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Ozdemir Zeydanli E, Ozdek S. Persistent Fetal Vasculature: Current Insights and Future Directions. Semin Ophthalmol 2024; 39:599-609. [PMID: 38628063 DOI: 10.1080/08820538.2024.2344026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Revised: 03/21/2024] [Accepted: 03/31/2024] [Indexed: 10/19/2024]
Abstract
BACKGROUND AND PURPOSE Persistent fetal vasculature (PFV) is a complex congenital ocular condition, characterized by the incomplete regression of the embryonic hyaloid system. It encompasses a spectrum of abnormalities, affecting various ocular structures and presenting a range of fetal hyaloid remnants. Despite its long-standing recognition, the full extent of PFV's manifestations continues to evolve, unveiling novel findings, primarily driven by advancements in clinical experience and imaging techniques. This review focuses on the evolution of PFV management, emphasizing the disease heterogeneity and the consequent challenges in diagnosis and treatment. METHODS We present a comprehensive guide on PFV based on the current evidence, detailing its recognition, associated anatomical variations, the intricacies of surgical indications and techniques, and postoperative expectations. CONCLUSION The progress over the last decade in innovative instruments and surgical techniques has not only enhanced functional and anatomical outcomes but also enriched our understanding of PFV. However, continued exploration and research remain pivotal for future breakthroughs in more effectively understanding and managing this complex ocular anomaly.
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Affiliation(s)
| | - Sengul Ozdek
- Department of Ophthalmology, Gazi University School of Medicine, Ankara, Turkey
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Chapron T, Abdelmassih Y, de Saint Sauveur G, Metge F, Caputo G. Lens-Sparing Surgery for Retrolental Stalk in Persistent Fetal Vasculature. Am J Ophthalmol 2023; 255:1-6. [PMID: 37433352 DOI: 10.1016/j.ajo.2023.06.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 06/18/2023] [Accepted: 06/19/2023] [Indexed: 07/13/2023]
Abstract
PURPOSE To describe a new surgical technique and outcomes of lens-sparing vitrectomy and retrolental stalk dissection in posterior persistent fetal vasculature (PFV). DESIGN Retrospective interventional case series. METHODS RESULTS: Among the 21 included eyes, 8 (38%) had no macular involvement and 4 (19%) presented with microphthalmia. Median age at the first surgery was 8 months (range: 1-113 months). Surgical success was obtained in 71.4% of cases (15 of 21). In the remaining cases, the lens was removed because of capsular rupture in 2 cases (9.5%) and a large capsular opacity after stalk removal or an adherent stalk impossible to dissect in 4 cases (19.1%). In the capsular bag, IOL implantation was accomplished for all but 1 eye. None of the eyes developed retinal detachment or required glaucoma surgery. Endophthalmitis occurred in 1 eye. Secondary lens aspiration was needed in 3 eyes after a mean interval of 10.7 months following initial surgery. At last follow-up, half of the eyes remained phakic. CONCLUSION Lens-sparing vitrectomy is a useful approach to addressing the retrolental stalk in selected cases of persistent fetal vasculature syndrome. By delaying or avoiding lens extraction, this approach allows preservation of accommodation, reduction of the risk of aphakia, glaucoma, and development of secondary lens reproliferation.
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Affiliation(s)
- Thibaut Chapron
- From the Pediatric Ophthalmology Department, Rothschild Foundation Hospital (T.C., Y.A., G.d.S.S., F.M., G.C.); Université Paris Cité, CRESS, Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, INSERM, INRAE (T.C.), Paris, France.
| | - Youssef Abdelmassih
- From the Pediatric Ophthalmology Department, Rothschild Foundation Hospital (T.C., Y.A., G.d.S.S., F.M., G.C.)
| | - Guy de Saint Sauveur
- From the Pediatric Ophthalmology Department, Rothschild Foundation Hospital (T.C., Y.A., G.d.S.S., F.M., G.C.)
| | - Florence Metge
- From the Pediatric Ophthalmology Department, Rothschild Foundation Hospital (T.C., Y.A., G.d.S.S., F.M., G.C.)
| | - Georges Caputo
- From the Pediatric Ophthalmology Department, Rothschild Foundation Hospital (T.C., Y.A., G.d.S.S., F.M., G.C.)
