We read with interest the photo essay by Lai et al.1 They show fundus photographs of a patient with osteoporosis-pseudoglioma syndrome to support the development of pseudoglioma from persistent fetal vasculature (PFV). We find the photographic evidence for this questionable.
A review of the figures does not support a primary role for PFV. Part A of their Figure shows a falciform retinal fold extending temporally from the optic disc rather than a fibrotic band. The falciform retinal detachment common in retinopathy of prematurity and familial exudative vitreoretinopathy should be distinguished from the tent-shaped retinal detachment more typical of PFV.2 Furthermore, the arrow points to a retinal blood vessel on the anterior aspect of the fold and not a remnant of the hyaloid artery. Retinal blood vessels are always found at the ridge of falciform folds from peripheral fibrovascular contraction. Finally, there are peripheral avascular zones in both eyes, and the latticelike degeneration in the left eye may represent the vascular termini at the junction with avascular retina.
Blair MP, Shapiro MJ. Osteoporosis-Pseudoglioma Syndrome May Not Be Caused by Persistent Fetal Vasculature. Arch Ophthalmol. 2007;125(3):432-433. doi:10.1001/archopht.125.3.432-b