An asymptomatic 16-year-old male presented with a complaint of an intraocular whitish lesion in the left eye noticed incidentally for 1 year that appeared to be a foreign body. However, there was no history of past trauma. On examination, his visual acuity was 6/6, intraocular pressures and fundus were normal in both eyes with no evidence of uveitis in either eye. On gross examination, it appeared to be an opaque foreign body over the left inferior iris [Figure 1a]. On higher magnification on slit-lamp biomicroscopy, it was seen attached to thick iris strands arising from collarette [[Figure 1b]; arrow] and showed dynamicity on ocular movements. On high-resolution anterior segment optical coherence tomography (Spectralis, Heidelberg, Germany), it was confirmed to be attached to the iris strands arising from the iris stroma and was partially cystic [Figure 1c]. Due to these characteristics, the lesion was finally diagnosed as regressed “persistent pupillary membrane,” and the patient was advised against intervention. Classically described as thin white cobweb-like strands over the pupil, it is composed of fibrovascular tissue.[1,2] Failure of involution of primitive hyaloid vasculature may result in its persistence, which is usually innocuous.[3,4] Although cysts arising from the pigmented iris epithelium have been shown to wobble with ocular movements and have also been shown to be free-floating sometimes, demonstration of dynamicity on ocular movement [Video 1] in this type of persistent membrane has not been described before.[5]
Figure 1.
(a) slit-lamp clinical picture showing foreign body-like structure (white fibrotic lesion) in the anterior chamber, attached to iris strands (b, white arrow) arising from the collerette. Furthermore, the white fibrotic lesion had dispersed brown pigmentation akin to that of the iris, suggesting a common origin. (c) Anterior segment optical coherence tomography confirming its attachment to the iris strands arising from the iris stroma (white arrow)
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The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient has given his consent for his images and other clinical information to be reported in the journal. The patient understands that his name and initials will not be published and due efforts will be made to conceal identity, but anonymity cannot be guaranteed.
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