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Shallowing of the Anterior Chamber During Optical Iridectomy for Peters Anomaly

Educational Objective
Based on this clinical scenario and the accompanying image, understand how to arrive at a correct diagnosis.
1 Credit CME

A 4-week-old male infant presented to the pediatric ophthalmology clinic with bilateral congenital corneal opacities. The pregnancy was full-term and uncomplicated, and he was delivered spontaneously without the use of forceps. His corneal abnormalities were noted by the neonatologists on the first day of life. A systemic survey revealed no other dysmorphic findings. He was referred to the clinic for further evaluation and management. Examination under anesthesia revealed bilateral corneal opacities with peripheral clearing and absent red reflexes. The white-to-white corneal diameters were 10 mm horizontally and vertically in both eyes, and B-scan ultrasonography revealed unremarkable posterior segments. Ultrasound biomicroscopy confirmed the diagnosis of Peters anomaly type I with iridocorneal adhesions and no apparent lens involvement. At the same session, a large iridectomy with lysis of iridocorneal adhesions was performed in both eyes to establish a clear, noncentral optical axis.

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Peters anomaly type I

C. Inject a sterile air bubble.

Congenital corneal opacities may induce dense amblyopia, resulting in poor visual outcomes. In patients with an incompletely opacified cornea, a clear visual axis can sometimes be established by either optical dilation with pharmacological agents or with an optical sector iridectomy.13 The use of sterile air bubble as a space-occupying agent in ophthalmic surgery has largely been replaced by the use of various ophthalmic viscosurgical devices, with indications for sterile air limited to the tamponade of retinal breaks or in support of a graft during endothelial keratoplasty.4,5

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Article Information

Corresponding Author: Ta C. Chang, MD, Bascom Palmer Eye Institute, 900 NW 17th St, 450 N, Miami, FL 33136 (t.chang@med.miami.edu).

Published Online: July 26, 2018. doi:10.1001/jamaophthalmol.2018.0407

Conflict of Interest Disclosures: Both authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest and none were reported.

Additional Contributions: We thank the patient’s parents for granting permission to publish this information.

References
1.
Zaidman  GW, Rabinowitz  Y, Forstot  SL.  Optical iridectomy for corneal opacities in Peter’s anomaly.  J Cataract Refract Surg. 1998;24(5):719-722.PubMedGoogle ScholarCrossref
2.
Jünemann  A, Gusek  GC, Naumann  GO.  Optical sector iridectomy: an alternative to perforating keratoplasty in Peters’ anomaly [in German].  Klin Monbl Augenheilkd. 1996;209(2-3):117-124.PubMedGoogle ScholarCrossref
3.
Sundaresh  K, Jethani  J, Vijayalakshmi  P.  Optical iridectomy in children with corneal opacities.  J AAPOS. 2008;12(2):163-165.PubMedGoogle ScholarCrossref
4.
Sharma  T, Challa  JK, Ravishankar  KV, Murugesan  R.  Scleral buckling for retinal detachment. Predictors for anatomic failure.  Retina. 1994;14(4):338-343.PubMedGoogle ScholarCrossref
5.
Chamberlain  W, Austin  A, Terry  M, Jeng  BH, Rose-Nussbaumer  J.  Survey of experts on current endothelial keratoplasty techniques.  J Clin Exp Ophthalmol. 2016;7(5):608.PubMedGoogle ScholarCrossref
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