Crystalline Lens Research Articles

Combined cataract and glaucoma surgery

Cataracts and glaucoma commonly co‐exist, largely due to both being associated with older age. The crystalline lens can however cause glaucoma by phacomorphic or phacolytic processes, or by contributing to pupil block leading to primary angle closure. Medical and surgical treatments for glaucoma can also result in accelerated cataract formation. Cataract surgery in patients with glaucoma provides an opportunity to reduce medication burden and improve intraocular pressure control but has a higher risk than surgery in non‐glaucomatous eyes. Special consideration should be given to those with pseudoexfoliation (e.g. zonular instability), advanced glaucoma (e.g., risk of pressure spike and wipe out) or in those with short axial length or angle closure (e.g., shallow anterior chamber and risk of malignant glaucoma). Cataract surgery in eyes with previous subconjunctival glaucoma surgery is a particular challenge as it increases the risk of wound healing and failure of the filtering procedure. This presentation will outline steps for success in cataract surgery in patients with glaucoma and will also present recent evidence regarding the efficacy of phacoemulsification combined with minimally invasive glaucoma surgery (MIGS).

Toward optical correction of cataract opacities

Cataracts is a common pathology where the crystalline lens tends to become opaque, degrading the quality of the retinal images because of the increase of scattering. This leads to a deterioration of visual quality affecting the life of patients. The widely used solution is cataract surgery, replacing the natural lens with artificial intraocular lenses. Although surgical approaches are very successful, it would be useful to have alternative non‐invasive approaches based in optics to correct the retinal images in cataract patients. There are different options, some of them already tested in my laboratory. In this presentation, I will describe some of those based in wavefront shaping technologies. Results in simulations and using excised crystalline lenses will be shown and the prospects and limitations for practical in vivo implementations will be discussed.

Quantitative analysis of crystalline lens and vitreous opacities

Intraocular light scattering affects the contrast of the image created on the retina thus reducing the vision quality. Although one can consider the ocular components transparent, the microstructural changes (that are associated with aging or other factors) lead to the increase in intraocular light scattering. Therefore, the opacification of ocular structures is associated with vision‐affecting diseases such as corneal dystrophies, crystalline lens cataracts, vitreous floaters etc.Optical coherence tomography (OCT) is a non‐invasive imaging modality enabling generation of micrometre resolution, two‐dimensional (2‐D) cross‐sectional images and three‐dimensional (3‐D) volumetric data presenting internal structure of optically scattering tissues. OCT detects light that is back‐scattered/back‐reflected at the optical in homogeneities within the ocular structures. Due to its high sensitivity, OCT enables detection of ultralow scattered light levels obtained from weakly scattering tissues such as the vitreous body.In this talk, we will demonstrate in vivo enhanced three‐dimensional visualization of vitreous and lens opacities in normal subjects and cataract patients of different ages using a swept source OCT (SS‐OCT) system deployed to the Laboratory of Optics at the University of Murcia, Spain. The instrument operated at the central wavelength of 1050 nm and was optimized to image the anterior segment of the eye. Volumetric images were used to effectively map the opacities and to generate en‐face projection images of opacities.The results revealed the changes in the transparency of the crystalline lens showing lens micro‐ and macro‐scale features related to cataract such as cortical spokes, water clefts and enhanced scattering in the lens nucleus. On the other hand, vitreous imaging with SS‐OCT allowed for visualization of gel vitreous, liquefied lacunae, Berger's space, retrolental laminae and fibrous opacifications.Volumetric OCT data of the lens and retrolental vitreous were used to perform quantitative analysis of light scattering (transparency). We introduced indices describing transparency and optical homogeneity of ocular structures. Later on, we showed that those biomarkers correlate with age. Finally, statistical association between transparency of crystalline lens / vitreous and degradation of visual function was performed.The proposed imaging platform can be a new‐generation ophthalmic diagnostic tool in the fundamental studies as well as for objective clinical evaluation and management of eye diseases.

