Título / Title

USING THE ELECTRORETINOGRAM TO ESTIMATE RETINAL FUNCTION IMPAIRMENT IN PERSISTENT FETAL VASCULATURE AND LEUKOCORIA: A CASE REPORT

Introdução / Purpose

Persistent fetal vasculature (PVF), or persistent hyperplastic primary vitreous, occurs when the vascular structures present during the embryogenic development of the eye fail to wither. The main symptoms are leukocoria, strabismus, microphthalmia and retinal detachment, causing severe vision impairment. Surgical intervention should be considered for lens removal and reattach the retina. But prognosis depends mainly on retinal function.
Eyes with retinal detachment usually show significant decreases on electroretinogram (ERG) a and b wave amplitudes of both rod- and cone-driven responses, but ERG responses are expected to recover after surgery. Furthermore, ERG has been proposed as a prognostic tool since 1958 (AMA Arch Ophthalmol. 1958;59(4):515-520).
In this case report, we highlight the importance of the electroretinogram (ERG) during surgical planning in this condition.

Material e Método / Methods

We report a case of a nine-month boy with vascularized lens opacity on right eye. ERG was performed by means of skin electrodes using the RetEval (LKC – USA) following the recommendations of the ISCEV, and ocular ultrasound (US) Sonomed Inc.

Resultados / Results

US evidenced a hyperechoic retrolental structure that extended to the optic nerve. OD axial length was 15.19mm, while OS was 19,48mm. Photopic ERG was extinguished on OD indicating an extensive retinal function impairment that was considered as a sign of poor prognostic, thus no surgical intervention was conducted.

Discussão e Conclusões / Conclusion

Eyes with PVF are extremely challenging cases, the main risks are post-operative aphakia, no visual recovery, pain, and aesthetic ocular changes that may be even worse than the monocular vision during the development of these children. Future studies regarding the application of ERG in eyes with PVF are needed, but an extinguish ERG response may be considered supplementary information during the decision to submit these children to surgery.

Palavras Chave

Persistent fetal vasculature ; electrorretinogram

Area

CLINICAL RETINA