Outcome of surgical excision and histopathologcial features of cyclitc membranes in children

Abstract

Purpose: To examine the outcome of surgical excision of cyclitc membranes and describe their histopathological features in a series of children.

Methods: This is a retrospective case review of 6 consecutive children that underwent surgical excision of cyclitic membranes and had a minimum follow up of 6 months. The indications for surgery included recurrent corneal graft rejection (n=2), chronic anterior uveitis after intraocular lens implantation (n=2) and recurrent retinal detachment (n=2). All patients were either pseudophakic (n=4) or aphakic (n=2) and had had penetrating keratoplasty procedure (n=5), pars plana vitrectomy for retinal reattachment (n=3) or removal of vitreous haemorrhage (n=1), silicone oil injection (n=2) and trabeculotomy or trabeculectomy (n=4). Excision of the cyclitic membrane was carried out through anterior and pars plana dissection of the membrane in association with or following anterior or posterior vitrectomy or removal of silicone oil. The outcome of interest was the change in intraocular pressure (IOP), visual acuity (VA) and the results of histopathological examination of the excised membranes.

Results: The mean age was 8.7 years (5 to 14 years). Preoperative median IOP was 7.4 mmHg (0 to 12 mmHg) and mode VA was PL (PL to 20/300). After a median follow-up of 12 months (6 to 24 months) the median IOP was 16.4 mmHg (10 to 25.7 mmHg) and mode VA was HM (PL to 20/300). VA was stable in 4 patients, improved (from PL to 20/400) in 1 patient and worsened (from CF to PL) in 1 patient. Causes of poor visual acuity included chronic retinal detachment under silicone oil with extensive proliferative vitreoretinopathy (n=1), corneal graft failure or re-rejection with or without advanced glaucomatous optic neuropathy (n=2). Histopathological examination showed an abundance of fibrous tissue with variable lymphocytic and macrophage cellular infiltration and pigmentation.

Conclusions: In children, cyclitic membranes seem to represent a fibrotic response resulting from chronic inflammation and multiple intraocular surgery. Despite the small number, this study suggests that surgical excision should be considered in children with cyclitic membranes as it appears to help the restoration of IOP and therefore preservation of the eye. It may also assist visual recovery at least in some cases.

Keywords: 762 vitreoretinal surgery • 455 ciliary body • 557 inflammation