Window within the web: Bilateral florid persistent pupillary membranes

A 14-year-old boy was found to have bilateral persistent pupillary membranes with best-corrected visual acuity of 6/6 in both eyes. (A, B) Diffuse slit-lamp photographs of the right and left eyes show extensive pigmented pupillary membrane strands arising from the iris collarette and interlacing across the pupillary apertures, producing a dense web-like configuration with multiple irregular fenestrations. (C, D) Retroillumination sharply delineates the membrane architecture against the red reflex, revealing residual optical windows, including clear openings along the visual axis. Despite the florid appearance of the membranes, preservation of these central optical windows likely accounts for the excellent visual acuity. The panels highlight a striking anatomy-function dissociation in which a dense pupillary web retains sufficient optical windows for excellent vision.