Download - PENETRATING KERATOPLASTY FOR UNILATERAL CORNEAL OPACITIES IN PETERS' ANOMALY: A CASE SERIES
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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
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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
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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
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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
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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