MANAGEMENT AND EVOLUTION OF PERSISTENT FETAL VASCULARIZATION: ABOUT 30 CASES

The aim of our study is to analyse the files of the children treated in our department and to study their clinical, therapeutic and evolutionary profile.

Ophthalmology department. 20 august 1953 hospital. CASABLANCA - MOROCCO

We conducted a retrospective study of 30 children with PVF treated and followed up in the pediatric ophthalmology department at the 20 Aout University Hospital between January 2013 and March 2023.

We found a male predominance with a sex ratio of 1.5. The diagnosis was made between the ages of 1 month and 8 years, with an average age of 21 months. Prematurity was noted in 9% of cases, and psychomotor retardation in 7%. The main cause of consultation was leukocoria, followed by strabismus. Initial visual acuity was quantifiable in only 2 patients, one aged 8, where corrected visual acuity was 2/10, the other aged 6, where corrected visual acuity was finger-counting at 1m. Ocular pursuit was present in all our patients, nystagmus was found in 14% of cases, strabismus in 16%, and the left side was most often affected. Bilateral involvement was observed in 5 cases, with cataracts present in 93% of cases, microphthalmia in 16% of cases, retrolental vascularization visible in 20% of cases, and fundus initially inaccessible in 80% of cases. A preoperative work-up and an embryofetopathy work-up were systematically requested in all our patients. Ocular ultrasound was systematically performed in all patients, and electrophysiological investigations were requested in 20% of our patients. The anterior form was found in 43.3% of cases, the posterior form in only 1 case, and the mixed form in 53.3%. Operation was indicated in 24 patients, while the remainder were left untreated, where the disease was deemed too complex for surgical treatment. Post-operative aphakia was corrected by a posterior chamber implant in 83% of cases operated on; in the 18% of cases not implanted, microphthalmia and intraoperative bleeding were the reasons for non-implantation. Post-operative follow-up was straightforward in 66.6% of cases, marked by an inflammatory reaction in 16.6%, ocular hypertonia in 6.6% and retinal detachment in 10%. The average follow-up time was 20.6 months, and glasses were used in 80% of cases. All patients underwent amblyopia rehabilitation. Final visual acuity was 3/10 in 16.6% of cases, 7/10 in one case, and difficult to quantify in the rest. Late complications were mainly ocular hypertonia in 2 cases, secondary cataract in 3 cases, and pupillary secclusion in one case.
In the 6 non-operated cases, the VA was limited to negative light perception in 3 cases, doubtful light perception in 2 cases, and < 1/10 in 1 case. Regular clinical monitoring was carried out to detect possible PVF-related complications at an early stage

The persistence of the fetal vascular system constitutes a group of complex ocular malformations whose functional prognosis remains poor, requiring early diagnosis and appropriate management.