Аномалия Петерса: клиника, диагностика и результаты хирургического лечения

Abstract

The Peters’s Anomaly (PA) is an infrequent congenital anomaly of a cornea and anterior segment of eye. The rarity of this pathology and difficulty bound to inspection of newborns generate a situation when more or less certain clinical approaches to maintaining this anomaly remain obscure for most of children’s ophthalmologists. Purpose. To study clinical implications and to estimate results of surgical treatment in children with PA. Material and methods. Under observation from 1996 for 2016 on examination and treatment there were 51 children with the PA different forms, aged from 3 months up to 10 years: 1 group – mesodermal – 20 people (37%), 2 – group the ectodermal 31 child (63%). Surgical treatment – penetrating keratoplasty (PKP) was carried out at 43 patients (69 eyes) aged from 8 up to 36 months. At other children (8 people) surgery was contraindicative because of serious somatic and eye pathology. Clinical-functional and ophthalmologic examination at all was conducted in the conditions of medication sleep. PKP carried out by a traditional technique, as donor material used a fresh cadaver cornea with prescription of a fence from death moment before operation no more than 48 hours. The biological result of surgery was estimated by a moment method (or Kaplana-Maier’s method) by means of which calculated so-called survival of a graft. Functional result – at children to 3-x years estimated approximately: on tracking of the child toys from a certain distance and method of a preferable look, at children of advanced age according to Sivtsev-Golovin’s table. Postoperative observation proceeded from 3 months to 15 years. The corneal disks removed during surgery were exposed to a histological research. Results. Within the first year after PKP a transparence of the replaced cornea remained in 1 group on 29 eyes (90%), in 2 group – at 21 patients of 26 eyes (67%). In 2 years after surgery the transparent donor cornea at children in 1 group remained at 17 patients (20 eyes, 62%); in – the second at 15 patients of 18 eyes (54%). In 5 years after surgery – at patients of 1 group a transparence of the replaced donor tissue was kept by 17 eyes (53%), in the second only 12 of 31 executed surgery (39%). In 10 years transparent were 53% and 31% of corneas, respectively. In 15 years after surgery a transparence was kept in 1 group of 15 eyes (46%), in 2 – on 9 (22%). Visual acuity (0,3 and above) was observed at 8 of 13 children (61%) after surgery about one year at children of advanced age only in 27% of cases, even at tr ansparent engraftment of a graft. Conclusion. The keratoplasty at PA at children of early age is the only chance to save the child from a blindness and disability on vision.