Yttrium Aluminum Garnet (YAG) Treatment for Persistent Fetal Vasculature: Nonsurgical Lens-Sparing Procedure to Cut Fibrovascular Stalk

A 32-month-old child with a thick fibrovascular stalk but a clear visual axis (Fig 1A) presented with a localized peripapillary tractional retinal detachment (Fig 1B). A neodymium-doped yttrium aluminum garnet ([Nd]:YAG) laser transection (12 perpendicular impulses, 4 to 6 mJ) of the inextensible stalk was performed under general anesthesia (Fig 1C), resulting in subsequent retinal reattachment without further intervention, and preservation of a quantifiable vision (20/400 at 6 months after intervention and additional amblyopia therapy). Conventional surgery in such cases includes lensectomy or lens-sparing vitrectomy, which is nevertheless often followed by cataract development. (Nd):YAG transection of the stalk when technically possible may spare the lens for a longer term, therefore preserving accommodation, and avoid the potential complications of intraocular surgery. (Magnified version of Fig 1A-C is available online at www.aaojournal.org).