Noor Ophthalmology Research Center, Noor Eye Hospital, Tehran, Iran.
Cornea. 2012 Oct;31(10):1201-5. doi: 10.1097/ICO.0b013e31825697a4.
To report the outcome of Descemet stripping automated endothelial keratoplasty (DSAEK) in 2 patients with Peters anomaly.
Case 1 was a 6-year-old boy who presented with congenital central corneal opacity, cataract, and iridocorneal adhesion in both eyes and keratolenticular touch in the left eye. The second case was an 11-year-old boy with a history of congenital corneal opacity involving the central cornea with iridocorneal adhesion, cataract, and mild microphthalmos in the left eye. Both patients had a more prominent corneal opacity localized posteriorly. DSAEK was performed with lensectomy and posterior chamber intraocular lens implantation in the left eye in both patients (2 months later in a second stage in case 1). During the procedure, stripping of Descemet membrane was performed in the periphery of the opacity with scraping of the posterior part of the opacity.
Descemetorhexis in the periphery of the opacity was found to be more difficult in both cases with the absence of Descemet membrane in the center. Both the patients had reduction in the density of corneal opacity and improved vision postoperatively, which was more obvious in case 2. Except for a peripheral graft detachment that necessitated rebubbling in both cases, the operation was uneventful and the patients retained clear grafts up to 1 year after the operation.
Posterior lamellar keratoplasty (DSAEK) may be a promising option in properly selected cases of Peters anomaly. Further studies are needed to define the role of DSAEK or other types of posterior lamellar keratoplasty in this condition.
报告 2 例 Peters 异常患者行去表皮化自动内皮角膜移植术（DSAEK）的结果。
例 1 为 6 岁男童，双眼表现为先天性中央角膜混浊、白内障和虹膜角膜粘连，左眼伴有角膜晶状体接触。例 2 为 11 岁男童，左眼先天性角膜混浊累及中央角膜，伴有虹膜角膜粘连、白内障和轻度小眼球。两名患者的角膜混浊均更明显地局限于后部。两名患者均行左眼晶状体切除术和后房型人工晶状体植入术（1 例于 2 个月后行二期手术）。在手术过程中，于混浊的周边部行 Descemet 膜撕除术，刮除混浊的后部。
发现混浊周边的撕囊比在中心无 Descemet 膜的情况下更困难。两名患者术后角膜混浊密度均降低，视力均改善，例 2 更为明显。除了 2 例均需要重新注气以修复周边移植物脱离外，手术过程顺利，患者术后 1 年仍保持透明移植物。
在后层角膜移植术（DSAEK）中，适当选择病例可能是一种很有前途的选择。需要进一步的研究来确定 DSAEK 或其他类型的后层角膜移植术在这种情况下的作用。
