The authors present the clinical characteristics and outcomes of different treatment methods for congenital fibrovascular pupillary membrane (CFPM). This was a retrospective case series from a single centre including 12 patients (13 eyes; 4 males, 8 females) over a 7-year period. Treatment was conservative for 3 eyes and surgical for 10 eyes. Conservative treatment involved topical brinzolamide drops x3 daily and/or observation only. Surgical options were indicated for obstructed visual axis and included extraction of membrane ± removal of cataract, posterior capsulorhexis and vitrectomy. Surgery was undertaken at a mean of 49.6 ±42.4 months. Results were reported in 2 groups; 1, <3 years old and 2, >3 years old. Results were also reported for axial length as long (D>0.1mm) and short (D≤0.1mm). Twelve had fibrovascular membranes covering part or all of the pupil areas of the affected eyes, with miosis and dyscoria due to adhesions between the membrane and iris or lens. The membranes were filamentous or webbed. Central corneal thickness and lens thickness were higher in affected than fellow eyes whilst anterior chamber depth measurements were lower. There were no significant differences for axial length between affected and fellow eyes. Two patients had strabismus. For surgical follow-up, there was no persistent glaucoma or surgically induced cataract or recurrence, with an average follow-up of 13.8 months. All had anisometropia. Amblyopia occurred in a third of young children and all of the older children. The authors conclude CFPM can cause visual impairment due to obstruction of the visual axis. Affected eyes have thickened corneas and lens, with shallow anterior chambers. Glaucoma is not a typical feature. They support early surgery as being safe and effective, with low surgical complications and low recurrence rates. Conservative therapy was found to have limited efficacy. Surgery under the age of 3 years showed a reduced risk of amblyopia.
Conservative vs surgical management outcomes for congenital fibrovascular pupillary membrane for young vs older children
Reviewed by Fiona Rowe
Therapeutic effect observation of surgery on congenital fibrovascular pupillary membrane.
CONTRIBUTOR
Fiona Rowe (Prof)
Institute of Population Health, University of Liverpool, UK.
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