Surgical management of persistent hyperplastic primary vitreous

The pars plana approach in two cases of persistent hyperplastic primary vitreous (PHPV)

Two cases of persistent hyperplastic primary vitreous were operated by the pars plana approach. The technique applied appears to be safe and effective.

The morphology and natural history of childhood cataracts

The morphology of congenital cataract reflects a combination of the timing and nature of the cause, the anatomy of the lens including its capsule, its development, and changes that take place with time. Morphology may variably affect prognosis, give a clue to the etiology and the age of onset and, in an isolated case, sometimes suggest heritability. The spectrum of morphological variations is enormous and can be complex. A comprehensive approach is to classify the variations according to the area of the lens involved, and sub-dividing them by a detailed description of the shape and appearance. Each specific morphological type is then analyzed determining the etiology, visual prognosis, and management. The use of gene markers has allowed many of these variations to be identified and categorized. Cataracts in childhood can involve the whole lens, in which case they are called total, Morgagnian, or disk-like. They can affect only the center of the lens: lamellar, nuclear, oil droplet, cortical, or coronary. They can be anterior: anterior polar, anterior subcapsular, or anterior lenticonus. The posterior aspect of the lens can also be affected in different fashions: Mittendorf's dot, posterior lenticonus, posterior cortical cataracts, or posterior subcapsular. There are five more forms that must be described separately: punctuate lens opacities, sutural cataracts, coralliform or crystalline, wedge-shaped, and persistent hyperplastic primary vitreous.

Surgical management of the lens and retrolenticular fibrotic membranes associated with persistent fetal vasculature

PURPOSE

To evaluate a surgical technique that allows safe, effective, near-total removal of retrolenticular fibrotic membranes in eyes with persistent fetal vasculature syndrome (PFVS).

SETTING

Pediatric ophthalmologist's academic practice.

METHODS

This retrospective review comprised 5 children (6 eyes) who had excision of a retrolenticular fibrovascular membrane during cataract surgery over a 6-month period. Long, spoke-like radial incisions of the membrane were made to the ciliary processes, resulting in wedge-shaped segmentation of the membrane. A vitrector was used to excise each wedge and perform an anterior vitrectomy.

RESULTS

The mean age at time of surgery was 8 months (range 1 to 24 months) and the mean follow-up, 9 months (range 2 to 13 months). The membrane was successfully removed in all eyes. One eye of a patient who did not comply with the postoperative medical regimen or follow-up developed pupillary block glaucoma requiring pupilloplasty and trabeculectomy.

CONCLUSION

This anterior surgical technique to remove tenacious retrolenticular membranes associated with PFVS was effective, allowing near-total removal of the offending fibrovascular membrane.