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Incising the thick retrolental fibrovascular tissue with a hooked sclerotome in persistent hyperplastic primary
K Shiraki1, M Moriwaki, T Kohno
1Department of Ophthalmology, Osaka City University Medical School, Osaka, Japan.
Abstract:
A technique for incising thick retrolental fibrovascular tissue and extensive cyclitic membrane is reported in a case of anterior persistent hyperplastic primary vitreous. A membranectomy was performed in a 1-month-old post-lensectomy baby via a limbal approach. A sclerotome tip was hooked to cut through an extremely thick fibrovascular tissue by rotating the sclerotome by its grip. Sutherland microscissors (Grieshaber, Switzerland) and a vitrectomy cutter were used for further membranectomy. The baby was followed-up until age 18 months. A total of 3 membranectomy sessions were required because of rapid cyclitic membrane formation, severe centripetal retraction of the membrane on the ciliary processes, and posterior synechia. Thorough membranectomy and cutting the iris edge maintained a clear pupillary area during the 13-month postoperative period. Extremely thick retrolental fibrovascular tissue is a challenging condition that can be dealt with by delicate instrumentation.
Insights
A novel surgical technique effectively incised thick retrolental fibrovascular tissue and cyclitic membranes in a persistent hyperplastic primary vitreous case. Delicate instrumentation allowed for successful membranectomy, maintaining a clear pupillary area.
Area of Science:
- Ophthalmology
- Surgical Techniques
Background:
- Persistent hyperplastic primary vitreous (PHPV) can lead to challenging intraocular membrane formation.
- Anterior PHPV, especially post-lensectomy, may present with thick retrolental fibrovascular tissue and extensive cyclitic membranes.
Observation:
- A 1-month-old infant with anterior PHPV underwent membranectomy via a limbal approach.
- A sclerotome was utilized to incise extremely thick fibrovascular tissue, followed by Sutherland microscissors and a vitrectomy cutter for further membranectomy.
Findings:
- Three membranectomy sessions were necessary due to rapid membrane formation, ciliary process retraction, and posterior synechia.
- Thorough membranectomy and iris edge cutting successfully maintained a clear pupillary area throughout the 13-month postoperative follow-up.
Implications:
- This case demonstrates a viable surgical approach for managing extremely thick retrolental fibrovascular tissue.
- Delicate instrumentation is crucial for successfully treating complex intraocular membranes in pediatric cases of PHPV.
