Photo Quiz

A young patient came for a routine eye examination. Slit-lamp examination demonstrated the anterior segment as shown in Figure 1. The patient gave a history of the presence of these findings, as demonstrated in Figure 1, since birth. The patient did not have a history of eye redness, eye pain, or photophoia in the past. He had no history of joint pain or any other systemic illness.Figure 1: Bilateral persistent pupillary membraneQuestion 1: Identify the clinical entity present in both eyes. Posterior Synechiae Persistent Pupillary Membrane Ectropion Uvea Spherophakia Answer: B. Question 2: Which among the following are the treatment modalities for the mentioned condition? Nd: YAG laser iridectomy Nd: YAG laser membranectomy Topical steroid medication None of the above Answer: B. Question 3: The mentioned condition is Always bilateral Always unilateral Can be unilateral or bilateral None of the above Answer: C DISCUSSION Persistent pupillary membrane (PPM) is a congenital anomaly that represents remnants of the anterior tunica vasculosa lentis. Embryologically, the iris forms as a sheet of tissue derived from the mesoderm, also known as the pupillary membrane.[1] The pupillary membrane is composed of vessels derived from mesenchyme and anterior ciliary arteries. In the sixth month of gestation, the pupillary membrane undergoes regression due to phagocytosis by macrophages and disappears completely by the eighth month of gestation.[2] Failure of this resorption of the pupillary membrane leads to PPM. The differential diagnosis of PPM includes congenital idiopathic microcoria and accessory iris membrane (AIM). Congenital idiopathic microcoria results from underdevelopment of the dilator pupillae.[3] A differentiating feature includes the iris tissue connected to the collarette in the case of PPM. AIM is always bilateral, whereas PPM can be unilateral or bilateral. Patients with PPM are generally asymptomatic. PPM does not cause significant visual complaints; hence, it can go undetected. Pupillary apertures of less than 1.5 mm may affect visual acuity due to decreased retinal illumination and diffraction. Management of PPM depends on the size of the pupillary opening and extent of the membrane. Small PPM is managed conservatively. Other treatment modalities include mydriatics, refractive correction, and patching for amblyopia. Nd: YAG laser membranectomy, for removing membrane, has also been found to be an effective treatment option. However, hyphema has been found to be a complication following the procedure due to the presence of blood vessels and photodisruption of these membranes. It also carries the risk of cataract formation, iritis, and pigment dispersion.[4] Surgical excision of the membrane is another treatment modality but is associated with various complication, including intraocular infection, intraocular bleeding, and the risk of cataract formation. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.