Penetrating keratoplasty performed by residents.

OBJECTIVE: To report the results of penetrating keratoplasty performed by residents. METHOD: A retrospective medical record review of all patients undergoing penetrating keratoplasty performed by residents at our institution from April 1998 to April 2002. RESULTS: Forty penetrating keratoplasty procedures were performed by 8 residents. The most common indication was keratoconus (17 eyes [43%]), followed by corneal scarring (14 eyes [35%]). Mean preoperative best-corrected visual acuity was 20/250. No intraoperative complications were reported. Mean follow-up time was 15 months. Postoperatively, mean best-corrected visual acuity was 20/40, mean postoperative astigmatism was 3.4 +/- 2.1 diopters, and graft survival was 92.5%. Postoperative complications included elevated intraocular pressure, wound dehiscence, and endophthalmitis. MAIN OUTCOME MEASURES: Best-corrected visual acuity, postoperative astigmatism, graft survival, and intraoperative and postoperative complications. CONCLUSION: Residents can be introduced to penetrating keratoplasty and achieve surgical success with intraoperative and postoperative complication rates similar to those previously published.

Clinical and ultrastructural features of a novel hereditary anterior segment dysgenesis.

OBJECTIVE: To describe the clinical, histopathologic, and hereditary features of a novel familial anterior segment dysgenesis. DESIGN: Prospective, observational case series and interventional case report. PARTICIPANTS: Ten individuals from three generations of a single family with iris and corneal abnormalities associated with congenital cataracts. MAIN OUTCOME MEASURES: An ophthalmic evaluation including slit-lamp examination, corneal topography, pachymetry, and specular biomicroscopy of all family members, and histopathologic and ultrastructural evaluation of one excised corneal button. RESULTS: The proband was an 81-year-old man with bilateral aphakia and diffuse corneal haze, and thinning associated with corneal guttae. His pupils were small, mildly eccentric, and difficult to dilate. Pachymeter readings were 335 microm (right eye) and 330 microm (left eye). Topography confirmed advanced steepening of both corneas. Light microscopic and transmission electron microscopic examinations of the corneal button revealed an attenuated endothelium with prominent intracellular random aggregates of small-diameter filaments staining positively for cytokeratin. Descemet's membrane was thickened and had marked posterior nodularity. Various-sized polymorphic vacuoles containing layered electron-dense material were present within and between collagen lamellae and within keratocytes throughout the stroma and Bowman's membrane. Secondary bullous changes of the epithelium with thickening of the basement membrane were also observed. The family pedigree demonstrated an autosomal dominant inheritance pattern. CONCLUSIONS: This constellation of autosomal dominantly inherited corneal endothelial and stromal disorder, with congenital cataracts and iris abnormalities, represents a novel anterior segment disorder. Its etiology may involve an abnormal migration of the secondary mesenchyme.