Anterior Persistent Hyperplastic Primary Vitreous Research Articles

A Case of Unilateral Pseudoglioma of Eye in A Neonate

Pseudoglioma is a condition presenting as leukocoria other than retinoblastoma. Persistent hyperplastic primary vitreous is a type of pseudoglioma in an ocular developmental defect in which the hyaloid vasculature within the vitreous overgrows and fails to regress.In this case , 25 days old female child presented with the complaints of white pupillary reflex in the right eye since birth. Baby was born to second degree consanguineous parents. The child was born at full-term by normal delivery. The Antenatal period was uneventful. No history of oxygenation and birth trauma. Anterior segment examination of the right eye showed a shallow anterior chamber and leukocoria. Lens was cataractous and vascular. The left eye was normal. Examination under anesthesia revealed normal corneal diameter and Intraocular pressure in both the eyes. Fundus examination was normal in the left eye and cannot be performed in the right eye. Ultrasound B-scan in the right eye showed an echogenic band in the posterior surface of the lens and on colordoppler arterial blood flow was seen in the band. Hence, the patient was diagnosed to have Anterior persistent hyperplastic primary vitreous in the righteye.In this case ,child is advised to undergo Right lensectomy with cautery of the persistent anterior hyaloid stalk and anterior vitrectomy.

A case of anterior persistent hyperplastic primary vitreous associated with morning glory disc anomaly and retinopathy of prematurity like retinopathy in a term-born child

BackgroundAssociation of morning glory disc anomaly (MGDA) with persistent hyperplastic primary vitreous (PHPV) has been reported earlier. Retinopathy of prematurity (ROP) like retinopathy in preterm babies with optic disc anomalies has also been published. Our case is unique in terms of presence MGDA, PHPV, unilateral ROP like retinopathy in a term infant with normal birth weight.Case presentationA 5-month-old girl, born at term with a birth weight of 3750 g, presented with anterior PHPV, MGDA and ROP like retinopathy. In order to prevent retinal detachment, she received 360 degree barrage laser photocoagulation at the edge of the optic disc excavation of the left eye. In the follow-up a month later, laser scars were found in her left fundus without other complications.ConclusionPHPV and MGDA with ROP like retinopathy in term and normal weight baby is rare. The peripheral avascular retinal area, caused by the dragging of the defected optic disc, might have been more vulnerable to the oxygen change after birth which resulted in ROP like retinopathy. High sensitivity to oxygen results in a series of changes such as upregulation of VEGF and IGF-1 may cause ROP-like retinopathy.

Outcomes of cataract surgery in children with persistent hyperplastic primary vitreous.

To evaluate postoperative outcomes of cataract surgery in children with persistent hyperplastic primary vitreous (PHPV) and factors affecting outcomes. We analyzed 29 eyes of 28 children with PHPV presenting at a tertiary care center in northern India. All eyes underwent phacoaspiration followed by primary posterior capsulotomy with or without cauterization of persistent fetal vasculature under general anesthesia. Hydrophobic intraocular lens was implanted in selective cases. Postoperative outcomes such as clarity of visual axis, need for secondary surgical procedures, and complications were noted. Out of a total of 28 children (16 male and 12 female), 27 were unilateral while 1 patient had bilateral involvement. Mean age at surgery was 25.14 months, ranging from 2 months to 144 months. Mean axial length of the globe at surgery was 19.66 ± 2.28 mm. Cataract surgery with intraocular lens implantation was done in 22 eyes whereas 7 were left aphakic. The most common intraoperative complication noted was intraoperative bleed in 11 eyes (37.9%) resulting in postoperative hyphema in 9 eyes (31%) and vitreous hemorrhage in 8 eyes (27.5%). Visual axis opacification was seen in 12 eyes and all required membranectomy. Three eyes developed glaucoma while retinal detachment was noted in 2 eyes and 1 of them became phthisical. Favorable outcome was more often achieved in anterior PHPV. Surgical outcomes in eyes with PHPV undergoing cataract surgery are limited by intraoperative and postoperative complications such as hyphema, vitreous hemorrhage, recurrent visual axis opacification, glaucoma, and retinal detachment.

Surgical treatment and visual outcomes of cataract with persistent hyperplastic primary vitreous.

To evaluate the surgical treatment and visual outcomes of eyes with cataract and persistent hyperplastic primary vitreous (PHPV). This retrospective study included patients with cataract and PHPV treated with various strategies. Anterior PHPV was treated using phacoemulsification with underwater electric coagulation on posterior capsule neovascularization, posterior capsulotomy, anterior vitrectomy, and intraocular lens (IOL) implantation. Posterior PHPV was treated with lensectomy, posterior vitrectomy, retinal photocoagulation, and IOL implantation or silicone oil tamponade. Visual acuity (VA), pattern visual evoked potential (P-VEP), anatomic recovery, postoperative complications, and amblyopia outcome were examined. Subjects were followed-up for 3-48mo after surgery. Of the 30 patients (33 eyes) with congenital cataract and PHPV included (average age, 39.30±35.47mo), 9 eyes had anterior PHPV and 24 had posterior PHPV. Thirty-two eyes were surgically treated. Eyes with anterior PHPV received an IOL during one-stage (6 eyes) and two-stage (3 eyes) implantation. Postoperative complications included retinal detachment (1 eye) and recurrent anterior chamber hemorrhage (1 eye). In eyes with posterior PHPV, 6 and 11 eyes received IOLs in one- and two-stage procedures, respectively. Silicone oil was retained in 2 eyes, and IOLs were not implanted in 4 eyes. VA significantly improved in 25 eyes following operations and 3-48mo of amblyopia treatment. P-VEP P100 was improved following surgery in both PHPV types. Our surgical strategies are appropriate and effective for anterior and posterior PHPV. Early surgical intervention and amblyopia therapy result in positive treatment outcomes.

