Posterior Persistent Hyperplastic Primary Vitreous

The photograph illustrates persistence of fibroglial remnants of the posterior hyperplastic primary vitreous, or Bergmeister's papilla, in the right eye of a 12‐year‐old boy. Vision of this eye was 6/9 and there was no detectable visual field loss. The left eye was normal. Bergmeister's papilla contains the embryonic vascular and fibroglial material from which the hyaloid artery and central retinal artery systems develop. Developmental abnormalities may occur in any portion of the hyaloid system, from the tunica vasculosa lentis anteriorly, to Bergmeister's papilla at the optic disc. Normally the hyaloid artery resorbs at about the 7th month of gestation. 1 Persistence of portion of the posterior primary vitreous results in a number of anomalies, the most common of which are epipapillary glial membranes that are seen in 6.6% of clinic patients 2 and vascular loops on the disc. The condition illustrated is an uncommon and more extreme form of persistence of fibroglia. Strands of this tissue may attach to the inner limiting membrane of the peripapillary and more peripheral retina 1 and may proliferate, or persist as preretinal fibroglial tufts, 3 as in this illustration. The tufts are seen to be associated with retinal blood vessels and also as isolated bands radiating from the disc. Additional amorphous glial remnants are situated in the vitreous over the disc and partly obscure its features. The congenital anomaly is commonly associated with disturbed macular function 4 and shrinking of the glial strands may result in retinal folds and detachment. 5 In this illustration there is an unusual heightening of the reflex from the internal limiting membrane, suggesting that there is traction on the retinal ‐ vitreous interface. The differential diagnosis should include medullated nerve fibers, glioma of the optic never head, 6 and trauma 7 .