Severe corneal burn due to the accidental application of salicylic acid packed in a plastic dropper bottle / Quemadura corneal grave debida a la aplicación accidental de ácido salicílico envasado en un frasco gotero plástico

Eye burns due to the accidental application of pharmacological or nonpharmacological substances packaged in plastic dropper bottles have been described for more than three decades and continue to occur. These burns can cause potentially serious corneal injuries. We report the case of a patient who mistakenly applied salicylic acid to the right eye after confusing it with an eye lubricant, which caused him a severe corneal burn. Fortunately, after aggressive medical and surgical management (including oxygen therapy and amniotic membrane grafting), the visual results were good. We suggest conducting educational campaigns and taking legislative measures in our country to avoid packaging corrosive substances in this type of dropper bottle to reduce the risk of accidental burns.

Las quemaduras oculares por aplicación accidental de sustancias farmacológicas o no farmacológicas envasadas en frascos goteros plásticos, se han descrito desde hace más de tres décadas y siguen ocurriendo. Estas quemaduras pueden causar lesiones potencialmente graves de la córnea. Se presenta el caso de un paciente que se aplicó ácido salicílico en el ojo derecho al confundir el envase con el de un lubricante ocular, lo que le causó una grave quemadura corneal. Afortunadamente, tras un manejo médico y quirúrgico agresivo (incluida oxigenoterapia e injerto de membrana amniótica) los resultados visuales fueron buenos. Se sugiere hacer campañas educativas y adoptar normas en el país para evitar el envase de sustancias corrosivas en este tipo de frascos goteros, con el fin de disminuir el riesgo de quemaduras accidentales.

Evaluation of the accuracy of sub bowman's keratomileusis [SBK] microkeratome in flap creation during lasik surgery

Purpose: To evaluate the accuracy of SBK microkeratome in flap creation during myopic LASIK surgery using anterior segment optical coherence tomography [AS-OCT]

Design: A Prospective non-randomized noncomparative interventional clinical study

Methods: Flaps were created using the One Use-Plus SBK microkeratome [intended flap 90 micro m] in 40 eyes of 20 patients. Flap thickness was measured using AS-OCT one month after surgery

Results: The mean achieved central corneal flap thickness in both eyes was 88.67 +/- 7.19, 1.33 micro m thinner than the intended 90 micro m thickness [difference from intended thickness -1.33 +/- 7.19] with a p value of 0.067 which is statistically insignificant [p>0.05]. The mean achieved central corneal thickness in the right eye was 88.56 +/- 7.95 micro m [ranging from 70 micro m to 112micro m], 1.44 micro m thinner than the intended 90 micro m [difference from intended thickness -1.44 +/- 7.95] thickness with a p value of 0.206 which is statistically insignificant [ p>0.05]. The mean achieved central corneal flap thickness in the left eye was 88.78 +/- 6.41 micro m [ranging from 77micro m to 105 micro m] showing a difference from intended thickness of -1.22 +/- 6.41 micro m deviation from the intended thickness that is statistically insignificant [p value of 0.185, p>0.05]

Conclusion: Using the one use -plus SBK microkeratome is a safe, accurate and effective modality for creating a thinner SBK flap, hence increasing the available residual stromal bed and preserving corneal tissue. It has excellent predictability and reproducibility when it comes to flap thickness with minimal intra operative complication. There was several limitations to our study. The tool of measurement [AS-OCT], is that the boundaries between the flap and stroma become ambiguous with time, increasing the examiner's subjectivity

Queratometrías por Pentacam y método de Maloney en pacientes con catarata y cirugía refractiva corneal previa / Keratometries taken with Pentacam and Maloney method in patients with cataract and previous corneal refractive surgery

