Limbal approach to anterior persistent fetal vasculature: A surgical illustration

Background: Persistent fetal vasculature (PFV) is a congenital condition where fetal ocular blood vessels fail to regress as they should. [1] This incomplete involution can lead to significant visual impairment, accounting for 5% of childhood blindness in the US. [2] PFV commonly presents with leukocoria and microphthalmia. [2] While mixed forms of PFV are most prevalent, followed by anterior and then posterior forms, the prognosis is generally better for isolated anterior PFV due to the absence of macular and optic nerve involvement. [2,3] Purpose: Surgical intervention for PFV is tailored to the specific type of PFV. The primary goal is to maximize the eye’s visual potential while addressing amblyopia, refractive errors, and strabismus. Managing unilateral PFV is particularly complex, especially when the other eye is normal. Overcoming amblyopia and achieving good vision in the affected eye with consistent amblyopia treatment is challenging but achievable. Synopsis: This video presents the case of a full-term infant with unilateral PFV, microcornea, dense amblyopia, and sensory esotropia. We illustrate a limbal approach to clear the visual axis of the dense and thick persistent tunica vascular lentis layer leaving the child surgically aphakic. The limbal approach is crucial as it helps prevent accidental tears in the ora serrata or peripheral retina. Thanks to advances in microinvasive vitrectomy techniques, early surgical treatment for PFV has become safer and more effective, offering improved outcomes for affected children. Highlights: This video provides a detailed, step-by-step guide to the challenging yet compelling case of persistent tunica vasculosa lentis. Video Link: https://youtu.be/NCDml1xnVWk