Corneal graft survival in HLA-A- and HLA-B-matched transplantations in high-risk cases with retrospective review of HLA-DR compatibility.

In 107 HLA-A- and HLA-B-matched corneal transplantations performed in high-risk patients, the 3-year graft survival was 60.5%. The criteria used for the definition of high risk were vascularization of the recipient cornea and/or one or more previous failed grafts; they were also the indications for HLA typing and matching. Donor/recipient compatibility was defined by the presence of only 0 or 1 HLA-A or HLA-B mismatches. When non-immunological factors leading to graft failure were excluded, the 3-year survival was 76.3%. During that follow-up period, a total of 33 grafts failed; in 13 cases, the cause was allograft rejection. When only first transplants were considered, a 3-year graft survival of 81.0% was observed. Retrospective DR typing was possible in 33 cases. Because only three graft rejections occurred in that group, we were unable to assess the importance of DR compatibility on the survival of corneal allografts.

Results of penetrating keratoplasty for pseudophakic bullous keratopathy with the exchange of an intraocular lens.

We report on 29 consecutive patients with pseudophakic bullous keratopathy who underwent in one eye penetrating keratoplasty with an exchange of the original intraocular lens for a Pearce tripod posterior chamber lens, and who were available for a follow up of at least 12 months. The average interval between cataract extraction with lens implantation and the appearance of bullous keratopathy was five and a half years (range 10 months to 16 years). The mean follow-up period after penetrating keratoplasty was 36 months (range 12 to 56 months). The corneal graft remained clear in 22 (76%) eyes. One year after the operation 45% of the eyes had a vision of 20/40 or better, and 20% had visual acuities between 20/40 and 20/100. The remaining 31% had a vision of 20/100 or less (one unknown). Nine eyes (31%) had cystoid macular oedema or macular degeneration. 45% of the eyes had a refraction within approximately 2 dioptres of emmetropia. In patients with pseudophakic corneal oedema we continue to exchange the intraocular lens by a Pearce tripod posterior chamber lens sutured to the iris when it is necessary to remove the lens.

Conjunctival transplantation.

In 1986, conjunctival transplantations were performed on 54 patients. Patients with severe corneal ulcers, who did not react adequately to local therapy, formed the largest group who were treated in this way, in particular patients in whom the prognosis for a perforating corneal graft was poor. Other indications are: bullous keratopathy, pterygium, trauma, symblepharon, etc,. In general other forms of therapy are tried first before conjunctival transplantations are performed.

Infectious crystalline keratopathy.

In seven patients white branched crystalline opacities, which grew very slowly, were seen in the corneal stroma. They were associated with very little inflammatory activity, so that the clinical picture at first did not suggest an infectious etiology. Pathological examination, however, demonstrated colonies of bacteria between intact corneal lamellae. On bacterial examination gram-positive commensals were mainly found. All the patients described so far were found to be taking corticosteroids regularly, sometimes in combination with antibiotics. The immunosuppression brought about by corticosteroids is probably an important factor in the development of these crystalline opacities. The therapy for this infectious crystalline keratopathy is difficult and lengthy. It consists of local bactericidal antibiotics and the lowest possible dosage of corticosteroids, if necessary combined with a partial lamellar keratectomy and removal of the affected corneal tissue by fraising.

Effect of oxybuprocaine 0.4% in preventing surgically induced miosis.

In a group of 68 patients a double-blind study was performed to assess the effect of preoperative oxybuprocaine 0.4% (Dorsacaine, Novesin) eye drops in comparison with a placebo in preventing surgically induced miosis during extracapsular cataract extraction. One drop of oxybuprocaine 0.4% or placebo was instilled 10 and 5 minutes preoperatively. The pupil diameter was recorded at different stages of the operation. It was found that oxybuprocaine reduced the amount of pupil constriction during the operation significantly as compared with the placebo group, facilitating the removal of lens material and the implantation of an intraocular lens. The effect of oxybuprocaine is considered to be due to anaesthetic action on sensory nerves in the eye, which may inhibit the release of a miotic substance.

Indomethacin eyedrops and the postoperative irritation after extracapsular cataract extraction combined with intraocular lens implantation.

Indomethacin 0.5% solution eyedrops inhibit the prostaglandin effects after extracapsular cataract extraction combined with intraocular lens implantation. In a double-blind study Indomethacin was compared to Dexamethason and placebo using corneal thickness and iris vessel dilatation and leakage as parameters for postoperative irritation. The present evidence indicates that Indomethacin is an important additive medication to diminish the postoperative reaction.

Therapeutic keratoplasty for active herpetic corneal disease: viral culture and prognosis.

Data are presented on a 5-year follow-up of 23 patients with active herpetic corneal disease, who underwent lamellar or penetrating corneal grafts. Excised corneal buttons were virologically examined and positive herpes simplex virus was found in 7 cases. The prognosis of these 7 cases was particularly grave. For comparison 23 cases are reported of patients with inactive herpetic corneal disease. Causes of failure in both groups are discussed.

Multicenter trial of acyclovir and trifluorothymidine in herpetic keratitis.

Acyclovir 3 percent ophthalmic ointment was compared with trifluorothymidine 2 percent ointment in a double-blind trial of 59 herpes keratitis patients. Clinical progress was measured by direct clinical assessment and retrospective photographic evaluation. Ninety percent of acyclovir-treated patients and 75 percent of trifluorothymidine-treated patients had healed within 14 days. There was no significant difference in the rate of healing between the two treatment groups.

Intracorneal haemorrhage.

In the vascularized cornea of a 63-year-old woman a haematoma developed which was so large that pupillary block resulted. Evacuation of the haematoma restored the form of the cornea and normalized the intraocular pressure. For the restoration of vision a transplantation was necessary.

Aciclovir and trifluorothymidine in herpetic keratitis. Preliminary report of a multicentered trial.

The efficacy of Aciclovir and Trifluorothymidine (TFT) treatment was tested in a double blind trial of thirty-eight patients with dendritic keratitis. All twenty patients treated with Aciclovir healed within 10 days with an average healing time of 5.0 days. Two of the eighteen patients treated with TFT failed to heal within 22 days, the others healed within ten days, the average healing was 6.6 days. Punctate keratopathy was seen in 70% of both groups. Intense conjunctival hyperaemia developed in two TFT patients.