J.ophthalmol.(Ukraine).2018;2:60-66.

https://doi.org/10.31288/oftalmolzh/2018/2/6066


Removal of Persisting Pupillary Membrane with Refractive Lens Exchange

N. F. Bobrova, Dr. Sc. (Med.), Prof.; A. V. Artemov, Cand. Sc. (Med.); T. V. Romanova, Cand. Sc. (Med.); D. V. Smaglii, an internship doctor 

SI “Filatov Institute of Eye Diseases and Tissue Therapy of NAMS of Ukraine”; Odessa (Ukraine) 

E-mail: filatovbobrova@gmail.com  

dashaalexa0508@gmail.com

TO CITE THIS ARTICLE: Bobrova NF, Artemov AV, Romanova TV, Smaglii DV. Removal of Persisting Pupillary Membrane with Refractive Lens Exchange. J.ophthalmol.(Ukraine).2018;2:60-6. https://doi.org/10.31288/oftalmolzh/2018/2/6066 


Background. Clinical characteristics, histological structure, and surgical technique of persisting pupillary membrane (PPM) have been presented in the modern literature in insufficient and, in some cases, contradictory reports.   

Purpose. To describe clinical characteristics and histological structure of PPM, as well as PPM surgery for restoring the transparency of the optic axis and eliminating anisometropia through refractive lens exchange.

Material and Methods. Complete ophthalmic examination including ultrasound biometry and scanning followed by surgical removal of PPM and refractive exchange of the clear lens was performed in an 11-year-old patient with high myopia, anisometropia and myopia

Results. The PPM case reported is a combination of multiple strands, aligning with the iris in color,  involved in the stroma and the inner half of the iris and attached to the anterior lens. The strands, thus, obscured 2/3 of the iris. By sequential surgical dissection of the PPM strands, the membrane was detached from the anterior capsule and removed from the eye. Refractive lens exchange was performed using a standard technique. Histological studies showed a dual character of the removed PPM: the presence of both thick fibrous connective tissue and loose fibrous tissue, resembling the stroma of the iris with the presence of collapsed capillaries. 

Conclusions. 1. The rare clinical case described is an example of combined type 1 and type 2 PPM according to Duke-Elder’s classification (1964) or a combination of accessory iris membrane and persistant pupilеae membrane. With the point of Duke-Elder’s classification, this membrane can be considered a special variant of type 2 PPM whereas there is no connection with the lens capsule. 2. Attachement of PPM to the anterior lens capsule, which seemed quite tight, was false since PPM, after being dissected, spontaneously detached from the lens with the latter preserved intact and transparent, which contributed to recover the transparency of the optic axis. 3. One-stage refractive replacement of the lens made it possible to eliminate high myopia and high anisometropia, which made it possible to increase visual acuity of the eye and to create maximal favorable conditions for amblyopia treatment that followed. 

Key-words: persistant pupilеae membrane, refractive lens exchange, children

References

  1. Bobrova NF, Vit VV. [Atlas of congenital and hereditary diseases of the eye]. Odessa:Palmira;2006. 140p. Russian
  2. Bobrova NF, Dembovetskaia AN, Romanova TV, Sorochinskaia TA. [Preserving the lens transparent is the main task of pupillary membrane surgery]. [Collection of scientific papers “Modern technologies of cataract and refractive surgery – 2013] M.;2013: 47. Russian.  
  3. Bobrova N F, Dumbrova NE, Dembovetskaya AN, Romanova TV, Molchanuk NI. [Microinvasive interventions with preservation of the transparent lens in obscure pupillary membranes]. Oftalmol Zh.2014;1:12-17. Russian. 
    Crossref 
  4. Bobrova NF, Skripnichenko ZM. [Cataract: toxic, congenital, secondary]. Odessa:Feniks; 2017. 320p. Russian. 
  5. Vit VV. [The structure of the human visual system]. Odessa: Astroprint; 2003. 664 p.  Russian.
  6. Voino-Yasenetskii VV. [Growth and variability of eye tissues in case of eye diseases and injuries]. Kyiv:Vyshcha shkola; 1979. 224p. Russian.  
  7. Bhatti S, Kapoor H. Bilateral accessory iris membrane. Indian Journal of Ophtalmology.1998;46:110-1.
  8. Brueckner A. Ueber Persistenz von Resten der tunica vasculosa lentis. Arch. Fur Augenheilk. 1907;56: 5-149.
  9. Duke-Elder S. System of Ophthalmology. 1st ed. Vol.3. Henry Kimpton, London; 1964. 587-775.
  10. Gavris M, Horge J, Avram E et al. Persistant pupillary membrane or accessory iris membrane. Romaian Journal of Ophthalmol. 2015;59:184-7.
  11. Gupta R, Kumar S, Sonika S. Laser and surgical management of hyperplastic persistent pupillary membrane. Ophthalmic Surgery. 2003;34:136-9.
  12. Han K, Kim C, Chung J et al. Successful argon laser photocoagulation of diffuse epithelial in growth following concomitant persistant pupillary membrane removal and phacoemulsification. J Cataract Refract Surg. 2012;38:906-11.
    Crossref   Pubmed
  13. Kapoor K, Baratz K, Barkmeier A. Laser photocoagulation of an avulsed persistent pupillary membrane vessel causing recurrent hyphema. Clin Experiment Ophtalmol.  2013;41:513-515.
    Crossref   Pubmed
  14. Kolin T, Murphee L. Hyperplastic persistent pupillary membrane. Am Journal of Ophthalmol. 1997;123(6):839-41.
    Crossref   Pubmed
  15.  Kraus C, Lueder G. Clinical characteristics and surgical approach to visually significant persistent pupillary membranes. JAAPOS. 2014;18:596–9.
    Crossref   Pubmed
  16. Kumar H, Sakhuja N, Sadchev M. Hyperplastic pupillary membrane and laser therapy. Ophthalmic Surgery. 1994;25:189-90.
  17. Levy W. Congenital iris lesion. British Journal of Ophtalmol. 1957;41:120-23.
    Crossref   Pubmed
  18. Lim K, Yu Y. Surgical management for persistent pupillary membrane with vitreous scissors. Korean journal of ophthalmol. 1996;10(2):124-6.
    Crossref   Pubmed
  19. Pandey S, Ram J, JainA et al. Surgical management of complete hyperplastic persistent pupillary membrane. J Pediatr Ophtalmol Strabismus. 1999;36:221-3.
  20. Reynolds J, Hiles D, Johnson B, Biglan A. Hyperplastic persistent pupillary membrane – surgical management. J Pediatr Ophtalmol Strabismus. 1983;20:149-52.
  21. Suh D. 2 cases of accessory iris membrane. Journal of the Korean Ophtalmol  Society. 1979;20 (1):107-111.
  22. Vega L, Sabates R. Neodymium: YAG laser treatment of persistent pupillary membrane. Ophthalmic Surgery. 1987;18(6):452-4.