Changes in peripheral visual field perception after intraocular lens implantation

Aims/Purpose: To assess whether the eccentricity of the perception of objects in the peripheral visual field changes when a crystalline lens is replaced by an intraocular lens (IOL).Methods: The effect of the IOL on the eccentricity at which peripheral objects are perceived was assessed using phakic and pseudophakic versions of the same eye model. Non‐sequential ray tracing simulations were used to determine the relation between the input eccentricity at which an object was positioned in the visual field and the corresponding eccentricity at which the object was perceived by the eye in every eye model. Two different IOL designs were evaluated in the pseudophakic eye model. For each IOL design five different axial positions and seven different intrinsic powers were tested. Subsequently, the results of the pseudophakic eye models were compared to the results of the phakic model.Results: For central vision, the perceived eccentricity differed less than 1 degree between the phakic and pseudophakic models. For peripheral vision, the light rays were refracted to a more central retinal location in pseudophakic eyes than in phakic eyes, therewith shifting perceived eccentricity. The amount of the perceived shift depended on the IOL design and its axial position. The maximal shift within the evaluated pseudophakic models was 5.4 degrees towards central vision.Conclusions: IOL implantation has a minor effect on how the central visual field is perceived, but it can alter the eccentricity at which objects in the peripheral visual field are perceived by over 5 degrees. Such a shift in eccentricity can, for instance, affect how peripheral visual complaints, such as negative dysphotopsia, are experienced.

TRAUMATIC LENS SUBLUXATION FROM PICKLEBALL INJURY: A CASE SERIES

Purpose: The purpose of this study was to describe two cases of traumatic lens subluxation resulting from pickleball injury. Methods: This is a case series. Results: A 77-year-old man presented with worsening vision and was noted to have subluxation of his intraocular lens 10 days after being struck in the eye with a pickleball. The patient underwent a lens exchange with scleral fixation. A 76-year-old woman presented with blurry vision on the same day as her injury and was noted to have subluxation of her crystalline lens. She also underwent a lens insertion with scleral fixation. However, she experienced additional complications of postoperative cystoid macular edema and traumatic glaucoma. Conclusion: We recommend increased use of eye protection in pickleball.

Adaptive optics ‐ Basic optical principles

Adaptive Optics (AO) refers to a technique to compensate for distortions caused by optical aberrations in the media between the camera and the object being imaged. It was originally developed for use in astronomical telescopes to compensate for optical distortions induced by the inhomogeneous earth atmosphere. It has since evolved to become a powerful clinical tool in ophthalmology. In the eye, a “wavefront sensor” (aberrometer) measures the distortion of incoming light induced by inhomogeneities within the cornea and crystalline lens, which is then “undistorted” via reflection by a deformable mirror. AO thus enables imaging of the human retina with unprecedented resolution in vivo, such as revealing individual photoreceptors or the walls of blood vessels. One should note that AO by itself does not provide an image; rather an AO subsystem is incorporated into an existing imaging device. AO subsystems have thus far been successfully integrated into three ophthalmic imaging devices: fundus cameras, scanning laser ophthalmoscopes, and the OCT device. This lecture will introduce the basic principles of AO, illustrate its value with state‐of‐the‐art clinical examples, and discuss potential future applications in ophthalmology.

Objective and independent measurement of scattering caused by the cornea and crystalline lens

