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 Table of Contents  
PHOTO ESSAY
Year : 2021  |  Volume : 1  |  Issue : 4  |  Page : 814-815

Effect of trabeculectomy on glaucoma secondary to Peters' anomaly


Dr Rajendra Prasad Center for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India

Date of Submission03-Feb-2021
Date of Acceptance05-Apr-2021
Date of Web Publication09-Oct-2021

Correspondence Address:
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
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijo.IJO_289_21

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  Abstract 


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

How to cite this URL:
Lakra S, Sihota R. Effect of trabeculectomy on glaucoma secondary to Peters' anomaly. Indian J Ophthalmol Case Rep [serial online] 2021 [cited 2021 Oct 21];1:814-5. Available from: https://www.ijoreports.in/text.asp?2021/1/4/814/327732



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 Top


Peters' anomaly is associated with glaucoma in 50–70% of cases[1],[2] and is difficult to treat. Surgical success in primary congenital glaucoma is better with combined trabeculectomy + trabeculotomy (CTT)[3] compared to Glaucoma Drainage Devices (GDD)[4] at 5 years, with an increased risk of failure and of corneal complications with GDD[5]. CTT allows aqueous drainage to Schlemm's canal, together with subconjunctival drainage, and was therefore done.[6] Outcomes of surgery in Peter's anomaly are IOP control in 32%[7] while only 12% have a visual acuity of 20/200 or better, with 53% have a perception of light or less.[7]

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.

Acknowledgement

The authors would like to thank Dr Anand Naik Bukke for providing the clinical photograph of the Bleb.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Kenyon KR. Mesenchymal dysgenesis in Peters' anomaly, sclerocornea and congenital endothelial dystrophy. Exp Eye Res 1975;21:125-42.  Back to cited text no. 1
    
2.
Stone DL, Kenyon KR, Green WR, Ryan SJ. Congenital central corneal leukoma (Peters' anomaly). Am J Ophthalmol 1976;81:173-93.  Back to cited text no. 2
    
3.
Mullaney PB, Selleck C, Al-Awad A, Al-Mesfer S, Zwaan J. Combined trabeculotomy and trabeculectomy as an initial procedure in uncomplicated congenital glaucoma. Arch Ophthalmol 1999;117:457-60.  Back to cited text no. 3
    
4.
Chen A, Yu F, Law SK, Giaconi JA, Coleman AL, Caprioli J. Valved glaucoma drainage devices in pediatric glaucoma retrospective long-term outcomes. JAMA Ophthalmol 2015;133:1030-5.  Back to cited text no. 4
    
5.
Medert CM, Cavuoto KM, Vanner EA, Grajewski AL, Chang TC. Risk factors for glaucoma drainage device failure and complication in the pediatric population. Ophthalmol Glaucoma 2021;4:63-70.  Back to cited text no. 5
    
6.
Bitrian E, Grajewski AL. Surgical outcomes of congenital glaucoma in Peters' anomaly. Invest Ophthalmol Vis Sci 2015;56:2735.  Back to cited text no. 6
    
7.
Yang LL, Lambert SR, Lynn MJ, Stulting RD. Surgical management of glaucoma in infants and children with Peters' anomaly: Long-term structural and functional outcome. Ophthalmology 2004;111:112-7.  Back to cited text no. 7
    


    Figures

  [Figure 1], [Figure 2], [Figure 3]



 

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