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Viscodelamination of Localized Retrolental Plaques During Lens-Sparing Vitrectomy in Eyes With Pediatric Tractional Vitreoretinopathy. Retina 2023; 43:523-528. [PMID: 32516225 PMCID: PMC9935560 DOI: 10.1097/iae.0000000000002834] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE To report viscodelamination of localized retrolental plaques during lens-sparing vitrectomy in eyes with pediatric tractional vitreoretinopathy. METHODS Viscodelamination of retrolental plaques was performed during 23-gauge lens-sparing vitrectomy in 11 eyes from 11 children with a median age (range) of 12 (4-58) months. There were five eyes with Stage 4 familial exudative vitreoretinopathy, one eye with Stage 4B retinopathy of prematurity, and five eyes with anterior-posterior persistent fetal vasculature syndrome. Retrolental plaques were separated from the posterior lens capsule by the tension of viscoelastic injection in the Berger's space. RESULTS In 10 of 11 eyes, retrolental plaques were removed from posterior surface of lens without capsular tearing. During the 12-month to 18-month follow-up period, lens clarity along the visual axis was retained in 5 eyes with familial exudative vitreoretinopathy, one eye with retinopathy of prematurity, and 2 of 5 eyes with persistent fetal vasculature. Atraumatic viscodelamination was associated with retrolental plaques that did not incorporate into the posterior lens capsule. Retinal dragging was reversed in all 11 eyes. CONCLUSION Viscodelamination may be effective for the dissection of retrolental plaques related to pediatric vitreoretinopathy in selected cases.
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Khandwala N, Besirli C, Bohnsack BL. Outcomes and surgical management of persistent fetal vasculature. BMJ Open Ophthalmol 2021; 6:e000656. [PMID: 34013048 PMCID: PMC8094357 DOI: 10.1136/bmjophth-2020-000656] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 03/13/2021] [Accepted: 04/16/2021] [Indexed: 11/11/2022] Open
Abstract
Objective To analyse outcomes in different forms of persistent fetal vasculature (PFV). Methods and analysis Retrospective cohort study at a university-based practice of children presenting with PFV between 2011 and 2020. Exclusion criteria was surgical management outside of our institution and follow-up less than 1 month. Wilcoxon and Student’s t-tests were used for statistical analysis. Results Forty-six eyes of 45 patients presented with PFV at 16.7±31.3 (median 2.8) months old with 32.6±29.8 (median 22.5) months of follow-up. Types of PFV included: mild combined anterior-posterior (23 eyes, 50%), severe combined anterior-posterior (18 eyes, 39%), severe anterior (3 eyes, 7%), mild anterior (1 eye, 2%) and posterior (1 eye, 2%). Thirty-two eyes (70%) underwent PFV surgical correction; lensectomy (13 mild combined), vitrectomy (3 mild combined), sequential lensectomy then vitrectomy (3 severe combined), combined lensectomy-vitrectomy (11 severe anterior or severe combined), laser retinopexy (1 mild combined). Five eyes required additional vitrectomy surgery for retinal detachment, fold or cyclitic membrane. Nine eyes developed glaucoma, six requiring Intraocular pressure (IOP)-lowering surgery. At final follow-up, 32 eyes had at least form vision and 6 eyes were aversive to light. Eight eyes, all which were severe combined, and four that did not undergo PFV surgery, were unable to detect light due to phthisis bulbi (7) and optic nerve hypoplasia (1). Conclusions Classification of PFV is important in determining surgical approach with severe cases often requiring both lensectomy and vitrectomy for optimal anatomic and functional outcomes.
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Affiliation(s)
- Nikhila Khandwala
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, Michigan, USA
| | - Cagri Besirli
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, Michigan, USA
| | - Brenda L Bohnsack
- Ophthalmology and Visual Sciences, Ann and Robert H Lurie Children's Hospital of Chicago, Chicago, Illinois, USA.,Ophthalmology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
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Prakhunhungsit S, Berrocal AM. Diagnostic and Management Strategies in Patients with Persistent Fetal Vasculature: Current Insights. Clin Ophthalmol 2020; 14:4325-4335. [PMID: 33335385 PMCID: PMC7737165 DOI: 10.2147/opth.s236117] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Accepted: 10/30/2020] [Indexed: 11/30/2022] Open
Abstract
Persistent fetal vasculature (PFV), previously known as persistent hyperplastic primary vitreous, is a developmental malformation of the eyes that is caused by a failure of the hyaloid vasculature to regress in utero. PFV has been reported for decades; however, our understanding of the pathophysiology/pathogenesis of PFV, and the diagnostic and treatment modalities for PFV have evolved over time, and these advancements have improved diagnosis, treatment, and outcomes. However and in spite of these advancements, the heterogeneity of this disease continues to make PFV a diagnostic challenge. Here, we review what is currently known about various important aspects of PFV to update and enhance the knowledge of ophthalmologists who encounter and manage PFV in clinical practice.
