Congenital pupillary-iris-lens membrane with goniodysgenesis: histopathologic findings in an enucleated eye

Use of ultrasound biomicroscopy to predict the outcome of anterior segment reconstruction in congenital fibrovascular pupillary membrane with secondary glaucoma

AIMS

To evaluate the efficacy and safety of anterior segment reconstruction (ASR) in congenital fibrovascular pupillary membrane-induced secondary glaucoma (CFPMSG) basing ultrasound biomicroscopy (UBM) classification.

METHODS

This ambispective cohort study enrolled patients with CFPMSG who underwent ASR between January 2014 and September 2020. Comprehensive ophthalmic examinations and UBM were performed before surgery and postoperatively. The patients were classified into three types according to the UBM configurations. Anterior chamber recovery (ACR) was defined as deepening in anterior chamber (≥1.5 mm all through final follow-up (FFU), while success following ASR was defined as ACR and intraocular pressure (IOP)≤21 mm Hg.

RESULTS

25 eyes of 25 patients underwent ASR (average age at operation 5.8±5.0 months, 48% girls) with FFU 15.8±16.9 months. Enrolled subjects were classified into type Ⅰ (11 eyes), type Ⅱ (11 eyes) and type Ⅲ (3 eyes). After ASR, 23 eyes (92%) achieved ACR, and the mean ACD increased in all groups (p=0.006, <0.001 and 0.003, respectively). Eyes with types Ⅰ and Ⅱ demonstrated a reduction of IOP (p=0.009 and 0.002, respectively). ASR success rate was highest in type Ⅰ (72.9%) compared with types Ⅱ and Ⅲ (18.2% and 0%, respectively; p=0.011). ASR led to decreased number of antiglaucoma medications for type Ⅰ CFPMSG at FFU (p=0.016). No vision-threatening postoperative complications occurred.

CONCLUSIONS

ASR for CFPMSG results in increased ACD and improvement in IOP. Postoperative IOP control was best in type Ⅰ CFPMSG but not as effective in types Ⅱ and Ⅲ. UBM-based classification helps to predict the surgical outcome of ASR in CFPMSG.

Secondary glaucoma caused by a special type of persistent fetal vasculature

PURPOSE

To investigate the clinical features and surgical outcomes in infants with glaucoma secondary to a special anterior-anterior type of persistent fetal vasculature (AAPFV).

METHODS

This study retrospectively reviewed the medical records of infants who underwent of the synechialysis, pupilloplasty, with or without lensectomy and limbal vitrectomy due to AAPFV and with at least 6 months of postoperative follow-up.

RESULTS

Eleven patients were included. The median age at surgery was 4.0 months (interquartile range: 7 months). The mean follow-up was 21.0 ± 11.3 months. All patients achieved a normal anterior chamber, improved pupillary configuration, and normal intraocular pressure (IOP), except one that developed phthisis bulbi at the last visit. A total of 81.8% (9/11) eyes exhibited improved corneal transparency. Histopathologic findings of four pupillary membranous specimens under light microscopy showed similar components compared with PFV. Two eyes developed postoperative complications, including retinal detachment and hyphema, requiring additional surgeries. Postoperative visual acuity changed from no light perception to light perception in 6/9 patients.

CONCLUSIONS

AAPFV is a special type of PFV with a potential for secondary glaucoma. Surgery treatment may offer better vision with improved cosmetic outcomes and a better controlled IOP.

TRIAL REGISTRATION

The study was approved by the local institutional review board (IRB) (Approval No. XHEC-D-2021-043, Ethical Committee of Xin Hua Hospital Affiliated to Shanghai Jiao Tong University, Shanghai, China).

Clinical and Ultrasound Biomicroscopic Characteristics of Congenital Fibrovascular Pupillary Membrane-Induced Secondary Glaucoma

Purpose: The purpose of this study was to describe and summarize the clinical features of congenital fibrovascular pupillary membrane-induced secondary glaucoma (CFPMSG).

Design: Cross-sectional case series.

Methods: Eyes of 32 patients with CFPMSG were enrolled. Demographic data, including gender, laterality, age at presentation, and age at onset of glaucoma were collected. Patients underwent comprehensive ophthalmic examinations and ultrasound biomicroscopy (UBM). CFPMSG eyes were classified into three groups based on UBM findings and intergroup analysis was performed using ANOVA.

Results: The average age at presentation was 2.4 ± 4.6 months (mean ± SD) and at glaucoma onset was 3.8 ± 4.5 months. Compared to normal fellow eyes, all affected eyes had increased intraocular pressure (IOP), axial length, corneal diameter, and central corneal thickness, and decreased anterior chamber depth (ACD) (all P ≤ 0.001). Twenty-two affected eyes (68.8%) had evidence of glaucomatous optic neuropathy. Based on iris configuration on UBM, eyes were classified as 53% type I (“U” shape), 34% type II (“Y” shape), and 13% type III (no anterior chamber). IOP in types II (33.8 ± 5.9 mmHg) and III (35.2 ± 5.9 mmHg) was significantly higher than in type I eyes (26.5 ± 5.1 mmHg). The ACD was shallower in type II compared to type I (P = 0.045).

Conclusion: Congenital fibrovascular pupillary membrane-induced secondary glaucoma is characterized by ocular hypertension, corneal enlargement and edema, axial length elongation, and glaucomatous optic neuropathy. Glaucoma in this condition is secondary to pupillary block and angle-closure. UBM provides important information for the diagnosis and classification of CFPMSG. This novel classification system demonstrated varying levels of severity and may guide on management of this disease.