Bilateral dense persistent pupillary membrane in an 8-year-old – A case report of successful surgical excision and visual recovery

Persistent pupillary membrane (PPM) is a common congenital remnant of the anterior tunica vasculosa lentis and is usually clinically insignificant. Dense PPM causing visual impairment beyond early childhood is rare. We report an 8-year-old girl who presented with a 5-month history of bilateral blurred vision affecting school performance. Ocular examination revealed bilateral dense, pigmented pupillary membranes almost completely occluding the pupillary apertures with clear corneas, normal lenses, and no associated ocular or systemic abnormalities. Visual acuity was reduced in both eyes and did not improve with refraction. Due to significant visual axis obstruction, bilateral surgical excision of the membranes was performed under general anesthesia using a two-port limbal approach with viscoelastic support and vitrectomy scissors. The procedure was uneventful. Postoperatively, visual acuity markedly improved with best-corrected vision of 6/6 bilaterally. Slit-lamp examination demonstrated clear visual axes, round pupils, and no residual iris strands. Bilaterally, the lenses remained clear. This case demonstrates that dense, bilateral PPM persisting into late childhood can be safely and effectively treated surgically, resulting in excellent visual recovery. Timely recognition and intervention are essential to restore the visual axis and optimize visual outcomes, even beyond the typical amblyogenic period.