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 Table of Contents    
CLINICAL IMAGE
Year : 2013  |  Volume : 6  |  Issue : 1  |  Page : 58-60  

Persistent hyaloid artery with an aberrant peripheral retinal attachment: A unique presentation


1 Department of Vitreoretina, Lotus Eye Care Hospital, Coimbatore, Tamilnadu, India
2 Department of Paediatric Ophthalmology, Lotus Eye Care Hospital, Coimbatore, Tamilnadu, India

Date of Web Publication15-May-2013

Correspondence Address:
Ashish Sharma
Consultant, Retina and Research, Lotus eye Care Hospital, Coimbatore, Tamilnadu
India
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Source of Support: Lotus vision research fund, Conflict of Interest: None


DOI: 10.4103/0974-620X.111924

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How to cite this article:
Sheth JU, Sharma A, Chakraborty S. Persistent hyaloid artery with an aberrant peripheral retinal attachment: A unique presentation. Oman J Ophthalmol 2013;6:58-60

How to cite this URL:
Sheth JU, Sharma A, Chakraborty S. Persistent hyaloid artery with an aberrant peripheral retinal attachment: A unique presentation. Oman J Ophthalmol [serial online] 2013 [cited 2019 Dec 11];6:58-60. Available from: http://www.ojoonline.org/text.asp?2013/6/1/58/111924

Persistence of the hyaloid vascular system is seen in 3% of full term infants and 95% of premature infants. [1] It may be present as Mittendorf's dot located at the posterior lens capsule or as Bergmeister's papilla located at the optic disc. [1] Persistent hyaloid artery extending from the disc upto the posterior lens capsule is uncommon. [1] We hereby present a patient with persistent hyaloid artery extending from the optic disc to the superior part of retina with no remnant at the posterior lens capsule.

A 15-year-old male patientpresented to the out-patient department for routine eye examination. Present and past ocular history, and past medical history were unremarkable. He was born at eighth months of gestation. There was no history of developmental delay. General examination was normal.

On ocular examination, the best-corrected visual acuity (BCVA) with − 1.00 spherical power was 20/20, N6 in both eyes. Intraocular pressure was 16 mmHg with applanation tonometry in both eyes. Examination of the right eye was normal. Slit lamp examination of the left eye revealed a normal anterior segment with clear posterior lens capsule [Figure 1]. Fundus examination showed the presence of a greyish-white rounded fibrous tubule extending from the optic disc and attaching to the superior retina at 12 O'clock position, about 1 disc diameter posterior to the ora serrata. The site of attachment was greyish white in colour with the presence of glial tissue [Figure 2]a and b. Rest of the fundus examination was normal.
Figure 1: Slit-lamp photo of the left eye in retroillumination showing clear posterior lens capsule

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Figure 2: (a) Fundus photo of the left eye showing the persistent hyaloid artery arising from the optic disc. (b) Fundus photo of the left eye showing the aberrant attachment of the persistent hyaloid artery at the peripheral retina. (c) FFA of the left eye showing the occluded hyaloid artery. (d) FFA of the left eye showing hyperfluorescense at the site of retinal attachment

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On A-scan biometry, the AC depth was 3.06 mm, the lens thickness was 3.42 mm, and the axial length was 23.35 mm. The corneal diameters were 11.00 horizontally and 10.50 vertically by callipers. B-scan ultrasound showed the presence of a moderately echogenic band extending from the optic disc to the peripheral retina. On kinetic examination, the band had minimal mobility with no after movements [Figure 3]. The posterior lens capsule did not reveal the presence of any remnant of the hyaloid vessel. Fundus fluorescein angiography showed the absence of blood flow in the hyaloid artery remnant, along with late hyperfluorescence at the site of attachment indicating staining [Figure 2]c and d. Spectral domain - optical coherence tomography (SD-OCT) at the level of the optic disc revealed the presence of a hollow tubule along with perivascular glial tissue [Figure 4]. With the help of all these investigative modalities, a diagnosis of left eye persistent hyaloid artery with an abnormal attachment to the superior retina was made. The patient has been advised to continue the current glasses and follow-up annually.
Figure 3: Ultrasound B-scan showing the persistent hyaloid artery extending from the optic disc to the peripheral retina

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Figure 4: SD-OCT image showing a tubular structure at the optic disc along with perivascular glial tissue

