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Management and Outcomes of Posterior Persistent Fetal Vasculature
Guy de Saint Sauveur1, Thibaut Chapron2, Youssef Abdelmassih1
1Pediatric Ophthalmology Department, Rothschild Foundation Hospital, Paris, France.
Insights
Posterior persistent fetal vasculature (PFV) in children often requires complex vitreoretinal surgery. This study outlines clinical features, outcomes, and proposes a management algorithm for posterior PFV.
Area of Science:
- Ophthalmology
- Pediatric Ophthalmology
- Retinal Surgery
Background:
- Persistent fetal vasculature (PFV) is a congenital condition affecting the eye.
- Posterior PFV involves structures within the posterior segment of the eye.
- Understanding PFV's clinical features and outcomes is crucial for effective management.
Purpose of the Study:
- To describe the clinical features, management strategies, and outcomes of posterior persistent fetal vasculature (PFV).
- To propose a management algorithm for posterior PFV based on a case series.
Main Methods:
- Retrospective analysis of 96 children diagnosed with posterior PFV between 2011 and 2021.
- Evaluation of clinical characteristics, surgical techniques, and postoperative outcomes.
- Classification of patients based on disease severity and anterior segment involvement.
Main Results:
- Surgery was performed in 89% of patients with an 81% total success rate.
- Anterior segment involvement was noted in 64% of eyes; 42.7% were microphthalmic.
- Postoperative adverse events occurred in 38% of eyes, including ocular hypertension and retinal detachment.
Conclusions:
- Most posterior PFV cases necessitate complex vitreoretinal surgery.
- Surgical goals include retinal flattening, reducing traction, and visual axis clearance.
- A management algorithm for posterior PFV is proposed based on the findings.
Purpose:
To describe clinical features, management, and outcomes of posterior persistent fetal vasculature (PFV) and suggest a management algorithm.
Design:
Retrospective, consecutive case series.
Participants:
All children diagnosed with posterior PFV and treated or followed at the Rothschild Foundation Hospital in France between June 2011 and September 2021.
Methods:
Retrospective analysis of the clinical characteristics of posterior PFV. We reported age, gender, presenting symptoms, intraocular pressure, and visual acuity (VA) at diagnosis. Patients were divided into 4 groups depending on the severity and involvement or not of anterior segment. We reported the vitreoretinal surgical techniques used.
Main Outcome Measures:
Anatomic results, ocular hypertension, best-corrected distance visual acuity (BCDVA), presence of postoperative adverse events, and additional surgical interventions were recorded at each follow-up visit.
Results:
Ninety-six patients were included. The median age at diagnosis was 8 months (IQR = 12), mean 18.9 ± 30.9 months) with a mean follow-up of 27 ± 31.2 months. Although PFV is often an isolated disease, it was associated with a systemic disease in 8% of cases. There was anterior involvement in 62 (64%) of eyes. Forty-one eyes (42.7%) were microphthalmic and more frequently associated with severe PFV (53% vs. 25%; P = 0.01). Surgery was performed in 85 patients (89%). Of them, 69 (81%) had a total success, 5 (6%) had a partial success due to persistent limited peripheral retinal detachment (RD), and 11 (13%) had a failure due to persistent total RD after surgery. Postoperative adverse events occured in 38 eyes including ocular hypertension requiring eye drop medication (7.1%), secondary cell proliferation around the intraocular lens (8.2%), intravitreal hemorrhages (7.1%), and persistent tractional RD (10.6%). Second surgery was performed in 18 patients (21%). At last follow-up, VA could be measured in logarithm of the minimum angle of resolution in 43 children (45%), light perception in 21 eyes (22%), and no light perception or impossible to assess in 32 eyes (33%).
Conclusions:
In our case series, most patients presenting with posterior PFV received complex vitreoretinal surgery. Goals of the surgery vary and include retinal flattening, reduction of vitreoretinal traction, freeing of visual axis, and aesthetic concerns. We propose a surgical and medical management algorithm for PFV.
Financial Disclosure(S):
Proprietary or commercial disclosure may be found after the references.
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