Comparison study of clinical features between persistent hyperplastic primary vitreous and congenital fibrovascular pupillary membrane / 国际眼科杂志(Guoji Yanke Zazhi)

AIM: To analyze the similarities and differences of the clinical features between persistent hyperplastic primary vitreous(PHPV)and congenital fibrovascular pupillary membrane(CFPM).METHODS: Retrospectively analyze the ocular biometric parameters, clinical features and morphological changes in children with PHPV(PHPV group)and CFPM(CFPM group)who received surgery at the department of ophthalmology, Xijing Hospital from March 2006 to December 2021.RESULTS: The study included 56 cases(61 eyes)of PHPV and 24 cases(25 eyes)of CFPM. There were no differences on the gender and age of onset between PHPV and CFPM, and both of them were mainly unilaterally affected, with the ratio of 91% and 96%. Children with PHPV and cataract combined with other complications and ocular developmental abnormalities. CFPM was mainly presented different degrees of blockage and morphological abnormalities of pupillary area. In unilateral cases of PHPV and CFPM, the anterior chamber depth(ACD)of affected eyes was smaller than that of the fellow eyes, and in subgroups with age of operation ≤24mo, the axial length(AL)of affected eyes was smaller than that of the fellow eyes(P<0.05). The corneal diameter(CD)of the affected eyes in PHPV group was smaller and the intraocular pressure(IOP)was higher than those of the fellow eyes(all P<0.05); while there were no significant differences on CD and IOP between affected eyes and the fellow eyes in CFPM group(P>0.05). The ACD of affected eyes in PHPV group was significantly smaller than that of CFPM group(P<0.05). The fibrovascular membrane in PHPV group was located in the posterior part of the lens and vitreous cavity; while the fibrovascular membrane in CFPM group was located between the iris and the anterior capsule of the lens, rarely involving the lens.CONCLUSION: PHPV and CFPM had the similar clinical features, suggesting that they may belong to the different variants of persistent fetal vasculature(PFV). However, PHPV had a wider range of lesions and more complex conditions.

All Persistent Pupillary Membranes need not be treated - A case report

Persistent Pupillary Membrane is a common congenital anomaly which appears as a dense network of tissue across the pupil. It is usually asymptomatic, although blurring of vision can be seen in extensive conditions. This is a hospital based case study of an eleven year old girl with bilateral Persistent Pupillary Membrane since birth. The aim of the study is to establish that the treatment approach varies specific to the individual case and when asymptomatic, it can be safely left untreated as in the present study. Surgical Membranectomy, Pupilloplasty, Argon Laser Photocoagulation are the treatment options that can be considered in case of symptomatic conditions.

A rare case of persistent pupillary membrane: Case-based approach and management

Persistent pupillary membranes (PPMs) are a common congenital anomaly seen in 95% of neonates. Extensive PPMs, occluding the visual axis and resulting in reduced visual acuity, are relatively uncommon. We describe a case of bilateral total PPM in a 36-year-old female who presented with complaints of blurred vision in both the eyes. Dense pupillary membranes obscuring the visual axis need early surgical treatment. It is essential that the lens status remains clear along the visual axis both before and after pupilloplasty.

Surgical treatment for persistent pupillary membranes / 中南大学学报(医学版)

Objective:To explore surgical treatment for persistent pupillary membrane (PPM) and its effect.Methods:The medical records and postoperative follow-up data for 12 consecutive patients (16 eyes),who were submitted to PPM resection in Xiangya Hospital,Central South University from March 2011 to August 2016,were retrospectively reviewed.Results:Among 12 consecutive patients (16 eyes),8 patients (12 eyes) with PPM and clear lens were submitted to simply PPM resection,and 4 patients (4 eyes) with PPM and cataract were submitted to PPM resection combined with cataract surgery.In the patients who received the combined operation,phacoaspiration with or without intraocular lens implantation was performed in 3 eyes or in 1 eye.In the early stage after surgery,1 eye was complicated with a transient high intraocular pressure.In the patients who were submitted to PPM resection,the final follow-up visual acuity in 7 patients (11 eyes) were improved except 1 patient (1 eye).After the PPM resection combined with cataract surgery,the follow-up visual acuity was improved in 2 patients (2 eyes) but not in the other 2 patients (2 eyes).Conclusion:The surgical treatment is effect on congenital pupil residual membrane.Serious membrane pupil residual membrane should be surgically treated at early stage,and amblyopia treatment after the surgery is important.

Long-term Lens Complications Following Removal of Persistent Pupillary Membrane

PURPOSE: We evaluated the long-term surgical outcome and lens complications in children with persistent pupillary membrane following removal using vitreous scissors. METHODS: Patients diagnosed with persistent pupillary membrane who received surgical treatment from 1987 to 2012 were retrospectively reviewed. The removal was performed using vitreous scissors after instillation of miotics. The minimum follow-up period after surgery was four years. Factors of age, sex, visual acuity, refractive errors, and complications during or after surgery were evaluated. RESULTS: A total of 32 eyes of 26 patients were included. The mean age at the initial visit was 22.6 ± 34.7 (range, 0.9 to 141.2) months, and the mean age at surgery was 43.7 ± 36.0 (range, 1.0 to 142.5) months. There were no intraoperative complications using vitreous scissors, and all lesions were completely removed. After a mean follow-up period of 6.5 ± 3.3 (range, 4.0 to 14.8) years, the best corrected visual acuity at the final visit was 0.6 ± 0.9 logarithm of the minimum angle of resolution, and two eyes (6.3%) presented with lens opacity during follow-up. CONCLUSIONS: In children with persistent pupillary membrane, there were no intraoperative complications, and only two patients presented with lens change during the long-term postoperative follow-up period. Surgical removal should be considered a safe and effective treatment for patients with visually significant persistent pupillary membrane.

