The patient was a 4-year-old male, admitted for poor visual acuity and severe photophobia. Two years prior, the patient received vitreoretinal surgery on his right eye because of an 'unknown disease' at another hospital. His right eye had a visual acuity of NLP, pupillary seclusion, band keratopathy and a funnel retinal detachment revealed by echographic scans. His left eye (fig. 1) had a visual acuity of CF at 1 foot, minimal band keratopathy, posterior synechiae, cataract and the following echographic findings: abundant vitreous opacities and increased chorioretinal thickness (1.6 mm). Complete medical and laboratory assessments were performed to determine the presence of infectious and immunological diseases such as toxoplasmosis, toxocariasis, Lyme disease, sarcoidosis, syphilis, tuberculosis, HIV, juvenile rheumatoid arthritis and multiple sclerosis. All of them were negative and no infectious or immunological pathologies were found. On the basis of clinical and echographic findings and those diseases discarded, the patient was diagnosed with PP.
Anti-inflammatory and immunosuppressive therapies such as topical prednisolone and nepafenac as well as oral methotrexate and deflazacort were provided in order to control the inflammation. The patient then returned for multiple clinical and echographical follow-ups. Four months after the initial diagnosis, the inflammation was clinically and echographically controlled in terms of anterior chamber reaction and vitreous opacities, and the medical team, with the consent of the family, decided to perform surgery. Taking his medical history, literature, uveitis and anterior segment services experience into account, a slow-motion phacoemulsification with iris-retractors (fig. 2a) was performed after removing the anterior inflammatory membrane attached to the anterior capsule (fig. 2b). A challenging surprise appeared after the cataract was removed: an opaque-vascular retrolental membrane attached to the posterior capsule (fig. 2c). The membrane vasculature was cauterized with diathermy (fig. 2d) and primary posterior capsulotomy and membranectomy were performed, followed by a limited anterior vitrectomy (fig. 2e). A hydrophobic acrylic one-piece IOL was chosen because of its folding ability, a successful in-the-bag implantation and its uveal compatibility (fig. 2f). In addition to postoperative antibiotics, anti-inflammatory and immunosuppressive medication was continued (topical prednisolone and nepafenac, and oral methotrexate and deflazacort) and periocular betamethasone was injected three days before surgery to avoid postoperative inflammatory complications. The patient had close monitoring with clinical (fig. 3) and echographical evaluations after surgery. His visual acuity improved to no more than 20/200 three months after the surgery due to the presence of cystoid macular edema. Macular OCT was impossible to get because of the patient's poor cooperation. The patient continues with clinical evaluations, anti-inflammatory and immunosuppressive management (nepafenac, deflazacort and methotrexate) and has required control from ocular hypertension.