meritxell.vilaseca@upc.eduThere are several methods that provide information on the intraocular scattering. Procedures based on the observation of the lens through the slit lamp from which a gradation of the state of every cataract is assessed (e.g. lens opacities classification system III ‐ LOCS III) are the most widely used in clinics. Nevertheless, they provide information related to the back‐scattered light and not forward scattering, which is responsible for the degradation of vision. To do so, a procedure that assess retinal straylight using a device based on a psychophysical compensation‐comparison approach was proposed, in which the subject's task is a forced‐choice between two half fields to decide which one flickers more intensely. From these measurements, a psychometric function is fitted and used to determine the straylight compensation level log(s) on the basis of a few stimuli responses.As an alternative approach, some attempts have been made to use the double‐pass as a means of objectively estimating forward scattering. The double‐pass technique is a procedure that is able to capture the complete optical information of the eye, including the effect of higher‐order aberrations and intraocular scattering within a small visual angle. Artal et al. proposed the Objective Scatter Index (OSI) calculated from double‐pass images for estimating scattering with the intention to grade cataracts. This technique was also used successfully to account for scattered light in patients with keratitis and uveitis, and those undergoing refractive surgery. More recently, a new Frequency Scatter Index (FSI3) based on the analysis of double‐pass retinal images in the frequency domain has also been suggested, as a means of minimizing the impact of optical aberrations on the results obtained.Nevertheless, all of the former methods provide information on the total scattered light in the eye, which consists of the combined contributions originating from different ocular structures. In this regards, we recently proposed a technique for the objective and independent assessment of scattering caused by the cornea and the lens based on the analysis of the contrast of the third and fourth Purkinje images. The technique was preliminarily validated first by using artificial eyes with different levels of corneal and lens scattering; second, it was validated in eyes wearing customized contact lenses to simulate corneal scattering and eyes with nuclear cataracts. Finally, it was tested on a larger population of eyes with cataracts and corneal disorders to prove its clinical usefulness.In this work, we review all the above‐mentioned techniques that have been proposed for objective intraocular scattering assessment, putting especial emphasis on the last one based on Purkinje images, and compare their results and clinical performance.

Femtosecond laser iridorexis during cataract surgery

Introduction: Femtosecond laser‐assisted cataract surgery (FLACS) is currently the most widely used by surgeons, which is an evolution in technology compared to the phacoemulsification technique. However, the femtosecond laser may present complications such as increased intraocular pressure, incomplete fragmentation of the lens, incomplete capsulotomy, capsular tear, subconjunctival haemorrhage, among others. Its main advantages are less loss of endothelial cells, shorter phacoemulsification time, better visual and refractive prognosis, although its cost is higher. The femtosecond laser is the most commonly used technique for cataract surgery. However, it requires previous experience on the part of the surgeon, and in cases with miotic pupils, another approach is recommended.Report of Case: An 82‐year‐old woman underwent cataract surgery. Pre‐operatively, she underwent visual acuity (VA) tests with and without correction, topography, biometry, endothelial count, optical coherence tomography (OCT), intraocular pressure (IOP) measurement and fundus examination. The surgery is performed with femtosecond laser with the laser platform Femtosegundovictus® (Bausch+Lomb., Messerschmittstr, Munich, Germany). By chance, iridorexis is produced to subsequently perform the extraction of the crystalline lens with the respective IOL implantation.Discussion: Cataract surgery can present complications, one of which is iris rexis. This condition is rare and usually occurs because the pupils are too small or do not dilate well during cataract surgery, which leads to poorer management and control over the flap.Conclusions: The use of femtosecond laser during cataract surgery is a high‐precision, personalized, safe and effective treatment, although it requires previous training and experience on the part of the surgeon for the success rate to be good.

3D visualization of cellular and molecular distributions in human crystalline lenses at different ages

3D visualization of cellular and molecular distributions in human crystalline lenses at different ages

Clinical management of a nonoptimal vault and unexpected postoperative refraction in a patient implanted with a phakic intraocular lens

