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Peters anomaly occurs as an isolated malformation but also as a feature of other syndromes. It is often unilateral. A wide variety of other ocular findings may occur with Peters anomaly as well. Here we limit our description to ‘simple’ Peters anomaly in which the findings are limited to the eye having the classic findings of adhesions of the iris to the posterior cornea and a central or paracentral corneal leukoma. The lens may also be adherent to the cornea and is often opacified to some degree. Descemet’s membrane and portions of the posterior stroma are usually missing as well. Glaucoma is frequently present. Importantly, there is a wide range in the presentation of clinical features.
Peters anomaly is a frequent feature of numerous syndromes, both ocular and systemic, among them the Peters-plus (261540) syndrome (sometimes called the Kivlin-Krause (261540) syndrome) and has been reported in a case with aniridia (106210).
Isolated Peters anomaly usually occurs in an autosomal recessive pattern but autosomal dominant patterns have been reported as well. The recessive disorder may be caused by a mutation in several genes, notably PAX6, PITX2, CYP1B1, FOXC1, and FOXE3. The latter gene is also mutated in anterior segment mesenchymal dysgenesis (107250) and congenital primary aphakia (610256). The variety of clinical features are likely the result of a disruption in some common pathway or pathways. Mutations in B3GALTL associated with the Peters-Plus syndrome have not been identified in isolated Peters anomaly.
This is a genetically and clinically heterogeneity condition as whole genome sequencing reveals numerous additional gene mutations in patients with both syndromic and isolated Peters anomaly.
Glaucoma is the most serious threat to vision on Peters anomaly but also the most difficult to treat. Less than a third of patients achieve control of intraocular pressure even with the most vigorous combinations of therapy. Corneal opacities can be treated with transplantation but the prognosis is often guarded when glaucoma is present.
From eye bank and other data, it has been estimated that 65% of penetrating keratoplasties in infants for visually significant congenital corneal opacities are performed in patients with Peters anomaly.