Bilateral persistent hyaloid artery in the adult patient

Introduction: Hyaloid artery occurs in the third week of gestation and reaches the lens in the fourth or fifth week of gestation to form the tunica vasculosa lentis. Atrophy of the hyaloid artery usually ends before birth. The existence of the hyaloid artery with the active blood flow is rare, e specially if bilateral. There are several reports about vitreous hemorrhages (spontaneous and traumatic) and tractional retinal detachments that are associated with persistent hyaloid artery. Patient and Methods: A male patient, aging 25, reported to an ophthalmologist because of subjective complaints of visual impairment. Visual acuity in both eyes was 1.0 determined by Snellen, intraocular pressure of 12 mmHg. Refractometry showed ROD + 1.50 diopters / +0.25 Dcyl (103 °), ROS +1.50 diopters / + 0.50 Dcyl (38 °). The bio microscopy study showed the opalescence in the space of the vitreous body behind a transparent lens on both eyes. Fundus examination showed that both optic nerves were large and with a large central coloboma. It was observed as a. hyaloidea persistens, which comes from the optic disc, surrounded by primary vitreous and at the front end visible as opaque vitreous body behind the clear lens. B -scan confirmed the echogenic visible linear structure, medium to higher reflectivity, in the back of t he vitreous body, which starts with the optic nerve head and extends towards the lens (a. hyaloidea persistens). In addition, fluorescein angiography was performed, which showed a slow and sustained filling of the narrow persistent hyaloid artery. Computerized perimetry showed enlargement of the blind spots on both sides. Optical coherence tomography of the optic nerve of both eyes showed a tubular structure on the optic nerve with hiporeflectivity interior. Conclusion: Persistent hyaloid artery must be con side red as a possible etiologic factor for bleeding in the vitreous body, particularly in healthy young men. Its presence can warn us of possible complications during cataract surgery and other surgical procedures. Ultrasound provides essential information when making a diagnosis, in view to determine the presence of lesion, its provision and the involvement of the retina and optic disc head. The review should include the fluorescein angiography and optical coherence tomography.