Huang Yu-Te, Lin Hui-Ju
Department of Ophthalmology, China Medical University Hospital, China Medical University, 2 Yuh-Der Road, Taichung City, 40447, Taiwan.
BMC Ophthalmol. 2021 May 25;21(1):232. doi: 10.1186/s12886-021-01990-8.
Deprivation amblyopia is a great concern in hyperplastic persistent pupillary membranes (PPM) which blocked visual axis. Other ocular abnormality may accompany and further hinder the visual development of the infants. We evaluate the long-term visual prognosis and complications in patients with dense PPM and other associated abnormalities treated with early surgical intervention and timely visual rehabilitation.
Medical records of patients with surgical removal of PPM from 2000 to 2020 and also receiving visual rehabilitation were retrospectively reviewed. Besides visual axis blocked PPM, patients combined with other amblyopic risk factors or ocular abnormalities were included. Due to preparation for subsequent lens extraction if an underlying cataract was present, the surgical settings including the instruments and wound direction were similar to cataract surgery. All patients were enrolled in a visual rehabilitation program as soon as possible. The results including sex, age, timing of operation, initial and final visual acuity, refractive errors, and complications were recorded.
Seven cases of five patients were included in this case series. Mean age at surgery was 42.3 ± 21.1 months (range, 5 to 66 months) and the post-operative follow-up period was 4.9 years (range, 1.2 to 8.2 years). The patient age at time of surgery ranged from 2.5 months to 2.5 years (mean, 14 months). Mean postoperative follow-up was 5.3 years (range, 2.5-8 years). There were no intra-operative and post-operative complications. Final BCVA varied with a mean value of 0.29 logMAR (range, 0 to 1 logMAR). An associated ocular abnormality of ametropia and strabismus led to the best visual prognosis.
In patients with PPM, there were no significant complications in any patient using our technique. The surgical settings are easier to handle and more familiar with pediatric surgeons. Besides deprivation with patching, early PPM intervention and timely visual rehabilitation achieve the best visual prognosis in patients associated with risk of ametropic and strabismic amblyopia.
This retrospective, interventional case series study was conducted at China Medical University Hospital between April 1, 2000 and April 31, 2020. (IRB number: CMUH109-REC2-069 ).
剥夺性弱视是增生性持续性瞳孔膜（PPM）遮挡视轴时的一个重大问题。其他眼部异常可能伴随出现，并进一步阻碍婴儿的视觉发育。我们评估早期手术干预和及时视觉康复治疗的致密PPM及其他相关异常患者的长期视觉预后和并发症。
回顾性分析2000年至2020年接受PPM手术切除并接受视觉康复治疗的患者的病历。除了视轴被遮挡的PPM外，还纳入了合并其他弱视危险因素或眼部异常的患者。如果存在潜在白内障，由于要为后续晶状体摘除做准备，手术设置（包括器械和伤口方向）与白内障手术相似。所有患者尽快纳入视觉康复计划。记录结果包括性别、年龄、手术时间、初始和最终视力、屈光不正和并发症。
本病例系列纳入了5例患者的7只眼。手术时的平均年龄为42.3±21.1个月（范围5至66个月），术后随访期为4.9年（范围1.2至8.2年）。手术时患者年龄范围为2.5个月至2.5岁（平均14个月）。平均术后随访时间为5.3年（范围2.5 - 8年）。无术中及术后并发症。最终最佳矫正视力（BCVA）有所不同，平均值为logMAR 0.29（范围0至logMAR 1）。屈光不正和斜视等相关眼部异常导致了最佳视觉预后。
在PPM患者中，使用我们的技术，任何患者均无明显并发症。手术设置更易于操作，儿科外科医生也更熟悉。除了遮盖剥夺外，早期PPM干预和及时视觉康复能使合并屈光不正性和斜视性弱视风险的患者获得最佳视觉预后。
本回顾性、干预性病例系列研究于2000年4月1日至2020年4月31日在中国医科大学医院进行。（伦理审查委员会编号：CMUH109 - REC2 - 069）
