Peters Anomaly Treatment & Management

Updated: Sep 12, 2018
  • Author: Danielle Trief, MD; Chief Editor: Donny W Suh, MD, FAAP  more...
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Treatment

Medical Care

General

In a child suspected of having Peters anomaly, a thorough physical examination by a pediatrician is warranted.

Genetic counseling must be offered as needed.

Ocular

Glaucoma is very common in patients with Peters anomaly, occurring in up to 90% of cases.

Topical medications or surgery may be necessary to control elevated intraocular pressure (IOP).

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Surgical Care

Peripheral optical iridectomy

Peripheral optical iridectomy may be performed in patients with a clear peripheral cornea..

Penetrating keratoplasty

Penetrating keratoplasty is recommended in patients with bilateral visually disabling corneal opacity. To prevent amblyopia, the surgery should be performed at age 2-12 months.

Peters anomaly type 1 has a significantly higher rate of graft clarity (80%) than type 2 (20%). [2]

Intense postoperative care, consisting of frequent follow-up visits, high-dose topical corticosteroids, and early suture removal, is necessary. [1]

In patients with unilateral Peters anomaly, the decision whether to perform a penetrating keratoplasty or observe is challenging and must be made after a comprehensive discussion between the family and ophthalmologists, weighing the risks of transplantation (rejection, infection, permanent vision loss) versus the risks of Peters anomaly (usually, dense amblyopia).

Lensectomy/vitrectomy

Lensectomy/vitrectomy is indicated in patients with cataract. If left aphakic, these patients will require aphakic contact lenses or aphakic spectacles.

Filtration surgery, cryoablation, or tube shunt

Filtration surgery, cryoablation, or a tube shunt may be required in patients with glaucoma whose increased intraocular pressure cannot be managed with medications. [35]

Pupil dilatation or iridectomy

Pupil dilatation or iridectomy can be performed to optimize visual function in patients with small corneal opacity. [2]

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Consultations

See the list below:

  • Pediatrician - Thorough examination to rule out other systemic abnormalities
  • Neonatologist
  • Geneticist - Genetic counseling
  • Glaucoma specialist- Management of glaucoma (Most patients with Peters anomaly have glaucoma. No FDA-approved glaucoma medications are available for children.)
  • Vitreoretinal surgeon – if lensectomy/vitrectomy is necessary
  • Cornea specialist - Keratoplasty
  • Low-vision specialist - Management of poor vision, provision of optical aids
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Complications

Complications of corneal transplantation and cataract surgery are numerous, especially in children.

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Further Outpatient Care

An ophthalmologist should provide regular follow-up care to monitor the status of the cornea and glaucoma.

A pediatrician should monitor patients with Peters anomaly for other congenital anomalies.

Patients should receive visual rehabilitation as needed.

A pediatric contact lens specialist should fit patients with aphakic contact lenses if the natural lens is removed.

Aggressive amblyopia therapy should be performed to aid with good visual acuity. 

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Inpatient & Outpatient Medications

Medications may be indicated for glaucoma and postgraft treatment.

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