Clinical characteristic and management of Peters anomaly

Background

Peters anomaly is a rare eye disease.Understanding the clinical features of Peters anomaly is helpful for us to correctly manage this disease.

Objective

This study was to investigate the clinical characteristics and treatment methods of Peters anomaly and provide available basis for the diagnosis and individualized treatment of Peters abnormal.

Methods

A descriptive study was performed.The clinical data from 8 eyes of 4 patients with Peters anomaly who were diagnosed and treated in Beijing Children’s Hospital from January 1, 2014 to March 30, 2016 were retrospectively analyzed.The clinical manifestations of the anterior ocular segment were examined by handheld slit-lamp microscope, and corneal curvature, corneal thickness, axial length and intraocular pressure were measured.The therapy and outcomes of the patients were evaluated.

Results

Peters anomaly was classified into type Ⅰ, type Ⅱ and Peters plus syndrome based on the findings and literature’ criteria.Regarding to the clinical findings, the adhesion of peripheral angle with cornea, shallow or disappeared anterior chamber were found in all the eyes, and these manifestations were type Ⅰ Peters anomaly and occurred in 2 eyes of 2 patients.The opacity and adhesion of the central lens capsula to corneal endothelium was seen in 6 eyes which belonged to type Ⅱ Peters anomaly.The mean corneal thickness was (680±127)μm in 4 measured eyes, which was thicker than normal eyes; the mean corneal curvature was (37.40±1.79)D in 4 measured eyes; the mean axial length was (21.06±0.19)mm and the mean diameter of cornea was (9.4±0.5)mm in 4 measured eyes.Iridocoloboma was found in 4 eyes and congenital aniridia was in 4 eyes.In addition, esotropia appeared in 1 patient, and nystagmus occurred in 3 patients.The 3 patients of type Ⅱ in this study were found to have the disorders associated with systemic neurogenic developmental abnormalities and diagnosed as Peters plus syndrome.Trabeculectomy with anterior vitrectomy was performed in 2 eyes with the intraocular pressure >30 mmHg(1 mmHg=0.133k Pa) and the introcular pressure reduced to below 21 mmHg after operation.Penetrating corneal transplantation was carried out on 1 eye with central opacity.However, rejection of graft occurred at 1 month and became complete cloudy at 3 months after surgery.Cataract extraction surgery was performed on 4 eyes with lens opacity and intraocular lens were implanted in 2 eyes or iridectomy was carried out in another 2 eyes, and the visual quality was evidently improved after operation.

Conclusions

The clinical characteristics of Peters anomaly include leukoma, shallow anterior chamber, peripheral iris adhesion with cornea and lens opacity due to adhesion of lens anterior capsule to corneal endothelium.Personalized operative regimen should be determined based on the clinical findings of the eyes with Peters anomaly.