Journal of Pediatric Ophthalmology and Strabismus

Images in Pediatric Ophthalmology 

Correlation Between Clinical Examination and Diagnostic Imaging in Type II Peters Anomaly

Ta C. Chang, MD; Daniela Reyes-Capo, BA; Kara M. Cavuoto, MD

Abstract

A full-term 7-week-old infant presented to a pediatric ophthalmologist for evaluation of a congenital corneal opacity of the left eye. The pregnancy and delivery were uneventful and the infant was otherwise healthy. On clinical ophthalmic examination, visual acuity was grimace to light in both eyes. Examination under anesthesia revealed a central leukoma (Figure 1A) with a corneolenticular adhesion of the affected eye (Figure 1B), which correlated with high-resolution ultrasound imaging (Figure 1C). Gonioscopy showed an anteriorly coned lens with adhesion to the central cornea. The intraocular pressure was 20 mm Hg, axial length was appropriate for age, and the optic nerve appeared healthy. Cycloplegic refraction was attempted but the reflex could not be accurately neutralized. The infant was diagnosed as having type II Peters anomaly without glaucoma. No genetic testing was performed. Topical phenylephrine to achieve optical dilation around the opacity was initiated to facilitate visual development. A subsequent examination 1 month later revealed that the opacity was unchanged and a bright red reflex around the opacity was maintained with pharmacologic dilation. This case highlights the use of imaging in distinguishing type I Peters anomaly, which is characterized by iridocorneal adhesions, from type II Peters anomaly, which is characterized by corneolenticular adhesions or cataracts.1,2

A full-term 7-week-old infant presented to a pediatric ophthalmologist for evaluation of a congenital corneal opacity of the left eye. The pregnancy and delivery were uneventful and the infant was otherwise healthy. On clinical ophthalmic examination, visual acuity was grimace to light in both eyes. Examination under anesthesia revealed a central leukoma (Figure 1A) with a corneolenticular adhesion of the affected eye (Figure 1B), which correlated with high-resolution ultrasound imaging (Figure 1C). Gonioscopy showed an anteriorly coned lens with adhesion to the central cornea. The intraocular pressure was 20 mm Hg, axial length was appropriate for age, and the optic nerve appeared healthy. Cycloplegic refraction was attempted but the reflex could not be accurately neutralized. The infant was diagnosed as having type II Peters anomaly without glaucoma. No genetic testing was performed. Topical phenylephrine to achieve optical dilation around the opacity was initiated to facilitate visual development. A subsequent examination 1 month later revealed that the opacity was unchanged and a bright red reflex around the opacity was maintained with pharmacologic dilation. This case highlights the use of imaging in distinguishing type I Peters anomaly, which is characterized by iridocorneal adhesions, from type II Peters anomaly, which is characterized by corneolenticular adhesions or cataracts.1,2

References

  1. Bhandari R, Ferri S, Whittaker B, Liu M, Lazzaro DR. Peters anomaly: review of the literature. Cornea. 2011;30:939–944. doi:10.1097/ICO.0b013e31820156a9 [CrossRef]
  2. Mireskandari K, Tehrani NN, Vandenhoven C, Ali A. Anterior segment imaging in pediatric ophthalmology. J Cataract Refract Surg. 2011;37:2201–2210. doi:10.1016/j.jcrs.2011.09.026 [CrossRef]
Authors

From Bascom Palmer Eye Institute, Department of Ophthalmology (TCC, KMC), University of Miami Miller School of Medicine (DR-C), Miami, Florida.

The authors have no financial or proprietary interest in the materials presented herein.

Correspondence: Kara M. Cavuoto, MD, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, 900 NW 17th Street, Miami, FL 33136. E-mail: kcavuoto@med.miami.edu

10.3928/01913913-20170703-09

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