Surgical approach to and morphology of visually significant persistent pupillary membranes

Abstract

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: A 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: Thirty-one eyes from 19 patients were included with the mean age of 7.2 years. Three 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 best corrected 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. Conclusion: PPMs were categorized into three types according to their different morphologies, which helped to determine the best surgical strategy.