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ABSTRACT
Extensive persistent pupillary membranes which occlude the pupil may occur in isolation or in association with other ocular anomalies. Amblyopia may result if the membranes are extensive. We favor nonsurgical intervention except if unusual circumstances are present as demonstrated in one of our two cases.
INTRODUCTION
Persistent pupillary membranes (PPM) are congenital membranes often present in the newborn. They disappear during the 1st year of Ufe but remnants of the membranes have been reported to be detectable in 30% to 95% of healthy, normally-sighted adults.1 Remnant structures vary from a few nonpigmented threads, which are probably vestiges of precursor vessels, to a thick membrane covering the entire pupil.2'5 The latter condition has been called variously hyperplastic persistent pupillary membrane, enlarged pupillary membranes, or hyperplasia of the iris;2·6'7 it may occur in isolation or in association with other ocular anomalies including cataracts, microphthalmos, and strabismus.3'4'6'11 PPM is distinguished UOm congenital idiopathic microcoria, in which there is no distinct membrane attached to the collarette. We advocate nonsurgical intervention unless unusual circumstances are present as demonstrated in one of our two cases.
CASE REPORTS
Case 1. In 1976, a 12-year-old Palestinian girl of nonconsanguineous parents was seen at the St John Ophthalmic Hospital in Jerusalem. The parents felt that her eyes were cosmetically unacceptable, as their appearance was likely to reduce her marriage prospects (Fig 1). There was no relevant family history of ocular or other disease. The mother's pregnancy had been unremarkable, as was the perinatal period. The patient's visual capabilities were adequate enough to allow her to attend a mainstream state school.
She was an intelligent young girl with no systemic deformities. Ophthalmic assessment gave best corrected visual acuities of 6/18 bilaterally. Extensive bilateral pupillary membranes were conspicuously evident (Figs 2-3). The membranes in the right (Fig 2) and left (Fig 3) eyes were not complete. There were holes in some areas but no red reflex was present; however, with pupillary dilation, some normal retina could be seen in each eye. The intraocular pressures were normal as was ocular motility. There were no posterior synechiae or cataracts.
Both the patient and her parents were very eager for the membranes to be surgically removed. It was emphasized to them that surgery was unlikely to...