1. Peters’ anomaly: A Clinical Study of 36 Patients
Calixto, Nassim S.1; Silva, Maria Valeria C.1; Cronemberger, Sebastião1;
Milhomens, Eduardo G.1; Dantas, Adalmir M.2
1Department of Ophthalmology and Otorhinolaryngology, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil; Hospital São Geraldo, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
2Department of Ophthalmology, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
METHODS
We analyzed the medical records of 36 patients with Peters’ anomaly from 1968 to We included only those records that presented complete biomicroscopic findings. We assessed demographic data, first degree relatives in the family history, biomicroscopy, intraocular pressure (IOP), horizontal corneal diameter (HCD) and axial length (AL).
Statistical analysis was descriptive.
INTRODUCTION
Peters’ anomaly was bilateral in 23 (64%) patients and unilateral in 13 (36%) (Graph. 4).
Three patients had parents that were cousins.
The most important biomicroscopic findings were:
Corneal opacities with or without posterior ulcer;
Annular or partial anterior synechiae;
Narrow anterior chamber depth;
Iris’ changes and lens opacities;
Our patients were classified as Peters I, II or III. We found 63% Peters I, 28% Peters II e 9% Peters III (Graph. 5).
The structural corneal changes invalidate the true IOP values. Despite this, the approximate IOP values at the initial examination were 11.11±8.5mmHg in the right eye (RE) and 10.76±8.05 mmHg in the left eye (LE);
The initial HCD average was 11.93±1.62 mm in RE and 12.22±1.9 mm in LE;
The initial AL average was 22.00±3.12 mm in RE and 21.52±3.67mm in LE. Some eyes included in this sample had already abnormal AL at the first examination.
Peters’ anomaly (PA) is a rare dramatic form of ocular anterior segment digenesis found at birth and related to abnormal crest cells migration. The majority of cases are sporadic; however, autosomal recessive and dominant patterns of inheritance have been found in consanguineous mates.
It is characterized by a congenital central opacity of the deep layers of the corneal stroma; the Descemet’s membrane may be present or not inside the ulcer (nest) (Peters I) (Fig. 1). In more advanced cases, there is annular synechia of the iris collarette in the ulcer border (Peters II) (Fig. 2). In the most advanced anomaly the cristalline lens (transparent or opaque) is nestled in the ulcer (Peters III) (Fig. 3).
RESULTS
We included 36 patients, 22 males and 14 females (Graph. 1).
Fourteen patients were white, 14 mulatto, 3 black and in 5 cases race wasn’t
available (Graph. 2).
Peters’ anomaly is congenital but, in spite of this, the patients’ age at the first examination in our sample ranged from 2 days to 122 months (Graph. 3).
Graphic 4: PA’s laterality distribution.
Figure 1. Cornea with central leukoma.
Figure 2. Cornea with iris’ annular anterior synechia.
Graphic 1. PA’s gender distribution.
Figure 3. Cornea with central leukoma and corneolenticular touch.
Graphic 5: PA’s classification.
Graphic 2. PA’s race distribution.
CONCLUSIONS
Peters’ Anomaly predominantly affects both eyes. The structural corneal changes render the IOP measurements less reliable. Narrow anterior chamber and iris’ changes were found in the great majority of eyes with PA. The HCD and AL average at the first examination were within the normal range but the standard deviation was high.
PURPOSE
To describe the clinical findings of 36 patients with Peters’ anomaly (PA) examined at Glaucoma Division at Hospital São Geraldo, UFMG, between 1968 and
Graphic 3. PA’s distribution by age at the first examination.
Commercial Relationships: Calixto, Nassim S., none; Silva, Maria Valeria C., none; Cronemberger, Sebastião, none; Milhomens, Eduardo G., none; Dantas, Adalmir M., none.