Optical sector iridectomy: an alternative to perforating keratoplasty in Peters' anomaly

Abstract

The penetrating keratoplasty as an early surgical procedure to present deep irreversible amblyopia in patients suffering from Peters' anomaly has shown an extremely high risk for transplantat failure. From 1980 to 1992 20 sectoriridectomies (6 bilateral, 1 twice because of progressive corneal opacification in the area of sectoriridectomy) were performed in 13 patients with Peters' anomaly (diameter of corneal opacification greater than half of the corneal diameter). The mean age at surgery was 1 year and 9 months, the mean follow-up was 3 years and 6 months. Preoperatively the visual function was uncertain light perception in all eyes with marked horizontal nystagm. Except for two eyes (24 mm Hg) the intraocular pressure (IOP) was normal. In 9 (47%) eyes the visual acuity was 20/500 to 20/200. One eye showed certain light fixation, one eye hand movement. In one eye the visual function remained uncertain light perception "after combined lens aspiration." One eye developed a phthisis after combined anterior vitrectomy and lens aspiration for PHPV. In three eyes, the visual outcome could not be determined certainly, in three eyes, the follow-up failed. In two eyes the IOP was regulated under topical antiglaucomatous eye drops, in the other eyes the IOP was normal. In contrast to penetrating keratoplasty sectoriridectomy seems not to be followed by secondary glaucoma postoperatively. The visual outcome is comparable to that after early keratoplasty. We recommend "optical" sectoriridectomy as an alternative surgical approach to early penetrating keratoplasty in patients suffering from Peters' anomaly.