Determinants of axial length growth in infantile persistent fetal vasculature following early lensectomy–vitrectomy: a retrospective cohort

To identify clinical determinants of axial length (AL) before and after early surgery in infantile persistent fetal vasculature (PFV). Single-center retrospective cohort of 58 unilateral PFV eyes (2019–2022). All infants underwent lensectomy, posterior capsulectomy, vitrectomy, and targeted cauterization under general anesthesia before 12 months. Baseline AL, phenotype, and structural findings (enlarged ciliary processes, retrolental membrane, posterior capsular defect, corneal opacity, posterior synechiae, retinal detachment, Morning Glory disc anomaly) were recorded. Mean follow-up was 21.9 ± 11.4 months (12–48). Primary endpoint: poor growth, defined a priori as an absolute postoperative inter-eye AL difference ≥ 2.0 mm at last visit. Secondary outcomes: preoperative inter-eye asymmetry and postoperative AL change (ΔAL). Multivariable models evaluated predictors. All surgeries occurred < 12 months. Preoperatively, anterior PFV, corneal opacity, posterior synechiae, retinal detachment, and Morning Glory anomaly were associated with shorter AL versus the fellow eye (all P < 0.05), whereas posterior capsular defect correlated with longer AL ( P < 0.05). Postoperatively, greater ΔAL occurred when enlarged ciliary processes, retrolental membrane, and posterior capsular defect were absent (all P < 0.05). Poor growth occurred in 12.1%; presentation ≤ 6 months independently predicted poor growth (OR 11.62; 95% CI 1.20–112.46; P = 0.034). In infantile PFV, age at onset, phenotype, and specific structural abnormalities determine AL trajectories. Early standardized surgery may favorably modify growth, whereas complicated cataract in early infancy signals risk for subnormal postoperative elongation and warrants closer surveillance.