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Cataract surgery in children with congenital keratolenticular adhesion (Peters anomaly type 2)
Anagha Medsinge1, Ken K Nischal2
1Pediatric Ophthalmology, Strabismus, and Adult Motility, Children's Hospital of Pittsburgh of UPMC, UPMC Eye Center, Pittsburgh, Pennsylvania.
Insights
Cataract surgery in children with keratolenticular adhesion (Peters anomaly type 2) and iris defects led to improved vision and no complications. Meticulous lensectomy achieved satisfactory visual outcomes.
Area of Science:
- Ophthalmology
- Pediatric Ophthalmology
- Genetics
Background:
- Keratolenticular adhesion (KLA), often associated with Peters anomaly type 2, presents unique challenges in pediatric cataract management.
- Aniridia, either partial or complete, can coexist with KLA, further complicating surgical planning and visual prognosis.
Purpose of the Study:
- To evaluate the visual and surgical outcomes of cataract surgery in children diagnosed with keratolenticular adhesion (Peters anomaly type 2).
- To assess the impact of cataract surgery on visual acuity and corneal opacity progression in this specific pediatric population.
Main Methods:
- Retrospective review of medical records for pediatric patients with KLA and partial/complete aniridia who underwent cataract surgery.
- Surgical procedures included in-the-bag irrigation and aspiration, with options for intraocular lens implantation and broad iridectomy.
Main Results:
- The study involved 4 eyes from 3 pediatric patients (age 3 months to 7 years).
- All eyes demonstrated improved visual acuity post-surgery, ranging from counting fingers to 20/60.
- No progression of corneal opacity or postoperative complications were observed.
Conclusions:
- Pediatric cataract surgery, specifically meticulous lensectomy with or without iridectomy, can yield satisfactory visual outcomes in children with KLA and coexisting iris defects.
- Early intervention and careful surgical technique are crucial for managing these complex cases.
Purpose:
To report the visual and surgical outcomes after cataract surgery in children with keratolenticular adhesion (Peters anomaly type 2).
Methods:
The medical records of consecutive patients with keratolenticular adhesion (KLA) with partial (iris defects)/complete aniridia were retrospectively reviewed. Cataract surgery (in-the-bag irrigation and aspiration) with or without intraocular lens implantation and with or without broad iridectomy was performed. The main outcome measures were postoperative visual acuity, complications, and progression of corneal opacity.
Results:
The study included 4 eyes of 3 patients ranging in age from 3 months to 7 years. The mean age at cataract surgery was 37 months; the median, 24 months (range, 3-84 months). The mean follow-up was 3.3 years and median was 2 years (range, 2-6 years). Preoperative visual acuity ranged from fixing and following objects to 20/200. Only 1 patient had PAX6 mutation-confirmed aniridia. The other 2 patients had partial iris defects. All eyes improved in visual acuity ranging from counting fingers at 3 feet to 20/60. There was no progression of corneal opacity. There were no postoperative complications.
Conclusions:
Children with KLA with complete or partial iris defects with localized corneal opacity and cataract can achieve satisfactory visual outcomes by undergoing meticulous lensectomy with or without iridectomy.
