MYOPIA PREDICTS BETTER OUTCOME IN PERSISTENT HYPERPLASTIC PRIMARY VITREOUS

Purpose: Persistent hyperplastic primary vitreous (PHPV) is a congenit al disorder that presents with a spectrum of ocular anomalies, includi ng cataracts, microphthalmia, and hyaloid vessel remnants, Severe visu al loss due to secondary glaucoma and retinal detachment is common, Th is report evaluates the visual outcome of a variant of PHPV with myopi a not associated with glaucoma. Methods: The records of 23 consecutive patients with the diagnosis of PHPV (all unilateral) from October 199 2 to August 1995 were reviewed, All but three patients had a cataract extraction procedure and all underwent amblyopia therapy. Eyes with a phakic myopic refractive error (Rx) or aphakic refractive correction l ess than or equal to 8.5 diopters (D) in the immediate postoperative p eriod were designated as myopic. Results: Six patients were in the myo pic group (Group 1) and 17 in were the nonmyopic group (Group 2), The mean age of diagnosis was 21.1 months in Group 1 versus 2.0 months in Group 2, with a comparable follow-up period of 36 months. The mean pre operative Rx of Group 1 was -7.78 D. The mean aphakic Rx of Group 2 wa s +18.29 D. Average axial length measurement determined by echography was 22.46 mm in Group 1 and 14.03 mm in Group 2. The mean corneal diam eter was 11.3 mm in Group 1 vs 8.9 mm in Group 2. In Group 2, seven ey es developed retinal detachment and four developed glaucoma. These com plications did not develop in Group 1 during the follow-up period. Ove rall functional visual acuity was better in Group 1, with a median vis ual acuity at final follow up of 20/160, as compared with light percep tion for Group 2. Conclusions: PHPV eyes with myopia were not detected as early as the typical PHPV eyes, primarily because of less media op acification and near-normal corneal diameters. These eyes showed a mor e favorable visual outcome as they were less likely to develop typical PHPV-related postoperative complications. Myopic PHPV eyes may requir e a different management approach.