Am J OphthalmolAugust 201928 citations

Glaucoma and Cornea Surgery Outcomes in Peters Anomaly.

Dolezal Kara A, Besirli Cagri G, Mian Shahzad I, Sugar Alan, Moroi Sayoko E, Bohnsack Brenda L

View on PubMed DOI: 10.1016/j.ajo.2019.08.012

AI Summary

This study found Peters anomaly patients have poor long-term corneal transplant survival and high rates of complex, multi-surgery glaucoma, often requiring drainage devices or laser.

Abstract

Purpose

To conduct a qualitative description of corneal and glaucoma outcomes in Peters anomaly.

Design

Retrospective case series.

Methods

Children with Peters anomaly who presented between 1982-2017 were included. Visual acuity, intraocular pressure (IOP), survival of corneal grafts, and success of glaucoma surgery (defined as IOP of 5-20 mm Hg and no additional IOP-lowering surgery or visually devastating complications) were analyzed.

Results

Fifty-eight eyes of 37 patients (19 males) with Peters anomaly presented at 0.7 ± 1.5 years of age and had a follow-up of 10.2 ± 10.8 years. Twenty-three eyes underwent penetrating keratoplasty (PKP) with an average of 2.0 ± 1.3 grafts per eye. PKP survival at 1 year was 60% (95% confidence interval 41-75%) but decreased at 10 years to 34% (95% confidence interval 18-51%). Thirty-four eyes were diagnosed with glaucoma at 2.8 ± 6.4 years of age. Twenty eyes required glaucoma surgery, and the average number of IOP-lowering surgeries was 2.9 ± 2.0 per eye. Glaucoma drainage devices (15 eyes) had a 53% success rate. Laser cycloablation (9 eyes, transcleral or endoscopic) had a success rate of 67% with 2.0 ± 1.0 treatments per eye. Trabeculectomy with mitomycin C (8 eyes) and trabeculotomy (8 eyes) had 25% and 0% success rates, respectively. Fifteen eyes that underwent glaucoma surgery obtained IOP control, and GDD with or without cycloablation accounted for 80% of the successes. Eyes that underwent PKP did not show increased rates of glaucoma, higher IOP, or a greater necessity for IOP-lowering surgery.

Conclusions

In Peters anomaly, PKP shows poor long-term success. In addition, >50% of eyes with Peters anomaly have secondary glaucoma that often requires multiple surgeries.

MeSH Terms

Anterior Eye SegmentChild, PreschoolCorneal DiseasesCorneal OpacityEye AbnormalitiesFemaleFollow-Up StudiesGlaucomaGlaucoma Drainage ImplantsGraft SurvivalHumansInfantIntraocular PressureKeratoplasty, PenetratingMaleRetrospective StudiesTonometry, OcularTrabeculectomyTreatment OutcomeVisual Acuity

Shields Classification

Ch. 14Developmental Glaucomas with Associated Anomalies

Ch. 40Filtering Surgery

Ch. 41Drainage Implant Surgery

Key Concepts6

In a retrospective case series of 58 eyes of 37 patients with Peters anomaly, penetrating keratoplasty (PKP) survival at 1 year was 60% (95% confidence interval 41-75%), but decreased at 10 years to 34% (95% confidence interval 18-51%).

PrognosisCase seriesRetrospective case seriesn=58 eyes of 37 patientsCh15Ch17

In a retrospective case series of 58 eyes of 37 patients with Peters anomaly, 34 eyes were diagnosed with glaucoma at 2.8 ± 6.4 years of age, indicating that more than 50% of eyes with Peters anomaly have secondary glaucoma.

DiagnosisCase seriesRetrospective case seriesn=58 eyes of 37 patientsCh15

In a retrospective case series of 58 eyes of 37 patients with Peters anomaly, glaucoma drainage devices (15 eyes) had a 53% success rate for controlling intraocular pressure (IOP), defined as IOP of 5-20 mm Hg and no additional IOP-lowering surgery or visually devastating complications.

TreatmentCase seriesRetrospective case seriesn=58 eyes of 37 patientsCh15Ch42

In a retrospective case series of 58 eyes of 37 patients with Peters anomaly, laser cycloablation (9 eyes, transcleral or endoscopic) had a success rate of 67% with 2.0 ± 1.0 treatments per eye for controlling intraocular pressure (IOP), defined as IOP of 5-20 mm Hg and no additional IOP-lowering surgery or visually devastating complications.

TreatmentCase seriesRetrospective case seriesn=58 eyes of 37 patientsCh15Ch44

In a retrospective case series of 58 eyes of 37 patients with Peters anomaly, trabeculectomy with mitomycin C (8 eyes) and trabeculotomy (8 eyes) had 25% and 0% success rates, respectively, for controlling intraocular pressure (IOP), defined as IOP of 5-20 mm Hg and no additional IOP-lowering surgery or visually devastating complications.

TreatmentCase seriesRetrospective case seriesn=58 eyes of 37 patientsCh15Ch39Ch41

In a retrospective case series of 58 eyes of 37 patients with Peters anomaly, eyes that underwent penetrating keratoplasty (PKP) did not show increased rates of glaucoma, higher intraocular pressure (IOP), or a greater necessity for IOP-lowering surgery.