Elsevier

Ophthalmology

Volume 106, Issue 2, 1 February 1999, Pages 280-284
Ophthalmology

Surgical results of persistent hyperplastic primary vitreous

https://doi.org/10.1016/S0161-6420(99)90066-0Get rights and content

Abstract

Purpose

To evaluate the surgical success of patients with persistent hyperplastic primary vitreous (PHPV) and to identify preoperative indicators of visual outcome.

Design

Noncomparative case series.

Methods

The diagnosis of PHPV was made in 35 eyes of 27 patients from 1982 to 1994. In each case, anterior and/or posterior PHPV findings, preoperative testing, surgical procedures, and visual outcomes were documented. Twenty-nine of 35 eyes were managed surgically. Follow-up ranged from 2 months to 12 years.

Results

Of the 35 eyes, 2 (5.7%) had strictly anterior PHPV, 8 (22.9%) had strictly posterior PHPV, and 25 (71.4%) had components of both anterior and posterior disease. Initial lensectomy and vitrectomy was performed in 24 eyes (68.6%). Surgery was withheld in four eyes secondary to severity of disease with an unrecordable visual-evoked potential (VEP). Reoperation rate was 32.3% for membrane reproliferation, glaucoma, vitreous hemorrhage, retinal detachment, or strabismus. Best-corrected final visual acuity ranged from 20/60 to no light perception. Six eyes (17%) maintained Snellen visual acuity despite posterior PHPV with some degree of retinal dysplasia.

Conclusions

Surgical treatment of PHPV can result in functional visual outcome despite posterior segment involvement. The degree of ocular malformation, however, will ultimately limit the amount of visual improvement. Preoperative testing, including VEP, may aid in determining surgical candidates.

Section snippets

Patients and methods

Twenty-seven patients with PHPV were referred to a tertiary retinal practice for evaluation and treatment from 1982 to 1994 (Table 1). Eight patients had bilateral disease, resulting in 35 eyes total for review. Five additional patients were identified but not included in the study because of lack of follow-up. The diagnosis of PHPV in each patient was made clinically by the presence of anterior and/or posterior segment findings including microphthalmos, cataract, retrolental membrane,

Results

Twenty-nine of 35 eyes were managed surgically. Two of these eyes (patients 1 and 2) had strictly anterior PHPV and were treated with lensectomy and anterior vitrectomy. Of the remaining 27 eyes, 8 had strictly posterior PHPV and 19 had components of both anterior and posterior disease. Of these 27 eyes, 24 eyes underwent primary lensectomy and vitrectomy with or without membrane peeling. Two eyes (patients 18 and 20) underwent scleral buckling as their primary procedure with one eye (patient

Discussion

Persistent hyperplastic primary vitreous is a well-described clinical entity in which early surgical management has been advocated by many authors. When described by Reese9 in 1955, a two-staged approach was recommended, consisting of needling of the lens followed by later discission of the retrolental membrane. Others also recommended variations of two-staged techniques, including open-sky dissection, to minimize hemorrhagic complications.10, 13, 14 With the advent of vitreous cutting

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