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Affiliation(s)
- Supalert Prakhunhungsit
- Department of Ophthalmology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Audina M Berrocal
- Bascom Palmer Eye Institute, Miller School of Medicine, University of Miami, Miami, FL, USA
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SPECTRAL DOMAIN OPTICAL COHERENCE TOMOGRAPHY IMAGING OF THE MACULA AND VITREOMACULAR INTERFACE IN PERSISTENT FETAL VASCULATURE SYNDROME WITH POSTERIOR INVOLVEMENT. Retina 2020; 39:581-586. [PMID: 29252974 DOI: 10.1097/iae.0000000000001993] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To describe the microstructural features of the macula and vitreomacular interface in persistent fetal vasculature syndrome (PFVS) with posterior involvement managed with early vitrectomy or with observation, with functional correlation. METHODS We retrospectively identified 45 consecutive pediatric patients with PFVS with posterior involvement treated from 2005 to 2016. The eyes that could be imaged with spectral domain optical coherence tomography were included, and images were correlated with best-corrected visual acuity. RESULTS Thirty-eight imaging sessions were performed on 10 eyes from 9 patients, including 7 that had been managed with vitrectomy for PFVS-related tractional retinal detachment, and 3 that had been observed. Mean age of the patients who were imaged was 9.1 years and their average length of follow-up was 5.9 years. Best-corrected visual acuities of the eyes imaged ranged from 20/30 to count fingers, with mean best-corrected visual acuity 20/163. All eyes imaged had microstructural anomalies identified. The main anomalous features included posterior hyaloidal organization, vitreoretinal traction, vitreopapillary traction, diminished foveal contour, foveal displacement, and disruption of the ellipsoid zone. Posterior hyaloidal organization (P = 0.043), diminished foveal contour (P = 0.019), and disruption of the ellipsoid zone (P = 0.014) were associated with worse best-corrected visual acuity. CONCLUSION Macular and vitreomacular interface anomalies were identified in all pediatric patients with posterior PFVS imaged with spectral domain optical coherence tomography. These microstructural findings, together with functional measures, may inform the diagnosis and management of PFVS with posterior involvement.
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Gan NY, Lam WC. Retinal detachments in the pediatric population. Taiwan J Ophthalmol 2018; 8:222-236. [PMID: 30637194 PMCID: PMC6302562 DOI: 10.4103/tjo.tjo_104_18] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Accepted: 10/17/2018] [Indexed: 11/10/2022] Open
Abstract
In this review, we present a concise summary of the more commonly seen types of retinal detachments (RDs) that one can encounter in pediatric patients. A spectrum of diseases from rhegmatogenous RD in Stickler syndrome, Marfan syndrome, and choroidal coloboma to exudative RD in Coats disease, to tractional RD in persistent fetal vasculature, and combined RDs in familial exudative vitreoretinopathy are described with the management pearls for each.
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Affiliation(s)
- Nicola Yi'an Gan
- Department of Ophthalmology, Tan Tock Seng Hospital, National Healthcare Group, Singapore
| | - Wai-Ching Lam
- Department of Ophthalmology, The University of Hong Kong, Hong Kong
- Department of Ophthalmology and Vision Science, University of Toronto, Toronto, Ontario, Canada
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Liu JH, Lu H, Li SF, Jiao YH, Lin N, Liu NP. Outcomes of small gauge pars plicata vitrectomy for patients with persistent fetal vasculature: a report of 105 cases. Int J Ophthalmol 2017; 10:1851-1856. [PMID: 29259903 DOI: 10.18240/ijo.2017.12.10] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Accepted: 08/01/2017] [Indexed: 11/23/2022] Open
Abstract
AIM To evaluate the surgical outcomes in eyes with persistent fetal vasculatures (PFV) managed by small gauge pars plicata vitrectomy. METHODS Consecutive patients with PFV treated by small gauge pars plicata vitrectomy at Beijing Tongren Eye Center between January 2010 and January 2013 were retrospectively reviewed. RESULTS A total of 118 eyes of 105 patients with PFV were included and undergone small gauge pars plicata vitrectomy, of which 84 (71.2%) eyes had lensectomy and 16 (13.6%) eyes had lens aspiration and immediate intraocular lens implantation. The percentage of sutured scleral incision of 23 gauge vitrectomy (71.7%, 33/46) was higher than that of the 25 gauge vitrectomy (18.1%, 13/72). At last follow-up, visual acuity remained stable in 34 eyes (28.8%) and improved in 84 eyes (71.2%). Age at surgery (less than 2y), anterior type of PFV, and immediate IOL implantation were associated with postoperative improved visual acuity. Sixty five (55.1%) eyes had retinal detachment preoperatively, among which 33 (50.8%, 33/65) eyes had retinal reattachment or partial retinal reattachment. CONCLUSION The results suggest that cases with PFV have a potential for developing good visual acuity after small gauge pars plicata vitrectomy with favorable anatomic outcomes and acceptable rate of serious surgical complications.