Objetivo: comparar las queratometrías obtenidas por el Pentacam y el método de Maloney en pacientes con catarata, operados previamente de cirugía refractiva corneal. Métodos: se realizó un estudio descriptivo, longitudinal, prospectivo y comparativo entre los valores queratométricos obtenidos mediante el método de Maloney y el Pentacam en pacientes con catarata y cirugía refractiva corneal previa. Se estudiaron 41 ojos de 31 pacientes distribuidos en dos grupos, con 23 y 18 ojos para Maloney y Pentacam respectivamente. La información de la base de datos fue procesada con el software SPSS versión 11.0 para Window. Se trabajó con un nivel de confianza del 95 por ciento y de error inferior al 0,05 por ciento. Resultados: en ambos grupos prevaleció el astigmatismo miópico (simple o compuesto), lo cual se encontró en 14 ojos (60,9 por ciento) del grupo 1 y 16 ojos (89 por ciento) del grupo 2. La mayoría de los ojos estudiados (37) tenían queratotomía radiada, y solo 4,3 del Grupo 1 y 1 del Grupo 2 tenían LASEK miópico. La queratometría promedio obtenida por el método de Maloney fue de 37,55 D, mientras que el valor promedio brindado por el Pentacam (EKR a 4,0 mm) fue de 39,18 D, con una diferencia promedio de 1,64 D, que fue significativa (p= 0,019). Conclusiones: los valores queratométricos aportados por el método de Maloney y las EKR a 4,0 mm del modo Holladay Report del Pentacam presentan diferencias significativas en pacientes con queratotomía radiada previa(AU)

Objective: to compare the keratometries with Pentacam and with Maloney method in patients with cataract, who had previously undergone refractive corneal surgery. Methods: comparative, prospective, descriptive and longitudinal study of keratometric values estimated with Pentacam camera and with Maloney's method in patients with cataract and previous corneal refractive surgery. Forty one eyes were distributed into two groups; twenty three were studied by Maloney method and 18 by Pentacam. Database information was processed by was processed by version 11.0 SPSS software for Windows. The confidence interval was 95 percent and the error margin below 0.05 percent. Results: myopic astigmatism (simple or compound) prevailed and it was found in 14 eyes (60.9 percent) of Group 1 and in 16 eyes (89 percent) of group 2. Most of the studied eyes (37) had radiated keratotomy and just 4.3 in group 1 and one in group 2 had myopic LASEK. The average keratometry with Maloney's method was 37.55 D whereas the average value provided by the Pentacam (EKR at 4,0 mm) was 39.18 D, with a significant average difference of 1.64 D (p= 0.019). Conclusions: the keratometric values estimated by Maloney's method and the EKR at 4,0 mm from the Holladay Report of Pentacam show significant differences in patients with previous radiated keratotomy(AU)

Queratectomía fototerapéutica en la queratopatía en banda / Phototherapeutic keratectomy in the band keratopathy

Las opciones quirúrgicas con la utilización del láser excímer en determinadas entidades corneales reporta importantes beneficios. La queratopatía en banda, considerada como una degeneración de la córnea superficial caracterizada por la presencia de depósitos de calcio en la membrana de Bowman, es una de las afecciones corneales que han mostrado alentadores resultados con la realización de la queratectomía fototerapéutica. Se presenta un paciente de 68 años, del sexo femenino y piel blanca, con antecedentes de uveítis anterior. En la consulta refirió sensación de cuerpo extraño del ojo derecho. En la exploración oftalmológica del ojo derecho se apreciaron en la córnea superficial depósitos de color blanco-grisáceo de localización interpalpebral. Los estudios refractivos realizados constataron una disminución marcada de la agudeza visual de cuenta dedos en ambos ojos. Se le realizó queratectomía fototerapéutica del ojo derecho y mejoró la sintomatología ocular(AU)

