Outcomes of Optical Sector Iridectomy in Peters Anomaly

Abstract

Purpose : Peters anomaly is a rare congenital corneal opacity which may result in profound amblyopia in children if the opacity involves the visual axis. The treatment options for this condition have long been a subject of debate. We performed a retrospective, observational clinical study to evaluate the outcomes of optical sector iridectomy in children with Peters anomaly.

Methods : A retrospective case series of all patients diagnosed with Peters anomaly who underwent optical sector iridectomy from January 2004 to December 2014. Data collection included demographics, intra- and post-surgical complications, and visual outcome. Statistical analysis was done using Student’s t test and Pearson’s correlation coefficients.

Results : Twenty-nine eyes of 22 children (55% female) with a mean age of 15.6 ± 26.3 months (range 1 week – 7.7 years) diagnosed with Peters anomaly in which the corneal opacity involved the visual axis and who underwent sector iridectomy were included in the analysis. Four children (18.2%) had unilateral disease, while 18 (81.2%) had bilateral disease. Seven patients underwent bilateral sector iridectomy. Eleven patients underwent unilateral sector iridectomy, with the second eye being inoperable or having undergone penetrating keratoplasty (PK). No intra- or post-operative complications were recorded. Subsequently, one eye (3.4%) underwent another sector iridectomy, 2 eyes (6.9%) underwent PK, and 1 eye (3.4%) underwent keratoprosthesis. Mean follow-up was 41.6 ± 43.8 months (2-118 months). Pre-operative mean visual acuity was light perception/blinks or grimace to light (2.5±0.3 in logMAR, range 20/400 to NLP). Mean visual acuity on last follow up improved to 20/1250 (1.8±0.6 in logMAR, range 20/150 to NLP) (p<0.01). Visual acuity improved (Pearson coefficient=0.4, p=0.03) and the difference between the pre- and post-operative visual acuities increased (Pearson coefficient=0.5, p<0.01) with older age and longer follow up.

Conclusions : Children who underwent optical sector iridectomy had improvement in visual acuity and a low complication rate. The procedure is a safe and effective alternative to penetrating keratoplasty in cases where there is a clear peripheral corneal zone.

This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.