1. Roxana Ursea, MD Matthew T. Feng, MD Ovette Villavicencio, PhD
Role of Anterior Segment Imaging in Peters Anomaly with Significant Cataract: Diagnosis and Preoperative Planning
Roxana Ursea, MD
Matthew T. Feng, MD
Ovette Villavicencio, PhD
The authors have no financial interest in the subject matter of this poster

2. Purpose
To report a case of successful cataract extraction guided by preoperative anterior segment imaging in a patient with Peters anomaly OD OS
Preoperative slit lamp photos illustrating the off-center leukoma with focal area of corneal thinning & PAS

3. Methods
Case report of a 62 yo monocular Native American male with B/L Peters anomaly type 1, with 3+ NS cataract in his good eye
Due to anterior segment dysgenesis, view of the anterior segment and lens was limited by routine slit lamp exam
Imaging was performed for both diagnosis & preoperative planning using
Ultrasound biomicroscopy (UBM; VuMax, Sonomed, Lake Success, NY)
Anterior segment optical coherence tomography (AS-OCT; Visante, Carl Zeiss Meditec, Dublin, CA)

4. Results
The combination of UBM & AS-OCT allowed a complete evaluation of anterior segment anatomic changes due to Peters:
corneal surface irregularities
significant corneal thinning
peripheral anterior synechiae & corneal thinning masked by a paracentral leukoma
narrow angle
Subsequent preoperative planning was based on these findings
No anatomical surprises or complications were encountered intraoperatively
Postoperative Snellen BCVA was 20/25 & stable at 14 months

5. Preoperative Imaging - OS
UBM
AS-OCT
Narrow Angle
Irregular thickness of the cornea and corresponding adhesions
Iris-endothelial adhesions with a thinned overlying cornea in the inferotemporal quadrant

6. synechiae, corneal irregularities and increased corneal thickening
Results
PREOP
POSTOP 0o 0o
224o
295o
312o
312o
Various AS-OCT scans at different meridians showing extent of the peripheral anterior
synechiae, corneal irregularities and increased corneal thickening

7. Results POSTOP PREOP Increased depth of anterior chamber
Increased corneal thickness

8. Conclusions
Dense central leukomas are common in Peters anomaly and may limit examination of the anterior segment in such patients
Preoperative anterior segment imaging provided invaluable anatomic details in our monocular patient, allowing the safe and successful extraction of his cataract with posterior chamber intraocular lens placement
Both modalities, UBM & AS-OCT, visualized the anatomical changes within the anterior segment pre- & postoperatively

9. References
1. Reese AB, and Ellsworth, RM. The anterior cleavage syndrome. Arch. Ophthalmol. 1966; 75: 307.
2. Waring GO III, Rodrigues MM, Laibson PR. Anterior chamber cleavage syndrome. A stepladder classification. Surv Ophthalmol. 1975; 20: 3-27.
3. Ozeki H, Shirai S, Nozaki M, et al. Ocular and systemic features of Peters' anomaly. Graefes Arch. Clin. Exp. Ophthalmol. 2000;238(10):833-9.
4. De Respinas PA and Wagner RJ. Peters’ anomaly in a father and son. Am. J. Ophthalmol. 1987; 104:
5. Baqueiro A, and Hein PA Jr. Familial congenital leukoma: case report and review of the literature. Am. J. Ophthalmol. 1960; 50: