Edit an article: Aniridic Fibrosis Syndrome

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= Disease Entity = Aniridic fibrosis syndrome is a rare complication of intraocular surgery (especially after cataract surgery with intraocular lens implantation) that can occur in patients with congenital aniridia. It is characterized by a fibrotic membrane that originates at the rudimentary iris root and can extend over the intraocular lens (IOL), ciliary body, and anterior retina<ref name=":0">Tsai JH, Freeman JM, Chan CC, et al. A progressive anterior fibrosis syndrome in patients with postsurgical congenital aniridia. ''Am J Ophthalmol''. 2005. doi:10.1016/j.ajo.2005.07.035</ref><ref name=":1">Kothari M, Rao K, Moolani S. Recurrent progressive anterior segment fibrosis syndrome following a descemet-stripping endothelial keratoplasty in an infant with congenital aniridia. ''Indian J Ophthalmol''. 2014. doi:10.4103/0301-4738.128635</ref><ref name=":2">Bakhtiari P, Chan C, Welder JD, De La Cruz J, Holland EJ, Djalilian AR. Surgical and visual outcomes of the type i Boston Keratoprosthesis for the management of aniridic fibrosis syndrome in congenital aniridia. ''Am J Ophthalmol''. 2012. doi:10.1016/j.ajo.2011.10.027</ref>. == Etiology == The etiology of aniridic fibrosis syndrome is unknown. All cases have been reported in patients with congenital aniridia who have undergone intraocular surgery<ref name=":0" /><ref name=":1" /><ref name=":2" />. == Risk Factors == Risk factors for aniridic fibrosis syndrome are unestablished. However, 88% of reported cases have been female, and all have undergone intraocular surgeries. The large majority of affected patients have had cataract extraction with IOL insertion. Many patients also have other intraocular hardware including glaucoma drainage implants<ref name=":0" /><ref name=":1" /><ref name=":2" />. == Primary prevention == Patients with congenital aniridia frequently have poor baseline visual acuity, and often must undergo multiple ocular procedures to address sequela of their underlying condition. However, as cases are associated with multiple procedures and intraocular hardware, limiting intraocular devices or surgeries as appropriate may help to prevent this rare complication. = Diagnosis = Diagnosis of aniridic fibrosis syndrome is made by clinical observation in patients with congenital aniridia and previous intraocular surgery == History == The chief complaint in patients with aniridic fibrosis syndrome is a decrease in visual acuity from baseline. The process is painless and gradual. Observant individuals may notice the membrane in more advanced disease<ref name=":0" /><ref name=":1" /><ref name=":2" />. == Physical examination == On slit lamp examination a fibrous membrane should be observed originating at the iris root and affecting the IOL if present. If left untreated, or in presentations with late disease, the IOL may be pulled forward into contact with the cornea. Additionally, the membrane may extend to cover the ciliary body and retina which may cause hypotony and retinal detachment respectively. Finally, endothelial decompensation may be present<ref name=":0" />. == Differential diagnosis == The differential for patients with aniridic fibrosis syndrome involves other causes of intraocular membranes, postsurgical inflammatory response, and associated sequela of the underlying aniridia<ref name=":0" /><ref name=":2" /><ref>Pavilack MA, Foster CS, Kowal VO, Dutt JE, Albert DM. Peripseudophakic Membrane: Pathologic Features. ''Arch Ophthalmol''. 1993. doi:10.1001/archopht.1993.01090020094031</ref>. = Management = == Surgery == Early surgical membranectomy via penetrating keratoplasty is recommended to prevent further membrane growth and destruction. As recurrence of this postsurgical complication has only been noted in patients who underwent membranectomy and IOL exchange, IOL membranectomy and IOL explantation may help to prevent recurrence<ref name=":0" />. The Boston KPro type 1 has not been associated with recurrence<ref name=":2" /> and may be a viable treatment option. Surgical follow up is necessary to assess for recurrence. == Prognosis == Early surgical intervention may allow patients to return to, or close to, their baseline visual acuity<ref name=":2" /> = References = <references />
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