The surgical options with the use of the excímer laser in certain corneal diseases provide important benefits. Band keratopahy, considered a superficial corneal degeneration characterized by the presence of calcific bands in Bowman's membrane, is one of the corneal affections that have shown encouraging results with the performance of phototherapeutic keratectomy. Here is a 68 years-old Caucasian female with no history of previous uveitis. At the ophthalmological service, she said she felt some foreign body in her right eye. The eye examination revealed white-gray superficial deposits of intereyelid location in the cornea. The refractive studies confirmed a marked reduction of visual acuity in both eyes. The patient underwent phototherapeutic keratectomy and her ocular symptoms improved(AU)

Correlação clínico-patológica em ceratites fúngicas e uma possível evidência de infecção oportunista: relato de dois casos / Clinicopathological correlation in fungal keratitis and a possible evidence of opportunistic infection: a report of two cases

RESUMO Os autores relatam dois casos de ceratite fúngica, que apresentam em comum no exame histopatológico: a ausência de epitélio, sem ulceração e a integridade da camada de Bowman com a presença de formas fúngicas no seu interior. São sugeridos prováveis mecanismos de recidiva das ceratites fúngicas, ressaltando uma possível "via externa não usual", por meio da penetração do fungo através da camada de Bowman íntegra. A existência desta infecção oportunista não está relatada na literatura oftalmológica e são necessárias mais evidências para que seja considerada como tal.

ABSTRACT The authors describe two cases of fungal keratitis which, upon histopathological examination, are found to have in common the absence of epithelium, without ulceration and the lack of integrity of the Bowman's layer with the presence of fungal forms in their interior. Through them the authors suggest probable mechanisms of recurrence of fungal keratitis, highlighting the possible existence of an "unusual external route" that would occur by the fungus penetration through the full Bowman layer. Although these findings appear not yet reported or recovered in the ophthalmic literature, the authors suggest that they could be possible opportunistic infection signals which, however, require more evidence to be considered as such.

Biomicroscopia ultrassônica na viscocanalostomia / Ultrasound biomicroscopy in viscocanalostomy

OBJETIVO: Estudar por biomicroscopia ultrassônica (UBM) de alta frequência as características anatômicas da viscocanalostomia, e a relação dessas características com a redução da pressão intraocular. MÉTODOS: Estudo transversal, que incluiu nove olhos (sete pacientes) submetidos à viscocanalostomia, e posteriormente examinados por UBM de alta frequência (80 MHz). Os parâmetros da UBM avaliados após um follow-up mínimo de seis meses foram: presença de espaço intraescleral, comprimento e altura máximos do espaço intraescleral, e a espessura mínima da membrana trabéculo-descemética (MTD) residual. O sucesso cirúrgico definiu-se como pressão intraocular (PIO) <22mmHg ou redução de 20% da PIO sem medicação tópica. Possíveis associações entre as variáveis da UBM e o resultado cirúrgico foram avaliados. RESULTADOS: O tempo médio entre a cirurgia e a realização da UBM foi de 15,5 ± 8,8 meses (6 - 29 meses). Verificou-se uma redução da PIO de 23,5 ± 6,9 mmHg (13,7-32,0) pré-operatória para 14,5 ± 2,4 mmHg (10,7-17,3) pós-operatória (p<0,05). Identificou-se a presença de espaço intraescleral em todos os olhos. A média do comprimento máximo do espaço intraescleral era 1,83 ± 0,51mm; a média da altura máxima do espaço intraescleral era 0,36 ± 0,17mm; e a média da espessura mínima da MTD era 0,14 ± 0,07mm. Não foram encontradas correlações significativas entre o valor da PIO pós-operatória e o comprimento do espaço intraescleral (r²=0,359), a altura do espaço intraescleral (r²=0,017) e a espessura da MTD (r²=0,003). CONCLUSÃO: Em pacientes submetidos à viscocanalostomia, a UBM após um follow-up mínimo de seis meses identificou o espaço intraescleral em todos os olhos. Não se encontrou qualquer correlação estatisticamente significativa entre os valores de PIO pós-operatória e as características anatômicas do espaço intraescleral.

