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Clinical characteristics and surgical approach to visually significant persistent pupillary membranes
Courtney L Kraus1, Gregg T Lueder1
1Departments of Ophthalmology and Visual Sciences and Pediatrics, Washington University School of Medicine, St. Louis Children's Hospital, St. Louis, Missouri.
Insights
Surgical removal of visually significant persistent pupillary membranes (PPM) in infants effectively clears the visual axis, leading to excellent long-term visual acuity and anatomical outcomes without complications.
Area of Science:
- Ophthalmology
- Pediatric Surgery
- Visual Development
Background:
- Persistent pupillary membranes (PPM) can obstruct the visual axis in infants, potentially causing deprivation amblyopia.
- Effective surgical intervention is crucial for preserving visual function.
Purpose of the Study:
- To evaluate the long-term visual and anatomical outcomes of a surgical technique for removing visually significant PPMs in infants.
- To assess the safety and efficacy of the described surgical approach.
Main Methods:
- Retrospective review of medical records for patients under 3 years old who underwent PPM removal.
- Surgical technique involved viscoelastic injection, peeling of strands, and lysis with intraocular scissors.
- Assessment of pre- and postoperative visual acuity and anatomical results.
Main Results:
- The study included 10 eyes of 6 pediatric patients.
- All patients achieved successful visual axis clearance and good visual acuity post-surgery.
- No intraoperative complications were reported, with a mean follow-up of 5.3 years.
Conclusions:
- The described surgical technique for PPM removal yields excellent long-term visual and structural outcomes in infants.
- This method is a safe and effective option for improving visual function and pupil appearance in pediatric patients with visually significant PPMs.
Background:
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.
Methods:
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.
Results:
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.
Conclusions:
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.
