ASCRS
25-29/3/2011
SAN DIEGO- CALIFORNIA
PENETRATING KERATOPLASTY FOR UNILATERAL
CORNEAL OPACITIES IN PETERS' ANOMALY:
A CASE SERIES
Chrysanthi BASDEKIDOU, Pascal DUREAU
The authors have no financial interest in the subject matter of this e-poster
3/22/2016
Basdekidou Chrysanthi
1
PETERS' ANOMALY
(PETERS A. 1906)
•40,3% of congenital corneal opacities
(Rezende R, Cornea 2004)
•80% bilateral, 50-70% associated glacoma
(Ciralsky J, Sem Ophthalmol 2007)
•Type 1 : central corneal opacity, all corneal layers, IC synechiae
Type 2 : lens implication
3/22/2016
Basdekidou Chrysanthi
2
METHODS AND RESULTS
3/22/2016
Basdekidou Chrysanthi
3
SURGICAL TECHNIQUE
Flieringa ring
•Corticoïdes (oral and local) and
single use trephine
ciclosporine 2% local
donnor and receipient:
•Suture ablation: 1st and 2nd post
•
•
•
0,5 mm graft difference
•
POSTOPERATORY TREATMENT
operative months under GA
16 seperated knots
•Amblyopia treatment: occlusion –
(2 cases: additional running suture)
3/22/2016
regular optometry control
Basdekidou Chrysanthi
4
COMPLICATIONS
3/22/2016
Basdekidou Chrysanthi
5
3/22/2016
Basdekidou Chrysanthi
6
3/22/2016
Basdekidou Chrysanthi
7
3/22/2016
Basdekidou Chrysanthi
8
DISCUSSION
Ciclosporine
 Only one prospective study→
Ciclosporine 2% in pediatric ophthalmology: sure and efficient
(Cosar CB, Eye & Contact lens 2003)
• Enfants: immature immunitary systemhigh risk KT!
• No established protocole-when shall we stop the treatment?
• Oral use of CsA for 12 months for high risk KT
(Hill JC, Ophthalmology 1994)
3/22/2016
Basdekidou Chrysanthi
9
REJECTION RISK FACTORS
Yang LHH, Ophthalmology 1999
• Severeness of the disease
stromal vessels, total limbal opacification,
anterior synechiae in several quadrants
• Glaucoma
• CNS pathology
• Grafts greater than 8 mm in diameter: independant factor
• Ulterior grafts: inferior survival probability
(Yang LLH Ophthalmology 2004)
• Association between combined surgeries and rejection
(Cowden Ophthalmology 1990)
3/22/2016
Basdekidou Chrysanthi
10
LITTERATURE: ENCOURAGING RESULTS
Author
Year
Number
of eyes
with
Peters
Number of
unilateral
cases
Graft
survival
probability
Graft
transparency
Mean
followup
Parmley
1993
16
*
*
*
30 mois
Gollamudi
1994
22
*
*
*
6 ans
Althaus
1996
8
2
*
50%
3,8 ans
Yang
1999
72
11
44%-3 ans
*
11 ans
Zaidman
2007
32
16
*
90%
78,9
mois
Rao
2008
32
16
22%-2 ans
43%
11,4
mois
Our study
2011
14
14
*
78,6%
30 mois
3/22/2016
Basdekidou Chrysanthi
11
CONCLUSIONS
 KT aims at giving the pathologic eye a useful vision
 Surgeon: Evaluation of anomaly's severity and
Family Context: cooperative parents
 Final decesion: the family, a life time commitment
 Long term aggressive amblyopia treatment
 Multidisciplinary follow-up
3/22/2016
Basdekidou Chrysanthi
12