PURPOSE: To evaluate by high frequency ultrasound biomicroscopy (UBM) the anatomical characteristics of viscocanalostomy and their relationship with the intraocular pressure (IOP) lowering. METHODS: A transversal study which included 9 eyes (7 patients) undergoing viscocanalostomy and examined by high frequency UBM (80 MHz). Several UBM variables were evaluated, including the presence of the intrascleral space, the maximum length and height of the intrascleral space and the minimum thickness of residual trabeculo-Descemet membrane (TDM). Surgical success was considered to be achieved when IOP was <22mmHg or the IOP was lowered 20% or more without the use of any medication. The possible association between UBM variables and the surgical outcome was determined. RESULTS: The mean time between surgery and the UBM examination was 15.5 ± 8.8 months (range 6-29). The mean IOP decreased from a preoperative value of 23.5 ± 6.9 mmHg (range 13.7-32.0) to 14.5 ± 2.4 mmHg (range 10.7-17.3) postoperative (p<0.05). The presence of an intrascleral space was a constant finding. The mean length of the intrascleral space was 1.83 ± 0.51mm, the mean height was 0,36 ± 0,17mm; and the mean TDM thickness was 0.14 ± 0.07mm. There were a poor correlation between the level of IOP at the time of UBM and the lenght of the intrascleral space (r²=0.359), the height of the intrascleral space (r²=0.017) or the thickness of the remaining TDM (r²=0.003). CONCLUSION: In patients undergoing viscocanalostomy, UBM examination after a minimum of 6-month follow-up period showed the presence of an intrascleral space in all patients. There was no statiscally significant relationship between the level of IOP and the anatomical characteristics of the intrascleral space.

Cauterización de la membrana de Bowman y el injerto de membrana amniótica en la queratopatía bullosa dolorosa poscirugía de catarata / Cauterization of Bowman´s membrana and amniotic membrane graft in painful bullous keratopathy after cataract surgery

Introducción: La queratectomía con cauterización de la membrana de Bowman y el injerto de membrana amniótica son algunos de los tratamientos paliativos en pacientes con queratopatía bullosa dolorosa sin criterio de trasplante corneal. Describir los resultados de cada una de estas técnicas fue nuestro objetivo fundamental en este estudio. Métodos: Se realizó un estudio descriptivo con 34 pacientes con queratopatía bullosa dolorosa poscirugía de catarata. Se distribuyeron en dos grupos: queratectomía con cauterización de la membrana de Bowman y queratectomía con injerto de membrana amniótica con seguimiento por seis meses. Resultados: A los seis meses se mantenían sin bulas 64,7 y 41,2 por ciento de los casos con cauterización de la membrana de Bowman e injerto de membrana amniótica respectivamente. El incremento de la vascularización corneal fue mínimo para ambas técnicas quirúrgicas. Se logró el alivio de los síntomas en la primera semana de la cirugía para 82,4 por ciento en la cauterización de la membrana de Bowman y 94,1 por ciento en el injerto de membrana amniótica. A los seis meses de la cirugía se mantenían asintomáticos 88,2 y 70,6 por ciento de los casos con cauterización de la membrana de Bowman e injerto de membrana amniótica, respectivamente. La epitelización corneal se produjo antes de los 14 días en el 100 por ciento de los pacientes tratados con injerto de membrana amniótica y en el 94,1 por ciento de los pacientes con cauterización de la membrana de Bowman. Conclusiones: Ambas técnicas quirúrgicas fueron eficaces en el tratamiento a corto plazo de la queratopatía bullosa dolorosa poscirugía de catarata.

