Anterior Synechiae Common After Penetrating Keratoplasty in Children With Peters Anomaly

TRUJILLO, PERU – APRIL 20: A surgeon works on the eye of Reis-Buckler syndrome patient Diana, aged 17, during surgery onboard the Orbis Flying Eye Hospital on April 20, 2018 in Trujillo, Peru. Reis-Buckler corneal dystrophy is a rare genetic condition which causes the Bowman’s layer of the cornea to disintegrate. Diana’s mother Rosa has the same syndrome and has struggled with sight loss since the age of nine. After suffering with the condition since the age of three, Diana was chosen for a penetrating keratoplasty procedure (cornea transplant) during a programme run by Orbis, the ophthalmic training organisation. Founded in 1982 by ophthalmologist David Paton, Orbis trains eyecare teams across Africa, Asia and Latin America to improve the standard of eyecare in the region. As well as working in local hospitals, the charity also has a self-sufficient surgical unit on the Orbis Flying Eye Hospital, a converted McDonald-Douglas MD10 aircraft. (Photo by Leon Neal/Getty Images)
The finding is especially likely in patients with preexisting iridocorneal adhesion and shallow anterior chambers, according to the report.

Anterior synechiae is a relatively common occurrence in patients with Peters anomaly who undergo penetrating keratoplasty (PK), according to research published in BMC Ophthalmology

Researchers conducted a retrospective cross-sectional study to evaluate anterior synechiae after PK in patients with Peters’ anomaly using anterior segment optical coherence tomography (AS- OCT).

The team reviewed medical records of patients diagnosed with Peters’ anomaly who underwent PK between 2013 and 2018. All patients had ophthalmic examinations, including imaging of anterior segment structures via spectral-domain OCT at baseline and during the postoperative follow-up period. The researchers analyzed the profiles of postoperative anterior synechiae and potential risk factors.

A total of 71 eyes of 58 patients (mean age at the time of surgery of 9.6 months) were included in the study. Bilateral corneal opacity was present in 38 patients, and 13 underwent bilateral grafting. Systemic anomalies, including cardiopulmonary anomaly (n=3) and developmental delay (n=1), were present in 6.9% of patients. Among all eyes that underwent PK, there was mild disease in 8.4%, moderate disease in 81.7%, and severe disease in 9.9%.

The researchers found that postoperative anterior synechiae were present in 83.1% of eyes that underwent PK. The OCT findings revealed graft-host junction synechiae in 50.8% of eyes, peripheral anterior synechiae in 11.9% of eyes, and a combination of both in 37.3% of eyes. 

Using multivariate regression analysis, the team demonstrated that preexisting iridocorneal adhesion (odds ratio [OR], 16.64; 95% CI, 1.49-185.29; P = .022) was positively correlated with postoperative anterior synechiae and anterior chamber depth (OR, 0.01; 95% CI, 0.00-0.36; P =.012) and graft size (OR, 0.02; 95% CI, 0.00-0.53; P =.020) were negatively correlated with postoperative anterior synechiae. They also found that quadrants of preexisting iridocorneal adhesion (OR, 9.61; 95% CI 1.87–49.33; P =.007) and width of the host corneal bed (OR, 0.31; 95% CI, 0.11–0.89; P =.029) were independent risk factors for increased postoperative anterior synechiae.

“The results allow predictions to be made regarding which patients are more likely to form postoperative [anterior synechiae] and may help clinicians to manage this rare yet challenging disease,” according to the researchers. “Still, the association between postoperative [anterior synechiae] and clinical outcomes of PK (graft survival, visual gain) remains to be determined.”

Limitations of the study included the retrospective design, short-term follow-up duration, and lack of measurement of surgical and visual outcomes.


Yang Y, Xiang J, Xu J. Anterior synechiae after penetrating keratoplasty in infants and children with Peters’ anomaly. BMC Ophthalmol. 2022;22(1):259. Published online June 9, 2022. doi:10.1186/s12886-022-02473-0