Roxana Ursea , MD Matthew T. Feng , MD Ovette Villavicencio, PhD

1. 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 ZeissMeditec, 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. 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. SurvOphthalmol. 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: 545-6. 5. Baqueiro A, and Hein PA Jr. Familial congenital leukoma: case report and review of the literature. Am. J. Ophthalmol. 1960; 50: 810-81.