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Affiliation(s)
- Jing-Hua Liu
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology and Visual Sciences Key Laboratory, Beijing 100730, China
| | - Hai Lu
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology and Visual Sciences Key Laboratory, Beijing 100730, China
| | - Song-Feng Li
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology and Visual Sciences Key Laboratory, Beijing 100730, China
| | - Yong-Hong Jiao
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology and Visual Sciences Key Laboratory, Beijing 100730, China
| | - Nan Lin
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology and Visual Sciences Key Laboratory, Beijing 100730, China
| | - Ning-Pu Liu
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology and Visual Sciences Key Laboratory, Beijing 100730, China
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Plasmin-assisted vitrectomy for bilateral combined hamartoma of the retina and retinal pigment epithelium: histopathology, immunohistochemistry, and optical coherence tomography. Retin Cases Brief Rep 2014; 3:186-9. [PMID: 25391071 DOI: 10.1097/icb.0b013e318185ea69] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To report the surgical outcome, histopathology, immunohistochemistry, and optical coherence tomographic findings in a case of bilateral combined hamartoma of retina and retinal pigment epithelium. METHOD Bilateral heterologous plasmin-assisted lens-sparing vitrectomy was performed. The surgical specimen underwent histopathological and immunohistochemical analysis. PATIENT An 18-month-old male child with bilateral combined hamartoma of the retina and retinal pigment epithelium. RESULTS After surgery, structural improvement (optical coherence tomography) and improved visual function were noted. Immunohistochemistry was positive for astrocytic markers and negative for others. DISCUSSION Plasmin-assisted vitrectomy and membrane peeling in this child with bilateral combined hamartoma resulted in a marked improvement in the clinical and topographical appearance in both eyes and significantly improved visual function. The prospect of hamartoma recurrence is not a contraindication to surgical management. Immunohistochemically, the peeled epiretinal tissue showed characteristics of astrocytic origin providing insight into the possible source and structure of these membranes.
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Lee TC, Chiang MF. Pediatric Retinal Vascular Diseases. Retina 2013. [DOI: 10.1016/b978-1-4557-0737-9.00061-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Meier P, Wiedemann P. Surgery for Pediatric Vitreoretinal Disorders. Retina 2013. [DOI: 10.1016/b978-1-4557-0737-9.00115-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Choroidal neovascular membrane in persistent fetal vasculature syndrome managed with intravitreal pegaptanib sodium in an infant. Retina 2010; 30:S41-4. [PMID: 20419850 DOI: 10.1097/iae.0b013e3181c7017c] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE The purpose of this study was to report the successful management of a case of choroidal neovascular membrane secondary to persistent fetal vasculature syndrome in an infant using intravitreal pegaptanib sodium (Macugen). METHODS A 14-month-old male infant developed a peripapillary choroidal neovascular membrane 10 months after lens-sparing vitrectomy that he underwent for persistent fetal vasculature syndrome and confirmed on angiography and optical coherence tomography. A single dose of intravitreal pegaptanib sodium (0.3 mg) was administered after informed consent was obtained. Angiography and optical coherence tomography scans were performed at 6 and 14 weeks after the injection to determine the result. RESULTS Six weeks after the single injection, the lesion reduced in size and exhibited less leakage on angiography. At 14 weeks, leakage was absent, and the lesion had involuted. CONCLUSION Choroidal neovascular membrane in a case of persistent fetal vasculature syndrome is rare. This report shows that intravitreal pegaptanib sodium is highly effective in treating this lesion even in an infant.
