Cataract surgery after keratolimbal allograft surgery in patients with congenital aniridia

Congenital aniridia: etiology, manifestations and management

Congenital aniridia manifests as total or partial absence of the iris caused most commonly by mutations in PAX6, FOXC1, PITX2, and CYP1B1. Recently two new genes, FOXD3 and TRIM44, have also been implicated in isolated studies. We discuss the genotype-phenotype correlations for the main implicated genes. Classic aniridia is a panocular condition, which includes aniridia, cataract, corneal pannus, foveal, and optic nerve hypoplasia associated with mutations in the PAX6 gene. Classical aniridia is due to PAX6 mutations, while other genes contribute to aniridia-like phenotypes. We review the challenges involved in the management of aniridia, and discuss various surgical interventions. The clinical importance of defining the genotype in cases of congenital aniridia has become acutely apparent with the advent of possible therapies for classical aniridia, which are discussed.

Long-term clinical course and visual outcome associated with Peters' anomaly

PURPOSE

To investigate the long-term clinical course and visual outcomes of Peters' anomaly cases treated with various treatment modalities.

PATIENTS AND METHODS

All patients with Peters' anomaly treated at Seoul National University Children's Hospital from 1985 to 2005 were reviewed retrospectively. Patients who were followed for more than 5 years after the first visit were enrolled for analysis of the visual outcome. Final visual outcomes were presented with respect to disease severity and treatment modalities. Disease severity was determined according to the corneal status and accompanied eye anomalies in mild or severe form. Treatment plans were classified into the following groups: (1) a medical treatment group; (2) a surgical treatment group; and (3) a no-treatment group.

RESULTS

A total of 106 eyes in 76 patients were diagnosed as Peters' anomaly, and 90 eyes in 65 patients were analysed regarding the visual outcome. Overall, 60 eyes (67%) had severe disease, and 30 eyes (33%) had mild disease. Twenty-six eyes (29%) received medical treatment, 44 eyes (49%) received surgical treatment, and 20 eyes (22%) received no treatment. The mean final visual acuity was 1.415 logMAR, 2.344 logMAR, and 2.282 logMAR, respectively. The visual outcomes of the eyes with mild disease in each group were significantly better than the eyes with severe disease.

CONCLUSIONS

The long-term visual outcomes of Peters' anomaly differed according to the disease severity in each treatment group. Therefore, before making treatment plans for Peters' anomaly, it is important to investigate the corneal status and accompanying eye disease to determine disease severity.