Utilization rate of corneal tissue obtained from donors over 75 years of age in Western India for keratoplasty

Purpose: To examine the utilization patterns of cornea procured from diseased individuals ?75 years of age at an eye bank in western India. Methods: In this retrospective study, data from 1,217 eyes of 653 donors with age ?75 years were reviewed from October 2008 to December 2019. Donor age, lens status, endothelial cell count (ECD), utilization of the tissue for transplantation or non?clinical purposes (e.g., research, training/discarded), and causes of non?utilization were noted. Results: The mean age of the donors was 80.9 ± 4.6 years and the tissue utilization rate was 36.5% (445 out of 1,217 eyes). The eyes used for keratoplasty procedures had a lower donor age (79.6 ± 5.7 vs. 81.5 ± 5.1; P < 0.001), a higher endothelial cell count (2493 ± 531 vs. 2034 ± 581; P < 0.001), and were more often phakic (61% vs. 36.6%) compared to the unused group. A multivariable logistic regression analysis showed that the likelihood of tissue utilization for keratoplasty was 13% higher with every 100?cell increment in donor ECD (odds ratio [OR] = 1.13, 95% CI = 1.10–1.16, P < 0.001) and 33% lower with having a pseudophakic status in the donor eye (OR = 0.67, 95% CI = 0.52–0.87, P = 0.03). Age was not a significant determinant of tissue utilization when used in the same multivariable model. Conclusion: More than one?third of the eyes (36.5%) can be utilized even when the donors are above 75 years of age. Eyes that were more likely to be utilized for keratoplasty were phakic and had a significantly higher ECD; age was not a determinant in tissue utilization

Efficacy and safety of modified four-point fixed IOL suspension implantation in aphakic eyes / 国际眼科杂志(Guoji Yanke Zazhi)

AIM: To observe the efficacy and safety of modified four-point fixed intraocular lens suspension implantation in aphakic eyes.METHODS:A prospective study. A total of 32 aphakic patients(32 eyes)with an average age of(44.56±8.48)years who underwent modified four-point fixed intraocular lens suspension implantation in our hospital from October 2020 to May 2021 were selected. Uncorrected visual acuity(UCVA), best corrected visual acuity(BCVA), corneal astigmatism, intraoperative and postoperative complications were observed before and after operation.RESULTS:The mean follow-up of all patients was(4.84±0.64)mo. The preoperative UCVA(LogMAR)was 1.25±0.42 and the last follow-up was 0.5±0.25(P&#x003C;0.001). The preoperative BCVA(LogMAR)was 0.41±0.19 and the last follow-up was 0.42±0.19,(P &#x003E;0.05). The preoperative corneal astigmatism was(1.17±0.64)D and the last follow-up was(1.20±0.59)D(P&#x003E;0.05). There were no intraoperative complications, but 2 eyes had low intraocular pressure, 1 eye had high intraocular pressure and 2 eyes had corneal edema occurred after operation. There were no complications of hyphema, vitreous hemorrhage, macular cystoid edema, corneal endothelial decompensation, inclination or eccentricity of intraocular lens and exposure of suture.CONCLUSION:The modified four-point fixed intraocular lens suspension implantation can significantly improve the postoperative visual acuity of aphakic patients without additional corneal astigmatism,and with fewer complications.

Vitrectomía pars plana asociada a banda de silicona comparada con vitrectomía pars plana para desprendimiento de retina pseudofáquico y afáquico / Pars plana vitrectomy plus scleral buckle versus pars plana vitrec-tomy in pseudophakic retinal detachment

