Persistent foetal vasculature: Developmental mechanisms, contemporary management and evolving therapeutics

Abstract Persistent foetal vasculature (PFV) is a spectrum of congenital malformations arising from incomplete regression of the hyaloid–tunica vasculosa lentis complex. Since Reese’s original description of persistent hyperplastic primary vitreous and Goldberg’s seminal reinterpretation of PFV as a unified developmental spectrum, our understanding has expanded through advances in genetics, imaging, and vitreoretinal surgery. PFV remains one of the most challenging causes of unilateral childhood visual loss. Although modern microsurgical techniques now deliver consistent anatomical success and globe preservation, functional vision is often limited by primary retinal and optic-nerve maldevelopment. This review traces the evolution of PFV management from its embryological basis to current surgical paradigms, integrating evidence from major series and highlighting practical lessons from contemporary vitreoretinal practice.