Introduction: Keratectomy with cauterization of Bowman´s membrane and the amniotic membrane graft are some of the palliative therapies to be applied in patients with painful bullous keratopathy without any criterion of corneal transplant. To describe the results of each technique was our fundamental objective in this study. Methods: A descriptive study of 34 patients with painful bullous keratopathy after cataract surgery was carried out. They were divided into two groups: one undergoing keratectomy with cauterization of Bowman´s membrane and the other amniotic membrane graft followed-up for six months. Results: After six months, 64.7 percent of cases with cauterization of Bowman´s membrane and 41.2 percent of those with amniotic membrane graft had no blebs. Increase of corneal vascularization as minimal for both techniques. The symptom relief in the first week of surgery was observed in 82.4 percent and 94.1 percent of cases respectively. After six months, the patients kept asymptomatic in 88.2 percent of cases with cauterized Bowman´s membrane and 70.6 percent of amniotic membrane grafts. Corneal epithelization occurred before 14 days of surgery in 100 percent of patients treated with graft and in 94.1 percent of cauterized cases. Conclusions: Both surgical techniques are effective in short-term treatment of painful bullous keratopathy after a cataract surgery.

Keratectasia after Laser in Situ Keratomileusis: Clinicopathologic Case Report

PURPOSE: To describe the morphological features of a prominent ectasia of the cornea after laser in situ keratomileusis (LASIK). METHODS: The morphology of the ectatic corneas were examined using corneal topography, optical microscopy and transmission electron microcopy in 2 cases who had undergone penetrating keratoplasty due to a poor visual acuity induced by progressive corneal ectasia after LASIK. RESULTS: On a topographic examination, the apex of the corneal surface was observed within the central 3 mm zone and the smallest thickness was 116 micrometer and 271 micrometer in each case. The histological examination showed that the epithelial layer had become thinner and detached easily. The Bowman's membrane was broken down and folded. An irregular arrangement of the stromal lamellae with the fibroblastic keratocytes was found. Scar tissue was observed between the epithelium and the Bowman's layer in the central region. In contrast, the corneal endothelium was intact and no abnormality was found in both cases. CONCLUSIONS: The morphologic examination of 2 cases with corneal ectasia revealed a forward protrusion of both the anterior and posterior corneal surface. In addition epithelial detachment, breakage and folding of the Bowman's membrane and irregular lamellae were found. The 2 cases had greatly thinned and protruding corneas, yet there was no abnormality in the corneal endothelium.

Multilayer Amniotic Membrane Transplantation for Corneal Ulcer Perforation

PURPOSE: To evaluate the clinical outcome of multilayer amniotic membrane transplantation (AMT) in the cornea which was perforated or had impending perforation due to corneal ulcer. METHODS: Human multilayer amniotic membrane transplantation were performed in patients with perforation or impending perforation of cornea due to herpetic keratopathy (2 eyes of 2 patients) and fungal ulcer (1 eye). The surgical procedure consists of the following steps: First, all cellular debris was carefully removed from the base and the walls of the ulcer and loosened epithelium. In addition 1 to 2 mm zone is created around the ulcer by removal of healthy, adherent epithelium overlaying the normal Bowman membrane. Depending on the depth and the configuration of the ulcer, three or more of small pieces of human amniotic membranes are stacked one above the others to fill the cavity of the ulcer. Finally, a larger piece of membrane is trimmed to cover the ulcer and then secured with interrupted 10-0 nylon suture. RESULTS: The corneal perforations were prevented and the stable ocular surface were achieved in all patients. CONCLUSIONS: Human multilayer amniotic membrane transplantation is a useful treatment prior to corneal transplantation and considered as an alternative treatment to keratoplasty for perforation or impending perforation of corneal ulcer.

Confocal Microscopic Findings of Keratoconus

PURPOSE: To report the confocal morphological changes of keratoconus in comparison with that of normal cornea. METHODS: Confocal microscopy (ConfoScan 2.0, Fortune Technology, Italy) was used to obtain data from healthy volunteers and keratoconus. We evaluated corneal morphological images of the corneal epithelium, Bowman's layer, stromal layer (anterior, middle, and posterior keratocyte), Descemet's membrane, and endothelium. RESULTS: In keratoconus cornea, the wing cells of epithelium had somewhat irregular margin, and the subepithelial nerve bundle was slightly enlarged. Near Bowman's membrane, highly reflective changes and tear like structure were visible. While the anterior stromal keratocyte had nuclei with a highly reflective density and indefinite cell border, posterior keratocyte had a more distinct shape with less cellularity. Near descemet's membrane, vertical fold (Vogt's striae) was observed and keratocytes with long processes arranged nearly in parallel. Morphological change was not observed in the endothelium. CONCLUSIONS: Our confocal microscopic findings of keratoconus may help early diagnosis and assessment of prognosis in the management of keratoconus.