INTRODUCCIÓN: La cirugía de cataratas es un factor de riesgo para el desprendimiento de retina regmatógeno. Dentro de las técnicas utilizadas para su reparación, se encuentran la vitrectomía pars plana y la banda de silicona. La combinación de ambas técnicas ha sido propuesta en pacientes con desprendimiento de retina previamente operados de cataratas (pseudofáquicos o afáquicos), pero su efectividad no está clara. MÉTODOS: Realizamos una búsqueda en Epistemonikos, la mayor base de datos de revisiones sistemáticas en salud, la cual es mantenida mediante el cribado de múltiples fuentes de información, incluyendo MEDLINE, EMBASE, Cochrane, entre otras. Extrajimos los datos desde las revisiones identificadas, analizamos los datos de los estudios primarios, realizamos un metanálisis y preparamos una tabla de resumen de los resultados utilizando el método GRADE. RESULTADOS Y CONCLUSIONES: Identificamos cuatro revisiones sistemáticas que en conjunto incluyeron ocho estudios primarios, de los cuales, uno corresponde a un ensayo aleatorizado. A partir de éste, concluimos que la combinación de vitrectomía pars plana y banda de silicona podría resultar en poca o nula diferencia en la reaplicación retinal primaria, en la reaplicación retinal final y en la agudeza visual, pero la certeza de la evidencia es baja. Respecto a las complicaciones, no es posible establecer con claridad si la combinación de ambas técnicas aumenta la frecuencia de vitreorretinopatía proliferativa o si disminuye el desarrollo de glaucoma, debido a que la certeza de la evidencia fue evaluada como muy baja.

INTRODUCTION: Cataract surgery increases the risk for rhegmatogenous retinal detachment. Pars plana vitrectomy and scleral buckling are two surgical procedures used for its repair. The combination of both techniques had been proposed for rhegmatogenous retinal detachment in patients with previous cataract surgery (pseudophakic or aphakic), but its effectiveness remains unclear. METHODS: We searched in Epistemonikos, the largest database of systematic reviews in health, which is maintained by screening multiple information sources, including MEDLINE, EMBASE, Cochrane, among others. We extracted data from the systematic reviews, reanalyzed data of primary studies, conducted a meta-analysis and generated a summary of findings table using the GRADE approach. RESULTS AND CONCLUSIONS: We identified four systematic reviews with eight studies overall, one of them was a randomized trial. With this data, we conclud-ed that pars plana vitrectomy plus scleral buckle may make little or no difference in primary or final retinal reattachment rate nor in final visual acuity, but the certainty of the evidence is low. In terms of surgery complications, we are uncertain if vitrecto-my plus scleral buckle increases the risk of proliferative vitreoretinopathy or reduces the risk of glaucoma because the certainty of the evidence is very low.

Scleral Fixation of Intraocular Lens and Retropupillary Fixation of Iris Claw Lens for Aphakic Eyes

PURPOSE: To compare the efficacy and complications of scleral fixation of posterior chamber intraocular lens (IOL) and retropupillary fixation of iris claw IOL for dislocated IOL or aphakia without sufficient capsular support. METHODS: This retrospective study was comprised of 17 eyes of 16 patients undergoing scleral fixation and 14 eyes of 13 patients undergoing retropupillary fixation from August 2013 to June 2018. Uncorrected visual acuity (UCVA), best corrected visual acuity (BCVA), intraocular pressure (IOP), slit lamp examination, corneal topography, refractive indices, corneal curvatures, corneal endothelial cell density, and complications of both groups were examined preoperatively and 1 day, 1 week, 1 month, 2 months, and 6 months postoperatively. RESULTS: Six months after the operation, UCVA and BCVA improved in both groups; however, there were no significant differences between the two groups (UCVA, p = 0.162; BCVA, p = 0.418). IOP was temporarily higher in the scleral fixation group at one day postoperatively (p = 0.023). The mean absolute prediction error was smaller in the retropupillary iris fixation group at 6 months postoperatively (p = 0.034). Postoperative total astigmatism, corneal astigmatism, and corneal endothelial cell density were not significantly different between the two groups. CONCLUSIONS: The retropupillary iris fixation group did not show significant improvement in visual acuity compared with the scleral fixation group. However, the retropupillary iris fixation group provided better mean absolute prediction error and a low risk of postoperative increase in IOP compared with the scleral fixation group. Retropupillary fixation of iris claw IOL is a promising option for scleral fixation of posterior chamber IOL for dislocated IOL or aphakia without sufficient capsular support.

