Evangelia Papavasileiou, D. Dereklis, I. Vasiliadis, F. Topouzis (Thessaloniki, Greece)

Advantages:

Persistent hyperplastic primary vitreous (PHPV) is a rare developmental malformation of the eye characterized by the presence of a vascular membrane located behind the lens and that is usually unilateral and sporadic. We present a case in which a 25-year old female was referred to our office for reduced visual acuity in the left eye. Visual acuity was 2/10 in the left eye and 10/10 in the right eye. She was found to have persistent hyperplastic primary vitreous (PHPV) associated with retinal folds and spontaneous vitreous haemorrhage. She underwent ultrasonography, colour photographs and fluorescein angiography.

Methods:

She was treated with pars plana vitrectomy and diathermy of the remnant persistent hyperplastic primary vitreous and the hyaloid artery. Indications for surgical treatment were reduced visual acuity, hyaloid vascular bleeding and traction folds of the retina.

Effectiveness / Safety:

Visual acuity improved to 5/10 after surgery. The traction folds of the retina were reduced. Vitrectomy with ILM peeling was deferred because of no metamorphospia.

Take home message:

The vitreous hemorrhage had occurred due to rupture of a hyaloid artery, in the woman’s case probably due to a spontaneous posterior vitreous detachment or during the rapid eye movement (REM) phase during sleep which may create a tractional force and leads to rupture of the freely floating hyaloid artery. A patent persistent hyaloid artery should be included in the list of the causes of vitreous hemorrhage, especially in healthy young people.