Abstract
Purpose To report a case of persistent fetal vasculature (PFV) with a retinal detachment that worsened after cataract surgery. Pars plana vitrectomy (PPV) was performed which reduced the vitreous traction and reattached the retina. Observations. A 20-year-old Myanmarese woman presented with a mature cataract, and her vision was light perception. She underwent uneventful cataract surgery with implantation of an intraocular lens. Her visual acuity improved to 20/200 immediately after the surgery. However, fibrotic tissue was observed between the optic nerve head and the posterior capsule. She was diagnosed with PFV, and she was followed without any intervention. One and a half years after the cataract surgery, she had an advanced retinal detachment which extended over the inferior two quadrants. Her vision deteriorated to 20/400. She underwent PPV, and the PFV tissue was removed which resulted in the reattachment of the retina. The visual acuity improved to 20/60. Conclusions Surgeons should be aware that it is possible to worsen a retinal detachment after cataract surgery in the eyes with PFV. A simple technique to release the anterior-posterior traction by the PPV was sufficient to achieve the reattachment of the retina.
Highlights
Persistent fetal vasculature (PFV) which was previously called persistent hyperplastic primary vitreous (PHPV) is a rare congenital ocular disorder [1]
Discussion e eyes with PFV are characterized by cataracts, vascularized persistent hyaloid, retrolental tissue, microphthalmos, and retinal detachment. e retinal detachment sometimes presents as a falciform retinal detachment, and it usually extends from the optic nerve to the inferior temporal region. e visual function in the eyes with PFV is usually poor because of the involvement of macula by the retinal detachment, severe macular deformity, and refractory glaucoma
Dass et al reported that the final visual acuity was better than 20/800 6 in 35 eyes (17%) [4], and Alexandrakis et al reported that 14 in 30 eyes (47%) achieved a final visual acuity of 20/400 or better [5]
Summary
Persistent fetal vasculature (PFV) which was previously called persistent hyperplastic primary vitreous (PHPV) is a rare congenital ocular disorder [1]. PFV is characterized by unilateral cataract, persistent vascularized hyaloid, retrolental tissues, microphthalmos, and retinal detachment [2]. PFV is usually diagnosed in childhood because the eyes with PFV usually have poor visual function, leukocoria, and strabismus. Phacoemulsification of the cataract and insertion of an intraocular lens is usually performed on these children, and the postsurgical outcomes are generally good [3]. We have had a case of PFV in an adult Myanmarese woman, and she was initially treated for her advanced cataract with phacoemulsification and implantation of an intraocular lens. There was worsening of the retinal detachment, but we successfully reattached the retina by a simple PPV with removal of the connecting tissue in the retrolental space and optic nerve head
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