Clinical observation of ciliary sulcus fixation of posterior chamber intraocular lens in aphakic eyes / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To explore the clinical efficacy of ciliary sulcus fixation of posterior chamber intraocular lens(IOL)in aphakic eyes with inadequate capsule support. <p>METHODS: A retrospective review of medical records of 38 eyes of 38 patients who were underwent ciliary sulcus fixation of posterior chamber IOL from 2015 to 2018 were analyzed for the intraoperative and postoperative complications, intraocular pressure and position of intraocular lens. Also, the preoperative and postoperative visual acuity and refractive status were compared respectively. The follow-up time was 3mo after surgery. <p>RESULTS:The intraoperative hyphema occurred in 6 eyes(16%)postoperative hypotony in 4 eyes(11%)transient high intraocular pressure in 11 eyes(29%), yet all were cured by treatment. Four eyes(11%)with obvious tilt of intraocular lens were observed. All the cases were an visual improvement according to the last postoperative follow-up(<i>P</i><0.05). No obvious difference between target refraction(spherical lens)and actual refraction(spherical lens)at postoperative 3mo was discovered(<i>P</i>>0.05).<p>CONCLUSION: The ciliary sulcus fixation of posterior chamber IOL is a safe and effective way to treat the aphakic eyes, but the possible complications should be attentional.

Iris-claw intraocular lens implantation after pupil re construction for aphakic eyes caused by ocular trauma / 眼科新进展

Objective To observe the effect of implantation of iris-claw intraocu lax lens combined with pupil reconstruction on aphakic eyes caused by ocular trauma.Methods The clinical data of 17 patients (17 eyes) of aphakic eyes treated with irisclaw intraocular lens implantation and pupil reconstruction were analyzed retrospectively,and the visual acuity,corneal endothelial cell count,intraocular pressure,intraocular lens location,pupil condition and postoperative complications were observed.Results Intraocular lens were implanted and pupils were repaired in all 17 patients (17 eyes) successfully,with no complications of intraocular lens dislocation and corneal decom pensation.The postoperative uncorrected visual acuity (0.52 + 0.17) was better than the preoperative visual acuity (0.04 + 0.02) and preoperative best corrected visual acui ty (0.44 +0.13).The corneal endothelial cell count was (1993.88 + 127.24) mm-2 6 months after operation,which was lower than that of preoperative date (2178.88 + 132.61)mm-2 (P ＜ 0.05).Preoperative intraocular pressure (15.91 + 2.73) mmHg (1 kPa =7.5 mmHg) was not significantly different from postoperative intraocular pressure (16.69 + 2.61) mmHg (1 kPa =7.5 mmHg) (P ＞ 0.05).The postoperative pupil size [(4.4 + 0.2) mm] was smaller than that of preoperative date [(5.5 + 0.3) mm] (P ＜ 0.05).The symptoms of photophobia,glare and diplopia did not occur postoperatively.Conelusion Pupil reconstruction combined with iris-claw intraocular lens implanta tion is a safe and effective method for aphalic eyes combined with absence of capsule support and ruptured iris.

Iris-claw intraocular lens implantation after pupil re construction for aphakic eyes caused by ocular trauma / 眼科新进展

Objective To observe the effect of implantation of iris-claw intraocu lax lens combined with pupil reconstruction on aphakic eyes caused by ocular trauma.Methods The clinical data of 17 patients (17 eyes) of aphakic eyes treated with irisclaw intraocular lens implantation and pupil reconstruction were analyzed retrospectively,and the visual acuity,corneal endothelial cell count,intraocular pressure,intraocular lens location,pupil condition and postoperative complications were observed.Results Intraocular lens were implanted and pupils were repaired in all 17 patients (17 eyes) successfully,with no complications of intraocular lens dislocation and corneal decom pensation.The postoperative uncorrected visual acuity (0.52 + 0.17) was better than the preoperative visual acuity (0.04 + 0.02) and preoperative best corrected visual acui ty (0.44 +0.13).The corneal endothelial cell count was (1993.88 + 127.24) mm-2 6 months after operation,which was lower than that of preoperative date (2178.88 + 132.61)mm-2 (P ＜ 0.05).Preoperative intraocular pressure (15.91 + 2.73) mmHg (1 kPa =7.5 mmHg) was not significantly different from postoperative intraocular pressure (16.69 + 2.61) mmHg (1 kPa =7.5 mmHg) (P ＞ 0.05).The postoperative pupil size [(4.4 + 0.2) mm] was smaller than that of preoperative date [(5.5 + 0.3) mm] (P ＜ 0.05).The symptoms of photophobia,glare and diplopia did not occur postoperatively.Conelusion Pupil reconstruction combined with iris-claw intraocular lens implanta tion is a safe and effective method for aphalic eyes combined with absence of capsule support and ruptured iris.