The Confocal Microscopic Findings of Cornea In Soft Contact Lens Wearer

PURPOSE: To investigate the change of morphometric characteristics of the corneal cells by confocal microscopy in long-term soft contact lens wearer. METHODS: Confocal microscopy (ConfoScan 2.0, Fortune Technology, Italy) was used to obtain data from healthy volunteers and soft contact lens wearers for 10 years. We evaluated the morphological images of the corneal epithelium (superficial cell, wing cell), Bowman's membrane, stromal cells (anterior, middle, and posterior keratocyte), Descemet's membrane, and endothelium. RESULTS: In comparison with control, the wing cells from corneal epithelium of contact lens wearer appeared to have irregular and blurred cell borders, and enlarged subepithelial nerve plexus. The bowman's membrane and the anterior stroma showed an increased reflectivity. The keratocyte from a highly reflective area showed no definite cell border anteriorly and more distinct shape with less cellularity posteriorly. Descemet's membrane showed an evidence of vertical fold and keratocytes with long processes were arranged in parallel. The endothelial layer showed polymegathism and polymorphism with some gutta. CONCLUSIONS: According to these data, it would be suggested that a long-term wearing of soft contact lens could influence the morphology of corneal epithelium and stroma as well as of corneal endothelium.

A case of Excimer Laser PRK in Schnyder's Dystrophy

PURPOSE: Schnyder's dystrophy with severe corneal opacity need lamellar or penetrating keratoplasty. But recently, excimer laser is used to decrease the corneal opacity. So we performed excimer laser PRK in myopic SCD patient. METHODS: A 34-year-old female whose chief complaint was visual hazeness had multiple needle-shape crystalline deposit and disc-shaped opacity in Bowman's membrane and superficial corneal stroma in her both eyes. We diagnosed as Schnyder's dystrophy and performed PRK on her right eye. RESULTS: After PRK, visual improvement was achieved. We report this case with literature review as we believe that our case is the first report in our country.

Migration of Normal Corneal Epithelial Cells in Rats / 대한해부학회지

In the stratified squamous epithelium, most of basal cells in the entire epithelium function as stem cells. But many researchers report that stem cells in the corneal epithelium are located exclusively in the limbus. We planned to investigate the morphological characteristics of migrating corneal epithelial cells by the electron microscopy. Sprague-Dawley rats at fullterm, postnatal day 5, 10, 15, and adult were used as experimental animals. The results are as follows. 1. Stratification of the corneal epithelium : The number of layers in the corneal epithelium was dramatically increased in the period between postnatal day 10 and 15. 2. Migration of the corneal epithelial cells : In the groups of postnatal day 10 and adult, wide intercellular spaces were noted. Especially in the adult, the limbal side of basal cells was being lifted from the Bowman's membrane and centripetal polarity of them are noted. According to the above results, the wide intercellular spaces at postnatal day 10 seems to be resulted from the migration of corneal epithelial cells for epithelial stratification. The centripetal polarity of limbal basal cells in adult rat suggests that only the limbal basal cells may function as stem cells in that period.

