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Manifestations of persistent pupillary membrane
N F Bobrova1, T V Romanova2, O D Dovhan2
1Pediatric Ophthalmology Department, State Institution "The Filatov Institute of Eye Diseases and Tissue Therapy of the NAMS of Ukraine", Odesa, Ukraine. filatovbobrova@gmail.com.
Insights
Persistent pupillary membranes (PPM) with iridolenticular attachment are common and can cause significant visual loss, necessitating surgical removal. This study details their clinical and structural features in children.
Area of Science:
- Ophthalmology
- Pediatric Ophthalmology
- Anatomical Pathology
Background:
- Persistent pupillary membranes (PPM) are congenital remnants of fetal vasculature.
- Understanding PPM's clinical and structural characteristics is crucial for managing visual impairment in children.
- Previous studies have not comprehensively analyzed a large cohort of PPM cases.
Purpose of the Study:
- To investigate the clinical and structural manifestations of persistent pupillary membranes (PPM).
- To characterize PPM types, associated ocular findings, and visual acuity outcomes.
- To utilize light and electron microscopy for detailed structural analysis of PPM.
Main Methods:
- Descriptive case series of 32 children (38 eyes) with various PPM types (2005-2023).
- Comprehensive ophthalmological examinations including biomicroscopy, gonioscopy, and imaging.
- Surgical removal and subsequent histological/electron microscopic examination of PPM in 17 eyes.
Main Results:
- Type II PPM (iridolenticular attachment) was dominant (76.3%), often causing significant visual loss (50%).
- PPM affected pupil size/configuration (44.76%) and anterior chamber angles (26.3%).
- Microphthalmia (34.2%) and microcornea (23.7%) were observed; lens remained transparent in 84.2%.
Conclusions:
- Iridolenticular PPM is the most prevalent type, frequently leading to visual impairment requiring surgical intervention.
- PPM significantly impacts pupil morphology and anterior segment structures.
- Histological analysis confirms PPM as a remnant of the tunica vasculosa lentis with mesodermal origin.
Purpose:
To study the clinical and structural manifestations of persistent pupillary membranes (PPM) using light and electron microscopy.
Materials And Methods:
This descriptive case series study included 32 children (38 eyes) with different clinical PPM types. The cases were collected between 2005 and 2023. The age of the patients ranged from 7 months to 13 years, with a mean age of 3 ± 2.6 years. All children underwent standard ophthalmological examinations, including biomicroscopy, keratometry, gonioscopy, ophthalmoscopy, tonometry, visometry, ultrasonic biometry, scanning, and photo and video recording. Surgical removal of PPM was performed in 15 children (17 eyes), and the removed PPMs were histologically and electron microscopically studied.
Results:
The PPMs were of different sizes, configurations, and volumes. The vast majority, 25 children (29 eyes, 76.3%), had type II PPM with iridolenticular attachment (Duke-Elder classification, 1964). Six children (8 eyes, 21.1%) had type I PPMs with iris-to-iris attachment. In one case (one eye, 2.67%), a combination of type I and type II PPM was observed. In the eyes with PPM, microphthalmia and microcornea were observed in 34.2% and 23.7% of cases, respectively. PPM affected the size and configuration of the pupil in 44.76% of cases and the anterior chamber angle structure in 26.3% of cases. The lens remained transparent in 84.2% of the cases. Congenital cataracts were observed in 15.89%. Visual acuity in the eyes with PPM varied from light perception to 0.4 logMAR. In 50.0% of cases, significant visual loss occurred in type II PPM. Histomorphological and electron microscopic studies showed that PPM was the remnant of the tunica vasculosa lentis, had a mesodermal origin, and did not penetrate the anterior lens capsule.
Conclusion:
For the first time, the clinical features of PPM were analyzed in a significantly large number of cases, and the analysis showed that PPMs with iridolenticular attachment were dominant. They were of different sizes and configurations and had a dense fit to the lens, causing significant visual loss and thus requiring surgical removal. In almost half of the cases, PPM caused pupil narrowing, decentration, and deformation, whereas the crystalline lens remained transparent in most cases (84.2%).
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