Effectiveness and safety of endothelial keratoplasty for pseudophakic and aphakic bullous keratopathy: a systematic review of randomized controlled trials and cohort studies / Eficácia da ceratoplastia endotelial no tratamento da ceratopatia bolhosa pseudofácica e afácica: revisão sistemática de ensaios clínicos randomizados e estudos coortes

ABSTRACT Objective: For nearly a century, penetrating keratoplasty has been the surgical technique of choice in the management of corneal changes. However, in recent years, several lamellar keratoplasty techniques have been developed, modified or improved, especially techniques for replacing the posterior portion, for the correction of bullous keratopathy. The aim of this study was to evaluate the effectiveness and safety of endothelial keratoplasty versus penetrating keratoplasty for pseudophakic and aphakic bullous keratopathy. Methods: A systematic review of the literature was carried out, and the main electronic databases were searched. The date of the most recent search was from the inception of the electronic databases to December 11, 2015. Two authors independently selected relevant clinical trials, assessed their methodological quality and extracted data. Results: The electronic search yielded a total of 893 published papers from the electronic databases. Forty-four full-text articles were retrieved for further consideration. Of these 44 full-text articles, 33 were excluded because they were all case series studies; therefore, ten studies (with one further publication) met the inclusion criteria: one randomized clinical trial with two publications; three controlled studies; and six cohort studies. The clinical and methodological diversity found in the included studies meant that it was not possible to combine studies in a metaanalysis. Conclusions: There is no robust evidence that endothelial keratoplasty is more effective and safe than penetrating keratoplasty for improving visual acuity and decreasing corneal rejection for pseudophakic and aphakic bullous keratopathy. There is a need for further randomized controlled trials.

RESUMO Objetivo: Durante quase um século, a ceratoplastia penetrante tem sido a técnica cirúrgica de escolha no tratamento de doenças corneais. No entanto, nos últimos anos, têm sido desenvolvidas várias técnicas de transplante lamelar, especialmente modificadas ou aperfeiçoadas para substituir a porção posterior para a correção da ceratopatia bolhosa. O objetivo deste estudo foi avaliar a eficácia e segurança da ceratoplastia endotelial quando comparada a ceratoplastia penetrante para a ceratopatia bolhosa afácica ou pseudofácica. Métodos: Uma revisão sistemática da literatura foi realizada, e as principais bases de dados eletrônicas foram pesquisadas. A data das bases de dados da última pesquisa foi 11 de dezembro de 2015. Dois autores selecionaram independentemente os estudos relevantes, avaliaram sua qualidade metodológica e extraíram os dados. Resultados: A busca eletrônica resultou em um total de 893 artigos publicados a partir das bases de dados eletrônicas. Quarenta e quatro artigos de texto completos foram recuperados para uma análise mais aprofundada. Destes 44 artigos de texto completos, 33 foram excluídos por serem estudos de séries de casos, portanto, dez estudos (com uma publicação adicional) preencheram os critérios de inclusão: um ensaio clínico randomizado, três estudos controlados e seis estudos de corte. A diversidade clínica e metodológica encontrada nos estudos incluídos tornou impossível combinar os resultados em uma metaanálise. Conclusões: Não há evidencias robustas de que a ceratoplastia endotelial é mais eficaz e segura do que o transplante penetrante de córnea para melhorar a acuidade visual e diminuir a rejeição da córnea na ceratopatia bolhosa afácica ou pseudofácica. Há necessidade de mais estudos controlados, randomizados.