Results of cataract surgery and plasma ablation posterior capsulotomy in anterior persistent hyperplastic primary vitreous

Purpose:To report the feasibility and outcome of lens aspiration, and Fugo blade-assisted capsulotomy and anterior vitrectomy in eyes with anterior persistent hyperplastic primary vitreous (PHPV).Materials and Methods:In this case series, 10 eyes of 10 patients with anterior PHPV underwent lens aspiration. The vascularized posterior capsule was cut with a Fugo blade (plasma knife) and removed with a vitrector. A foldable posterior chamber intraocular lens (IOL) was implanted in eight eyes and the outcomes were evaluated.Results:The mean age of patients was 16.8 ± 6.37 months (range: 5 to 28 months). The surgery was completed successfully in all eyes. There were no cases of intraocular hemorrhage intraoperatively. Foldable acrylic IOL was implanted in the bag in 3 eyes and in the sulcus in 5 eyes. Two eyes were microphthalmic and did no undergo IOL implantation (aphakic). None of the eyes had a significant reaction or elevated intraocular pressure postoperatively. The follow-up ranged from 4 to 21 months. All the pseudophakic eyes achieved a best corrected visual acuity of ≥20/200 with 50% (4/8) of these eyes with ≥20/60 vision.Conclusion:Lens aspiration followed by posterior capsulotomy with Fugo blade-assisted plasma ablation is a feasible technique for performing successful lens surgery in cases with florid anterior PHPV.

Intraocular lens implantation in a child with monocular cataract and anterior persistent hyperplastic primary vitreous

A 3-year-old girl had phacoemulsification during which the presence of anterior persistent hyperplastic primary vitreous (PHPV) was discovered. Visual rehabilitation comprised contact lens use for 1 year. However, visual acuity deteriorated gradually because of secondary cataract formation. In a second surgery 1 year after the first, the posterior capsule was incised, followed by an anterior vitrectomy and intraocular lens implantation. At the last follow-up 6 months after the second surgery, there was no evidence of ocular complications and best corrected visual acuity was 0.6.

Incising the Thick Retrolental Fibrovascular Tissue With a Hooked Sclerotome in Persistent Hyperplastic Primary Vitreous

A technique for incising thick retrolental fibrovascular tissue and extensive cyclitic membrane is reported in a case of anterior persistent hyperplastic primary vitreous. A membranectomy was performed in a 1-month-old post-lensectomy baby via a limbal approach. A sclerotome tip was hooked to cut through an extremely thick fibrovascular tissue by rotating the sclerotome by its grip. Sutherland microscissors (Grieshaber, Switzerland) and a vitrectomy cutter were used for further membranectomy. The baby was followed-up until age 18 months. A total of 3 membranectomy sessions were required because of rapid cyclitic membrane formation, severe centripetal retraction of the membrane on the ciliary processes, and posterior synechia. Thorough membranectomy and cutting the iris edge maintained a clear pupillary area during the 13-month postoperative period. Extremely thick retrolental fibrovascular tissue is a challenging condition that can be dealt with by delicate instrumentation.

Surgical results of persistent hyperplastic primary vitreous

Purpose To evaluate the surgical success of patients with persistent hyperplastic primary vitreous (PHPV) and to identify preoperative indicators of visual outcome. Design Noncomparative case series. Methods The diagnosis of PHPV was made in 35 eyes of 27 patients from 1982 to 1994. In each case, anterior and/or posterior PHPV findings, preoperative testing, surgical procedures, and visual outcomes were documented. Twenty-nine of 35 eyes were managed surgically. Follow-up ranged from 2 months to 12 years. Results Of the 35 eyes, 2 (5.7%) had strictly anterior PHPV, 8 (22.9%) had strictly posterior PHPV, and 25 (71.4%) had components of both anterior and posterior disease. Initial lensectomy and vitrectomy was performed in 24 eyes (68.6%). Surgery was withheld in four eyes secondary to severity of disease with an unrecordable visual-evoked potential (VEP). Reoperation rate was 32.3% for membrane reproliferation, glaucoma, vitreous hemorrhage, retinal detachment, or strabismus. Best-corrected final visual acuity ranged from 20/60 to no light perception. Six eyes (17%) maintained Snellen visual acuity despite posterior PHPV with some degree of retinal dysplasia. Conclusions Surgical treatment of PHPV can result in functional visual outcome despite posterior segment involvement. The degree of ocular malformation, however, will ultimately limit the amount of visual improvement. Preoperative testing, including VEP, may aid in determining surgical candidates.

Ultrastructural pathology of anterior persistent hyperplastic primary vitreous

Using transmission electron microscopy, the fine structure of anterior persistent hyperplastic primary vitreous (PHPV) removed from the eyes of four infants was studied. The tissue mass was composed of vessels derived from or representing the tunica vasculosa lentis posterior and the vasa hyaloidea propria. They were embedded in a loose connective-tissue matrix containing many fibroblasts and mature collagen fibrils. Toward the posterior surface, the fibroblasts became more numerous, elongated and densely packed. At the point of its entry into the posterior pole of the mass, the hyaloid artery was found to be surrounded by glial cells, probably representing an extension of the wall cells of the hyaloid canal. Venous drainage of the PHPV nodules seemed to occur via the ciliary body to which they were connected by tiny vessels bridging the distance from the PHPV lump to elongated ciliary processes. The anterior surface of the tissue lump was covered with lens fragments. These remnants showed signs of very early disturbance of lens development, with a failure to form posterior lens fibers. Based on these findings, the authors suggest that PHPV may be secondary to a primary defect in lens development.