Abstract
Purpose
To study the complications and surgical outcomes of cataract surgery in patients of persistent fetal vasculature (PFV) with cataract.
Methods
In this prospective study, phacoaspiration with/without intraocular lens implantation (IOL) was done in 20 children (mean age 14.2 months) with unilateral cataract with anterior (n = 6) or combined (n = 14) PFV. The rentrolental vascularized membrane was cauterized and dissected circumferentially, followed by cauterization and resection of the PFV stalk. The outcome measures included fixation preference using the CSM (central, steady, maintained) method and intraoperative and postoperative complications in an 18-month follow-up. The difference in outcomes of anterior and combined PFV, as well as aphakic and pseudophakic eyes, was studied.
Results
CSM fixation was seen in 16 patients after 18 months. The intraocular lens was implanted in 16 eyes and 4 eyes with combined PFV were left aphakic. None of our patients had intraoperative bleeding. Visual axis obscuration was the major complication seen, requiring membranectomy in 8 children. Pupilloplasty was required with membranectomy in one eye. None of our patients developed glaucoma or retinal detachment.
Conclusion
Timely surgical intervention and aggressive amblyopia therapy led to good visual results in our study. Poor prognosis was seen in combined PFV, aphakia, and microphthalmia.
Similar content being viewed by others
References
Goldberg MF (1997) Persistent fetal vasculature (PFV): an integrated interpretation of signs and symptoms associated with persistent hyperplastic primary vitreous (PHPV). LIV Edward Jackson memorial lecture. Am J Ophthalmol 124:587–626. https://doi.org/10.1016/S0002-9394(14)70899-2
Shastry BS (2009) Persistent hyperplastic primary vitreous: congenital malformation of the eye. Clin Exp Ophthalmol 37:884–890. https://doi.org/10.1111/j.1442-9071.2009.02150
Müllner-Eidenböck A, Amon M, Moser E, Klebermass N (2004) Persistent fetal vasculature and minimal fetal vascular remnants: a frequent cause of unilateral congenital cataracts. Ophthalmology 111:906–913. https://doi.org/10.1016/j.ophtha.2003.07.019
Rizvi SW, Siddiqui MA, Khan AA, Ahmad I, Ullah E, Sukul RR (2013) Bilateral persistent hyperplastic primary vitreous: a close mimic of retinoblastoma. Semin Ophthalmol 28:25–27. https://doi.org/10.3109/08820538.2012.730098
Kumar A, Jethani J, Shetty S, Vijayalakshmi P (2010) Bilateral persistent fetal vasculature: a study of 11 cases. JAAPOS 14:345–348. https://doi.org/10.1016/j.jaapos.2010.05.007
Solebo AL, Russell-Eggitt I, Cumberland P, Rahi JS (2016) Congenital cataract associated with persistent fetal vasculature: findings from IoLunder2. Eye (Lond) 30(9):1204–1209. https://doi.org/10.1038/eye.2016.159
Haddad R, Font RL, Reeser F (1978) Persistent hyperplastic primary vitreous. A clinicopathologic study of 62 cases and review of the literature. Surv Ophthalmol 23:123–134. https://doi.org/10.1016/0039-6257(78)90091-7
Pruett RC (1975) The pleomorphism and complications of posterior hyperplastic primary vitreous. Am J Ophthalmol 80:625–629. https://doi.org/10.1016/0002-9394(75)90392-X
Silbert M, Gurwood AS (2000) Persistent hyperplastic primary vitreous. Clin Eye Vis Care 12:131–137. https://doi.org/10.1016/S0953-4431(00)00054-0
Hu A, Pei X, Ding X, Li J, Li Y, Liu F, Li Z, Zhan Z, Lu L (2016) Combined persistent fetal vasculature. Ophthalmology 123:19–25. https://doi.org/10.1016/j.ophtha.2015.09.001
Yu YS, Chang BL (1997) Persistent hyperplastic primary vitreous in male twins. Korean J Ophthalmol 11:123–125. https://doi.org/10.3341/kjo.1997.11.2.123
Yusuf IH, Patel CK, Salmon JF (2015) Unilateral persistent hyperplastic primary vitreous: intensive management approach with excellent outcome beyond visual maturation. BMJ Case Rep:bcr2014206525. https://doi.org/10.1136/bcr-2014-206525
Li L, Fan DB, Zhao YT, Li Y, Cai FF, Zheng GY (2017) Surgical treatment and visual outcomes of cataract with persistent hyperplastic primary vitreous. Int J Ophthalmol 10(3):391–399. https://doi.org/10.18240/ijo.2017.03.11
Khokhar S, Tejwani KL, Kumar G, Kushmesh R (2011) Approach to cataract with persistent hyperplastic primary vitreous. J Cataract Refract Surg 37(8):1382–1385. https://doi.org/10.1016/j.jcrs.2011.06.012
Pollard ZF (1997) Persistent hyperplastic primary vitreous: diagnosis, treatment and results. Trans Am Ophthalmol Soc 95:487–549
Swamy BN, Billson F, Martin F, Donaldson C, Hing S, Jamieson R, Grigg J (2007) Secondary glaucoma after paediatric cataract surgery. Br J Ophthalmol 91:1627–1630. https://doi.org/10.1136/bjo.2007.117887
