Download VuMax, Sonomed, Lake Success, NY

Role of Anterior Segment Imaging
in Peters Anomaly with
Significant Cataract:
Diagnosis and Preoperative Planning
Roxana Ursea, MD
Matthew T. Feng, MD
Ovette Villavicencio, PhD
The authors have no financial interest in the subject matter of this poster
Purpose

To report a case of successful cataract extraction guided by
preoperative anterior segment imaging in a patient with
Peters anomaly
OD
OS
Preoperative slit lamp photos illustrating the off-center leukoma with focal area of corneal
thinning & PAS
Methods



Case report of a 62 yo monocular Native American
male with B/L Peters anomaly type 1, with 3+ NS
cataract in his good eye
Due to anterior segment dysgenesis, view of the
anterior segment and lens was limited by routine slit
lamp exam
Imaging was performed for both diagnosis &
preoperative planning using

Ultrasound biomicroscopy (UBM; VuMax, Sonomed, Lake Success, NY)

Anterior segment optical coherence tomography (AS-OCT; Visante, Carl
Zeiss Meditec, Dublin, CA)
Results

The combination of UBM & AS-OCT allowed a complete
evaluation of anterior segment anatomic changes due to Peters:
 corneal surface irregularities
 significant corneal thinning
 peripheral anterior synechiae & corneal thinning masked by a
paracentral leukoma
 narrow angle

Subsequent preoperative planning was based on these findings

No anatomical surprises or complications were encountered
intraoperatively

Postoperative Snellen BCVA was 20/25 & stable at 14 months
Preoperative Imaging - OS
UBM
AS-OCT
Narrow Angle
Irregular thickness of the cornea and
corresponding adhesions
Iris-endothelial adhesions with a thinned overlying
cornea in the inferotemporal quadrant
Results
PREOP
POSTOP
0o
0o
224o
295o
312o
312o
Various AS-OCT scans at different meridians showing extent of the peripheral anterior
synechiae, corneal irregularities and increased corneal thickening
Results
PREOP
POSTOP


Increased depth of anterior chamber
Increased corneal thickness
Conclusions

Dense central leukomas are common in Peters anomaly and may
limit examination of the anterior segment in such patients

Preoperative anterior segment imaging provided invaluable
anatomic details in our monocular patient, allowing the safe and
successful extraction of his cataract with posterior chamber
intraocular lens placement

Both modalities, UBM & AS-OCT, visualized the anatomical
changes within the anterior segment pre- & postoperatively
References

1. Reese AB, and Ellsworth, RM. The anterior cleavage syndrome. Arch. Ophthalmol.
1966; 75: 307.

2. Waring GO III, Rodrigues MM, Laibson PR. Anterior chamber cleavage syndrome. A
stepladder classification. Surv Ophthalmol. 1975; 20: 3-27.

3. Ozeki H, Shirai S, Nozaki M, et al. Ocular and systemic features of Peters'
anomaly. Graefes Arch. Clin. Exp. Ophthalmol. 2000;238(10):833-9.

4. De Respinas PA and Wagner RJ. Peters’ anomaly in a father and son. Am. J.
Ophthalmol. 1987; 104: 545-6.

5. Baqueiro A, and Hein PA Jr. Familial congenital leukoma: case report and review of
the literature. Am. J. Ophthalmol. 1960; 50: 810-81.