Introduction: This case reports the management of a bilateral toric implantable collamer lens (ICL) surgery with low vaulting and unilateral reduction in visual acuity (VA) associated with a combined effect of surgically induced astigmatism (SIA) and toric-ICL rotation. This case expands the common management of toric-ICL rotation, by adding surgically induced corneal changes. Patient and Clinical Findings: The patient presented with moderate myopia and high astigmatism and was implanted with a toric-ICL, resulting in bilateral low vault <150 μm and unilateral VA reduction (20/40) because of postoperative oblique astigmatism, observed at the 4-week follow-up. Diagnosis, Intervention and Outcomes: The low ICL vaulting was associated with a high crystalline lens rise and underestimation of the sulcus-to-sulcus distance. The VA reduction resulted from a combined effect of ∼1.0 diopter SIA and 8-degree ICL rotation. The authors associate the high SIA to abnormal corneal biomechanics indexes and the toric-ICL rotation to a lack of stability resultant from a small ICL size. The left eye toric-ICL has exchanged with one with larger size and the power recalculated using vectorial analysis. The toric-ICL exchange increased the vault 75 μm and improved VA. Conclusions: Detailed anterior chamber morphometry and corneal biomechanics may assist in improving the refractive outcome in toric-ICL surgery.

Refractive surgery to correct visual impairments in 267 children with autism spectrum and related neuro-developmental disorders: improvements in vision and behavior.

Children with autism spectrum disorder (ASD) may have impaired vision owing to high refractive errors and aversion to spectacles or contact lenses. Visual blurring is caused by near-sighted myopia, far-sighted hyperopia, or astigmatism in one or both eyes. Refractive surgery can restore sharp vision and eliminate the need for spectacles and contact lenses. Restoration of sharp vision may improve ASD behavior. We aimed to determine the refractive outcomes in this cohort using ophthalmic measures and behavioral and school performance alterations after refractive surgery by employing parent-proxy reports. This interventional, retrospective case series included data from 267 children with refractive errors and neurodevelopmental disorders (NDDs) diagnosed as ASD alone or NDD with ASD-like behaviors over a 15-year period. One of three refractive surgery methods was employed, with the choice of method uniquely tailored to the child's eye anatomy. Laser photorefractive keratectomy (PRK) was performed in 131 children, implantation of a phakic intraocular lens (pIOL) in 115 children, and removal of the crystalline lens and implantation of an intraocular lens (refractive lens exchange, RLE) in 21 children. All procedures were performed under brief general anesthesia, with the child returning home on the same day. The median age at surgery was 10.9 years and the median follow-up period was 3.1 years. Pre-operative refractive errors ranged from a mean (standard deviation) +7.5 (0.09) D to -14.3 (4.8) D. Surgery corrected 87% of the children to normal focal length (± 1 D). Visual acuity improved an average of 0.6 logarithm of the minimum angle of resolution, the equivalent of 6 lines on a standard eye chart. Change in visual acuity was significant (all P < 0.01) between baseline and the most recent follow-up examination in each of subgroups. Change in spherical equivalent refractive error at 3, 12, 24, 36, 60, and > 60 months post-operatively were significant (all P < 0.01) between baseline and each follow-up visit in each of subgroups. Social interactions and ASD behaviors improved in 72% (192) of the treated children (P < 0.01). The incidence of sight-threatening complications was low. Refractive surgery improves both visual function and behavior in most children with ASD and major myopia, hyperopia, or astigmatism. The PRK, pIOL, and RLE procedures appear to be effective and reasonably safe methods for improving refractive error, visual acuity, and behavior in many ametropic children with ASD and ASD-like NDDs.

Cortical ribboning: A sign of isolated posterior capsular rupture

Isolated posterior capsular rupture of the crystalline lens following blunt trauma is an uncommon entity, preoperative identification of which can prevent undesirable surgical outcomes. We describe “cortical ribboning” as a novel sign to aid the surgeon in identification of a preexisting posterior capsule rupture in a young male following blunt trauma. Separation of cortical fibers was seen as cortical ribboning on slit-lamp biomicroscopy. Ribbons and posterior capsular defect were confirmed on anterior segment optical coherence tomography (ASOCT). Intraoperatively, a defect was noted on the posterior capsule as was presumed on a preoperative examination. Thus, cortical ribboning can be used as a sign of preexisting posterior capsular defect in resource-limited settings for an uneventful management of the case.

In-Office Lens Repositioning for Anterior Crystalline Lens Dislocation.

