Basdekidou Chrysanthi ASCRS 25-29/3/2011 SAN DIEGO- CALIFORNIA PENETRATING KERATOPLASTY FOR UNILATERAL CORNEAL OPACITIES IN PETERS' ANOMALY: A CASE SERIES  Je voudrais remercier le prof Dufier et son equipe pour l interet qu ils ont montre a mon travail Je suis interne a la FOR en travaillant dans le service d ophtalmopediatrie on s est confronte a des cas d'opacite corneennes bilaterales. Je me suis rendu compte que la prise en charge est tres lourde et donc je me suis posee la question que faut il faire face une opacite unilaterale? donc faut il greffer ou pas? Chrysanthi BASDEKIDOU, Pascal DUREAU The authors have no financial interest in the subject matter of this e-poster 12/3/2018 Basdekidou Chrysanthi

PETERS' ANOMALY (PETERS A. 1906) 40,3% of congenital corneal opacities (Rezende R, Cornea 2004) 80% bilateral, 50-70% associated glacoma (Ciralsky J, Sem Ophthalmol 2007) Type 1 : central corneal opacity, all corneal layers, IC synechiae Type 2 : lens implication qui se caracterise par 12/3/2018 Basdekidou Chrysanthi

Basdekidou Chrysanthi METHODS AND RESULTS 12/3/2018 Basdekidou Chrysanthi

POSTOPERATORY TREATMENT SURGICAL TECHNIQUE POSTOPERATORY TREATMENT Flieringa ring single use trephine donnor and receipient: 0,5 mm graft difference 16 seperated knots (2 cases: additional running suture) Corticoïdes (oral and local) and ciclosporine 2% local Suture ablation: 1st and 2nd post operative months under GA Amblyopia treatment: occlusion – regular optometry control 12/3/2018 Basdekidou Chrysanthi

Basdekidou Chrysanthi COMPLICATIONS 12/3/2018 Basdekidou Chrysanthi

Basdekidou Chrysanthi 12/3/2018 Basdekidou Chrysanthi

Basdekidou Chrysanthi 12/3/2018 Basdekidou Chrysanthi

Basdekidou Chrysanthi 12/3/2018 Basdekidou Chrysanthi

DISCUSSION Ciclosporine Only one prospective study→ Ciclosporine 2% in pediatric ophthalmology: sure and efficient (Cosar CB, Eye & Contact lens 2003) Enfants: immature immunitary system- high risk KT! No established protocole-when shall we stop the treatment? Oral use of CsA for 12 months for high risk KT (Hill JC, Ophthalmology 1994) 12/3/2018 Basdekidou Chrysanthi

REJECTION RISK FACTORS Yang LHH, Ophthalmology 1999 Severeness of the disease stromal vessels, total limbal opacification, anterior synechiae in several quadrants Glaucoma CNS pathology Grafts greater than 8 mm in diameter: independant factor Ulterior grafts: inferior survival probability (Yang LLH Ophthalmology 2004) Association between combined surgeries and rejection (Cowden Ophthalmology 1990) il y ades facteurs de risque predisposant a un rejet que l on peut rechercher en pre operatoire 12/3/2018 Basdekidou Chrysanthi

LITTERATURE: ENCOURAGING RESULTS Author Year Number of eyes with Peters Number of unilateral cases Graft survival probability Graft transparency Mean follow-up Parmley 1993 16 * 30 mois Gollamudi 1994 22 6 ans Althaus 1996 8 2 50% 3,8 ans Yang 1999 72 11 44%-3 ans 11 ans Zaidman 2007 32 90% 78,9 mois Rao 2008 22%-2 ans 43% 11,4 mois Our study 2011 14 78,6% dans la litterature on trouve des etudes mixtes sur des cas uni et bilateraux. aucune etude purement pour les cas unilateraux les resultats sont encourageants en ce qui concerne la transparence du greffon et la probabilite de survie du greffon et estimee a 44% a 3 ans 12/3/2018 Basdekidou Chrysanthi

Basdekidou Chrysanthi CONCLUSIONS KT aims at giving the pathologic eye a useful vision Surgeon: Evaluation of anomaly's severity and Family Context: cooperative parents Final decesion: the family, a life time commitment Long term aggressive amblyopia treatment Multidisciplinary follow-up chaque cas est different 12/3/2018 Basdekidou Chrysanthi