Lens-Sparing Surgery for Retrolental Stalk in Persistent Fetal Vasculature

Thibaut Chapron; Youssef Abdelmassih; Guy de Saint Sauveur; Florence Metge; Georges Caputo

doi:10.1016/j.ajo.2023.06.019

Lens-Sparing Surgery for Retrolental Stalk in Persistent Fetal Vasculature

Am J Ophthalmol. 2023 Nov:255:1-6. doi: 10.1016/j.ajo.2023.06.019. Epub 2023 Jul 9.

Authors

Thibaut Chapron¹, Youssef Abdelmassih², Guy de Saint Sauveur², Florence Metge², Georges Caputo²

Affiliations

¹ From the Pediatric Ophthalmology Department, Rothschild Foundation Hospital (T.C., Y.A., G.d.S.S., F.M., G.C.); Université Paris Cité, CRESS, Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, INSERM, INRAE (T.C.), Paris, France. Electronic address: [email protected].
² From the Pediatric Ophthalmology Department, Rothschild Foundation Hospital (T.C., Y.A., G.d.S.S., F.M., G.C.).

PMID: 37433352
DOI: 10.1016/j.ajo.2023.06.019

Abstract

Purpose: To describe a new surgical technique and outcomes of lens-sparing vitrectomy and retrolental stalk dissection in posterior persistent fetal vasculature (PFV).

Design: Retrospective interventional case series.

Methods: RESULTS: Among the 21 included eyes, 8 (38%) had no macular involvement and 4 (19%) presented with microphthalmia. Median age at the first surgery was 8 months (range: 1-113 months). Surgical success was obtained in 71.4% of cases (15 of 21). In the remaining cases, the lens was removed because of capsular rupture in 2 cases (9.5%) and a large capsular opacity after stalk removal or an adherent stalk impossible to dissect in 4 cases (19.1%). In the capsular bag, IOL implantation was accomplished for all but 1 eye. None of the eyes developed retinal detachment or required glaucoma surgery. Endophthalmitis occurred in 1 eye. Secondary lens aspiration was needed in 3 eyes after a mean interval of 10.7 months following initial surgery. At last follow-up, half of the eyes remained phakic.

Conclusion: Lens-sparing vitrectomy is a useful approach to addressing the retrolental stalk in selected cases of persistent fetal vasculature syndrome. By delaying or avoiding lens extraction, this approach allows preservation of accommodation, reduction of the risk of aphakia, glaucoma, and development of secondary lens reproliferation.