Cataract Surgery for Tilted Lens in Peters’ Anomaly Type 2
A 16-year-old female, born with corneal opacity in both eyes, developed cataracts and was diagnosed with Peters’ anomaly type 2. This patient did not exhibit any of the systemic abnormalities commonly associated with Peters’ anomaly. Corneal opacity and conjunctival epithelial flaps had been observed in the left eye since childhood due to the high-grade dysgenesis of the anterior segment, and light perception was absent in the left eye. In the right eye, the corneal opacity had spread from the center of the cornea to the inferotemporal side (fig. ), and a synechia was detected between the corneal epithelium and the iris from the inferonasal to the inferotemporal side. Additionally, preoperative changes were detected in the circle form of the inferotemporal pupillary margin, due to the synechia (fig. ). Severe opacity was also observed in the cornea overlying the inferotemporal synechia between the corneal endothelium and the iris. Fortunately, the lens was still visible, because the central cornea had only mild opacification. A cataract was present in the lens, with severe opacity at the anterior pole. Ultrasound biomicroscopy (UBM) of the anterior segment revealed synechia between the anterior iris and the lens; an anterior deviation and tilting of the lens were also observed (fig. ). The right eye had an axial length of 27.39 mm, with a preoperative visual acuity of 20/250 and a preoperative refractive error of −13.00 – 5.00 × 120. The tilted lens resulted in severe astigmatism and was a cause of the diminished visual function. Severe opacity of the lens was observed at the site of the inferotemporal synechia; therefore, cataract surgery was necessary to remove the lens opacity and improve the astigmatism.\nThe progressive decline in visual acuity caused by the cataract resulted in cataract surgery on the right eye. In order to make synechiolysis from the opposite side, a 2.8-mm clear corneal incision was made on the superonasal side, and viscoelastic materials (Viscoat 0.5, Alcon, Tokyo, Japan) were used to protect the corneal epithelium and maintain the intracameral space. The inferonasal synechia was severed between the cornea and the iris using intraocular scissors. The synechia between the anterior iris and the lens capsule was also severed with intraocular scissors. Phacoemulsification was performed and an intraocular lens (16.5 diopter, KS-Xs, spherical lens, STAAR, Chiba, Japan) was inserted into the capsular bag.\nNeither hemorrhage nor increased intraocular pressure were observed postoperatively. Six months postoperatively, there had not been any positional deviation of the intraocular lens, nor increase in corneal opacity (fig. ); UBM did not reveal any positional deviation of the intraocular lens (fig. ). At this time, the patient's visual acuity had improved to 20/100, with a postoperative refractive error of +0.50 –[N1] 2.00 × 60. The large improvement in astigmatism was due to the absence of any intraocular lens positional deviations.