Posterior lamellar keratoplasty (DSAEK) in Peters anomaly

To report the outcome of Descemet stripping automated endothelial keratoplasty (DSAEK) in 2 patients with Peters anomaly.

Case 1 was a 6-year-old boy who presented with congenital central corneal opacity, cataract, and iridocorneal adhesion in both eyes and keratolenticular touch in the left eye. The second case was an 11-year-old boy with a history of congenital corneal opacity involving the central cornea with iridocorneal adhesion, cataract, and mild microphthalmos in the left eye. Both patients had a more prominent corneal opacity localized posteriorly. DSAEK was performed with lensectomy and posterior chamber intraocular lens implantation in the left eye in both patients (2 months later in a second stage in case 1). During the procedure, stripping of Descemet membrane was performed in the periphery of the opacity with scraping of the posterior part of the opacity.

Descemetorhexis in the periphery of the opacity was found to be more difficult in both cases with the absence of Descemet membrane in the center. Both the patients had reduction in the density of corneal opacity and improved vision postoperatively, which was more obvious in case 2. Except for a peripheral graft detachment that necessitated rebubbling in both cases, the operation was uneventful and the patients retained clear grafts up to 1 year after the operation.

Posterior lamellar keratoplasty (DSAEK) may be a promising option in properly selected cases of Peters anomaly. Further studies are needed to define the role of DSAEK or other types of posterior lamellar keratoplasty in this condition.