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D. Sobti, M. Gearinger, M. M. Chung, J. V. Aquavella; Keratoprosthesis and Peters Anomaly: Long-Term Outcome. Invest. Ophthalmol. Vis. Sci. 2010;51(13):1619.
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To describe the long-term experience of using keratoprosthesis to treat pediatric corneal opacity due to Peters anomaly.
This is a retrospective review of pediatric patients with a history of corneal opacification due to Peters anomaly treated with keratoprosthesis surgery. Patients followed for greater than 1 year after keratoprosthesis transplant were included in the review.
Twenty-seven eyes (n=27) in 18 patients with Peters anomaly, 1.7 to 110 months of age (mean 35.4 months), underwent keratoprosthesis implantations. Four patients exhibited extra-ocular signs indicative of Peters Plus Syndrome. Eight of these eyes had previous failed penetrating keratoplasties. Half (9 of 18 patients) had keratoprostheses placed bilaterally. Thirteen eyes underwent pars plana vitrectomy at the time of procedure. Follow-up period ranged from 14 to 52 months (mean 32 months). Complications included: retroprosthetic membrane formation (n=12), retinal detachment (n=7), extrusion of prosthesis (n=2), infection (n=2), prosthesis leak (n=1), corneal melt (n=1). In the nine patients older than 4 years, visual acuity ranged from 20/30 (near) to counting fingers. The remaining nine patients are able to fixate and follow objects.
Implantation of the Boston keratoprosthesis rapidly establishes and maintains a clear optical pathway and does not inhibit the management of concurrent glaucoma or retinopathy. In select cases, this implant may be an appropriate management option for pediatric corneal opacity due to Peters anomaly. Given the inherent complexity of this disease process, a team approach, including pediatric, cornea, vitreo-retinal and glaucoma ophthalmic services, is required to provide adequate treatment.
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