Ophthalmic Surgery, Lasers and Imaging Retina

Images in Ophthalmology 

Multiple Vascular Stalks in a Patient With Persistent Fetal Vasculature

Saumya M. Shah, BS; Darius M. Moshfeghi, MD

Abstract

Persistent fetal vasculature (PFV) is a well-defined phenomenon that is characterized by the presence of fetal hyaloid vessels within the eye after birth. Although there have been numerous studies describing the occurrence, surgical management, and possible pathogenesis of PFV, few studies have discussed the possibility of a patient having more than one vascular stalk. The authors describe a 5-year-old female with PFV having two well-delineated stalks.

[Ophthalmic Surg Lasers Imaging Retina. 2019;50:330–331.]

Abstract

Persistent fetal vasculature (PFV) is a well-defined phenomenon that is characterized by the presence of fetal hyaloid vessels within the eye after birth. Although there have been numerous studies describing the occurrence, surgical management, and possible pathogenesis of PFV, few studies have discussed the possibility of a patient having more than one vascular stalk. The authors describe a 5-year-old female with PFV having two well-delineated stalks.

[Ophthalmic Surg Lasers Imaging Retina. 2019;50:330–331.]

A 5-year-old female with a history of presumed persistent fetal vasculature in the left eye since birth was referred to our clinic for a possible retinal tear secondary to regression of retinal vessels. Past ocular history included cataract extraction with intraocular lens implant in the left eye. Her visual acuity (VA) was 20/30 in the right eye and counting fingers at a 1-foot distance in the left eye. She had intermittent esotropia and afferent pupillary defect in the left eye and normal pupillary response and extraocular movement in the right eye. On slit-lamp examination, the anterior segment was normal bilaterally, and a dilated funduscopic examination demonstrated haziness secondary to a combined tractional and rhegmatogenous retinal detachment in the left eye. Fundus photography revealed a normal retina in the right eye and a vascular stalk at the head of the optic nerve extending to the posterior lens capsule with some inferior vitreoretinal hemorrhage, in addition to another stalk extending and embedding into the temporal macula. There was no evidence of intraocular masses or calcifications. The patient underwent a pars plana vitrectomy with epiretinal membrane (ERM) peel and resection of the stalk anterior to the optic nerve head. Her VA improved slightly but she continued to have persistent amblyopia, which was addressed by undergoing left medial rectus and lateral rectus resection. She has subsequently remained stable on follow-up visits with no evidence of new retinal tears or detachments and minimal ERM development. At age 17, the patient continues to have the temporal vascular stalk, with no signs of activity or traction on the retina (Figure 1).

Residual vascular stalk extending antero-temporally in the retina of the left eye status post-vitrectomy and amputation of the primary stalk over the optic nerve head. Close evaluation demonstrates the residual stalk remnants as whitish fibrosis overlying the optic nerve head inferiorly.

Figure 1.

Residual vascular stalk extending antero-temporally in the retina of the left eye status post-vitrectomy and amputation of the primary stalk over the optic nerve head. Close evaluation demonstrates the residual stalk remnants as whitish fibrosis overlying the optic nerve head inferiorly.

Although persistent fetal vasculature has been well-described in the literature,1–3 there are limited reports that suggest the presence of multiple vascular stalks and provide a clear view of them. Rossin et al. describe the existence of double stalks in the eye of an 8-week-old infant; however, they report a limited follow-up time of 15 months in comparison to 12 years in our patient.4

References

  1. Mancera N, Bhaleeya S. Persistent Fetal Vasculature. In: Medina C, Townsend J, Singh A, eds. Manual of Retinal Diseases. Cham, Switzerland: Springer International Publishing; 2016:61–64. doi:10.1007/978-3-319-20460-4_14 [CrossRef]
  2. Karacorlu M, Hocaoglu M, Sayman Muslubas I, Arf S, Ersoz MG, Uysal O. Functional and anatomical outcomes following surgical management of persistent fetal vasculature: A single-center experience of 44 cases. Graefes Arch Clin Exp Ophthalmol. 2018;256(3):495–501. doi:10.1007/s00417-017-3886-4 [CrossRef]
  3. Tartarella MB, Takahagi RU, Braga AP, Fortes Filho JB. Persistent fetal vasculature: Ocular features, management of cataract and outcomes. Arq Bras Oftalmol. 2013;76(3):185–188. doi:10.1590/S0004-27492013000300011 [CrossRef]
  4. Rossin EJ, VanderVeen DK, Yonekawa Y. Anterior–posterior persistent fetal vasculature with multiple stalks: Persistent vasa hyaloidea propria. J Vitreoretin Dis. 2018;2(4):240–243. doi:10.1177/2474126418776072 [CrossRef]
Authors

From Mayo Clinic School of Medicine, Rochester, Minnesota (SMS); and Byers Eye Institute, Horngren Family Vitreoretinal Center, Department of Ophthalmology, Stanford University School of Medicine, Palo Alto, California (DMM).

Mr. Shah has no relevant financial disclosures. Dr. Moshfeghi is on the board of directors for and has equity in 1–800 Contacts; is on the Data Monitoring Committee for Alcon; is the founder of, on the board of directors for, and has equity in dSentz, Pr3vent, and Promisight; is on the Steering Committee for Iconic Therapeutics; has equity in Grand Legend Technology; is on the scientific advisory board for Irenix; is a CME consultant for Novartis, Regeneron, and Vindico; is on the scientific advisory board for and has equity in Pykus; is the founder of and has equity in Versl; and is the founder of, has equity in, and is a consultant for Visunex Medical Systems Co. Ltd.

Dr. Moshfeghi did not participate in the editorial review of this manuscript.

Address correspondence to Darius M. Moshfeghi, MD, Byers Eye Institute, Horngren Family Vitreoretinal Center, Department of Ophthalmology, Stanford University School of Medicine, 2452 Watson Court, Room 2277, Palo Alto, CA; email: darius.moshfeghi@stanford.edu.

Received: August 10, 2018
Accepted: November 06, 2018

10.3928/23258160-20190503-12

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