funnel and 6 of 7 eyes with a narrow-narrow funnel. A near-circular pupil without recurrent pupillary adhesion was preserved in all nine eyes showing retinal reattachment. This use of the iris speculum effectively exposes the surgical field for the entire removal of retrolental tissue and interruption of the peripheral trough in stage 5 retinopathy of prematurity-related tractional retinal detachment complicated with pupillary adhesion. The pupil's configuration is well preserved postoperatively.

Diagnosis of complicated FEVR preoperatively and intra\u2212/post-operatively: characteristics and risk factors for diagnostic timing

BackgroundTo delineate the characteristics of complicated familial exudative vitreoretinopathy (FEVR) patients diagnosed before surgery or intra−/post-operatively and to analyze the risk factors for the diagnostic timing.MethodsForty-eight patients who underwent surgery and were diagnosed as FEVR in our department were retrospectively reviewed. Data were collected including the demographic and clinical characteristics of these patients. FEVR patients were divided into 2 groups according to the diagnostic timing: FEVR diagnosed pre-operatively (23 patients), FEVR diagnosed intra−/post-operatively (25 patients). Multivariable analysis was applied for analyzing the risk factors for diagnostic timing.ResultsThe clinical characteristics of the FEVR patients were of great variability, including retinal detachment (RD), disappear of anterior chamber, retrolental membrane, epiretinal membrane (ERM), vitreous hemorrhage (VH), myopic foveoschisis (MF), lamellar macular hole (LMH), high myopia (HM). And the referral diagnosis or pre-operative diagnosis were always non-specific. The majority of the referral or preoperative diagnosis were unilateral RD (52.1%), bilateral RD (8.3%), unilateral persistent fetal vasculature (PFV) (8.3%), bilateral PFV (4.2%). There are two risk factors for the complicated FEVR cases diagnosed as FEVR preoperatively: pre-operative ocular manifestations with RD only (OR, 0.104; p-value, 0.022), positive parent’s fluorescein angiography (FA) (OR, 0.105; p-value, 0.035).ConclusionsThe phenotypes of FEVR were greatly variable, they can mimic many non-specific vitreoretinal disorders. The most non-specific referral diagnosis/pre-operative diagnosis was unilateral RD, bilateral RD, unilateral PFV, bilateral PFV. A positive family history or a simple ocular presentation with RD only could contribute to diagnose FEVR preoperatively.

Anterior elongation of the retina in persistent fetal vasculature: emphasis on retinal complications.

To identify the characteristics of peripheral retinal anomalies associated with persistent fetal vasculature (PFV) and evaluate the complications and outcomes. Retrospective, noncomparative case series of patients with PFV who underwent surgery. Type of PFV, presence of peripheral retinal anomalies, extent of the retrolental membrane, complications, and functional and anatomical results were evaluated. Twenty-nine eyes of 28 patients were enrolled in the study: 14 eyes (48.3%) with anterior PFV, 10 eyes (34.5%) with posterior PFV, and 5 eyes (17.2%) with combined PFV. The retina was found to elongate anteriorly as finger-like projections beyond the ora serrata, incorporating into retrolental fibrovascular tissue in 81.8% of the anterior PFV cases. Cases with more extensive retrolental tissue had a higher risk of retinal complications (p = 0.009) and anterior segment complications (p = 0.026) than those with localized disease. Leaving the peripheral part of the fibrovascular tissue in place led to complications by later contraction. A total of 35.7% of the anterior PFV cases had 20/200 or better vision at the final follow-up versus 6.7% of the cases with posterior involvement. Retinal attachment was achieved in 12 eyes (80%) with posterior involvement. Four eyes (13.7%) resulted in total retinal detachment at final follow-up. The high incidence of peripheral retinal anomalies that are found in anterior PFV patients and their relation to retinal complications warrant careful examination of the ora serrata-ciliary body area. Limbal approach may be preferred as a safer method in cases with an extensive fibrovascular membrane obscuring the view. Leaving the peripheral part of the fibrovascular tissue may result in severe postoperative complications, which should be avoided.

Retrolental vascular membrane in a case of ciliary body medulloepithelioma: Clinicopathologic correlation

A unilateral nonteratoid malignant ciliary body medulloepithelioma presented in a 13-year-old girl as a leukocoria with an extense vascularized retrolental membrane in her right eye. In this description, clinical documentation, posterior segment ultrasound, and ultrasound biomicroscopy were obtained, and an anatomopathological correlation was made by showing rosettes in some histological cuts stained by haematoxylin and eosin obtained from the mass and the membrane.

