Anterior Synechiae After Penetrating Keratoplasty In Infants And Children With Peters’ Anomaly

Purpose: To evaluate anterior synechiae (AS) after penetrating keratoplasty (PK) in patients with Peters’ anomaly using anterior segment optical coherence tomography (OCT). Methods: : A retrospective cross-sectional study was performed. The medical records of patients diagnosed with Peters anomaly who underwent PK between 2013 and 2018 were reviewed. In addition to basic ophthalmic examinations, images of anterior segment structures were obtained via spectral-domain OCT at baseline and during the postoperative follow-up period. The profiles of postoperative AS and multiple potential risk factors were analyzed. Results: : Seventy-one eyes of 58 patients, aged 5 to 23 months, were included. Various extent of postoperative AS were observed in 59 eyes (83.1%). OCT findings revealed graft-host junction synechiae, peripheral anterior synechiae and a combination of both. Disease severity and malapposition of the internal graft-host junction (GHJ) were significantly associated with the formation of postoperative AS. Multivariate regression analysis found that preexisting iridocorneal adhesion (ICA) (odds ratio [OR]=16.639, 95% confidence interval [CI] 1.494-185.294, p =0.022) was positively correlated with postoperative AS, whereas anterior chamber depth (OR=0.009, 95% CI 0.000-0.360, p =0.012), and graft size (OR=0.016, 95% CI 0.000-0.529, p =0.020) were negatively correlated with postoperative AS. In addition, quadrants of preexisting ICA and the width of the host corneal bed were identified as risk factors for increased postoperative AS. Conclusions: : Postoperative AS is a relatively common occurrence in Peters’ anomaly patients following PK and is found to be associated with preexisting ICA, a shallow anterior chamber, small graft size, GHJ malappositions and grafts closer to the corneal limbus. These data indicate the need for careful consideration when performing PK on these patients.