A case of unilateral presentation of peters' anomaly with fundus involvement

Abstract

Peters' anomaly is a rare congenital malformation of anterior segment dysgenesis, in which abnormal cleavage of anterior chamber occurs. A 22-month-old male was brought by his parents with a history of whitish discoloration in the right eye since birth. The child was born by full-term lower segment cesarean section, with breech presentation. His birth weight was 3 kg and he did not cry immediately. The patient was the first child of nonconsanguineous marriage. The child was diagnosed with hypoxic–ischemic encephalopathy at birth. On TORCH profile, he was found to be cytomegalovirus (CMV) immunoglobulin G positive. The mother gave a history of neonatal intensive care unit admission on the 3rd day of birth for seizures. On ophthalmic examination, the child followed torchlight and had nystagmus in horizontal gaze in both eyes and exophoria in the right eye. Slit-lamp examination of the right eye revealed microcornea, leucomatous corneal opacity measuring 2.5 mm × 3.5 mm involving the central cornea, and iridocorneal touch, however, peripheral cornea was clear. On fundus examination, a large coloboma involving the optic nerve head was noted in the right eye. Left eye anterior segment and fundus was normal. Intraocular pressure in both eyes was 14 mmHg using Perkins tonometer. Electroencephalography suggested right occipital lobe dysfunction. Diagnosis of unilateral Peters' anomaly type I with optic disc coloboma in the right eye with CMV was made. The parents were counseled about the condition, and 6-monthly ophthalmic checkup was advised.