Clinical manifestations and pathological characteristics of retrolental membranes secondary to persistent hyperplastic primary vitreous

Background Persistent hyperplastic primary vitreous (PHPV) is a congenital eye disease of children, because its clinical manifestations are nonspecific, it is easy to be misdiagnosed as congenital cataract and the prognosis is poor.There has been more researches on PHPV clinical characteristics than its histopathological feature and immunochemistry. Objective This study was to investigate the clinical characteristics of PHPV and the pathological characteristics of retrolental membranes secondary to PHPV. Methods The clinical data of 6 PHPV eyes from 6 patients during May 2005 to December 2014 were retrospectively analyzed.All the PHPV eyes received a combinating procedure of cataract extraction and anterior vitrectomy.The retrolental membranes were collected during surgery for the histopathological examination by hematoxylin & eosin staining and periodic acid-Schiff (PAS) staining.Immunochemistry was used to detect the expression of Vimentin, smooth muscle actin (SMA), S-100, glial fibrillary acidic protein (GFAP), neuron specific enolase (NSE), epithelial membrane antigen (EMA), CD34 and proliferating cell nuclear antigen (PCNA) in the retrolental membranes. Results Monocular PHPV was found in 6 cases since born, with the main clinical manifestation of similar to congenital cataract.The ocular axial was shorter in 5 PHPV eyes than that of the contralateral eye by A-sonography, and 1 eye accompanied by eye nystagmus, strabismus and small cornea.The retrolental membranes were seen during the surgery in all cases, and the white band through the vitreous in 2 eyes.Pathological examination showed that the retrolental membrane was mainly composed of loose or myxoid connective tissue fibers, the capillaries and small veins.PAS positive tissue, residual transparent artery and differentiated adipocytes were exhibited in some specimens.Immunohistochemistry indicated that spindle-shape cells in the retrolental membranes presented the characteristics of mesenchymal cells, and some cells appeared the myofibroblast characteristics with the low proliferation activity.The development of the lens and the ciliary body was abnormal because of the stretching of retrolental membranes into the lens capsule in 1 PHPV eye.The follow-up was performed for 6-9 years in 4 eyes, with the best corrected visual acuity (BCVA) for 0.06, light perception, 0.05 and 0.07 respectively.The intraocular pressure was normal in all the eyes. Conclusions PHPV is usually misdiagnosed as congenital cataract and shows a poor postoperative BCVA.PHPV occurs mainly due to an incomplete regression of the embryonic vitreous and hyaloid vasculature and eventual abnormality of lens. Key words: Child; Eye abnormalities/etiology; Eye diseases/congenital; Hyperplasia; Vitreous body/abnormalities; Retrolental membranes; Persistent hyperplasic primary vitreous/pathology

Controversies in intraocular lens implantation in pediatric uveitis.

Cataract is one of the most common and visually debilitating complications of pediatric uveitis. It develops as a consequence of chronic inflammation and steroid use and is seen most often in juvenile idiopathic arthritis (JIA)-associated uveitis. Cataract extraction with intraocular lens (IOL) insertion has been carried out with a measure of success in non-uveitic pediatric eyes, but in cases of uveitis, multiple factors affect the final outcome. Chronic inflammation and its sequelae such as band keratopathy, posterior synechiae, and cyclitic membranes make surgical intervention more challenging and outcome less certain. Postoperative complications like increased inflammation, glaucoma, posterior capsular opacification, retrolental membranes, and hypotony may compromise the visual outcome. Early refractive correction is imperative in pediatric eyes to prevent amblyopia. The use of contact lenses and intraocular lenses in pediatric uveitic eyes were fraught with complications in the past. Surgical interventions such as vitreo-lensectomy followed by contact lens fitting and small incision cataract surgery followed by different types of intraocular lenses have been utilized, and many reports have been published, albeit in small patient groups. This review analyzes and discusses the existing literature on intraocular lens implantation in cases of pediatric uveitic cataract surgery.

COMPLETE RESOLUTION OF LARGE RETINAL FOLD AFTER TRANSECTION OF RETROLENTAL MEMBRANE DURING LENS-SPARING VITRECTOMY FOR RETINOPATHY OF PREMATURITY: A 15-YEAR FOLLOW-UP.

To describe the long-term anatomical and visual outcomes of a patient with retinopathy of prematurity characterized by a prominent retinal fold adherent to the posterior lens capsule, treated by lens-sparing vitrectomy with surgical transection of the retrolental membrane. A premature infant was born at a gestational age of 25 weeks and birthweight of 636 g. She developed threshold retinopathy of prematurity bilaterally and was subsequently treated with laser ablative therapy. The left eye responded favorably, with regression of neovascularization; however, the right eye progressed to Stage 4A with a prominent retinal fold adherent to the posterior lens capsule. The patient underwent lens-sparing vitrectomy with dissection of the retrolental membrane at postmenstrual age of 44 weeks. At 15-year follow-up, the patient has maintained a best-corrected visual acuity of 20/60 and, of note, demonstrated complete resolution of the previous retinal fold. Surgical treatment for retinopathy of prematurity was considerably advanced by the introduction of lens-sparing vitrectomy techniques; however, cases developing retrolental membranes often persisted with poor visual outcomes, and lensectomy is conventionally performed. However, in select cases of Stage 4A retinopathy of prematurity, careful transection of retrolental membranes during lens-sparing vitrectomy using the appropriate technique may provide very good anatomical and visual outcomes.

Minimally fibrotic stage 5 ROP: a clinical prognostic factor in eyes undergoing vitrectomy for stage 5 retinopathy of prematurity.

