[Clinical recognition of congenital pupillary membranes]

Congenital pupillary membranes, as common developmental anomalies of the anterior segment, primarily include persistent pupillary membrane (PPM) and anterior-anterior type of persistent fetal vasculature (AAPFV). Although both manifest as residual membranous tissue in the pupillary area, they differ significantly in embryonic origin and clinical characteristics. PPM arises from incomplete regression of the embryonic pupillary membrane, presenting as non-progressive filamentous or web-like tissue with iris coloration. In contrast, AAPFV is associated with abnormal regression of the primitive hyaloid vascular system, characterized by progressive white fibrovascular membranes that may lead to secondary glaucoma and deprivation amblyopia, thus necessitating early surgical intervention. This article systematically elucidates the core distinctions between these two pupillary membranes in terms of clinical presentation, disease progression, and management strategies, emphasizing the need for ophthalmologists to improve diagnostic recognition to prevent misdiagnosis and inappropriate management.