Congenital Fibrovascular Pupillary Membranes: Clinical and Histopathological Findings

• Type of Material: Article
• Authors: Scott R Lambert, Emory University; Edward G. Buckley, Duke University; Phoebe Lenhart, Emory University; Qing Zhang, Emory University; Hans Grossniklaus, Emory University
• Language: English
• Date: 2012-03
• Publisher: Elsevier
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2011 American Academy of Ophthalmology, Inc. Published by Elsevier Inc. All rights reserved.
• License: Creative Commons Attribution-NonCommerical-NoDerivs 3.0 Unported
• Final Published Version (URL): http://dx.doi.org/10.1016/j.ophtha.2011.08.043
• Title of Journal or Parent Work: Ophthalmology (Section 12 EMBASE)
• ISSN: 0014-4169
• Volume: 119
• Issue: 3
• Start Page: 634
• End Page: 641
• Grant/Funding Information: Supported in part by NIH Departmental Core Grant EY06360 and Research to Prevent Blindness, Inc, New York, New York.
• Research Categories: Health Sciences, Opthamology

Abstract

Purpose: To report the clinical and histopathological findings associated with congenital fibrovascular pupillary membranes. Design: Case series. Participants: Seven infants; six with a unilateral congenital pupillary membrane and one with classic persistent fetal vasculature (PFV). Methods: Patients underwent a membranectomy, pupilloplasty and/or a lensectomy. Histopathological examination was performed on the excised membranes. Main Outcome Measures: Visual acuity and pupil size. Results: Four of the 6 patients with a unilateral congenital pupillary membrane had one or more recurrences after a membranectomy and pupilloplasty. The most recent pupil size ranged from 2 to 5 mm in the affected eye. When last tested, the vision in the affected eye was excellent in 4 of the 6 patients. The two patients without recurrences of the pupillary membranes underwent multiple iris spincterotomies at the time of the initial surgery. Histopathological examination of two primary pupillary membranes showed fibrovascular tissue that did not stain for neuron specific enolase. Smooth muscle actin was only present in vascular walls. In contrast, histopathology of a recurrent pupillary membrane revealed collagenized fibrovascular tissue that was immunoreactive for smooth muscle actin. Finally, histopathology of the retrolenticular membrane excised from an infant with classic PFV was similar to the latter aside from hypercellularity. Conclusions: Congenital fibrovascular pupillary membranes in infants are likely a variant of PFV that may recur if incompletely excised. The risk of these membranes recurring may be reduced by excising as much as the membrane as possible and enlarging the pupil with iris spincterotomies. A lensectomy should be avoided if possible.