|Year : 2021 | Volume
| Issue : 4 | Page : 814-815
Effect of trabeculectomy on glaucoma secondary to Peters' anomaly
Subodh Lakra, Ramanjit Sihota
Dr Rajendra Prasad Center for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
|Date of Submission||03-Feb-2021|
|Date of Acceptance||05-Apr-2021|
|Date of Web Publication||09-Oct-2021|
Dr. Subodh Lakra
Glaucoma Research Facility and Clinical Services, Room No 433, Fourth Floor, Dr Rajendra Prasad Center for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi
Source of Support: None, Conflict of Interest: None
Keywords: Congenital glaucoma, Peters Anomaly, trabeculectomy
|How to cite this article:|
Lakra S, Sihota R. Effect of trabeculectomy on glaucoma secondary to Peters' anomaly. Indian J Ophthalmol Case Rep 2021;1:814-5
A 1-month-old infant presented with bilateral corneal opacity and raised intraocular pressure (IOP) since birth. On examination under anesthesia (EUA), IOP using Perkins tonometer was 28 and 36 mmHg with corneal diameters 13.0 mm and 12.5 mm (both vertical and horizontal) in right eye (RE) and left eye (LE), respectively. [Figure 1]a Ultrasound biomicroscopy revealed a large central Descemet membrane defect with stromal edema and stromal cyst in LE. [Figure 2]a The diagnosis of type I Peters' anomaly with glaucoma was made and combined trabeculectomy + trabeculotomy with mitomycin C (0.04%) for 3 min was done. On EUA at 3 and 6 months, IOP was in the range of 8–12 mmHg in both Eyes (BE), with elevated, avascular blebs. The peripheral cornea cleared, however, a smaller central opacity persisted. [Figure 1]b, [Figure 1]c and [Figure 3] Ultrasound biomicroscopy on review showed significantly decreased corneal edema, resolution of the stromal cyst in both eyes, and reduction in Descemet's defect and an anterior iris insertion. [Figure 2]b The patient was evaluated for an optical iridotomy and registered for penetrating keratoplasty for the central corneal opacity.
|Figure 1: (a) Clinical picture showing increased corneal diameter and central corneal opacity at presentation. (b, c) Clinical picture on examination under anesthesia at 3 and 6 months after trabeculectomy, showing decreased corneal haze with intact central opacity respectively|
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|Figure 2: (a) Preoperative ultrasound biomicroscopy showing central Descemet Membrane (DM) defect (asterisk) with corneal thinning surrounded by corneal thickening due to stromal edema. The left eye also has a stromal cyst (arrow). (b) Ultrasound biomicroscopy 6 months postoperatively showing resolved stromal oedema with iris adhering to the area of DM defect in the left eye. (triangle)|
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|Figure 3: Bleb of the left eye showing elevated avascular bleb with a localized area of thinning|
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| Discussion|| |
Peters' anomaly is associated with glaucoma in 50–70% of cases, and is difficult to treat. Surgical success in primary congenital glaucoma is better with combined trabeculectomy + trabeculotomy (CTT) compared to Glaucoma Drainage Devices (GDD) at 5 years, with an increased risk of failure and of corneal complications with GDD. CTT allows aqueous drainage to Schlemm's canal, together with subconjunctival drainage, and was therefore done. Outcomes of surgery in Peter's anomaly are IOP control in 32% while only 12% have a visual acuity of 20/200 or better, with 53% have a perception of light or less.
Corneal remodeling seen here, reduced the size of the central leucoma so that penetration keratoplasty could be deferred. An optical iridotomy with amblyopia management may suffice initially. The association with neurological impairment and other cognitive dysfunction hinders the long-term goals of visual rehabilitation.
The authors would like to thank Dr Anand Naik Bukke for providing the clinical photograph of the Bleb.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Figure 1], [Figure 2], [Figure 3]