Sections

Peters Anomaly

Sections Peters Anomaly
Overview
Presentation
- History
- Physical
- Causes
- Complications
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DDx
Workup
Treatment
References

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).

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]

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

Complications

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

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.

Inpatient & Outpatient Medications

Medications may be indicated for glaucoma and postgraft treatment.

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Author

Danielle Trief, MD Assistant Professor of Ophthalmology, Columbia University College of Physicians and Surgeons

Disclosure: Nothing to disclose.

Coauthor(s)

Sara K Schroder Barnard College

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Christopher J Rapuano, MD Professor, Department of Ophthalmology, Sidney Kimmel Medical College of Thomas Jefferson University; Director of the Cornea Service, Wills Eye Hospital

Christopher J Rapuano, MD is a member of the following medical societies: American Academy of Ophthalmology, American Ophthalmological Society, American Society of Cataract and Refractive Surgery, Contact Lens Association of Ophthalmologists, Cornea Society, Eye Bank Association of America, International Society of Refractive Surgery

Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: AAO; OMIC; American Society of Ophthalmic Trauma (ASOT); Avellino, Baxis; Bio-Tissue; Celularity; Dompe; Emmecell; Glaukos; Kala; Oyster Point; Sun Ophthalmics; Tarsus; TearLab<br/>Serve(d) as a speaker or a member of a speakers bureau for: Glaukos; Dompe; Bio-Tissue<br/>Received research grant from: Glaukos<br/>Received income in an amount equal to or greater than $250 from: AAO; OMIC; Baxis; Bio-Tissue; Cellularity; Dompe; Glaukos; Kala; Sun Ophthalmics; TearLab<br/>stock options for: RPS, Fount Bio.

Chief Editor

Donny W Suh, MD, MBA, FAAP, FACS Professor, Department of Ophthalmology, Chief of Pediatric Ophthalmology and Adult Strabismus, Medical Director of Eye-Mobile, Gavin Herbert Eye Institute, UC Irvine Health, University of California, Irvine, School of Medicine; Associate Clinical Professor, Department of Pediatrics, Creighton University School of Medicine; Chief Medical Officer, Suh Precision Syringe, LLC; Medical Staff, Children’s Hospital of Orange County

Donny W Suh, MD, MBA, FAAP, FACS is a member of the following medical societies: American Academy of Ophthalmology, American Academy of Pediatrics, American Association for Pediatric Ophthalmology and Strabismus, American College of Healthcare Executives, American College of Surgeons, American Medical Association, Section on Ophthalmology, American Ophthalmological Society, International Strabismological Association, Iowa Medical Society, Metro Omaha Medical Society, National Eye Care Project, Nebraska Chapter of American Academy of Pediatrics, ORBIS, Surgical Eye Expeditions (SEE) International

Disclosure: Received research grant from: NIH / PEDIG.

Additional Contributors

Brian A Phillpotts, MD Ophthalmologist, St Luke's Cataract and Laser Institute

Brian A Phillpotts, MD is a member of the following medical societies: American Academy of Ophthalmology, American Diabetes Association, American Society of Retina Specialists, Association for Research in Vision and Ophthalmology, Association of University Professors of Ophthalmology

Disclosure: Nothing to disclose.

Guruswami Giri, MD, FRCS Vitreo-Retinal Surgeon, Sacramento, CA

Guruswami Giri, MD, FRCS is a member of the following medical societies: American Academy of Ophthalmology, Royal College of Surgeons of Edinburgh, Royal College of Ophthalmologists

Disclosure: Nothing to disclose.

Acknowledgements

The authors and editors of Medscape Reference gratefully acknowledge the assistance of Ryan I Huffman, MD, with the literature review and referencing for this article.

Peters Anomaly Treatment & Management

Medical Care

General

Ocular

Surgical Care

Peripheral optical iridectomy

Penetrating keratoplasty

Lensectomy/vitrectomy

Filtration surgery, cryoablation, or tube shunt

Pupil dilatation or iridectomy

Consultations

Complications

Further Outpatient Care

Inpatient & Outpatient Medications

Peters Anomaly Treatment & Management

Medical Care

General

Ocular

Surgical Care

Peripheral optical iridectomy

Penetrating keratoplasty

Lensectomy/vitrectomy

Filtration surgery, cryoablation, or tube shunt

Pupil dilatation or iridectomy

Consultations

Complications

Further Outpatient Care

Inpatient & Outpatient Medications

References

Tables

Contributor Information and Disclosures

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