Minimally fibrotic Stage 5: A clinical prognostic factor in eyes undergoing vitrectomy for stage 5 retinopathy of prematurity (ROP). To define minimally fibrotic stage 5 ROP and to demonstrate better surgical outcomes in this subgroup. A cohort of eligible eyes with stage 5 ROP undergoing vitrectomy were further divided into those with minimally fibrotic stage 5 and others. Minimally fibrotic stage 5 ROP was defined as those stage 5 eyes having a translucent retrolental membrane with visibility of the underlying retinal vessels and absence of anteriorly rotated ciliary processes. We reported on anatomic and visual outcomes in eyes with defined characteristics of this subgroup identified before surgery and then observing them post vitrectomy over a period of time as compared to others. Minimally fibrotic stage 5 eyes had better visual (p = .0068) and anatomical outcomes (p = .0001). Minimally fibrotic stage 5 ROP shows ridge to ridge traction that has resulted in a traction retinal detachment with a retrolental membrane, but fibrotic change has just begun. This stage 5 ROP with limited fibrosis represents a subset of this stage 5 ROP with a positive anatomic and visual prognosis.

Vitreoretinal surgery for advanced retinopathy of prematurity: Presentation and outcomes from a developing country

ObjectiveTo study the outcome of pars plana vitrectomy performed on patients with stage 4b and stage 5 retinopathy of prematurity and to examine differences in clinical presentation from developed countries. DesignObservational prospective case series. ParticipantsBabies with stage 4b or 5 retinopathy of prematurity who underwent vitrectomy. MethodsThe study was undertaken at a tertiary care ophthalmology centre in a developing country. Demographic variables, postnatal risk factors, and anatomic and visual status were noted preoperatively. Patients with stage 4b ROP underwent a 3-port lens-sparing vitrectomy. Those with stage 5 ROP additionally underwent lensectomy and retrolental membrane dissection. Patients were assessed on their last follow-up for anatomic, visual, and functional results. Statistical evaluation was performed using the nonparametric Wilcoxon rank sum test. ResultsThe results were evaluated by number of eyes treated, except for functional score. In 21 patients, 31 eyes underwent operation, of which 20 were stage 4b and 11 were stage 5. Anatomic success was achieved in 18 eyes (90%) with stage 4b. Mean vision in this anatomically successful group was 3.765, and the functional score was 5.36. In stage 5 eyes, anatomic success was achieved in 5 eyes (45.45%). Mean vision in this anatomically successful group was 1.833, and the functional score was 3. The visual results of stage 4b cases, compared with stage 5, were significantly better (p=0.0387). ConclusionsLarger, older babies and previously unablated eyes presented with retinopathy of prematurity for surgery compared with developed countries. Anatomic, visual, and (notably) functional recovery was found in a good percentage of eyes.

Ciliary Body Medulloepithelioma: Analysis of 41 Cases

To describe the clinical features, histopathology, treatment, and outcomes of ciliary body medulloepithelioma. Retrospective study. Forty-one patients with medulloepithelioma. Cryotherapy, plaque radiotherapy, external beam radiotherapy, tumor removal by partial lamellar sclerouvectomy (PLSU), or enucleation. Metastasis and death. Of 41 patients with ciliary body medulloepithelioma, the median age at diagnosis was 5 years. The mean tumor basal diameter was 11 mm, and the mean tumor thickness was 7 mm. Related features included secondary glaucoma (n = 18, 44%), iris neovascularization (n = 21, 51%), cataract (n = 19, 46%), lens subluxation (n = 11, 27%), lens coloboma (n = 8, 20%), retrolental neoplastic cyclitic membrane (n = 21, 51%), intratumoral cysts (n = 25, 61%), and extraocular extension (n = 4, 10%). There was systemic association with pleuropulmonary blastoma in 2 cases (5%). Primary tumor treatment included enucleation (n = 21, 60%), tumor removal by PLSU (n = 8, 23%), plaque radiotherapy (n = 3, 9%), external beam radiotherapy (n = 1, 3%), cryotherapy (n = 1, 3%), or palliative chemotherapy (n = 1, 3%). In 1 case, medulloepithelioma was diagnosed histopathologically after inadvertent evisceration for blind painful eye. Subsequent treatment for residual or recurrent tumor in cases treated conservatively/inappropriately (n = 15) was necessary in 7 cases (47%). Histopathology disclosed benign features in 6 cases (20%), malignant features in 24 cases (80%), teratoid features in 11 cases (37%), and nonteratoid features in 19 cases (63%). In the 26 enucleated eyes, other features included retrolental neoplastic cyclitic membrane (n = 18, 69%), neoplastic epiretinal membrane (n = 6, 23%), and persistent hyaloid artery (n = 6, 23%). Systemic metastasis occurred in 3 cases (8%) over a mean follow-up of 49 months, all of whom presented with extrascleral extension of tumor due to mean delay in diagnosis by 39 months. Medulloepithelioma most commonly occurs in children. Systemic association with pleuropulmonary blastoma rarely is found. Patients with extrascleral medulloepithelioma are at risk for metastasis.