Pediatric Cataract Extraction In Type Ii Peters Anomaly

We present the case of a 7-year-old female patient admitted to our service for evaluation of photophobia, visual impairment and a focal corneal opacity in the left eye. Ocular medical history revealed a posttraumatic evisceration of the right eye. On clinical examination, visual acuity was hand motion in the left eye. BCVA and cycloplegic refraction could not be measured due to the postural abnormalities and lack of fixation. Examination of the left eye revealed a central leukoma with corneal-lenticular adhesions, anterior lens dislocation and opacification, and a bright red reflex. The IOP was 17 mmHg using applanation tonometry. Conventional B-mode ultrasonography showed no anomaly of the optic nerve and an attached retina.

Based on our clinical findings, a suspicion of left Peters’ anomaly type II was raised. Genetic testing is needed to confirm the diagnosis. We decided to perform lens aspiration as the presence of cataract obliterated the visual axis and increased the risk of corneal decompensation. The patient had an uncomplicated post-operative evolution with an improved visual acuity of 20/600 UCVA at 1 week. No Descemet membrane detachment was diagnosed postoperatively, and the cornea appeared clearly, outside the area of previous leukoma. At 1 month postoperative, there was no progression of the corneal opacity. We attempted a correction of +10.0 D and obtained a BCVA of 20/100. We expected a moderate level of visual impairment due to amblyopia.

Type II PA represents a very rare and complex pathology, which affects multiple corneal layers. This diagnosis will require long follow-up with periodic measurement of IOP. The complexity and uniqueness of our case relied on the difficult approach made by the cloudy cornea and anterior lens dislocation. We applied a combination of techniques including adhesiolysis, cataract extraction and anterior vitrectomy. We presented a case of cataract surgery with lens aspiration and no penetrating keratoplasty in a child with dislocated lens. However, the surgical indication of our procedure is restrained to type II Peters anomaly that allows for a clear peripheral cornea associated with amblyopia that will decrease the advantages of other procedures