Management of Glaucoma Associated with Peters Anomaly
Kara A. Dolezal, MD; Brenda L. Bohnsack, MD, PhD; Cagri G. Besirli, MD, PhD; Sayoko E. Moroi, MD, PhD
University of Michigan, Kellogg Eye Center
Ann Arbor, MI
Introduction: Peters Anomaly, which is characterized by a central corneal opacity, is often associated with glaucoma.
Methods: We retrospectively reviewed cases of Peters Anomaly who have been followed at our institution since childhood and included 52 eyes of 34 patients.
Results: Mean follow-up was 10.95 ± 11.05 years (0.14-31.1 years). Thirty one eyes of 19 patients were diagnosed with glaucoma at a mean age of 2.91 ± 6.5 years. Twenty eyes of 15 patients required at least 1 glaucoma surgery (mean 2.9 ± 2.0). Six eyes underwent angle surgery, all of which required additional glaucoma surgery after 0.3 ±- 0.3 years. Twelve eyes underwent trabeculectomy, of which 10 needed additional glaucoma surgery. Fourteen eyes had glaucoma drainage device (GDD) placement of which 9 had combined vitrectomy, lensectomy, and posterior tube placement. Eight eyes with GDDs at last follow-up had continued IOP control.
Discussion: At last follow-up, 39 eyes of 27 patients had stable or improved vision compared to initial presentation. Of these 39 eyes, 21 had glaucoma with 16 requiring surgery to obtain IOP control. Thirteen eyes of 10 patients had worse vision. Of these 13 eyes, 10 had glaucoma with 6 requiring surgery to lower IOP. Not surprisingly, angle surgery is typically unsuccessful and trabeculectomies often fail in obtaining IOP control. Glaucoma drainage device placement can be effective, but may require combined vitrectomy and lensectomy for posterior placement due to anterior segment anomalies.
Conclusion: Glaucoma associated with Peters Anomaly is frequently diagnosed during early childhood and often requires multiple surgeries to obtain IOP control.
References: Ozgonul C, Besirli CG, Bohnsack BL. Combined vitrectomy and glaucoma drainage
device implantation surgical approach for complex pediatric glaucomas. J AAPOS. 2017 Apr;21(2):121-126.