Liang T W, Zhang C Y, Bai D Y, Peng C X, Bai X Q, Wu Q, Zhao J Y, Li L
Department of Ophthalmology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing 100045, China.
Zhonghua Yan Ke Za Zhi. 2018 Nov 11;54(11):849-854. doi: 10.3760/cma.j.issn.0412-4081.2018.11.010.
To investigate the clinical characteristics, surgical approaches and postoperative effects associated with congenital fibrovascular pupillary membranes. A retrospective study design was used. Thirteen children (13 eyes) with congenital fibrovascular pupillary membranes, treated in Beijing Children's Hospital from January 2014 to December 2017 were included. The morphology of the membrane and the anterior chamber was evaluated using a digital wide-area fundus imaging system. The ophthalmic signs, examination results, operation methods, intraocular pressure and ocular position were analyzed. There were 13 children (13 eyes) were enrolled, including 9 males and 4 females. The age at surgery ranged from 2.0 months to 34.5 months, with an median of 5.1 months. According to the degree of obstruction of the pupil and the intraocular pressure, the eyes were divided into three groups. In the 5 eyes of group A, the pupil membrane did not completely cover the pupil, and the depth of the anterior chamber was normal. Among them, 4 eyes had normal intraocular pressure (9-12 mmHg) (1 mmHg=0.133kPa), and 1 eye had elevated intraocular pressure (18 mmHg). In the 5 eyes of group B, the pupillary membrane completely covered the pupil into a pinhole, the anterior chamber was normal or slightly shallow, and the intraocular pressure was normal (6-16 mmHg). In the 3 eyes of group C, the pupillary membrane completely covered the pupil, the anterior chamber was shallow or disappeared, and the intraocular pressure was high (24-45 mmHg). Membranectomy and pupilloplasty were performed in group A, and trabeculectomy was combined when there was glaucoma; postoperative intraocular pressure was normal (4-10 mmHg). Membranectomy, pupilloplasty and iridectomy were performed in group B; postoperative intraocular pressure was normal (7-13 mmHg). Membranectomy, pupilloplasty, iridectomy and goniosychialysis were performed in group C; after surgery, intraocular pressure was normal in 2 eyes (10 mmHg and 13 mmHg) and 25 mmHg in 1 eye. All eyes were orthophoric before and after operation in group A. In group B, 1 eye was esotropic, 2 eyes were exotropic (worse after surgery in 1 eye), and 2 eyes were orthophoric before surgery. In group C, one eye was esotropic, one eye was exotropic, and one eye was orthophoric before surgery, and all eyes were exotropic after operation. Congenital fibrovascular pupillary membranes are unilaterally a continuation of the iris covering the pupil at different degrees, with or without glaucoma. Surgical treatment should be performed promptly when there is obscuring of the visual axis or incorporating of glaucoma. The main surgical procedures are membranectomy and pupilloplasty and iridectomy. Postoperative intraocular pressure can be well controlled, and strabismus has no improvement. .
探讨先天性纤维血管性瞳孔膜的临床特征、手术方式及术后效果。采用回顾性研究设计。纳入2014年1月至2017年12月在北京儿童医院接受治疗的13例先天性纤维血管性瞳孔膜患儿（13只眼）。使用数字广域眼底成像系统评估膜及前房的形态。分析眼部体征、检查结果、手术方法、眼压及眼位。共纳入13例患儿（13只眼），其中男性9例，女性4例。手术年龄为2.0个月至34.5个月，中位年龄为5.1个月。根据瞳孔阻塞程度和眼压将患眼分为三组。A组5只眼，瞳孔膜未完全覆盖瞳孔，前房深度正常。其中4只眼眼压正常（9～12mmHg）（1mmHg = 0.133kPa），1只眼眼压升高（18mmHg）。B组5只眼，瞳孔膜完全覆盖瞳孔呈针孔状，前房正常或略浅，眼压正常（6～16mmHg）。C组3只眼，瞳孔膜完全覆盖瞳孔，前房浅或消失，眼压高（24～45mmHg）。A组行膜切除术和瞳孔成形术，合并青光眼时联合小梁切除术；术后眼压正常（4～10mmHg）。B组行膜切除术、瞳孔成形术和虹膜切除术；术后眼压正常（7～13mmHg）。C组行膜切除术、瞳孔成形术、虹膜切除术和前房角分离术；术后2只眼眼压正常（10mmHg和13mmHg），1只眼眼压为25mmHg。A组所有患眼手术前后眼位均正常。B组术前1只眼内斜视，2只眼外斜视（1只眼术后加重），2只眼眼位正常。C组术前1只眼内斜视，1只眼外斜视，1只眼眼位正常，术后所有患眼均为外斜视。先天性纤维血管性瞳孔膜为单侧性，是虹膜不同程度覆盖瞳孔的延续，可伴有或不伴有青光眼。当视轴受阻或合并青光眼时应及时进行手术治疗。主要手术方式为膜切除术、瞳孔成形术和虹膜切除术。术后眼压可得到良好控制，但斜视无改善。