LASIK Using the Manual Microkeratome: Complications, Management, and Result

Laser in situ kratomileusis(LASIK) is a prefered method to excimer laser photorefractive keratectomy (PRK) because the former cuts only corneal stroma, while the latter cuts corneal epithelium, Bowmans membrane, and stroma, LASIK is a complex procedure composed of corneal flap preparation and photo-ablation. In corneal flap preparation, two types, manual and automatic, of microkeratomes have been used. We experienced problems during and after LASIK procedure using a manual microkeratome in learning curve period(8 months) and criticized the problems to shorten a learning curve of manual microkeratome. One hundred eighty six myopic eyes treated with LASIK using manual microkeratome(MLK, SCMD, USA) from January 1997 to August 1997 by one operator(Joo) were subjects. Problems occurred in 24 eyes(12.9%) and consisted of hole in corneal flap (5 eyes), thin corneal flap(3 eyes), winkling of corneal flap (2 eyes), hinge inside optical zone of laser(3 eyes), haze of interface (3 eyes), and free corneal flap(8 eyes). Majority of complications occurred in the first 3 months and most complicated cases were preventable when the speed of microkeratome enhancement was slow in late series of study. It seems that a manual microkeratome takes longer learning curve than automated microkeratome. Therefore, to decrease the number of problem cases in learning curve of LASIK using manual microkeratome a didatic course, advices from experienced surgeons, and participation in wet lab would be mandatory.

Autolytic Changes of Hair, Nail, and Cornea(I): Changes by Three Weeks after Resection / 대한법의학회지

This study was carried out to determine whether the autolytic changes of the hair, nail, and cornea were useful marker to estimate the postmortem interval. The hairs and nails obained from variable aged men and corneas from rabbits were placed in variable temperatures (10 degrees, 20 degrees, 30 degrees)and humidities (50%, 75%, 100%) and periodically investigated by electrom microscopy. The results were as follows. The hairs and nails were not significantly changed to 21 days after cut in variable temperatures and humidities. The cornea showed epithelial desquamation from the first day and endothelial desquamation from the third day. However, Bowman's membrane, stroma, and endothelial changes of the cornea were irregular on case. From the above results, it is concluded that the autolytic changes of the hair, nail and cornea were not useful to estimate the posmortem interval within a few weeks.

A Clinical Experience of Phototherapeutic Keratectomy for Reis-Bucklers' Dystrophy

Reis-Bucklers' dystrophy is an autosomal dominant disorder involving Bowman's membrane. It usually appears as a recurrent corneal erosion in early childhood and is characterized by an irregular, semi-opaque accumulation of fibrous connective tissue in the area of Bowman's membrane and symmetrical progressive opacity of superficial central cornea. Eventually, it causes visual disturbance due to re-ticulated gray-white corneal opacity and corneal surface irregularity. The ophthalmic surgeons have met difficulties in the management of Reis-Bucklers' corneal dystrophy because of poor long-term results following conventional penetrating and lamellar keratoplasties. We experienced a case of Reis-Bucklers' dystrophy in 25 years old man which was confirmed by clinical and pathological evidences and successfully treated by excimer laser phototherapeutic keratectomy(PTK) with VISX 20/20 B(R). In conclusion, we would suggest that PTK could be another modality of management in this anterior corneal disease when surgical intervention is required.

The Morphologic Changes of Epikeratoplasty Lenticule In a Case

The patients initially underwent epikeratoplasty for keratoconus but a penetrating kerato plasty was required due to the opacity in the cornea. By using of this specimen, which was obtained by trephination the healing process of the host-Ienticule cornea could be examined by electron microscopy and immunofluorescence method. Epithelial ingrowth over the lenticule was well formed by the regeneration of the basement membrane over the Bowman's membrane. However, the poor attachment of the lenticule over the host corneal stroma made the interface easily separated during the sectioning processes. Electron microscopic study revealed the keratocytes in the lenticule stroma vacuolized with large number of degenerated microorganelles. These results suggest that it may take a long time to complete the wound healing of the host-Ienticule interface despite the epithelial ingrowth onto the lenticule was well formed.

