eMedicine Specialties > Ophthalmology > Cornea

Congenital Clouding of the Cornea: Follow-up

Author: Noah S Scheinfeld, MD, JD, FAAD, Assistant Clinical Professor, Department of Dermatology, Columbia University; Consulting Staff, Department of Dermatology, St Luke's Roosevelt Hospital Center, Beth Israel Medical Center, New York Eye and Ear Infirmary; Private Practice
Coauthor(s): Benjamin D Freilich, MD, FACS, Assistant Clinical Professor, Department of Ophthalmology, Mount Sinai School of Medicine; Director of Retina Service, Bronx Veterans Administration Medical Center; Jonathan Freilich, MD, FACS, Clinical Instructor, Department of Ophthalmology, Mount Sinai School of Medicine; Consulting Staff, Department of Ophthalmology, Mount Sinai Hospital, St Luke's Roosevelt Hospital Center
Contributor Information and Disclosures

Updated: Jun 10, 2008

Follow-up

Further Outpatient Care

  • An ophthalmologist should provide regular follow-up care for patients with graft rejection.
  • In addition, a pediatrician should monitor patients for other congenital anomalies.
  • Patients should receive visual rehabilitation as needed.
  • A pediatric contact lens specialist should fit patients with aphakic contact lenses.

Inpatient & Outpatient Medications

  • Medications may be indicated for treatment after corneal transplantation.

Complications

  • Complications of corneal transplantation are varied.

Prognosis

  • The visual prognosis is guarded.
  • The earlier keratoplasty is performed (generally prior to 3-6 months of age), the better the likelihood of preventing deprivation amblyopia.
    • In most series, visual acuity in patients after keratoplasty was 20/80 or worse. Some investigators reported visual acuity of 20/40 in patients.
    • Also, in most series, the likelihood that patients maintain a clear graft was 30-50% at 10 years.
  • Patients with glaucoma and cataract had a worsened prognosis.
  • The prognosis for life depends on other systemic anomalies.

Patient Education

  • Children with Peters anomaly and other genetic syndromes associated with corneal opacities require special educational assistance depending on their visual outcome. A low-vision specialist should evaluate these children.
  • Patients may need loupes and binoculars depending on their visual potential.

Miscellaneous

Medicolegal Pitfalls

  • Failure to perform an evaluation under anesthesia in a timely fashion if an adequate examination cannot be performed in the office
  • Failure to differentiate Peters anomaly from other conditions that mimic it
  • Failure to refer the patient to other specialists to rule out systemic anomalies
  • Failure to provide regular follow-up care for children with graft rejection or glaucoma
  • Failure to offer visual rehabilitation

Special Concerns

  • Cases of congenital corneal clouding and Peters anomaly have been reported to occur with fetal alcohol syndrome.
  • Drinking during pregnancy should be discouraged.
 


More on Congenital Clouding of the Cornea

Overview: Congenital Clouding of the Cornea
Differential Diagnoses & Workup: Congenital Clouding of the Cornea
Treatment & Medication: Congenital Clouding of the Cornea
Follow-up: Congenital Clouding of the Cornea
Multimedia: Congenital Clouding of the Cornea
References
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Further Reading

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Keywords

Peters' anomaly, Peter anomaly, sclerocornea, congenital central corneal leukoma, primary congenital glaucoma, PCG, congenital hereditary endothelial dystrophy, CHED, posterior polymorphous dystrophy, PPMD, mucopolysaccharidosis, MPS

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Contributor Information and Disclosures

Author

Noah S Scheinfeld, MD, JD, FAAD, Assistant Clinical Professor, Department of Dermatology, Columbia University; Consulting Staff, Department of Dermatology, St Luke's Roosevelt Hospital Center, Beth Israel Medical Center, New York Eye and Ear Infirmary; Private Practice
Noah S Scheinfeld, MD, JD, FAAD is a member of the following medical societies: American Academy of Dermatology
Disclosure: Optigenex Consulting fee Independent contractor

Coauthor(s)

Benjamin D Freilich, MD, FACS, Assistant Clinical Professor, Department of Ophthalmology, Mount Sinai School of Medicine; Director of Retina Service, Bronx Veterans Administration Medical Center
Disclosure: Nothing to disclose.

Jonathan Freilich, MD, FACS, Clinical Instructor, Department of Ophthalmology, Mount Sinai School of Medicine; Consulting Staff, Department of Ophthalmology, Mount Sinai Hospital, St Luke's Roosevelt Hospital Center
Disclosure: Nothing to disclose.

Medical Editor

Richard W Allinson, MD, Associate Professor, Department of Ophthalmology, Texas A&M University Health Science Center, Scott and White Clinic
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Christopher J Rapuano, MD, Professor, Department of Ophthalmology, Jefferson Medical College of Thomas Jefferson University; Co-Chairman of the Cornea Service, Co-Chairman of Refractive Surgery Department, Wills Eye Institute
Christopher J Rapuano, MD is a member of the following medical societies: American Academy of Ophthalmology, American Society of Cataract and Refractive Surgery, Eye Bank Association of America, Pennsylvania Medical Society, and Philadelphia County Medical Society
Disclosure: Allergan Honoraria Speaking and teaching; Allergan Consulting fee Consulting; Alcon Honoraria Speaking and teaching; Inspire Honoraria Speaking and teaching; RPS Ownership interest Other

CME Editor

Ralph Garzia, OD, Assistant Dean for Clinical Programs, Associate Professor, School of Optometry, University of Missouri at St Louis
Ralph Garzia, OD is a member of the following medical societies: American Academy of Optometry and American Optometric Association
Disclosure: Nothing to disclose.

Chief Editor

Hampton Roy Sr, MD, Associate Clinical Professor, Department of Ophthalmology, University of Arkansas for Medical Sciences
Hampton Roy Sr, MD is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, and Pan-American Association of Ophthalmology
Disclosure: Nothing to disclose.

 
 
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