Analysis of application of rigid gas permeable lens in aphakic patients / 国际眼科杂志(Guoji Yanke Zazhi)

?AIM:To compare the corrected vision and improvement of visual quality after wearing rigid gas permeable corneal lens ( RGPCL) or spectacles in aphakic patients.?METHODS: We selected 29 aphakic patients ( 29 eyes ) caused by different reasons wearing RGPCL and spectacle.The corrected vision, eye condition and visual quality were observed and all patients were followed up for 6mo.? RESULTS: RGPCL was better than spectacle on corrected vision (P<0.05).The patients who wore RGPCL for long had no corneal complications reported. The patients who wore RGPCL had better subjective visual quality than those wore spectacle.?CONCLUSION: RGPCL is a good choice for correcting high myopia and astigmatism for aphakic patients.The patients'compliance is good. Wearing RGPL long has high safety for patients'ocular surface.

Combined scleral buckle and vitrectomy as a primary surgery for pseudophakic and aphakic retinal detachments / 国际眼科杂志(Guoji Yanke Zazhi)

·AIM: To determine whether a combined scleral buckle and pars plana vitrectomy, as a primary surgery, owns any advantage over a single scleral buckling in pseudophakic and aphakic retinal detachments.·METHODS: Thirty consecutive pseudophakic/aphakic retinal deachments were included in this retrospective study. Each patient underwent combined scleral buckle and pars plana vitrectomy, and was followed up for 3 to 14 months. Patients were examined with respect to anatomic reattachment, visual acuity improvement, and surgical complications.·RESULTS: All eyes were anatomically reattached after the first operation. All patients had an increase in their visual acuity, and there were no complications attributable to the vitrectomy procedure.·CONCLUSION: A combined surgery for primary pseudophakic/aphakic retinal detachments offers significant benefits to scleral buckling alone. The improved uccess rate is contributing to the function of vitrectomy, which improves peripheral visibility and reduces the occurrence of proliferative vitreoretinopathy (PVR).

Tratamiento del edema macular quístico afáquico con el empleo de la ultra-alta frecuencia / Treatment of aphakic cystic macular edema by using ultra-high frequency

Se realizó un estudio prospectivo, descriptivo en 50 pacientes operados de catarata que acudieron a la consulta de oftalmología (especialidad de retina), en el período comprendido entre septiembre de 2002 hasta junio de 2004 en el Hospital Militar Central "Dr. Carlos J. Finlay", los cuales, en el posoperatorio presentaron una disminución de la agudeza visual por edema macular quístico. Se les aplicó tratamiento con ultra-alta frecuencia a 20 watt, en un período de 10 a 20 sesiones. Al finalizar el tratamiento, el 94 % de los pacientes mejoró la agudeza visual, lo que demostró la utilidad del método empleado en esta patología.

A prospective descriptive study was conducted in 50 patients operated on of cataract that visited the ophthalmological office (retina specialty) from September 2002 to June 2004 at "Dr Carlos J. Finlay" Central Military Hospital. These patients presented in the postoperataive a reduction of the visual acuity due to cystic macular edema. They received between 10 and 20 sessions of ultra-high frequency of 20 watts. At the end of the treatment, 94 % of the patients improved the visual acuity, which showed the usefulness of the method applied to this pathology.

Clinical Characteristics and Surgical Outcomes of Pseudophakic and Aphakic Retinal Detachments

We retrospectively evaluated the clinical characteristics and surgical outcomes of 20 pseudophakic retinal detachment (RD) patients (20 eyes) and 17 aphakic RD patients (17 eyes). Males were predominated in both groups. The time interval between cataract extraction and RD was 31 months on average in the pseudophakic group, 32 months with intact posterior capsule and 27 months with ruptured posterior capsule, and 148 months in the aphakic group. In 50% of cases with ruptured posterior capsule in the pseudophakic group, RD occurred within 1 year. The anatomic success rate was 95% in the pseudophakic group and 88% in the aphakic group. The most common cause of failure was the development of proliferative vitreoretinopathy. Visual acuities more than 20/40 after RD surgery were found in 13 pseudophakic (65%) and 6 aphakic (36%) eyes. Aphakic patients were more inclined to have silent RD than pseudophakic patients because of their poor visual acuity. Post-operative follow-up is required especially for the first 1 year in cases of damaged posterior capsule due to the high incidence of RD during this period.

