PENETRATING KERATOPLASTY FOR UNILATERAL CORNEAL OPACITIES IN PETERS' ANOMALY:

A CASE SERIES 

The authors have no financial interest in the subject matter of this e-poster

04/21/23 1Basdekidou Chrysanthi

Chrysanthi BASDEKIDOU, Pascal DUREAU

ASCRS

25-29/3/2011 SAN DIEGO- CALIFORNIA

PETERS' ANOMALY (PETERS A. 1906)

•40,3% of congenital corneal opacities (Rezende R, Cornea 2004)

•80% bilateral, 50-70% associated glacoma (Ciralsky J, Sem Ophthalmol 2007)

•Type 1 : central corneal opacity, all corneal layers, IC synechiae

Type 2 : lens implication

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METHODS AND RESULTS

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SURGICAL TECHNIQUE

• Flieringa ring

• single use trephine

• donnor and receipient:

0,5 mm graft difference

• 16 seperated knots

(2 cases: additional running suture)

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POSTOPERATORY TREATMENT

•Corticoïdes (oral and local) and

ciclosporine 2% local

•Suture ablation: 1st and 2nd post

operative months under GA

•Amblyopia treatment: occlusion –

regular optometry control

COMPLICATIONS

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Only one prospective study→

Ciclosporine 2% in pediatric ophthalmology: sure and efficient

(Cosar CB, Eye & Contact lens 2003)

• Enfants: immature immunitary system-

high risk KT!

• No established protocole-when shall we stop the treatment?

• Oral use of CsA for 12 months for high risk KT (Hill JC,

Ophthalmology 1994)

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DISCUSSION Ciclosporine

REJECTION RISK FACTORSYang LHH, Ophthalmology 1999

• Severeness of the disease

stromal vessels, total limbal opacification,

anterior synechiae in several quadrants

• Glaucoma

• CNS pathology

• Grafts greater than 8 mm in diameter: independant factor

• Ulterior grafts: inferior survival probability

(Yang LLH Ophthalmology 2004)

• Association between combined surgeries and rejection

(Cowden Ophthalmology 1990)

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Author Year Number of eyes

with Peters

Number of unilateral

cases

Graft survival

probability

Graft transparency

Mean follow-

up

Parmley 1993 16 * * * 30 mois

Gollamudi 1994 22 * * * 6 ans

Althaus 1996 8 2 * 50% 3,8 ans

Yang 1999 72 11 44%-3 ans * 11 ans

Zaidman 2007 32 16 * 90% 78,9 mois

Rao 2008 32 16 22%-2 ans 43% 11,4 mois

Our study 2011 14 14 * 78,6% 30 mois

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LITTERATURE: ENCOURAGING RESULTS

KT aims at giving the pathologic eye a useful vision

Surgeon: Evaluation of anomaly's severity and

Family Context: cooperative parents

Final decesion: the family, a life time commitment

Long term aggressive amblyopia treatment

Multidisciplinary follow-up

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CONCLUSIONS