Yang L L, Lambert S R
Department of Ophthalmology, Emory University, Atlanta, Georgia, USA.
Ophthalmol Clin North Am. 2001 Sep;14(3):467-77. doi: 10.1016/s0896-1549(05)70245-5.
Peters' anomaly is not an isolated anterior segment abnormality, but occurs as a diverse, phenotypically heterogeneous condition associated with multiple underlying ocular and systemic defects. Surgical treatment of Peters' anomaly is a complex and challenging undertaking. The broad spectrum of disease severity, the lack of uniformity in clinical features, the differences and overlap of preoperative risk factors, and the variability in the numbers and types of intraocular procedures that are performed on individual eyes, as well as postoperative complications all contribute to the difficulties involved in surgical management. This article discloses useful information pertaining to keratoplasty for Peters' anomaly. The study by Yang et al showed that long-term graft clarity could be achieved in 36% of eyes. However, 93% of all clear grafts were first grafts, whereas only 7% were second grafts. All third or subsequent grafts failed. Other important findings were: (1) the significantly greater chance of maintaining a clear graft with initial grafts, compared with subsequent grafts; (2) the disclosure of periods of differential risk for graft failure; and (3) the identification of risk factors for graft failure. Surgical intervention involving one or more procedures is effective in controlling IOP in 32% of eyes with associated congenital glaucoma. Still, multiple procedures and adjunctive medical therapy are often required to achieve and maintain adequate IOP control. The visual outcome is guarded in children with Peters' anomaly. Achieving a satisfactory visual outcome and preventing further visual loss is impeded by the presence of congenital anterior and posterior segment anomalies, structural defects of the CNS, cognitive dysfunction and amblyopia, as well as postoperative complications such as graft failure, cataract, inoperable retinal detachment, and phthisis.
彼得斯异常并非孤立的眼前节异常，而是一种与多种潜在眼部及全身缺陷相关的、表现多样且表型异质性的病症。彼得斯异常的手术治疗是一项复杂且具有挑战性的工作。疾病严重程度范围广泛、临床特征缺乏一致性、术前危险因素存在差异与重叠、针对单眼进行的眼内手术数量和类型各不相同，以及术后并发症等，所有这些都导致了手术管理的困难。本文披露了与彼得斯异常角膜移植相关的有用信息。杨等人的研究表明，36%的眼睛可实现长期植片透明。然而，所有透明植片中93%是首次植片，仅有7%是二次植片。所有第三次或后续植片均失败。其他重要发现包括：（1）与后续植片相比，初次植片保持透明的可能性显著更高；（2）揭示了植片失败的不同风险期；（3）确定了植片失败的危险因素。对于伴有先天性青光眼的眼睛，涉及一种或多种手术的手术干预在32%的病例中可有效控制眼压。不过，通常需要多次手术及辅助药物治疗才能实现并维持足够的眼压控制。彼得斯异常患儿的视力预后不佳。先天性眼前节和后节异常、中枢神经系统结构缺陷、认知功能障碍和弱视，以及术后并发症如植片失败、白内障、无法手术的视网膜脱离和眼球痨等的存在，阻碍了获得满意的视力预后并防止进一步的视力丧失。