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The hyaloid artery is a branch of the ophthalmic artery, which is a branch of internal carotid artery. It is present in the optic canal and extends from the optic disc to the crystalline lens via the vitreous humour. It is most prominent around ninth week of gestation and slowly regresses by the seventh month. [1],[2] Atrophy of the vessels begins in the posterior region (vasa hyloidea propria) and gradually progresses toward the anterior part (tunica vasculosa lentis). [2] Mitchell and colleagues proposed that the regression is facilitated by the lens development that separates the fetal vasculature from the vascular endothelial growth factor leading to a reduction in the level of this survival factor culminating in endothelial cell apoptosis. [2] Regression of the hyaloid artery leaves behind a clear central zone in the vitreous humor, called the hyaloid or Cloquet's canal.

Occasionally, the artery may not fully regress, leading to a condition persistent hyaloid artery.[1] This may be either partial or complete. Partial remnant of the anterior portion is present at the former site of anastomosis of the hyaloid artery and tunica vasculosa lentis. [1] It is called Mittendorf's dot and is usually located on the posterior lens capsule, inferonasal to the posterior pole of the lens. [1]

Remnant of the posterior portion is present at the optic disc usually associated with some amount of glial tissue. It is called Bergmeister's papillae and appears as a greyish linear structure anterior to the optic disc and adjacent to the retina. [1] Prepapillary loops that were earlier thought to be an exaggeration of Bergmeister's papillae are now thought to be developmental anomaly of the mesenchymal tissue that was destined to form the mature retinal vasculature within the Bergmeister's papillae. [1],[3] Vitreous cysts are benign lesions containing remnants of the hyaloid vascular lesions resulting from abnormal regression. [3] Vitreous cysts are generally not symptomatic and thus do not require surgical intervention.

Rarely, the entire hyaloid artery may be present extending from the optic disc to the posterior lens capsule. This hyaloid artery may be patent or occluded. In patent hyaloid vessels, it may be supplying a part of the retinal tissue. This fact has to be kept in mind before planning to excise the vessel.

Anterior persistent hyperplastic vitreous (PHPV) has predominant features of persistent anterior tunica vasculosa lentis without much or any posterior hyaloid component. [4] Posterior PHPV is very rare in which opaque connective tissue arises from the Bergmeister's papillae and persistent hyaloid vessels. [4] They can cause congenital falciform folds of the retina and in severe cases, can cause tentlike retinal folds that may rarely lead to tractional or rhegmatogenous retinal detachment. [4]

In our case, the hyaloid vessel extended from the optic disc to the superior retina along with a clear posterior lens capsule. Embryologically, it may be explained by an abnormality in the fetal vasculature regression pattern. There has been a case report of connections between the branches of persistent hyaloid artery and peripheral retinal vessels. [5] However, after a thorough PUBMED/MEDLINE search, an abnormal retinal attachment of anterior end of persistent hyaloid artery has not yet been described. In our case report, we have utilized sophisticated modalities like B-scan and SD-OCT to validate the findings. The patient requires regular follow-up to look for early signs of complications such as tent-like retinal folds, tractional or rhemnatogenous retinal detachment, or any other unforeseen complications.

 
   References Top

1.Jones H. Hyaloid remnants in the eyes of premature babies. Br J Ophthalmol 1963;47:39-44.  Back to cited text no. 1
    
2.Mitchell CA, Risau W, Drexler HC. Regression of vessels in the tunica vasculosa lentis is initiated by coordinated endothelial apoptosis: A role for vascular endothelial growth factor as a survival factor for endothelium. Dev Dyn 1998;213:322-33.  Back to cited text no. 2
    
3.Francois J. Pre-papillary cyst developed from remnant of the hyaloid artery. Br J Ophthalmol 1950;34:365.  Back to cited text no. 3
    
4.Cockburn DM, Dwyer PS. Posterior persistent hyperplastic primary vitreous. Am J Optom Physiol Opt 1988;65:316-7.  Back to cited text no. 4
    
5.Schwab S, Schriever D. Connections between the branches of a persistent hyaloid artery and the peripheral retinal vessels. Ber Zusammenkunft Dtsch Ophthalmol Ges 1977;74:793-4.  Back to cited text no. 5
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4]



 

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