One Step Operation of the Persistent Pupillary Membrane Removal and Cataract Operation: A Case Report

PURPOSE: We report a case of one-step operation of persistent pupillary membrane removal, phacoemulsification, and posterior chamber lens implantation that was performed in a patient with persistent pupillary membrane and brunescent cataracts in both eyes. CASE SUMMARY: A 64-year-old male with no baseline disease visited our clinic with bilateral decreased visual acuity. His best corrected visual acuity at first visit was 0.1 in the right eye and 0.2 in the left eye. On anterior segment examination, both bilateral persistent pupillary membranes and brunescent cataracts were observed. First, we surgically removed the left pupillary membrane and performed phacoemulsification using posterior chamber lens implantation via one-stage operation. After one week, the same operation was performed for the right eye using the same method. At 6-months postoperative, his best corrected visual acuity was 0.2 in the right eye and 0.8 in the left eye. No complications such as anterior segment inflammation, uveitis, or intraocular pressure elevation were observed during the follow-up period. CONCLUSIONS: We report a case of one-step operation of persistent pupillary membrane removal and cataract operation, which can improve visual acuity without any complications.

The Cellular Characteristics of the Secondary Pupillary Membrane

PURPOSE: This study was performed to investigate the cellular characteristics of the secondary pupillary membrane. METHODS: The secondary pupillary membrane was removed from the anterior lens surface during cataract extraction from 2 patients with cataract associated with uveitis. Specimen from one patient was stained with hematoxylin-eosin with flat preparation method. Specimen from the other patient cultured for 1 and 2 weeks was observed with transmission electron microscopy. RESULTS: The flat preparation showed the neovascular membrane with pigment-laden cells. The cultured cells consisted of the well preserved vascular components which had the vascular endothelial cells and pericyte and pigment-laden cells lined by basement membrane on first week of culture. The iris pigment epithelial cell which contained the pigment granules within cytoplasm and lined by basement membrane were observed on second week of culture. CONCLUSIONS: These results suggest that the secondary pupillary membrane consists of vascular membrane and pigment epithelial cell of iris which is a major component of secondary pupillary membrane and secrets extracellular matrix.

Results of Surgical Treatment for the Children with Persistent Pupillary Membrane

PURPOSE: To evaluate the long-term results of surgical treatment for the children with persistent pupillary membrane. METHOD: A retrospective study comprised of 12 eyes of 11 Korean patients who underwent surgical removal of persistent pupillary membrane who could be followed up beyond 4 years of age, excluding eyes with any other vision-affecting ocular anomalies. The preoperative and final visual acuity, age at surgery, final refractive status, surgical complication and combined ocular abnormality were reviewed. Mean visual acuity was calculated using logarithm of minimum angle of resolution (logMAR). RESULTS: Mean final BCVA was 20/257 (logMAR 1.11+/-0.68) in the unilateral 5 eyes and 20/33 (logMAR 0.22+/-0.25) in the bilateral 7 eyes, and there was significant difference (p=0.03). Of the 12 eyes, five eyes were under 0.3 at the last follow-up. Four eyes were unilateral (deprivation amblyopia) and one eye was bilateral (anisometropic amblyopia). Significant anisometropia was found in 7 of the 11 patients. One mild capsular opacity occurred as a postoperative complication. CONCLUSIONS: The visual prognoses for eyes with surgically removed persistent pupillary membranes were relatively good if they were bilateral. However, they showed poor visual outcome if they were unilateral in this study, so the early surgical intervention and aggressive management will be helpful if the persistent pupillary membrane is unilateral. Close follow-up with evaluation of visual acuity and refractive status is mandatory because this condition can lead to deprivation amblyopia and anisometropic amblyopia.

Neodymium: YAG Laser Discission of Postoperative Pupillary Membrane: Peripheral Phtodisruption

PURPOSE: To treat pupillary membrane which developed after cataract operation and vitrectomy,steroid eye drops with mydriatics or, in sever case, tPA has been used. However steroid eye drops needs prolonged treatment and tPA has many complications such as, infection, or hemorrhage. We tried to remove pupillary membrane with Nd-YAG laser by using peripheral quadrantic disruption technique. METHODS: We treated 8 eyes from Jan. 1996 to Oct. 1999, and observed within 24 hours following Nd-YAG laser treatment. The pupillary membrane was cut with Nd-YAG laser and subsequently absorbed within 24 hours. RESULTS: There was no such complicaitons, as increased IOP, hemorrhage, and IOL damage. Immediately after Nd-YAG laser, visual acuity was improved and fundus was examined. CONCLUSION: Therefore we recommend Nd-YAG laser membrenectomy in cases of pupillary membrane, which did not respond to steroid therapy.

Surgical management for persistent pupillary membrane with vitreous scissors

Persistent pupillary membranes are common congenital disorders. To reduce the surgical complications, we used vitreous scissors instead of conventionally used Vannas scissors to remove the membrane and reviewed the surgical results. Five eyes of 4 children with persistent pupillary membrane were treated by surgery. Through the 1.5 mm limbal incision, the membrane was removed by using vitreous scissors after intracameral sodium hyaluronate. After 22.6 months follow-up, all pupils of operated eyes were round and no complications associated with the surgery were found. Three eyes showed improved visual acuities after the operation. We suggest that the surgery with vitreous scissors is better than with Vannas scissors.