A 21-year-old woman presented with bilateral poor visual acuity due to the bilateral remnants of pupillary membrane in June 2007. The patient underwent excisional removal of pupillary membrane remnant in both the eyes, 1 week apart. Postoperatively, the pupillary area was completely free of any membrane remnant, no complication was observed. Visual acuities were 0.6 right eye and 0.4 left eye.
Persistant Pupillary Membrane Surgery
From the Yüzüncü Yıl University, Faculty of Medicine, Department of Ophthalmology, Hafıziye M. Kazımbey 5. Sok No 24, VAN 65200, Turkey.
The authors have no financial or proprietary interest in the materials presented herein.
Address correspondence to Adil Kiliç, MD, Yüzüncü Yıl University, Faculty of Medicine, Department of Ophthalmology, Hafıziye M. Kazımbey 5. Sok No 24, VAN 65200, Turkey.
Accepted: October 20, 2008
Posted Online: March 09, 2010
The remnants of the pupillary membrane originate from the lesser circle, and by forming festoons or loops they float in the anterior chamber. The remnants may attach to the lens or the cornea. Histologically, their fibrils often contain thin vessels, without any blood circulation. Rarely, a blood circulation can be observed in some fibrils during anterior segment fluorescein angiography, giving rise to hemorrhage.1 In such circumstances, argon laser photocoagulation is a choice of treatment.2
We herein present a patient with pupillary membrane remnant in both the eyes, who was treated with excisional surgery.
A 21-year-old woman presented to our eye clinic in June 2007. She had a history of bilateral poor vision, since childhood. The patient’s best-corrected visual acuity in the right and left eyes were 0.5 and 0.2, respectively. Intraocular pressure was within normal limits bilaterally. The patient’s refractive error was +1.00 diopter sphere (DS), −6.00 diopter cylinder (DC) right eye and +0.50 DS, −5.25 DC left eye. A diagnosis of bilateral remnants of the pupillary membrane was made (Fig. 1). Figure 2 shows obstruction of the pupillary area by pupillary membrane remnants during miosis. The biomicroscopic examination was otherwise within normal limits. Initially, we attempted to treat the remnants of the pupillary membrane by Neodymium:Yittrium-Aluminium-Garnet (Nd:YAG) laser photodistruption, which did not work. The laser shoots were not effective because the attachments of the membrane were not tense. Because excessive laser energy would be required to excise all the attachments of the membrane a laser procedure was withheld and excisional surgery was preferred. The patient underwent pupillary membrane remnant excision of the left and right eyes 1 week apart. A clear corneal incision was made. The anterior chamber depth was maintained by viscoelastic substance. Coaxial micro-scissors were used for excision of the attachments of the membrane and removal of the remnant tissue. After replacement of the viscoelastic substance by balanced salt solution, interrupted 10-0 nylon sutures were used for closure of the corneal incision. The eye was covered after administration of topical antibiotic-steroid ointment. Postoperatively, the patient was free of any remnants and no complication was observed (Fig. 3) and his/her best-corrected visual acuity in the right and left eyes were 0.6 and 0.4, respectively.
Figure 1. Remnants of the Pupillary Membrane Preoperatively.
Figure 2. Remnants of the Pupillary Membrane Obstructs the Pupillary Area as a Result of Miosis, which Happens at Intensive Light.
Figure 3. Postoperatively, the Eye is Free of Remnants of the Pupillary Membrane.
The remnants of the pupillary membrane persist in some patients. Rarely, a blood circulation is observed in their fibrils.1 To prevent spontaneous haemorrhage, these vessels can be coagulated by means of argon laser photocoagulation.2 We did not observe any spontaneous haemorrhage in our case.
Although both sectioning the membrane remnants by laser or surgery have good functional results, the latter has potential complications. Therefore, the former treatment modality was proved as the treatment of choice by Gupta et al.3 However, Nd:YAG laser photodistruption was not efficient to disrupt the remnants of the pupillary membrane in our case. Therefore, the patient was treated with surgical excision.
Postoperatively, subjective improvement was observed. The visual acuity increased in both the eyes. We suggested that the relatively low-visual acuity after surgery was due to the presence of high-refractive error and deprivation ambliopia caused by pupillary membrane remnants in both the eyes. To conclude, patients with pupillary membrane remnants are mostly asymptomatic if the pupillary zone is not covered by the membrane. In cases with the risk of complications, such as high amblyopia, surgical removal should be taken into consideration without delay.
- Brusini P, Beltrame G. Spontaneous hyphema from persistent remnant of the pupillary membrane. Acta Ophthalmol. 1983;61:1099–1103. doi:10.1111/j.1755-3768.1983.tb01497.x [CrossRef]
- Rydberg M. Haemorrhage from remnants of the pupillary membrane. Acta Ophthalmol. 1965;43:160–163. doi:10.1111/j.1755-3768.1965.tb06381.x [CrossRef]
- Gupta R, Kumar S, SonikaSood S. Laser and surgical management of hyperplastic pupillary membrane. Ophthalmic Surg Lasers Imaging. 2003;34:136–139.