Macular Hole as an Unusual Complication of Posterior Persistent Fetal Vasculature

Purpose: To report a rare retinal complication of posterior persistent fetal vasculature (PFV) and describe the surgical outcomes. Methods: A retrospective review was performed of 3 cases undergoing vitrectomy for tent-like posterior PFV. Results: All 3 cases presented with unilateral tent-like posterior PFV; 2 of them were associated with significant lens opacity. One eye underwent lens-sparing vitrectomy, while 2 underwent combined lensectomy and vitrectomy. In all cases, a retinal defect was identified on the tent-like elevated retina at the posterior pole. Macular holes were detected intraoperatively immediately after transection of the fibrovascular stalk. The residual stalk was left positioned over the hole, and 20% sulfur hexafluoride gas tamponade was used. Conclusions: Posterior PFV may be associated with occult macular hole formation due to chronic retinal traction, particularly in cases with delayed diagnosis. Early surgical intervention may be important to prevent progression to total retinal detachment.