|Year : 2021 | Volume
| Issue : 3 | Page : 416-417
A curious case of macular edema in persistent fetal vasculature
Debdulal Chakraborty, Asmita Saha, Aditya Pradhan
Disha Eye Hospitals, Department of Vitreoretina Services, Kolkata, West Bengal, India
|Date of Submission||10-Oct-2020|
|Date of Acceptance||16-Jan-2021|
|Date of Web Publication||02-Jul-2021|
Dr. Debdulal Chakraborty
Disha Eye Hospitals, 88 Ghoshpara Road, Barrackpore, Kolkata - 700 120, West Bengal
Source of Support: None, Conflict of Interest: None
Keywords: Macular edema, persistent fetal vasculature, persistent hyperplastic primary vitreous, persistent pupillary membrane
|How to cite this article:|
Chakraborty D, Saha A, Pradhan A. A curious case of macular edema in persistent fetal vasculature. Indian J Ophthalmol Case Rep 2021;1:416-7
A 13-year-old boy presented with a 2-week history of decreased vision (20/200) in left eye. There was no history of trauma and family history was unremarkable. Slit-lamp examination revealed a quiet eye with persistent pupillary membrane (PPM) adherent to the anterior lens capsule, sparing the visual axis, translucent on retro-illumination. Higher magnification of the iris revealed mammilations [Figure 1]a, [Figure 1]b, [Figure 1]c. Fundus revealed a congenital falciform fold, with overlying fibrous tissue, dragging of the disc and adjoining retinal tissue upward, extending to the superior retinal periphery [Figure 2] suggestive of persistent fetal vasculature (PFV). Macular edema was noted on 90D examination and confirmed with spectral-domain optical coherence tomography (SD-OCT) along with thickened retinal tissue adjacent to the disc [Figure 3]a. Intraocular pressure was 18mmHg and axial-length was 22.5 mm. Other eye was within normal limits with 20/20 vision (supplementary Optos image)[Additional file 1]. Nepafenac drops were prescribed 3 times a day for 30 days. Follow-up examination after 1 month revealed improvement of vision (20/32) and partial separation of the fibrous tissue from the falciform fold, with some fibrovascular attachments still visible [Figure 4]. Resolution of macular edema was noted on SD-OCT [Figure 3]b. At 3 and 6months follow-up no recurrence of the macular edema was noted (supplementary OCT image).
|Figure 1: (a): Slit lamp photograph showing PPM adherent to anterior lens capsule (white star), with a fibrous stalk of PHPV visible behind the lens (white arrow). (b): Magnified slit lamp image showing the PPM (White star) and showing iris mammilations white circle, attachment to iris (white arrow). (c): Retro illumination slit lamp photograph with PPM appearing transluscent (White star) and shadow of the fibrous stalk of PHPV (white arrow)|
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|Figure 2: Optos widefield image showing congenital falciform fold with overlying fibrous tissue white arrow|
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|Figure 3: (a) SD OCT image showing neurosensory detachment and spongiform edema along with thickened retinal tissue adjacent to the disc. (b) Follow up SD OCT showing resolution of macular oedema|
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|Figure 4: Optos widefield image showing fibrous tissue (white arrow) partly separated from the falciform fold (red arrow), with fibrovascular attachments still visible (yellow circles)|
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| Discussion|| |
Persistent fetal vasculature (PFV) is a common developmental anomaly present in 95% of newborn babies. While PPM usually regress by the 1st year of life, hyaloid system remnants are known to regress by the 8th month of intrauterine life itself. PFV developing macular edema in a child has never been reported. The cause of macular edema is likely to have been due to vitreo-papillary traction. Nepafenac eye drop has been widely used to treat macular edema of various aetiologies. In this patient, however, the natural course of PFV leads to separation of the fibrous tissue from the falciform fold, relieving the vitreo-papillary traction and resolution of the macular edema. A careful periodic follow-up of patients with PFV is essential to keep track of any complications such as retinal detachment vitreous hemorrhage and raised IOP which often occur.,
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Figure 1], [Figure 2], [Figure 3], [Figure 4]