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PHOTO ESSAY
Year : 2019  |  Volume : 67  |  Issue : 1  |  Page : 122-123

Ultrasound biomicroscopic appearance of accessory iris membrane


Advanced Eye Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India

Date of Submission15-Jun-2018
Date of Acceptance21-Aug-2018
Date of Web Publication21-Dec-2018

Correspondence Address:
Dr. Surinder Singh Pandav
Advanced Eye Centre, Postgraduate Institute of Medical Education and Research, Chandigarh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijo.IJO_927_18

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  Abstract 


Keywords: Accessory iris membrane, iris, ultrasound biomicroscopy


How to cite this article:
Seth NG, Kashyap H, Jurangal A, Pandav SS. Ultrasound biomicroscopic appearance of accessory iris membrane. Indian J Ophthalmol 2019;67:122-3

How to cite this URL:
Seth NG, Kashyap H, Jurangal A, Pandav SS. Ultrasound biomicroscopic appearance of accessory iris membrane. Indian J Ophthalmol [serial online] 2019 [cited 2019 Jan 17];67:122-3. Available from: http://www.ijo.in/text.asp?2019/67/1/122/248179




  Case Report Top


A 14-year-old boy presented with a rare entity known as “accessory iris membrane” (AIM). He had unaided visual acuity of 6/18 (Snellen). [Figure 1]a shows accessory iris tissue of the same texture, connected to the collarette with a small pseudopupil. [Figure 1]b shows the pupil through gaps in the accessory membrane after dilatation of the pupil. The ultrasound biomicroscopy appearance (UBM) shows continuation of this membrane with anterior stromal layers of iris [Figure 1]c and [Figure 1]d. The other eye was normal except for dilated nonreactive pupil. The parents gave history of some surgery in the left eye 1 year back. The child was advised pupilloplasty for the right eye but the parents refused.
Figure 1: (a) Clinical photograph showing accessory iris membrane, connected to the collarette with thick strands and obscuring the pupil. There is a small “pseudopupil” in the center. (b) The pupil and the anterior lens surface, as seen through gaps in the accessory membrane after dilatation of the pupil. The ultrasound biomicroscopy, before (c) and after (d) dilatation of the pupil, showing the origin of the membrane from the superficial layers of iris and obscuring the pupil

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  Discussion Top


The AIM is an entity distinct from persistent pupillary membrane (PPM), in which strands of iris arise from the collarette, resulting from excessive anomalous stromal hyperplasia.[1] In fetal life, the superficial mesoderm of iris undergoes resorption, but it rarely gets hypertrophied forming anterior accessory layer of iris, referred as “iris duplication.”[2] It resembles the normal iris in thickness and color. On the other hand, PPM is seen as fine strands, stretching across the pupil, which represents the remnants of anterior tunica vasculosa lentis.[3] It may be unilateral or bilateral, while AIM is usually bilateral. AIM can present with a second virtual pseudopupil with no muscular activity, while there is no pseudopupil in PPM. Since pupil diameter of 1.5 mm is usually required for retinal image formation, this entity is rarely associated with dense amblyopia.[4] Duke-Elder[5] has referred to it as hyperplasia of anterior stromal layer of iris which has also been proven in histopathological studies.


  Conclusion Top


To date, UBM presentation of accessory iris membrane not been reported in the literature. The UBM of our patient classically highlights the origin of this AIM from the superficial stroma of iris.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Gavriş M, Horge I, Avram E, Belicioiu R, Olteanu IA, Kedves H, et al. Persistent pupillary membrane or accessory iris membrane? Rom J Ophthalmol 2015;59:184-7.  Back to cited text no. 1
    
2.
Bhatti SM, Kapoor HK. Bilateral accessory iris membrane. Indian J Ophthalmol 1998;46:110-1.  Back to cited text no. 2
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3.
Trattler WB, Keiser P, Friedman NJ. Review of Ophthalmology. 2nd ed. Philadelphia,.PA: Elsevier Inc.; 2012. p. 105-278.  Back to cited text no. 3
    
4.
Miller D, Johnson R. Quantification of the stenopeic effect. Surv Ophthalmol 1977;21:347-50.  Back to cited text no. 4
    
5.
Duke-Elder S. System of Ophthalmology. 1st ed., Vol. 3. London: Henry Kimpton; 1964. p. 587-775.  Back to cited text no. 5
    


    Figures

  [Figure 1]



 

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