In adults, previous studies have indicated that AS formation after PK may induce secondary glaucoma and immunological graft rejection, and further lead to graft failure or poor visual prognosis. A better understanding of intra- and postoperative problems has enabled us to achieve a higher level of anatomical success.Īnterior synechiae (AS) is a common postoperative complication in younger patients who undergo PK due to low scleral rigidity, increased fibrin reaction, and positive vitreous pressure. Factors associated with graft failure included preoperative vascularization, graft size, concomitant lensectomy/vitrectomy, and postoperative complications, especially allograft rejection and glaucoma. PK in pediatric patients with Peters’ anomaly has been reported to have poor surgical outcomes. Pediatric keratoplasty is a challenging and demanding procedure because of the technical difficulties encountered while performing the surgery, the high rate of complications, and the threat of amblyopia. When the corneal opacity obstructs the visual axis, penetrating keratoplasty (PK) may be the necessary first step in preventing irreversible loss of visual function. The degree of visual deprivation depends on the size, location, and density of the opacity. Co-existing glaucoma was observed in 50–70% of patients. Peters’ anomaly is not a homogenous disease cases vary from mild to severe.
Typically, iris strands extend from the collarette to the periphery of the corneal leukoma. Peters’ anomaly is a rare, congenital ocular malformation characterized by central corneal opacity with corresponding defects in the posterior stroma, Descemet's membrane, and endothelium. These data indicate the need for careful consideration when performing PK on these patients. ConclusionsĪnterior synechiae following PK is a relatively common occurrence in Peters’ anomaly patients and is found to be associated with preexisting iridocorneal adhesion, a shallow anterior chamber, small graft size, graft-host junction malposition, and graft closer to the corneal limbus. In addition, quadrants of preexisting iridocorneal adhesion and width of the host corneal bed were identified as risk factors for increased postoperative anterior synechiae. Multivariate regression analysis found that preexisting iridocorneal adhesion was positively correlated with postoperative anterior synechiae, whereas anterior chamber depth (OR = 0.009, 95% CI 0.000–0.360, p = 0.012) and graft size (OR = 0.016, 95% CI 0.000–0.529, p = 0.020) were negatively correlated with postoperative synechiae. Disease severity and malposition of the internal graft-host junction were significantly associated with the formation of postoperative synechiae. OCT findings revealed graft-host junction synechiae, peripheral anterior synechiae, and a combination of both.
Various extent of postoperative anterior synechiae was observed in 59 eyes (83.1%). Seventy-one eyes of 58 patients, aged 5 to 23 months, were included. The profiles of postoperative anterior synechiae and multiple potential risk factors were analyzed. In addition to basic ophthalmic examinations, images of anterior segment structures were obtained via spectral-domain OCT at baseline and during the postoperative follow-up period.
The medical records of patients diagnosed with Peters’ anomaly who underwent PK between 20 were reviewed.
MethodsĪ retrospective cross-sectional study was performed. To evaluate anterior synechiae after penetrating keratoplasty (PK) in patients with Peters’ anomaly using anterior segment optical coherence tomography (OCT).
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