We describe an in-office lens repositioning technique for anterior crystalline lens dislocation. We present a case series of four patients with spontaneous or traumatic anterior crystalline lens dislocation. The technique included supine patient positioning, gentle pressure with a cotton swab on the peripheral cornea to guide the lens into the posterior chamber, and the use of a miotic agent afterward to prevent subsequent subluxation. In the four cases described, the in-office technique successfully restored the lens to the posterior chamber, improved vision, and decreased intraocular pressure in most instances by resolving the angle closure secondary to pupillary block. The in-office lens repositioning technique is appropriate as an acute non-surgical intervention or temporizing measure for anterior crystalline lens dislocation. [Ophthalmic Surg Lasers Imaging Retina 2024;55:293-298.].

Comparison of Predictability in Vault Using NK Formula and KS Formula for the Implantable Collamer Lens Surgery.

This study aims to investigate the agreement between the NK and KS formulas in predicting the vault after implantation of an EVO-implantable collamer lens (ICL). This retrospective study included 106 eyes of 57 patients who underwent ICL-V4c implantation. Preoperative vault prediction was conducted by utilizing the NK and KS formulas, with postoperative measurements by anterior segment optical coherence tomography (AS-OCT) at one month. The analysis focused on the consistency between predicted and achieved vaults, as well as the correlation between the achieved vault and various biometric parameters. The mean achieved vault was 605.25 ± 212.72 µm, which was significantly smaller than the predicted vaults of 710.08 ± 195.08 and 673.80 ± 212.76 µm, using the NK and KS formulas, respectively (P < 0.05). The mean differences between the achieved vault and the predicted vault using the NK formula and KS formula were -104.82 μm (95% LoA: -600.38-391.19 μm) and -68.55 μm (95% LoA: -628.91-491.82 μm), respectively. Anterior chamber depth (ACD), vertical sulcus-to-sulcus (V-STS) diameter, and crystalline lens rise (CLR) were independent factors associated with the achieved vault (P < 0.05). The two formulas showed no statistically significant difference in absolute prediction error (APE). The NK formula exhibited superior consistency and low predictive error compared to the KS formula in the 12.6 mm ICL group. AS-OCT measurements overestimated the predicted ICL vault, especially in the 13.2 mm ICL size selection. Relying solely on the NK or KS formulas for predicting vaults before ICL surgery is not recommended.

Blue Light Filtration in Intraocular Lenses: Effects on Visual Function and Systemic Health.

Blue light-filtering (BLF) intraocular lenses (IOLs) are designed to mimic the healthy natural adult crystalline lens. Studies that evaluated the relative merit of ultraviolet-only IOL design (ie, blocking wavelengths <400 nm) versus BLF IOL design (ie, filtering wavelengths ~400-475 nm in addition to blocking wavelengths <400 nm) on protection and function of the visual system suggest that neither design had a deleterious impact on visual acuity or contrast sensitivity. A BLF design may reduce some aspects of glare, such as veiling and photostress. BLF has been shown in many contexts to improve visual performance under conditions that are stressed by blue light, such as distance vision impaired by short-wave dominant haze. Furthermore, some data (mostly inferential) support the notion that BLF IOLs reduce actinic stress. Biomimetic BLF IOLs represent a conservative approach to IOL design that provides no harm for visual acuity, contrast sensitivity, or color vision while improving vision under certain circumstances (eg, glare).

