Objective To observe the effects of vitrectomy for persistent fetal vasculature (PFV).Methods The clinical data of 11 patients (14 eyes) with PFV, including posterior PFV (one eye) and combined PFV (13 eyes), were retrospectively analyzed. Vitrectomy was performed for all patients, lensectomy was performed for seven eyes, retinotomy was performed for five eyes, retinotomy and scleral buckling was performed for one eye. Intraoperative and postoperative complications were observed. The followup period ranged from eight to 74 months, with the mean of 44 months. The visual acuity （VA） and intraocular pressure before and after surgery were comparatively analyzed.Results There were no intraoperative complications in all the patients. The surgery was performed successfully in 12 eyes （86.0%） and failed in two eyes （14.0%）. The postoperative VA of five eyes (35.7%) increased, four eyes （28.6%） didnprime;t change and five eyes （35.7%） decreased. The postoperative intraocular pressure of two eyes （14.3%） increased,11 eyes （78.6%） didnprime;t change and one eye （7.1%） decreased. There was one eye with persistent hypotension and one eye with recurrent retinal detachment after surgery.Conclusion Vitrectomy can prevent complications and improve visual acuity in some PFV patients.
ObjectiveTo investigate the effects of limbal vitrectomy for persistent hyperplastic primary vitreous (PHPV) with disappeared anterior chamber and corneal opacity. MethodsSixteen eyes of 16 children with unilateral PHPV were included in this retrospective study. All the 16 eyes had both anterior and posterior disease, including opaque cornea, disappeared anterior chamber, pupil occlusion and extensive synechia, and lens opacity. The visual acuity was hand movement in 1 eye, and light perception in 15 eyes. There were 7 eyes with microphthalmia, 4 eyes with total retinal detachment, 3 eyes with retinal dysplasia, 1 eye with retinal folds, and 4 eyes with high intraocular pressure preoperatively. All the eyes underwent limbal vitrectomy, including dissection of synechia, pupil formation, lensectomy, posterior lens membrane peeling and vitrectomy. Four eyes with retinal detachment received long-acting gas tamponade following vitrectomy. The mean follow-up was 15.8 months (range from 9 to 21 months). ResultsNo eye had intraoperative complications. After surgery, all the 16 eyes had normal anterior chamber, round pupil and improved corneal transparency. Two eyes achieved a final visual acuity of 20/940 or better. Of the 4 eyes with retinal detachment, 3 eyes achieved retinal reattachment. Of the 4 eyes with preoperative high intraocular pressure, 3 eyes had controlled intraocular pressure postoperatively and the remaining 1 eye underwent glaucoma procedure at 6 months after the primary surgery. ConclusionPHPV eyes with disappeared anterior chamber and corneal opacity have a potential for developing better vision with improved cosmetic outcome and controlled intraocular pressure after vitrectomy by limbal approach.
ObjectiveTo observe the diagnostic sensitivity and specificity of color Doppler flow imaging (CDFI) for persistent hyperplastic primary vitreous (PHPV). MethodsThe clinical data of 71 children (93 eyes) with congenital cataract which suspected of concurrent PHPV were retrospectively analyzed. The children included 45 males (54 eyes) and 26 females (39 eyes), aged from 1 to 24 months, with an average age of (7.6±4.3) months. All eyes were examined by CDFI, and observe whether there was a pathological strip in the vitreous, the site of the connection between the strip echo and the wall of the eye and the signal of blood flow on the strip echo. Within 1 week after a CDFI examination under general anesthesia, 64 children (79 eyes) underwent lens excision combined with vitrectomy and the other 14 eyes of 7 children underwent mydriatic fundus examination by two experienced eye specialists. Combined with clinical features of PHPV, the diagnosis and differential diagnosis were made according to the clouding of the lens, posterior capsule proliferation, vitreous proliferation and retinal detachment position which were found during operation and fundus examination. Compare and analyze the CDFI examination results and the above diagnosis results, calculate the sensitivity and specificity of CDFI for PHPV. ResultsIn surgery and mydriatic fundus examination results of 93 eyes, vitreous abnormal in 85 eyes, no significant changes were found in vitreous of the other 8 eyes. In 85 eyes of abnormal vitreous, 68 eyes were diagnosed as PHPV, 16 eyes were diagnosed as familial exudative vitreoretinopathy (FEVR), and 1 eye was diagnosed as treactional retinal detachment. In 85 eyes of abnormal vitreous which were found by surgery and fundus examination, CDFI confirmed 81 eyes and its diagnostic sensitivity was 95.3%; the other 4 eyes were not found vitreous abnormality, and the missed diagnosis rate was 4.7%. Surgery and mydriatic fundus examination found no vitreous abnormal in 8 eyes, but CDFI explored strip low echo connected with the optic disc or posterior lens capsule in vitreous. In the 68 eyes of PHPV which were diagnosed by surgery or fundus examination, 59 eyes had the same diagnosis of CDFI, the sensitivity of CDFI was 86.8%; PHPV was not diagnosed in 25 eyes by surgery or fundus examination, but only 8 eyes were also not diagnosed by CDFI, and the specificity of CDFI was 32.0%. The remaining 17 eyes were diagnosed as FEVR in 16 eyes and traction retinal detachment in 1 eye after surgery or mydriatic fundus examination, but they were all diagnosed as PHPV in CDFI. The misdiagnosis rate of CDFI was 68.0%. ConclusionFor PHPV, the diagnostic sensitivity and specificity of CDFI are 86.8% and 32.0%, respectively.
Persistent fetal vasculature syndrome (PFVS) is a rare congenital vitreous dysplasia, which is classified as anterior, posterior and combined types according to the location of the vascular abnormalities. The clinical manifestations of PFVS are diverse, and early surgical intervention is very important. The main objective of surgical treatment is to remove the anterior and posterior traction between fibrovascular membranes and retina as well as lens, and to reconstruct clear visual axis. Surgical treatments include pupilloplasty, lensectomy with or without intraocular lens implantation and vitrectomy via limbal or scleral approach. For new technologies, the applications of ophthalmic viscosurgical device and femtosecond lasers have desirable results . In addition to focusing on improving the success rate of surgery, it is also necessary to systematically and comprehensively assess the overall preoperative condition and postoperative visual function of the patients. PFVS eyes have limited improvement in postoperative vision, which is related to the extent of lesion involvement and the occurrence of complications. Eyes with macular dysplasia and tractional retinal detachment, as well as elongated ciliary process, have a poor prognosis of vision after surgery. How to improve postoperative vision in the eye affecting the posterior segment of the eye with PFVS from the microscopic anatomical relationship between the fibrous vascular pedicle and the retina is worth further study. On the other hand, reducing surgical trauma and optimizing surgical procedures in order to improve postoperative visual acuity and reduce postoperative complications are also the key research directions of future PFVS treatments.