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Long-term visual prognosis in children after corneal transplant surgery for Peters anomaly type I
Gerald W Zaidman1, Jessica K Flanagan, Catherine C Furey
1Department of Ophthalmology, New York Medical College and Westchester Medical Center, Valhalla, New York 10595, USA. pedkera@aol.com
Insights
Children undergoing corneal transplant surgery for Peters anomaly type I often achieve good vision. However, the presence of glaucoma significantly impacts long-term visual prognosis in these pediatric patients.
Area of Science:
- Ophthalmology
- Pediatric Surgery
- Genetics
Background:
- Peters anomaly type I is a congenital corneal defect requiring surgical intervention.
- Corneal transplantation, specifically penetrating keratoplasty (PKP), is a primary treatment for this condition in infants.
- Long-term visual outcomes and associated complications in pediatric patients are crucial to understand.
Purpose of the Study:
- To assess the long-term visual prognosis of children who underwent corneal transplantation for Peters anomaly type I.
- To identify factors influencing visual outcomes after PKP in this pediatric population.
Main Methods:
- A retrospective review was conducted on 24 children treated for Peters anomaly type I.
- Patients were stratified into preverbal and older verbal groups.
- Data collected included visual acuity, graft clarity, and complications such as glaucoma and graft rejection.
Main Results:
- Ninety percent of grafts remained clear at a mean follow-up of 78.9 months.
- Among older children, 29% achieved visual acuity of 20/50 or better.
- Children with co-existing glaucoma had a poorer visual prognosis compared to those without.
Conclusions:
- Penetrating keratoplasty for Peters anomaly type I can lead to good or functional vision in many children.
- Glaucoma is a significant negative prognostic factor for visual outcomes in these patients.
- Early intervention and management of complications are vital for optimizing vision.
Purpose:
To evaluate the long-term visual prognosis in children with corneal transplant surgery for Peters anomaly type I.
Design:
Retrospective review of interventional case series.
Methods:
Twenty-four children treated in a university-based practice were divided into two groups for analysis: a younger preverbal group and an older group of children three years of age or older. Children underwent corneal transplantation surgery (penetrating keratoplasty [PKP]) for Peters anomaly type I as infants (age range, two to 18 months). Visual acuity using Snellen or Allen charts and glaucoma and other complications were tabulated.
Results:
Twenty-four patients had Peters anomaly; 16 had unilateral disease, eight had bilateral disease. Thirty eyes underwent PKP. Average age at PKP was five months. The mean follow-up from PKP to the most recent visit was 78.9 months. Fifteen eyes (50%) were treated for glaucoma. Five transplants (17%) had graft rejection episodes; two of these failed and were regrafted. Six eyes (20%) required cataract surgery. One eye had a retinal detachment. Currently, 27 eyes (90%) have clear grafts. In the younger group of children, five of six grafts are clear (83%). In the older group of 24 eyes of verbal children, seven eyes (29%) have visual acuity ranging from 20/20 to 20/50, six (25%) have visual acuity ranging from 20/60 to 20/100, nine (38%) have visual acuity ranging from 20/200 to counting fingers, and two eyes (8%) have visual acuity of hand movements. In this group, nine of 12 eyes without glaucoma had visual acuity better than 20/100; only four of 11 eyes with glaucoma were better than 20/100.
Conclusions:
Many children with PKP for Peters anomaly type I can experience good or functional vision in their operated eye. Children with glaucoma have a poorer visual prognosis.
