Abstract:AIM: To characterize the distribution of persistent fetal vasculature (PFV) subtypes and to evaluate corneal astigmatism (CA) in children with unilateral PFV. METHODS: The medical records of patients diagnosed with PFV between January 2014 and August 2021 were retrospectively reviewed. Corneal keratometry parameters were measured using IOLMaster or a handheld keratometer. Differences in CA between the affected and fellow eyes were analyzed in 52 unilateral PFV patients with available examination data. RESULTS: Totally 133 patients diagnosed with PFV were retrospectively reviewed. The male-to-female ratio was 73/60. Median age at surgery was 38.03mo (interquartile range 58.27mo). Among the PFV patients, 32 (24.06%) had anterior PFV, 2 (1.50%) had posterior PFV, and 99 (74.44%) had combined anterior-posterior PFV. Mild combined PFV was the most common subtype. In unilateral PFV cases, the mean CA in the affected eye was 2.29±1.11 D, and 59.62% (31 eyes) had CA≥2.0 D. The mean CA in the affected eyes was significantly higher than in the fellow eyes (1.37±0.77 D; P<0.001). Among PFV-affected eyes with CA≥2.0 D, the steepest corneal meridian was vertically oriented in 30 cases (96.77%), while only 1 case (3.23%) had the steepest meridian oriented horizontally. CONCLUSION: In children with unilateral PFV, CA is significantly higher in the affected eyes than in the fellow eyes, and the steepest corneal meridian was predominantly oriented vertically.