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

Abstract

AimsTo evaluate the efficacy and safety of anterior segment reconstruction (ASR) in congenital fibrovascular pupillary membrane-induced secondary glaucoma (CFPMSG) basing ultrasound biomicroscopy (UBM) classification.MethodsThis 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.Results25 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.ConclusionsASR 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.

Fibrovascular pupillary membrane with persistent pupillary membranes initially suspected to be congenital cataract: a case report

“…The diagnosis of FPM is based on close examination through a slit lamp. Ultrasound biomicroscopy (UBM) or anterior segment optical coherence tomography (AS-OCT) can be used for the diagnosis and differential diagnosis [17] [18]. In addition, these tests can reveal the origin of cells and tissues at the pathological level, but they cannot be applied in some clinical settings.…”

Successful removal of a congenital fibrovascular pupillary membrane in 2 cases with variable age at presentation and sparing of the crystalline lens

“…Zhu Y, et al reported 25 cases of congenital fibrovascular membrane with secondary glaucoma [ 10 ]. All cases had anterior segment reconstruction surgery, by performing peripheral iridotomy and blunt dissecting the membrane from the anterior lens capsule.…”

“…In this study, they used UBM to classify the membrane severity. They found that class I had (72.7 %) success rate and additional surgery was needed in most of classes II and III [ 10 ].…”