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Ranchod TM, Quiram PA, Hathaway N, Ho LY, Glasgow BJ, Trese MT. Microcornea, posterior megalolenticonus, persistent fetal vasculature, and coloboma: a new syndrome. Ophthalmology 2010; 117:1843-7. [PMID: 20417569 DOI: 10.1016/j.ophtha.2009.12.045] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2009] [Revised: 12/29/2009] [Accepted: 12/30/2009] [Indexed: 10/19/2022] Open
Abstract
PURPOSE To report a newly identified syndrome of bilateral microcornea, posterior megalolenticonus, persistent fetal vasculature, and chorioretinal coloboma (MPPC). DESIGN Noncomparative case series. PARTICIPANTS Eight patients with MPPC syndrome. METHODS Clinical data collected retrospectively included visual acuity, findings on office examination as well as examination under anesthesia, and, in some cases, fluorescein angiography. Intraoperative findings and postoperative visual acuity and clinical findings were recorded when surgical intervention was performed. MAIN OUTCOME MEASURES Clinical description, intraoperative findings, and surgical outcomes. RESULTS All patients were found to have microcornea with corneal diameters of less than 8 mm. In all cases, the crystalline lens was found to be retrodisplaced with massive enlargement and a dramatic posterior lenticonus (posterior megalolenticonus), and the ciliary processes frequently were drawn to the lens capsule. A stalk of persistent fetal vascular tissue extended from the posterior pole of the lens to the optic disc. Posterior chorioretinal coloboma was present in all cases. Some cases also exhibited grossly dysplastic retina. Presentation frequently was asymmetric. Eight eyes of 6 patients underwent lensectomy, vitrectomy, membrane peeling, and fluid-Healon exchange (Healon OVD [sodium hyaluronate]; Advanced Medical Optics, Santa Ana, CA) with functional vision in at least 4 of the 5 patients with postsurgical follow-up. CONCLUSIONS Bilateral microcornea, posterior megalolenticonus, persistent fetal vasculature, and chorioretinal coloboma syndrome is a distinct syndrome previously unreported, to the authors' knowledge, and appropriate surgical intervention may result in significantly improved visual function.
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Cerón O, Lou PL, Kroll AJ, Walton DS. The vitreo-retinal manifestations of persistent hyperplasic primary vitreous (PHPV) and their management. Int Ophthalmol Clin 2008; 48:53-62. [PMID: 18427261 DOI: 10.1097/iio.0b013e3181695980] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Affiliation(s)
- Olga Cerón
- Massachusetts Eye and Ear Infirmary, 243 Charles Street, Boston, MA 02114, USA
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Yu YS, Kim SJ, Kim SY, Choung HK, Park GH, Heo JW. Lens-sparing vitrectomy for stage 4 and stage 5 retinopathy of prematurity. KOREAN JOURNAL OF OPHTHALMOLOGY 2006; 20:113-7. [PMID: 16892648 PMCID: PMC2908825 DOI: 10.3341/kjo.2006.20.2.113] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Purpose To describe the results of lens-sparing vitrectomy for the correction of retinal detachment associated with retinopathy of prematurity (ROP) and its associated complications. Methods Seventeen patients who underwent a lens-sparing vitrectomy for stage 4 and stage 5 ROP with plus disease at Seoul National University Children's Hospital between 1999 and 2003 were enrolled in this study. The patients who had bilateral retinal detachment of ROP underwent a lens-sparing vitrectomy in one eye and a scleral buckling surgery or lensectomy-vitrectomy in the other eye. The patients who had a retinal detachment in one eye and a regressed ROP in the other eye underwent unilateral lens-sparing vitrectomies. A review of their preoperative clinical findings (including the status of retinal detachment and plus disease), post-operative results, and any complications encountered was performed. Results In 17 patients, the postoperative success rate of lens-sparing vitrectomy was 58.8%. However, lens-sparing vitrectomy as a treatment for stage 5 ROP (25.0%) produced more negative post-operative results than it did when used to treat either those for stage 4a (75,0%) or 4b (66.7%) ROP. Among the 10 eyes in which the retina was attached, form vision was shown in six eyes, light could be followed by three eyes, and no light perception was present in one eye. Intra- and post-operative complications included retinal break formation, cataracts, vitreous hemorrhages, and glaucoma in patients with stages 4b and stage 5 ROP. Conclusions Lens-sparing vitrectomy resulted in encouraging surgical outcomes in the correction of retinal detachment of ROP, especially in stage 4 patients. Therefore, a lens-sparing vitrectomy for stage 4 ROP patient may be beneficial, although it is still associated with some intra- and post-operative complications.
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Affiliation(s)
- Young Suk Yu
- Department of Ophthalmology, Seoul National University College of Medicine, #28 Yeongeon-dong, Jongro-gu, Seoul 110-744, Korea.
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