Zipf RF (1976) Binocular fixation pattern. Arch Ophthalmol 94:401–405. https://doi.org/10.1001/archopht.1976.03910030189003
Pennie FC, Wood IC, Olsen C, White S, Charman WN (2001) A longitudinal study of the biometric and refractive changes in full term infants during the first year of life. Vis Res 41:2799–2810. https://doi.org/10.1016/S0042-6989(01)00169-9
Dahan E, Drusedau MUH (1997) Choice of lens and dioptric power in pediatric pseudophakia. J Cataract Refract Surg 23(Suppl):S618–S623. https://doi.org/10.1016/S0886-3350(97)80043-0
Enyedi LB, Peterseim MW, Freedman SF, Buckley EG (1998) Refractive changes after pediatric intraocular lens implantation. Am J Ophthalmol 126(6):772–781. https://doi.org/10.1016/S0002-9394(98)00247-5
Saleem SM (2018) Modified Kuppuswamy scale updated for Year 2018. PIJR 7(3):435–436. https://doi.org/10.36106/paripex
Reese AB (1955) Persistent hyperplastic primary vitreous. The Jackson Memorial Lecture. Am J Ophthalmol 40:317–331. https://doi.org/10.1016/0002-9394(55)91866-3
Jain TP (2009) Bilateral persistent hyperplastic primary vitreous. Indian J Ophthalmol 57(1):53–54. https://doi.org/10.4103/0301-4738.44487
Dass AB, Trese MT (1999) Surgical results of persistent hyperplastic primary vitreous. Ophthalmology 106:280–284. https://doi.org/10.1016/S0161-6420(99)90066-0
Hunt A, Rowe N, Lam A, Martin F (2005) Outcomes in persistent hyperplastic primary vitreous. Br J Ophthalmol 89:859–863. https://doi.org/10.1136/bjo.2004.053595
Anteby I, Cohen E, Karshai I, Benezra D (2002) Unilateral persistent hyperplastic primary vitreous: course and outcome. J AAPOS 6(2):92–99. https://doi.org/10.1067/mpa.2002.121324
Vasavada AR, Vasavada SA, Bobrova N, Praveen MR, Shah SK, Vasavada VA, Pardo JV, Raj SM, Trivedi RH (2012) Outcomes of pediatric cataract surgery in anterior persistent fetal vasculature. J Cataract Refract Surg 38(5):849–857. https://doi.org/10.1016/j.jcrs.2011.11.045
Vilms RJ, McDougal L, Atmavilas Y, Hay K, Triplett DP, Silverman J, Raj A (2017) Gender inequities in curative and preventive health care use among infants in Bihar, India. J Glob Health 7(2):020402. https://doi.org/10.7189/jogh.07.020402
Teske MP, Trese MT (1987) Retinopathy of prematurity-like fundus and persistent hyperplastic primary vitreous associated with maternal cocaine use. Am J Ophthalmol 103:719–720. https://doi.org/10.1016/S0002-9394(14)74343-0
Sinha R, Bali SJ, Kumar C, Sharma N, Titiyal JS, Vajpayee RB (2013) Results of cataract surgery and plasma ablation posterior capsulotomy in anterior persistent hyperplastic primary vitreous. Middle East Afr J Ophthalmol 20:217–220. https://doi.org/10.4103/0974-9233.114794
Walsh MK, Drenser KA, Capone A Jr, Trese MT (2010) Early vitrectomy effective for bilateral combined anterior and posterior persistent fetal vasculature syndrome. Retina 30(4 Suppl):S2–S8. https://doi.org/10.1097/IAE.0b013e3181d34a9e
Federman JL, Shields JA, Altman B, Koller H (1982) The surgical and non surgical management of persistent hyperplastic primary vitreous. Ophthalmology 89:20–24. https://doi.org/10.1016/S0161-6420(82)34854-X
Johnson CP, Keech RV (1996) Prevalence of glaucoma after surgery for PHPV and infantile cataracts. J Pediatr Ophthalmol Strabismus 33:14–17
Warren N, Trivedi RH, Wilson ME (2018) Persistent fetal vasculature with elongated ciliary processes in children. Am J Ophthalmol 198:25–29. https://doi.org/10.1016/j.ajo.2018.09.019
Khurana S, Gupta PC, Vaiphei K, Singh R, Ram J (2019) A clinicopathological study of persistent fetal vasculature. Indian J Ophthalmol 67:785–787. https://doi.org/10.4103/ijo.IJO_1375_18
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interests
The authors declare that they have no conflict of interest.
Ethical approval
All procedures performed in this study were in accordance with the ethical standards of the Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India, and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Informed consent
Informed consent was obtained from parents/guardians of all individual participants included in the study.
Additional information
Publisher’s note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Khurana, S., Ram, J., Singh, R. et al. Surgical outcomes of cataract surgery in anterior and combined persistent fetal vasculature using a novel surgical technique: a single center, prospective study. Graefes Arch Clin Exp Ophthalmol 259, 213–221 (2021). https://doi.org/10.1007/s00417-020-04883-6
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00417-020-04883-6