Visual and Anatomic Outcomes With or Without Surgery in Persistent Fetal Vasculature

ArticleinOphthalmology 117(11):2178-83.e1-2 · November 2010with49 Reads
DOI: 10.1016/j.ophtha.2010.03.062 · Source: PubMed
To determine visual and anatomic outcomes for patients with persistent fetal vasculature (PFV) observed or treated with surgery. Retrospective interventional consecutive case series. A total of 165 eyes of 150 patients diagnosed with PFV between January 1, 1983, and December 31, 2006, at the Bascom Palmer Eye Institute. Patients with media opacity, progressive glaucoma, or retinal detachment who were deemed to have visual potential underwent lensectomy, 3-port vitrectomy, or both, through a limbal or pars plicata/plana approach. Vision, postsurgical retinal attachment, lens status, need for eye removal, and rate of complications. Of the 81 eyes that underwent surgical repair, 70 had at least 6 months of follow-up (median 47 months) and 49 (70.0%) had form vision, defined as finger counting, fix-and-follow, or better. Twenty (95.2%) of 21 eyes without form vision had a significant posterior component of PFV (P < 0.001). Forty eyes had limbal incisions, and 30 eyes had pars plicata incisions. The choice of surgical approach did not have a statistically significant effect on final visual acuity or rate of complications (P=0.43). Postoperative events occurred in 28 eyes (40.0%). Retinal attachment was achieved in 54 eyes (77.1%), and 61 eyes (87.1%) were left aphakic. Eighty-four eyes were not offered surgery, of which 78 eyes (92.9%) had a posterior component of PFV. The median age at diagnosis was greater compared with the surgical group (197 vs. 67.5 days, P=0.00545). Fifty-eight eyes (69.0%) lacked form vision, and 39 eyes (46.4%) had no light perception. Posterior manifestations of PFV, bilaterality, and microphthalmia were associated with poorer visual outcomes (P < 0.001, 0.041, and 0.002, respectively). The majority of patients receiving surgical intervention for PFV achieved form vision. Posterior disease, microphthalmia, glaucoma, and amblyopia limited visual acuity outcomes even after aggressive intervention. The choice of limbal versus pars plicata approach produced similar visual and anatomic outcomes without a significant difference in rate of complications. The author(s) have no proprietary or commercial interest in any materials discussed in this article.
    • "the timely treatment of this cause of childhood blindness and for the prevention of visual impairments. Apart from the timing of surgery, it has also been reported that the presence of other associated ocular abnormalities , such as nystagmus, strabismus, PHPV, small eyes, and small corneal disorders, also has a significant effect on prognosis.[17, 18] In the 4-year period after CCPMOH establishment, the top three most common ocular abnormalities found in CC in-patients, namely, strabismus (exotropia and esotropia), nystagmus, and refractive error, were similar to those reported in our previous study and in other studies. For CC patients who present complications related to associated"
    [Show abstract] [Hide abstract] ABSTRACT: A review of 6 years of hospitalization charts from Zhongshan Ophthalmic Center (ZOC) revealed that congenital cataracts (CC) accounted for 2.39% of all cataract in-patient cases and that the age at surgery was decreasing before the establishment of the Childhood Cataract Program of the Chinese Ministry of Health (CCPMOH) in December 2010. We aimed to investigate data from the 4 years (January 2011 to December 2014) following the establishment of the CCPMOH, compared, and combined with data from the previous study period (January 2005 to December 2010) to generate a 10-year overview of the hospital-based prevalence and treatment of CC. In the 4-year period after CCPMOH establishment, the prevalence of CC was 2.01% in all hospitalizations, and was 2.78% in all cataract in-patients. Most of the eligible CC in-patients (71%) lived in south China. The ratio of boys to girls was 1.42:1. Nearly 2/3 of the patients underwent cataract extraction with primary intraocular lens (IOL) implantation at a mean age of 78.40±51.45 months, and cataract extraction surgeries without IOL implantation were performed in the remaining 1/3 of patients at a mean age of 10.03±15.92 months. After CCPMOH establishment, an increased incidence of CC was revealed, and the CC in-patients were younger than the patients in the previous period. The 10-year overview (2421 CC in-patients from 206630 hospitalizations) revealed upward trends in both the number and the prevalence of CC and a further reduction in age at surgery. In conclusion, the data from 4-year period after CCPMOH establishment and the 10-year overview showed upward trends in the hospital-based prevalence of CC cases and a further reduction in age at surgery, likely reflecting the effects of the CCPMOH establishment and providing useful information for further CC studies and a valuable foundation for the prevention and treatment of this cause of childhood blindness.
    Full-text · Article · Nov 2015
    • "This trend may be attributed to the strengthened recognition of the importance of early treatment for CC by parents and pediatric ophthalmologists and to the continuing improvement of ophthalmic surgical techniques and anesthetic techniques in China [13,14]. Although the timing of surgery is critical for CC prognosis, it has also been reported that the presence of other associated ocular abnormalities, [19,23,29] such as nystagmus, strabismus, PHPV, CPPM, small eyes, and small corneal disorders, also has a significant effect on prognosis. In this study, a total of 275 patients had associated ocular abnormalities, accounting for 1/5 of all the patients. "
    Full-text · Dataset · Feb 2015 · PLoS ONE
    • "Despite these complications, post-operative improvement in visual acuity has been reported as high as 83% [8]. Various surgical techniques have been documented [3,8,10,11,[13][14][15][16][17][18], however the literature regarding posterior segment surgical approach remains scarce. We report a patient that underwent pars plana vitrectomy, lensectomy, and posterior capsulectomywithout the use of endodiathermy as the primary treatment for cataract associated to PFV. "
    [Show abstract] [Hide abstract] ABSTRACT: Purpose: The purpose of this report is to present an alternative surgical approach to persistent fetal vasculature. Case: A 9 month old male presented with leukocoria in the right eye and was found to have lenticular opacity with posterior dysplastic mass with complex exudative tractional retinal detachment and fibrovascular stalk. Surgical approach consisted of fibrovascular membrane transection anterior to termination of the stalk. This was performed without endodiathermy despite vascularization. The posterior capsule was opened and stalk was removed. Lensectomy was performed to remove lens nucleus and cortex. The patient was left aphakic and the both anterior and posterior capsules were opened widely. One month follow up of the patient showed a clear visual axis and refractive error of +5.00 spheres OD Discussion: Surgical morbidity remains a major hurdle in the management of persistent fetal vasculature. The use of endodiathermy has gained popularity, but has the disadvantage of introducing intraocular energy. There has been a lack of literature regarding the management of persistent fetal vasculature with the presence of posterior involvement, and this case presents an alternative approach without the need for endodiathermy despite vascularization.
    Full-text · Article · Jan 2015 · PLoS ONE
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