Abstract
INTRODUCTION: Idiopathic tractional corectopia (ITC) is a rare congenital anomaly affecting the pupil's position and shape. In the literature, there are isolated cases of surgical treatment for ITC, which caused visual axis obstruction. CASE PRESENTATION: А 1-year-old child complained of low vision in the left eye and was diagnosed with ITC, microcoria, discoria, persistent pupillary membrane (PPM), anterior embryotoxon, and microphthalmos. Surgical removal of PPM with anterior embryotoxin was performed, restoring the pupil's size, position, and shape. Lens transparency was preserved. The anatomical structure of the anterior eye was restored. Postoperatively, the child received local/generalanti-inflammatory therapy and pupil massage. IOP remained normal, and VA improved to 0.13 Teller's cards (0.9 logMAR). At 12 months after surgery, stable optical and cosmetic results were observed with VA increased to 0.2 Teller's cards (0.7 logMAR). CLINICAL DISCUSSION: ITC is combined with PPM, usually unilateral, and can progress, leading to visual axis obstruction and amblyopia development. Various treatments have been proposed, involving PPM strand dissection and pupil sphincterotomy, which can cause complications such as loss of pupil shape and ability to dilate evenly, resulting in a cosmetic defect. The newly developed surgical technique helps prevent these complications. CONCLUSION: The case demonstrates the restoration of pupil position, size, shape, and function in ITC, achieved by atraumatic PPM removal as opposed to sphincterotomy. Preservation of lens transparency and accommodative ability improved VA and prevented amblyopia development. For the first time, surgical anterior embryotoxon removal without complications for the cornea, iris, and anterior chamber angle was described.