Intraoperative OCT Angiography in Pediatric Patients with Persistent Fetal Vasculature

To describe abnormalities of the optic nerve microvasculature in patients with persistent fetal vasculature (PFV) and their fellow eyes using optical coherence tomography angiography (OCTA). Cross-sectional study. 50 eyes of 25 patients with PFV who underwent prospective imaging using supine OCTA during examination under anesthesia (EUA) at Bascom Palmer Eye Institute from March 1, 2019, to December 31, 2022. OCTA images of the optic nerve of the included patients were analyzed with a primary focus on blood flow. Demographic, clinical, and treatment factors were compared to morphologic changes in the optic disc microvasculature. Prevalence of optic nerve microvascular abnormalities on OCTA in the affected and fellow eyes of patients with PFV. A total of 50 eyes from 25 patients were reviewed, and 28% (7/25) met image quality criteria for OCTA analysis. Optic nerve OCTA showed a persistent hyaloid artery in all (7/7) PFV eyes analyzed. Of these, flow on OCTA was detectable in 57% (4/7). A Bergmeister's papilla was evident in 100% (25/25) fellow eyes, of which flow was detected in 68% (17/25). Fluorescein Angiography (FA) demonstrated blood flow within the stalk in 40% (10/25) of PFV eyes and within the Bergmeister’s papilla in 25% (6/25) of fellow eyes. Similar findings of abnormal blood flow and presence of fibrovascular stalk were seen in both treatment naïve and treated groups. OCTA allows for high-resolution visualization of subtle vascular abnormalities that are not readily apparent using RetCam FA and may serve as a useful noninvasive test to confirm the patency of the PHA and Bergmeister’s papilla in children. Results of the present study suggest PFV may be a bilateral and asymmetric process. OCT angiography allows for high-resolution visualization of subtle vascular abnormalities and may serve as a useful noninvasive test to confirm the patency of the persistent vascular artery and Bergmeister’s papilla in children.