Persistent hyperplastic primary vitreous

Last revised by Dr Yair Glick on 19 Aug 2021

Persistent hyperplastic primary vitreous (PHPV), also known as the persistent fetal vasculature, refers to a rare congenital developmental malformation of the eye.

Clinically, this condition usually manifests as unilateral or bilateral leucocoria. Patients may also have poor vision, small eye (microphthalmia) and strabismus.

It arises due to a failure of normal regression of the embryonic hyaloid vascular system. Normally, the primary vitreous forms around the 7th week of gestation and starts involuting around 20th week and has nearly always disappeared by birth. Persistent fetal vasculature in PHPV can lead to fibrosis, resulting in elongation of the ciliary processes, retinal detachment, and spontaneous cataracts.

PHPV can be divided into anterior (ventral) or posterior (dorsal) types, with most patients with PHPV having a combination of these 3.

PHPV can occur on its own or in association with various other conditions, notably when bilateral. These include 9:

From an imaging standpoint, only the features of posterior PHPV are well known 3.

In posterior PHPV, the globe is small and can contain retinal detachments.

An echogenic band may be seen in the posterior segment of the globe, extending from the posterior surface of the lens to the optic nerve head. On color Doppler, arterial blood flow may be seen within this band.

The CT appearance can be quite variable 9. The described spectrum of CT findings includes 1:

  • soft-tissue replacement (infiltration) of the vitreous body
  • retrolental soft tissue along the Cloquet canal: fine linear structure
    extending from the head of the optic nerve to the posterior surface of the lens 3
  • absence of abnormal calcification within the orbit
  • microphthalmus
  • retrohyaloid layered blood
  • hypervascularity of the vitreous humor: after contrast administration, the vitreal abnormalities may enhance, which is believed to reflect a persistent hypervascular vitreous
  • retinal detachments can be hyperdense on CT

On MRI the retrolental tissue characteristic of this condition has a triangular shape resembling martini glass, appearing as low T2 signal against the normal high T2 signal of the globe 10.

  • clinically it is one of the more significant and frequent conditions that can mimic a retinoblastoma
  • at ultrasound the primary differential is of retinal detachment, which is commonly associated with PHPV

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Cases and figures

  • Case 1
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  • Case 2: with microphthalmia
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  •  Case 3
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  • Case 4
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  • Case 5: bilateral PHPV
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  • Case 6: left
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  • Case 7
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  • Case 8: bilateral
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