Secondary Intraocular Lens Implantation in Pediatric Aphakia

A retrospective study was done on secondary intraocular lens implantation in 19 children(22 eyes)who were not satisfied with aphakic glasses and were not tolerant with contact lenses.In all cases,postoperative visual acuity improved or remained at the preoperative level.In 10 cases,postoperative visual acuity was better than 20/40. After at least 12 months of follow-up,average difference of refractive power between the two eyes in the same patient is 0.79 diopter. Early postoperative complications related to secondary intraocular lens implantation were vitreous hemorrhage(1 eye)and IOL decentration. Vitreous hemorrhage was resorbed in three weeks.In case of IOL decentration,we repositioned the IOL.Late complcations during the follow-up period included development of dense capsular opacification in four eyes.They are all treated by Nd:YAG capsulotomy. After capsulotomy there were some improvement in visual acuity. From these results,secondary intraocular lens implantation appears to be a safe, effective method for correction of aphakic children who are not satisfied with aphakic glasses and/or intolerant of use of contact lenses.

Pseudophakic/Aphakic Retinal Detachment Surgery Using Scleral Depression Technique

In aphakic/pseudophakic retinal detachments, difficulty in visualizing the peripheral retina and perhaps higher incidence of proliferative vitreoretinopathy result in lower success rate than phakic retinal detachment. We performed pars plana vitrectomy on 20 eyes with aphakic/pseudophakic retinal detachment. In most cases, we combined scleral bucking or encircling procedure. Using scleral depression technique, we found retinal breaks, dissected the vitreous base meticulously, and removed the vitreoretinal tractions. Intraoperatively, we were able to find retinal breaks in 12 eyes in which retinal breaks were not identified preoperatively, and identify additional retinal breaks in 3 of the remaining 8 eyes. We obtained anatomical success in all eyes and favorable visual acuity of better than 0.025 in 16 eyes (80%). These results suggest that finding all retinal breaks and removing vitreoretinal tractions are directly related to the improvernent of the surgical results.

Clinical Evaluation of the Glaucoma after Penetrating Keratoplasty

We retrospectively evaulated the frequency and risk factors of glaucoma after penetrating keratoplasty by reviewing charts of 96 patients(112eyes) who received the penetrating keratoplasty from May 1992 to Novermber 1995 at Chonnam Universty Hospital. Intraocular pressure was increased over 21mmHg in 18 eyes after surgery. Underlying disease of them were graft failure (5 eyes), bullous keratoplasty(5 eyes), corneal ulcer(5 eyes), trauma(3 eyes). Ten eyes(55.5%) were glaucomatous preoperatively. Eight eyes(44.4%) were phakic, 7 eyes(38.9%) aphakic, and 3 eyes(16.7%) pseudophakic. Ten eyes(55.5%) underwent only penetrating keratoplasty, 4 eyes(22.2%) vitrectomy at the time of penetrating keratoplasty, and 4 eyes(22.2%) combined cataract extraction. The eyes with previous history of glaucoma(19 eyes) had higher incidence of increased intraouclar pressure than those 93 eyes with no glaucoma history(P<0.0001). Aphakic eyes(21 eyes) had higher incidence of glaucoma than phakic eyes(80 eyes)(p<0.05).

Results of Penetrating Keratoplasty with Scleral-Fixated Posterior Chamber Lens for Aphakic Bullous Keratopathy

Penetrating keratoplasty with or without intraocular lens implantation is necessary to restore a vision of an eye with aphakic bullous keratopathy. We analyzed surgical outcomes in eleven aphakic bullous keratopathy patients(11, eyes) who received penetrat-ing keratoplasty with scleral-fixated posterior chamber lens(PCL)at Kangnam St.Mary's hospital from January, 1989 to December 1991 and followed up more than 1 year Eight of eleven eyes showed the postoperative corrected VlSlOn of 0.3 to 0.8 at postoperative one year. The cuases of poor vision below 0.3 were age-related macular degeneration(1 eye), graft failure(I eye) and diabetic retinopathy(1 eye). At one year after surgery, mean spherical equivalent was-1.12, mean astigmatism was 4.21D and percent loss of corneal endothelium was 35.5%. Graft rejection(3 eyes) and secondary glaucoma(1 eye) were occured during the postoplasty with scleral-fixated PCL can be an excellent surgical technique to get visual rehabilitaion of patients with an aphakic bullous keratopathy.

