Bilateral persistent pupillary membranes associated with cataract

Abstract

SummaryExuberant persistent pupillary membranes (PPM) are rare in adult eyes. We report the case of a 53-year-old man diagnosed with bilateral, profuse, persistent pupillary membranes and unilateral cataract. Case ReportA 53-year-old man of Chinese descent presented to the ophthalmology clinic of Queen Elizabeth Hospital, Kota Kinabalu, Malaysia, with a complaint of progressive blurring of vision in the right eye of 6 months' duration. The patient claimed that his vision in both eyes was satisfactory prior to this time period. There were no documented systemic illnesses. Family history was unremarkable.On examination, uncorrected visual acuity was hand movements in the right eye and 6/24 in left eye. Refraction was −2.25 −1.50 × 76 in the right eye, with no improvement in visual acuity, and +1.75 −2.50 × 180 in left eye, giving a best-corrected visual acuity of 6/6. The intraocular pressure was 14mm Hg in the right eye and 16 mm Hg in left eye. On anterior segment examination, both eyes had clear corneas, deep and quiet anterior chambers, and no synechiae. Both eyes showed a dense network of tissue, more gross and exuberant in the right eye, running from the iris surface and spreading over the pupils (Figure 1). The right eye had 3+ and left eye 1+ nuclear sclerotic cataractous changes. There was no view of the fundus in right eye, while the left eye fundus did not reveal any abnormality. B-scan ultrasonography of the right eye revealed a flat retina. A cover-uncover test was normal. In cases such as this one, tests of macular function like entoptic tests, retina acuity meter (RAM) or laser interferometry can be performed to confirm the status of the macula and the visual prognosis. The patient was diagnosed with bilateral persistent pupillary membranes (PPM) and cataract in the right eye.Our challenge was to manage both the right eye cataract and the PPM. We could either use laser to cut the PPM prior to undertaking cataract extraction or cut the membranes during surgery. Fearing intraoperative bleeding of the membranes, we decided on the first, two-stage, option. The Nd:YAG laser has been used to cut such membranes 1 ; however, we decided against using it since treatment is painful and can cause pigment dispersion and bleeding. 2 We opted instead for photocoagulation by means of Argon laser (Carl Zeiss Meditech AG, Germany, Model 532s). The settings were 600-800 mW, 100 μm spot size and duration of 200 ms. A total of 60 shots were used to disrupt the PPM (Figure 2). Five days later the patient underwent cataract extraction and intraocular lens (IOL) implantation ( Figure 3A). The patient refused phacoemulsification; we performed an extracapsular cataract extraction and IOL implantation under local anesthesia. Intraoperatively, the ring of tissues left from the laser procedure was teased out of the anterior chamber using viscoelastic and Uttrata forceps. An extracapsular cataract extraction was then performed. We experienced a small posterior capsular rent superiorly and the IOL was implanted in the ciliary sul...