Acute Hydrops of the Cornea in Keratoconus

Keratoconus (conical cornea) is a condition, beginning about puberty and developing mainly in females, in which the apex of the cornea thins gradually and usually bilaterally. The etiology is unknown. The presenting symptom is a reduction of the patient's vision owing to the development of a high degree of irregular myopic astigmatism. Early in the course of the disease the cornea does not look conical. The diagnosis of Keratoconus is confirmed by the distorted reflex observed with a Placido's disc and abnormal keratometer readings. In more advanced stages, signs include the obvious cone-shaped cornea and indentation of the lower lid by the cornea. By slit lamp biomicroscopy, vertical lines are noted in the deep layers of the stroma: the corneal nerve fibers are increasingly visible; and in about 50% of cases a yellow or green line is present around the base of the corn (Fleischer's ring). In advanced cases Bowman's membrane and Descemet's membrane rupture. Microscopically there is thinning of the tissue spaces between the corneal lamellae, fragmentation of the basement membrane of the comeal epithelium, fibrillation of Bowman's membrane, and folds or ruptures in Descemet's membrane. Acute hydrops may occur when Descemet's membrane ruptures. This is characterized by sudden cloudiness of vision due to imbibition of aqueous in the corneal stroma. However, as Descemet's membrane regenerates, the edema subsides. Permanent scarring may result if Bowman's membrane ruptures. Acute hydrops of the cornea was developed respectively in left eye on Oct, 1976 and in right eye on Dec, 1976 in a 13 year old Korean girl with Keratoconus O.U.

A Case of Congenital Corneal Staphyloma

A case of congenital corneal staphyloma was presented. This 4 year-old boy was premature born and received oxygen in theLincubator during one month after birth. He showed mental retardation, articulation disturbance and gait disturbance. The right eye was free from any anomaly. The left eye was undergone enucleation for cosmetic improvement because of corneal opacity at birth. A detailed histologic examination of the congenital corneal staphyloma was given; epidermidialization of the corneal epithelium, scarring and vascularization of the stroma, with an absence of Bowman's membrane were shown. Descemet-endotheliallayer was completely defective in keratoiridic and corneal-abnormal pigment layer adhesions, but found in the seperated portion between cornea and iris. Iris root was not found in normal position. An abnormal pigment epithelial layer from ciliary epithelium was covered the surface of trabecular meshwork(anterior chamber angle) and an abnormal pigmentation of the trabecular meshwork poorly developed, which was running on iris pigment epithelium and covering inner surface of the cornea. The ciliary body, especially the process was atrophic. The lens was thin membranous and cataractous. Abnormal fibrinous band in the retinal capillary bed was argyrophilic strand. It was suggested that these findings of anterior corneal staphyloma was resulted from primary developmental anomaly of mesodermal and/or neuroectodermal tissue.

Granular Corneal Dystrophy

Granular corneal dystrophy is characterized by the presence of milk-white spots in the superficial stroma typically lying underneath Bowman's membrane in the axial region of the cornea. This corneal dystrophy was first described by Groenouw in 1890. Since then, not only this dystrophy but also many other types of familial corneal dystrophies have been described. In 1938 Bucklers classified the corneal dystrophy into three types; granular, lattice and macular corneal dystropy. Granular corneal dystrophy was inherited as an autosomal dominant characteristics. It begins in the first decade of life becoming obious at about the age of puberty. The early leasions are small, discrete, grayish-white spots in the superficial stroma of both corneas, and as the condition advances, the lesions are more evident and of various sizes and shapes. This opacities are confined mostly to the axial portion of the cornea. There is no decrease in coreal sensitivity nor any vascularization. Gradually the opacities enlarge, thicken and coalesce into irregular granules hooks, rings and streaks of whitish color and glassy structure. The progress of the disease is usually slow, and moderately good vision often remains in the fourth or fifth decade. The main histopathologic feature is the deposition of a hyalin-like material in the corneal stroma. When the opacification or the irritative epis:xles become disabling, corneal grafting may be indicated. The cases reported here are granu'lar dystrophies which involved four daughters of one family.