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Surgical approach to and morphology of visually significant persistent pupillary membranes
Wan Chen1, Kexin Chen, Hui Chen
1From the State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China .
Insights
Persistent pupillary membranes (PPMs) in pediatric patients were classified into three distinct morphological types. This classification guided tailored surgical strategies, leading to significant visual acuity improvement and no observed complications.
Area of Science:
- Ophthalmology
- Pediatric Ophthalmology
- Surgical Ophthalmology
Background:
- Persistent pupillary membranes (PPMs) are congenital remnants of the fetal vascular supply to the iris.
- PPMs can cause visual impairment in pediatric patients if they obstruct vision.
Purpose of the Study:
- To characterize the morphology of persistent pupillary membranes (PPMs) in pediatric patients.
- To explore surgical approaches tailored to different PPM morphologies.
Main Methods:
- A prospective observational study included 31 eyes from 19 pediatric patients undergoing PPM surgery.
- PPM morphology was assessed and categorized based on adherence to the anterior lens capsule and iris strand characteristics.
- Surgical techniques, visual outcomes, and complications were recorded.
Main Results:
- Three morphological variants of PPMs were identified: Type I (spider-like, no lens adhesion), Type II (loose lens adhesion), and Type III (tight lens adhesion).
- Surgical approaches varied, including natural or dilated pupil sizes and specific techniques like viscoelastic injection or discission needles.
- Corrected distance visual acuity significantly improved post-surgery (0.34 to 0.17 logMAR, P < .001).
Conclusions:
- Persistent pupillary membranes can be classified into three distinct morphological types.
- This morphological classification aids in determining the optimal surgical strategy for pediatric patients.
- The described surgical approaches resulted in improved visual acuity with no observed complications.
Purpose:
To characterize the morphology of persistent pupillary membranes (PPMs) in pediatric patients and explore the corresponding surgical approaches.
Setting:
Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China.
Design:
Prospective observational study.
Methods:
Consecutive pediatric patients with PPMs who underwent surgery from April 2020 to July 2022 were included. PPM morphology was assessed and categorized according to its anatomic relationship with crystalline lens and distribution of iris strands. The surgical approaches for different morphologies of PPMs were described in detail. The visual outcome and operation-related complications were recorded.
Results:
31 eyes from 19 patients were included with the mean age of 7.2 years. 3 morphological variants of PPMs were observed: type I (51.6%, 16/31), a spider-like appearance and no adhesion to the anterior lens capsule (ALC); type II (38.7%, 12/31), a loose central adherence to the ALC and partially thick iris strands attached to the iris collarette; type III (9.7%, 3/31), a tight central adherence to the ALC and only silk-like iris strands. Surgeries were performed with a natural pupil size in type I, while dilated pupil in the other types. The adhesions between PPM and the ALC were separated by viscoelastic injection in type II and by discission needles in type III. The corrected distance visual acuity was significantly improved from 0.34 ± 0.18 logMAR preoperatively to 0.17 ± 0.09 logMAR postoperatively ( P < .001). No operation-related complications were observed during 9.5-month follow-up.
Conclusions:
PPMs were categorized into 3 types according to their different morphologies, which helped to determine the best surgical strategy.