Thickness of the crystalline lens does not depend on cataract formation

Aims/Purpose: To assess the influence of cataract formation on the lens thickness (LT), anterior (ACS) and posterior (PCS) cortex space and nuclear thickness (NT).Methods: A prospective cross‐sectional study including patients seeking for cataract surgery was performed. The standardized Lens Opacification Classification System (LOCS)‐III was used to classify lens opacities. A control group composed of non‐cataractous patients was also created. In addition, cataract patients were also classified according to the cataract location (presence or absence of cortical, nuclear or posterior subcapsular cataract). Optical biometry was performed to measure LT, ACS, NT and PCS. Propensity score was used to match cataract and non‐cataract patients one‐to‐one for sex, age and axial length. Groups were compared using the Student's t‐test or Yuen's test.Results: A sample of 603 volunteers (403 females, 200 males) aged 59.1 ± 18.8 years was recruited. Before matching, the lens cataract and the non‐cataract group was composed of 361 cataractous and 242 non‐cataractous volunteers. Also, all participants were classified into cortical and non‐cortical cataract groups (226 vs. 377), nuclear and non‐nuclear cataract groups (313 vs. 209) and into subcapsular and non‐subcapsular cataract groups (242 vs. 361). Before matching, cataract groups showed significant (p ≤ 0.003) higher LT (4.52 ± 0.39 vs. 3.94 ± 0.46 mm), ACS (0.75 ± 0.20 vs. 0.58 ± 0.23 mm), NT (3.34 ± 0.23 vs. 3.18 ± 0.25 mm) and PCS (0.42 ± 0.19 vs. 0.37 ± 0.19 mm). After matching, the lens, cortical, nuclear and subcapsular cataract samples were composed of 146, 258, 182 and 226 participants, respectively. Then, no significant (p ≥ 0.08) differences were found for LT, ACS, NT and PCS.Conclusions: Thickness of the lens and/or its main components is not changed due to cataract formation. The progressive lens growth associated to aging might be the main confounding factor misleading the outcomes of previous studies that reported differences in LT between cataractous and non‐cataractous patients.

A perturbation method for the ray-transfer matrix of the crystalline lens

Analytical expressions for the ray-transfer matrix have been proven useful for the understanding of ray propagation in gradient-index (GRIN) lenses. The determination of an exact analytical expression for the ray-transfer matrix of arbitrary GRIN lenses remains unsolved. We propose an approximation based on the perturbation method with highly accurate results for models of the crystalline lens, which outperforms existing methods.

Cataract surgery in retinitis pigmentosa.

Retinitis pigmentosa (RP) is an inherited retinal dystrophy characterized by progressive vision loss due to photoreceptor degeneration. Complicated cataract formation, particularly posterior subcapsular cataract (PSC), frequently occurs in RP and exacerbates the visual impairment. Cataract surgery may improve vision; however, the distinctive challenges of RP require specific considerations. This mini-review aims to provide a comprehensive overview of the RP-related cataract. A comprehensive literature review was conducted via PubMed/MEDLINE, spanning the period from January 1976 to June 2024, using the keywords "cataract," "cataract surgery," "cystoid macular edema," "hereditary retinal dystrophy," "retinitis pigmentosa," "posterior subcapsular cataract," "posterior capsular opacification," "zonular weakness," and "artificial intelligence." We aimed to evaluate cataract surgery in patients with RP, focusing on cataract formation, its surgical management, postoperative complications, patient follow-up, and visual outcomes. Relevant review articles, clinical trials, and case reports with related reference lists of these articles were included. A total of 53 articles were examined in detail, including those identified through focused keyword searches and the reference lists of these articles. Cataract surgery in patients with RP generally results in substantial visual improvement. However, surgery can be complicated, particularly by zonular weakness and subluxation of the crystalline lens. These risks can be reduced by using capsular tension rings and employing meticulous surgical technique. Furthermore, postoperative complications, such as cystoid macular edema and posterior capsular opacification, are common. Despite these challenges, regular postoperative follow-up and appropriate management can help mitigate complications. Integrity of the ellipsoid zone and external limiting membrane on preoperative optical coherence tomographic examination are the main predictors of visual outcomes following cataract surgery; however, outcomes can vary. Though many patients experience significant visual improvement, some may experience limited benefits due to pre-existing advanced retinal degeneration. Cataract surgery may offer meaningful visual benefits in patients with RP; however, careful preoperative evaluation and meticulous surgical technique are required to address the possible challenges. Attentive postoperative care and follow-up are essential to optimize visual outcomes. Early surgical intervention can significantly improve the quality of life in selected candidates, and tailored approaches are necessary in patients with RP requiring cataract surgery. Further studies on the potential application of artificial intelligence to monitor postoperative recovery and detect complications may improve surgical outcomes and enhance patient care.

