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A Al-Awami, JM Little, R Beneish; Factors Influencing Final Visual Outcome In Patients with Persistent Hyperplastic Primary Vitreous (PHPV) . Invest. Ophthalmol. Vis. Sci. 2002;43(13):4688.
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Purpose:Persistent hyperplastic primary vitreous or persistent fetal vasculature is a congenital anomaly caused by failure of the primary vitreous to regress. Past experience with its management usually yielded a poor visual outcome. The purpose of this study is to ascertain the various factors which impact on the final visual acuity. Methods:Twenty six patients seen between Aug 1972 and Dec 2000 were classified in a retrospecive study as having anterior PHPV, posterior PHPV or a combination of both. Twenty-one patients had surgery (lensectomy, anterior vitrectomy). All patients underwent amblyopia treatment. Visual acuity was determined to be good if it was better than 20/100 or there was a central fixation on a target; vision was considered to be poor if it was less than 20/100 or the fixation was inadequate. Compliance was evaluated for each patient (keeping appointments, judgment of the orthoptist...etc). Results:There were 26 patients with 27 affected eyes. Fourteen eyes (51.85%) had poor vision ranging from 20/200-HM (group1). In this group, 6 had an abnormal posterior pole, 9 underwent surgery, only 3 complied with occlusion therapy, 5 developed glaucoma usually requiring surgical intervention, 11 had strabismus and 8 had nystagmus. On the other hand, there were 13 eyes (48.15%) with good vision in group2 (20/30-20/80). None of those had an abnormal posterior pole; all but one underwent surgery and all complied with occlusion therapy. Only 2 developed glaucoma that has thus far responded to medical management. Eight & five patients developed strabismus and nystagmus respectively. Conclusion:Poor visual outcome in patients with PHPV is associated with an abnormal posterior pole, a complicated glaucoma and an inadequate compliance with occlusion therapy. Prompt surgical intervention and an adequate patching regimen usually yield a good visual result. The presence of strabismus or nystagmus does not necessarily preclude good vision.
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