Kerala Journal of Ophthalmology

OPHTHA INSTA
Year
: 2022  |  Volume : 34  |  Issue : 1  |  Page : 19--20

Dense fibrin membrane mimicking anterior dislocated lens


Shivraj Tagare1, Harsh Vardhan Singh2, Iva Rani Kalita3,  
1 DNB Resident, Aravind Eye Hospital, Puducherry, India
2 Department of Retina-Vitreous, Aravind Eye Hospital, Puducherry, India
3 Department of Paediatrics and Strabismus, Aravind Eye Hospital, Puducherry, India

Correspondence Address:
Dr. Iva Rani Kalita
Department of Paediatric and Strabismus, Aravind Eye Hospital, Puducherry - 605 007
India




How to cite this article:
Tagare S, Singh HV, Kalita IR. Dense fibrin membrane mimicking anterior dislocated lens.Kerala J Ophthalmol 2022;34:19-20


How to cite this URL:
Tagare S, Singh HV, Kalita IR. Dense fibrin membrane mimicking anterior dislocated lens. Kerala J Ophthalmol [serial online] 2022 [cited 2022 Jun 28 ];34:19-20
Available from: http://www.kjophthal.com/text.asp?2022/34/1/19/343666


Full Text



A 40-year-old male diagnosed case of right eye uveitic glaucoma presented with flare-up. Slit lamp examination gave a first impression of anterior dislocated cataractous lens [Figure 1]a. However, after dilatation, on careful examination, lens was found to be in its normal anatomical position with dense fibrin membrane anterior to it, mimicking the crystalline lens [Figure 1]b. B-scan of the concerned eye showed lens in normal position but vitreous membrane in the posterior segment. The patient was started on oral prednisolone and topical dexamethasone in tapering dose. Along with these antiglaucoma medications, topical antibiotic and topical cycloplegics were given.{Figure 1}

 Clinical Sign/Finding: Dense Fibrin Membrane/Fibrinoid Syndrome



Seen in

Dense pupillary fibrin membranes are found following intraocular surgeries[1],[2]Fibrinoid syndrome is found in proliferative diabetic retinopathy (PDR) patients following vitreoretinal surgeries.[3]

Described by

“Fibrinoid syndrome” was first described by Sebestyen in 1982 for patients with PDR and those who developed dense retropupillary/vitreous fibrin bands after undergoing multiple surgical procedures for diabetic-related complications.[3]

 Cardinal Diagnostic Features



It occurs most commonly in patients undergoing pars plana vitrectomy for diabetic tractional detachments or patients with chronic retinal detachment. But has also been reported in patients undergoing cataract surgery with certain predisposing factors such as uveitis, glaucoma, or PES.[2],[4]

It presents as dense fibrin reaction commonly occurring either anterior or posterior to iris with most of the time having a history ocular surgery done 1–2 weeks before development of fibrinoid reaction.

 Pathophysiology



Although the exact pathophysiology of fibrinoid syndrome is unclear, the common proposed mechanisms include endothelial dysfunction and increased vascular permeability because of underlying inflammation.[3] Idiosyncratic reaction, or sterile, and noninfectious reactions to intravitreal medications and pharmacologic alteration of blood–brain barrier have also been proposed.[5],[6],[7] In our patient, the flare-up of anterior uveitis may have contributed to the development of fibrinoid/fibrinous-like reaction.

What else to examine (associated clinical signs – ocular or systemic): It is important to differentiate this syndrome from toxic anterior segment syndrome and endophthalmitis and to initiate appropriate treatment. The fibrin bands tend to be exquisitely sensitive to topical steroids and resolves within few weeks of treatment initiation without any sequelae.

The signs of fibrin or fibrinoid reaction can range from the presence of a few fibrin strands to a dense pupillary membrane in the anterior chamber[2]It is most commonly associated with diabetes, pseudoexfoliation, glaucoma, and extracapsular cataract extraction.[8]

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient has given his consent for his images and other clinical information to be reported in the journal. The patient understands that his name 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

1Heiligenhaus A, Schilling H, Schilling M, Mellin KB. Treatment with tissue plasminogen activator (tPA) in risk patients with fibrin reactions after cataract operations. Ophthalmologe 1996;93:49-53.
2Wålinder PE, Olivius EO, Nordell SI, Thorburn WE. Fibrinoid reaction after extracapsular cataract extraction and relationship to exfoliation syndrome. J Cataract Refract Surg 1989;15:526-30.
3Sebestyen JG. Fibrinoid syndrome: A severe complication of vitrectomy surgery in diabetics. Ann Ophthalmol 1982;14:853-6.
4Petraevsky AV, Gndoyan IA, Kushtareva LB. Prediction of operational complications based on assessment neurocirculatory and trophic changes in the anterior segment of the eye with pseudoexfoliation syndrome. Ophthalmosurgery 2009;1:9-13.
5Chiang A, Reddy S, Tsui I, Hubschman JP. Vitreous web after pars plana vitrectomy and bevacizumab with fluid-air exchange. Semin Ophthalmol 2011;26:25-7.
6Jabbur NS. Excessive fibrin after cataract surgery associated with aminocaproic acid use. J Cataract Refract Surg 2003;29:1636-7.
7Miyake K, Miyake Y, Maekubo K. Increased aqueous flare as a result of a therapeutic dose of mannitol in humans. Graefes Arch Clin Exp Ophthalmol 1992;230:115-8.
8Baltatzis S, Georgopoulos G, Theodossiadis P. Fibrin reaction after extracapsular cataract extraction: A statistical evaluation. Eur J Ophthalmol 1993;3:95-7.