Ashvin Agarwal, MD, focuses his blog on interesting cases and experiences he encounters as an anterior segment surgeon.

SURGICAL VIDEO: Persistent hyperplastic primary vitreous

This video showcases the steps involved in the surgical management of a case of persistent hyperplastic primary vitreous, or PHPV. After conjunctival peritomy and partial-thickness scleral flaps are done, capsulorrhexis is performed after injecting trypan blue dye. Removal of the soft cortical matter is done with a phacoemulsification probe.

For removal of PHPV, first, a stab incision is created in the thick fibrous membrane. Then, with the help of an endoilluminator, the prominent vascular support is cauterized followed by excision of plaque from the central zone. Sclerotomies are made, and all the remaining tags of plaque are removed with the vitrectomy cutter, which pushes the vascular stalk behind, followed by removal of any organized blood, keeping in mind not to cut or ligate the vascular stalk. After ensuring a clean posterior chamber, a glued IOL is implanted with the handshake technique. This allows for safer and faster visual recovery in the postoperative period.