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Two-stage operation for the treatment of cataract associated with persistent pupillary membrane
CORRESPONDENCE
Two-stage operation for the treatment of cataract associated with persistent pupillary membrane Jaesang Ko, MD, Ji Won Jung, MD, Eung Kweon Kim, MD, PhD Department of Ophthalmology, Eye and ENT Hospital, Severance Hospital, Institute of Vision Research, Yonsei University College of Medicine, Seoul, Korea We previously reported a complex case of epithelial ingrowth following concomitant removal of persistent pupillary membrane and phacoemulsification.1 In that case, the eye and vision were saved after repeated, extensive, argon-laser photocoagulation. Here, we describe a 2-stage procedure that successfully managed cataract associated with persistent pupillary membrane in the fellow eye of the same patient.1 CASE REPORT Five years after complete treatment of epithelial ingrowth in our patient's left eye, cataract was noted in the right eye, which had a corrected distance visual acuity (CDVA) of 20/50. Based on the experience with the left eye, the procedure was planned in 2 steps. In the first step, two 1.3 mm limbal incisions were made with a microvitreoretinal blade and a small amount of ophthalmic viscosurgical device (sodium chondroitin sulfate 4%–sodium hyaluronate 3% [Viscoat]) was injected into the anterior chamber. The persistent pupillary membrane was removed with an intraocular scissors in the same way as in the previous eye1 and with an intraocular forceps. In the second step, which was planned 10 months after removal of the persistent pupillary membrane, phacoemulsification with intraocular lens implantation was performed uneventfully. The anterior chamber of the right eye did not show an inflammatory reaction after phacoemulsification, which had been noticed in the left eye when the procedures were done at the same time. Two months postoperatively, the CDVA was 20/20 with no complication or epithelial ingrowth (Figure 1).
DISCUSSION Few reports discuss management of cataract associated with persistent pupillary membrane. A case of
successful sequential argon-YAG laser membranectomy and next-day phacoemulsification has been reported.2 However, laser membranectomy of persistent pupillary membrane is possible only if the iris strand connecting the membranous roof and the iris collarette is narrow.3 Cutting the broad base of the pillar between the membrane and iris collarette in our case would have been difficult without inducing massive iris bleeding. Because the 1-stage procedure in the left eye (membrane removal with scissors and phacoemulsification) resulted in severe intraocular inflammation with serious complications, we performed separate procedures in the fellow eye with good results. We propose a possible mechanism of epithelial ingrowth after removal of the persistent pupillary membrane combined with phacoemulsification, in which alterations in the aqueous humor might occur as plasmoid material oozed from the cut edge of the iris, providing the environment for epithelial cell growth. The 2-stage procedure enabled us to perform phacoemulsification with the anterior chamber condition similar to that in routine cases. We hope our experience helps surgeons establish surgical plans in cases of cataract combined with extensive persistent pupillary membrane. Supported by the Converging Research Center Program through the National Research Foundation of Korea (NRF) funded by the Ministry of Education, Science, and Technology (MEST; 2012K001354). REFERENCES 1. Han KE, Kim CY, Chung JL, Hong JP, Sgrignoli B, Kim EK. Successful argon laser photocoagulation of diffuse epithelial ingrowth following concomitant persistent pupillary membrane removal and phacoemulsification. J Cataract Refract Surg 2012; 38:906–911 2. Wang J-K, Wu C-Y, Lai P-C. Sequential argon-YAG laser membranectomy and phacoemulsification for treatment of persistent pupillary membrane and associated cataract. J Cataract Refract Surg 2005; 31:1661–1663 3. Gupta R, Kumar S, Sonika, Sood S. Laser and surgical management of hyperplastic persistent pupillary membrane. Ophthalmic Surg Lasers Imaging 2003; 34:136–139
Figure 1. A: Preoperative slitlamp photograph of the right eye shows a dense persistent pupillary membrane attached to the anterior lens capsule. B: One month after phacoemulsification, slitlamp photograph shows the membrane has been completely removed with no complication.
Q 2013 ASCRS and ESCRS Published by Elsevier Inc.
