Intraocular Lens Implantation for Persistent Pupillary Membrane A 76-year-old woman had a 5-year history of slowly progressive vision loss in both eyes. She was diagnosed as having cataracts by a local ophthalmologist and referred to us for operation. Visual acuity was 2/10 OD and 10/200 OS. The remnants of pupillary membrane were present, which extended from collarette of the iris to anterior surface of the lenses (Fig. 1). After mydriasis, persistent pupillary membrane consists of iris tissue became more prominent. The lenses showed epicapsular pigmentation within pupillary zone and nuclear sclerosis, which was more marked in the left eye (Fig. 2). Macular degeneration was also found in the left eye by ophthalmoscopic examination. The patient has undergone extracapsular lens extraction with implantation of posterior-chamber intraocular lens (PCIOL) in the left eye. The iris strand was cut at the site of collarette. The PC-IOL was fixed in the capsular bag (Fig. 3) and visual acuity has improved to 6110 OS.
COMMENT Persistent pupillary membrane is a common congenital abnormality of the anterior segment ofthe eye. It occurs due to the persistence of tunica vasculasa lentis, which usually disappear before birth [1, 2]. Its features have great variability. Occasional severe cases disturb the vision although most cases are clinically innocuous. In extreme degrees of this malformation, the remnants composed of iris tissue extend from collarette into pupillary zone and cause epicapsular pigmentation. On extracapsular lens extraction, we cut these remnants at the site of the collarettejust after anterior capsulotomy. Prognosis of visual acuity is fairly good after operation.
REFERENCES E Gutmann, M Goldberg. Persistent pupillary membrane and other ocular abnormalities. Arch. Ophthalmol., 1976; 94: 156. 2 S Merin, J Crawford, J Cardarelli. Hyperplastic pupillary membrane. Am. J. Ophthalmol., 1971; 72: 717-719.
Fig. 1 Persistent pupillary membrane The remnants of the pupillary membrane consist of iris tissue extendmg from collarette to the anterior surface ofthe lens Eur J Implant Ref Surg. Vol 3. December 1991
K. Hayashi, F. Nakao, F. Hayashi
After mydriasis. The lens showed eplcapsular pigmentatIOn and nuclear scleroRls.
Fig. 3 After lens extraction with posterior-chamber IOL. PC-IOL is inserted between collarettes still remain after operation
the capsular bag. Fine white strands connecting
Eur J Implant Ref Surg. Vol 3. December 1991