Alsarhani Waleed, Alkatan Hind, Maktabi Azza, Edward Deepak P, Kozak Igor
College of Medicine, King Saud University, Riyadh, Saudi Arabia.
King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia.
Am J Ophthalmol Case Rep. 2020 May 18;19:100743. doi: 10.1016/j.ajoc.2020.100743. eCollection 2020 Sep.
To provide clinical and pathological features of posterior persistent fetal vasculature (PFV) presenting with vitreous hemorrhage.
Case 1 was a one-year old male with PFV reaching up to the posterior lens capsule. Case 2 and 3 both had history of blunt trauma. B-scans in cases 2 and 3 revealed vitreous hemorrhage and an intravitreal tissue attached to the optic disc. Pre-operative visual acuity in cases 1, 2 and 3 was undetermined due to age, hand motion and light perception, respectively. During vitrectomy, a fibrotic stalk attached to the optic nerve was removed, which consisted of fibrovascular tissue enveloping pockets of hemorrhage histopathologically. The fibrovascular tissue contained smooth muscle actin (SMA) positive spindle-shaped myofibroblasts in one case and hemosiderin-laden macrophages in another case. Glial fibrillary acidic protein (GFAP) stain was focally positive in two specimens. The proliferation index was low using Ki-67 stain in all cases. Post-operative visual acuity in case 3 remained unchanged, while improved in case 2 from hand motion to 20/70. There was no recurrence of the vitreous hemorrhage.
Vitreous hemorrhage may occur in cases of PFV with or without history of blunt trauma. Hemorrhage within the persistent fetal vasculature may become organized with reactive process in the hyaloid stalk. The fibrovascular stalk contained astrocytes and myelofibroblasts which contribute to the formation and contractile function of PFV, respectively. The outcomes following vitrectomy seemed to be satisfactory.
提供伴有玻璃体积血的后部永存原始玻璃体（PFV）的临床和病理特征。
病例1为一名1岁男性，PFV延伸至晶状体后囊。病例2和病例3均有钝挫伤史。病例2和病例3的B超显示玻璃体积血以及附着于视盘的玻璃体内组织。病例1、2和3术前视力分别因年龄、手动和光感而无法确定。玻璃体切除术中，切除了附着于视神经的纤维化条索，病理组织学显示其由包绕出血腔隙的纤维血管组织构成。在一个病例中，纤维血管组织含有平滑肌肌动蛋白（SMA）阳性的梭形肌成纤维细胞，在另一个病例中含有含铁血黄素的巨噬细胞。胶质纤维酸性蛋白（GFAP）染色在两个标本中呈局灶性阳性。所有病例使用Ki-67染色显示增殖指数较低。病例3术后视力无变化，病例2术后视力从手动提高到20/70。玻璃体积血未复发。
有或无钝挫伤史的PFV病例均可发生玻璃体积血。永存原始玻璃体血管内的出血可在玻璃体条索中通过反应性过程形成机化。纤维血管条索分别含有星形胶质细胞和肌成纤维细胞，它们分别有助于PFV的形成和收缩功能。玻璃体切除术后的结果似乎令人满意。