0886-3350/$ - see front matter http://dx.doi.org/10.1016/j.jcrs.2013.08.013
1615
Two-stage operation for the treatment of cataract associated with persistent pupillary membrane Jaesang Ko, MD, Ji Won Jung, MD, Eung Kweon Kim, MD, PhD Department of Ophthalmology, Eye and ENT Hospital, Severance Hospital, Institute of Vision Research, Yonsei University College of Medicine, Seoul, Korea We previously reported a complex case of epithelial ingrowth following concomitant removal of persistent pupillary membrane and phacoemulsification.1 In that case, the eye and vision were saved after repeated, extensive, argon-laser photocoagulation. Here, we describe a 2-stage procedure that successfully managed cataract associated with persistent pupillary membrane in the fellow eye of the same patient.1 CASE REPORT Five years after complete treatment of epithelial ingrowth in our patient's left eye, cataract was noted in the right eye, which had a corrected distance visual acuity (CDVA) of 20/50. Based on the experience with the left eye, the procedure was planned in 2 steps. In the first step, two 1.3 mm limbal incisions were made with a microvitreoretinal blade and a small amount of ophthalmic viscosurgical device (sodium chondroitin sulfate 4%–sodium hyaluronate 3% [Viscoat]) was injected into the anterior chamber. The persistent pupillary membrane was removed with an intraocular scissors in the same way as in the previous eye1 and with an intraocular forceps. In the second step, which was planned 10 months after removal of the persistent pupillary membrane, phacoemulsification with intraocular lens implantation was performed uneventfully. The anterior chamber of the right eye did not show an inflammatory reaction after phacoemulsification, which had been noticed in the left eye when the procedures were done at the same time. Two months postoperatively, the CDVA was 20/20 with no complication or epithelial ingrowth (Figure 1).
DISCUSSION Few reports discuss management of cataract associated with persistent pupillary membrane. A case of
successful sequential argon-YAG laser membranectomy and next-day phacoemulsification has been reported.2 However, laser membranectomy of persistent pupillary membrane is possible only if the iris strand connecting the membranous roof and the iris collarette is narrow.3 Cutting the broad base of the pillar between the membrane and iris collarette in our case would have been difficult without inducing massive iris bleeding. Because the 1-stage procedure in the left eye (membrane removal with scissors and phacoemulsification) resulted in severe intraocular inflammation with serious complications, we performed separate procedures in the fellow eye with good results. We propose a possible mechanism of epithelial ingrowth after removal of the persistent pupillary membrane combined with phacoemulsification, in which alterations in the aqueous humor might occur as plasmoid material oozed from the cut edge of the iris, providing the environment for epithelial cell growth. The 2-stage procedure enabled us to perform phacoemulsification with the anterior chamber condition similar to that in routine cases. We hope our experience helps surgeons establish surgical plans in cases of cataract combined with extensive persistent pupillary membrane. Supported by the Converging Research Center Program through the National Research Foundation of Korea (NRF) funded by the Ministry of Education, Science, and Technology (MEST; 2012K001354). REFERENCES 1. Han KE, Kim CY, Chung JL, Hong JP, Sgrignoli B, Kim EK. Successful argon laser photocoagulation of diffuse epithelial ingrowth following concomitant persistent pupillary membrane removal and phacoemulsification. J Cataract Refract Surg 2012; 38:906–911 2. Wang J-K, Wu C-Y, Lai P-C. Sequential argon-YAG laser membranectomy and phacoemulsification for treatment of persistent pupillary membrane and associated cataract. J Cataract Refract Surg 2005; 31:1661–1663 3. Gupta R, Kumar S, Sonika, Sood S. Laser and surgical management of hyperplastic persistent pupillary membrane. Ophthalmic Surg Lasers Imaging 2003; 34:136–139
Figure 1. A: Preoperative slitlamp photograph of the right eye shows a dense persistent pupillary membrane attached to the anterior lens capsule. B: One month after phacoemulsification, slitlamp photograph shows the membrane has been completely removed with no complication.
Q 2013 ASCRS and ESCRS Published by Elsevier Inc.
0886-3350/$ - see front matter http://dx.doi.org/10.1016/j.jcrs.2013.08.013
1615