Roxana Ursea , MD Matthew T. Feng , MD Ovette Villavicencio, PhD

Role of Anterior Segment Imaging in Peters Anomaly with

Significant Cataract: Diagnosis and Preoperative Planning

Role of Anterior Segment Imaging in Peters Anomaly with

Significant Cataract: Diagnosis and Preoperative Planning

Roxana Ursea, MDMatthew T. Feng, MD

Ovette Villavicencio, PhD

Roxana Ursea, MDMatthew T. Feng, MD

Ovette Villavicencio, PhD

The authors have no financial interest in the subject matter of this poster

Preoperative slit lamp photos illustrating the off-center leukoma with focal area of corneal thinning & PAS

PurposePurpose

To report a case of successful cataract extraction guided by preoperative anterior segment imaging in a patient with Peters anomaly

OD OS

MethodsMethods

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)

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)

ResultsResults

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

Irregular thickness of the cornea and corresponding adhesions

Iris-endothelial adhesions with a thinned overlying cornea in the inferotemporal quadrant

Narrow Angle

UBM

Preoperative Imaging - OSPreoperative Imaging - OSAS-OCT

Various AS-OCT scans at different meridians showing extent of the peripheral anterior

synechiae, corneal irregularities and increased corneal thickening

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ResultsResults

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PREOP

POSTOP

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ResultsResults

PREOP

POSTOP

Increased depth of anterior chamber Increased corneal thickness

ConclusionsConclusions

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

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

ReferencesReferences

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.

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.