Comparison of short‐term clinical outcomes between sutured scleral fixation and modified Yamane sutureless scleral fixation

Aims/Purpose: To compare and investigate the short‐term clinical outcomes between 10‐0 polypropylene sutured intraocular lens (IOL) scleral fixation and modified Yamane sutureless IOL scleral fixation in patients with IOL or crystalline les dislocation and aphakic state.Methods: From August 2012 to May 2022, medical records were retrospectively analysed for 43 patients with sutured scleral fixation and 40 patients with sutureless scleral fixation. Uncorrected visual acuity (UCVA), best corrected visual acuity (BCVA), total astigmatism, IOL astigmatism, refractive error, corneal endothelial cell density, surgical time and complications were compared before surgery, 1 week, 1 month and 3 months after surgery.Results: In the two groups, after 3 months of surgery, UCVA and BCVA improved compared to before surgery, but there was no significant difference between two groups. The absolute refractive error and total astigmatism for 1 week after surgery and IOL astigmatism for 1 week and 1 month after surgery were significantly lower in sutureless fixation group. There was no significant difference in post‐operative corneal endothelial cell density changes between two groups, and total surgical time and IOL fixation time were measured significantly lower in sutureless fixation group.Conclusions: Although modified Yamane sutureless IOL scleral fixation did not show significant improvement in visual acuity compared with conventional sutured IOL scleral fixation, sutureless fixation provided better stability of IOL in the early stages after surgery and short in the surgical time. So it can be an effective alternative to conventional sutured scleral fixation in patients with IOL or crystalline lens dislocation and aphakic state.

OCT angiography findings in posterior persistent fetal vasculature

Aims/Purpose: To report optical coherence tomography angiography findings in a patient presenting unilateral posterior persistent fetal vasculature (PVF).Methods: We report the case of a 19‐year‐old female patient with longstanding visual impairment of the left eye (LE). Patient was assessed with multimodal imaging including color fundus photography, swept source optical coherence tomography (SS‐OCT) and SS‐OCT angiography (SS‐OCTA) of the macula and the optic disc.Results: The patient had a history of unilateral visual impairment of unknown aetiology and consulted for a routine examination. Best corrected visual acuity was 10/10 in the right eye (RE) and limited to counting fingers in the LE. Ophthalmological examination of the LE revealed a mild exophoria, a quiet anterior segment, a vestigial capsular bag and an inferonasal whitish spot at the posterior lens capsule corresponding to Mittendorf's dot. Dilated fundus examination of the LE showed a lack of foveal reflex, retinal vessel contraction associated to the presence of a fibrovascular stalk extending from the OD to the crystalline lens via the vitreous humour, corresponding to fibrovascular contraction of the persistent and hyperplastic Cloquet's canal. No associated retinal detachment was noted. The clinical diagnosis of posterior PVF was confirmed. Macular SS‐OCT revealed retinal thinning with absence of foveal pit. Optic disc SS‐OCT highlighted a hyporeflective tubular structure overlying a Bergmeister'papilla. Cross‐sectional SS‐OCTA detected a flow signal at the level of Bergmeister's papilla, but no confirmed flow signal was identified at the level of the fibrovascular stalk.Conclusions: PVF is a rare condition characterized by fetal remnant from developmental vascular system defects, clinically recognized in its three forms (anterior, posterior and combined). OCT‐angiography is a useful non‐invasive tool to confirm of persistent hyaloid artery patency and assess risk of vascular complications. Contraction of the fibrovascular mass is prone to tractional retinal detachment and repeated episodes of intravitreal or intracapsular haemorrhage. Monitoring is therefore recommended even in adulthood.