Filtering Surgery in Aphakia and Pseudophakia

Aphakic or pseudophakic glau-oma is known to be at high risk for failure after filtration surgery. The authors retrospectively investigated the results of trabeculectomy in 14 eyes of 14 patients with glaucoma, seven aphakic and seven pseudophakic eyes, which were followed from six months to three years with an average ot 16.5 months. A conventional trabeculectomy without using antifibrotic agents was performed in all the eyes. The site of conjunctival incision was prepared on the virgin area of the conjunctiva; 8 superonasal, 4 inferonasal and 2 inferotemporal approaches. An average postoperative intraocular pressure reduction was 13.4 mmHg. The number of medications decreased in 11 eyes. A spontaneously developed functioning bleb was found in seven eyes. In other four eyes, the filtering bleb was formed with an aid of massage or needling. The remallllllg three eyes did not show a functioning bleb. Postoperative complications included hyphema in 3 eyes, overfiltration in 2 eyes, choroidal detachment in 1 eye, corneal edema in 1 eye and endophthalmitis in 1 eye.

Clinical Evaluations of Penetrating Keratoplasty in Aphakic Bullous Keratopathy

We analysed a retrospective study of 22 aphakic bullous keratopathy patients (22 eyes) with penetrating keratoplasty for 5 years from January 1987 to December 1991 in the Department of Ophthalmology at St. Mary's Hospital, Catholic University Medical College. The results were as follows; 1. Of the 22 eyes with aphakic bullous keratopathy 16 eyes (72.7%) had previously undergone intracapsular cataract extraction, 6 eyes (27.3%) had extracapsular cataract extraction. 2. The mean time from cataract extraction to aphakic bullous keratopathy to penetrating keratoplasty was 13.8 months. 3. After keratoplasty, the visual acuity of 20 among the 22 transplants (90.9%) were significantly improved compared to the preoperative levels, however that of 2 among the 22 transplants were worse than the preoperative levels. The factors limiting postoperative visual acuity were senile macular degeneration and graft failure. 4. Postoperative complications were glaucoma (2 eyes, 9.1%), cystoid macular edema (1 eye, 4.6%) and graft failure (1 eye, 4.6%).

Clinical Evaluations of Penetrating Keratoplasty in Aphakic Bullous Keratopathy

We analysed a retrospective study of 22 aphakic bullous keratopathy patients (22 eyes) with penetrating keratoplasty for 5 years from January 1987 to December 1991 in the Department of Ophthalmology at St. Mary's Hospital, Catholic University Medical College. The results were as follows; 1. Of the 22 eyes with aphakic bullous keratopathy 16 eyes (72.7%) had previously undergone intracapsular cataract extraction, 6 eyes (27.3%) had extracapsular cataract extraction. 2. The mean time from cataract extraction to aphakic bullous keratopathy to penetrating keratoplasty was 13.8 months. 3. After keratoplasty, the visual acuity of 20 among the 22 transplants (90.9%) were significantly improved compared to the preoperative levels, however that of 2 among the 22 transplants were worse than the preoperative levels. The factors limiting postoperative visual acuity were senile macular degeneration and graft failure. 4. Postoperative complications were glaucoma (2 eyes, 9.1%), cystoid macular edema (1 eye, 4.6%) and graft failure (1 eye, 4.6%).

Migration of Photoreceptor Cells Into the Subretinal Space in Rabbit Retina

The migration of photoreceptors into the subretinal space has been reported to occur in developing and aged rat retina, in aged human retina, in detached owl monkey, and in detached cat retina. Subretinal photoreceptor cells have been observed in aphakic-vitrectomized rabbit eyes with or without intravitreal saline or antibiotic injection. Variety of photoreceptor cell nuclei can be distinguished. The nuclei of photoreceptor cells change their shape so as to pass easily through the juncition and thereafter they returned to their original shape in sub retinal space. The mechanisms and biological significance of this phenomenon are not yet certain, but it may by one of the important factors contributing to decreased vision with aging.