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E. Bui Quoc, M. Putterman, J.-L. Dufier, O. Roche; Ultrasound Biomicroscopy and Surgical Management of Peters’ Anomaly Type I. Invest. Ophthalmol. Vis. Sci. 2008;49(13):1975.
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To present our experience in the management of Peters’ anomaly type I which is a severe anterior segment of the eye malformation which requires corneal graft in most cases because the corneal opacity is sight threatening and in which penetrating keratoplasty is made uneasy by ocular abnormalities such as iridocorneal adhesions.
We present 7 eyes of four infants with Peters’ anomaly, the results of ultrasound biomicroscopy and anatomopathological examination of the cornea in case of penetrating keratoplasty. We detail surgical and postoperative management along with complications.
Four eyes have had penetrating keratoplasty so far. Preoperative ultrasound biomicroscopy revealed severe iridocorneal adhesions in 3 eyes out of 6 (UBM was not performed in patient one). Anatomopathological examinations of the 4 corneas examined revealed Descemet defects in three out of four eyes. All patient had ciclosporin topical therapy along with topical corticosteroids and no sign of rejection occurred. The follow up after initial surgery varied from 8 to 13 months. One case of infection occurred 6 monts after surgery. Postoperative iridocorneal adhesion occurred in three cases and required surgery.
Peters’ anomaly surgical management is difficult and penetrating keratoplasty can be made uneasy by the small size of the anterior chamber and by iridocorneal adhesions, whose diagnosis is helped by the use of ultrasound biomicroscopy. Rejection is rare despite very early surgery and its incidence is probably diminished by the use of topical cyclosporine. Postoperative management requires also topical corticosteroids, numerous examination so that stitches are taken off progressively, especially if they are loose and can favour infectionManagement of Peters’ anomaly is not easy. UBM is useful to guide initial surgery. Postoperative management requires the use of topical ciclosporin and corticosteroids. Surgery of adhesion between the graft or the cornea and the iris is often necessary.
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