Anterior corneal mosaic in eyes with keratoconus wearing hard contact lenses.

The anterior corneal mosaic is the pattern produced by massage of the cornea through the closed eyelids following the instillation of fluorescein sodium. This pattern has been observed without lid manipulation in eyes with keratoconus wearing hard contact lenses. Thirty-three (75%) of the 44 eyes with keratoconus wearing hard contact lenses spontaneously demonstrated the presence of the anterior corneal mosaic pattern; the pattern occurred spontaneously in two (5%) of 40 eyes in the control group of normal corneas. The mechanism by which the anterior corneal mosaic pattern is produced by hard contact lens wear provides an explanation of the high incidence of this pattern in eyes with keratoconus wearing hard contact lenses.

Intraocular cilia. Report of six cases of 6 weeks' to 32 years' duration.

In this study, we describe the clinicopathologic features seen in six cases of intraocular cilia and review the features of previously reported cases. Ultrastructural studies of the cilia showed partial loss of the cuticle layer, diffuse accumulation of small electron-dense granules in cuticle and cortical cells, and loss of continuous cell membranes of the cortex. The cilia were almost completely intact in most of our cases. Intraocular cilia can be tolerated for long periods.

Treatment of corneal opacification in mucolipidosis IV with conjunctival transplantation.

Mucolipidosis IV is a rare, inherited metabolic storage disease producing progressive psychomotor retardation and congenital corneal clouding. Histopathologic studies have shown that the corneal epithelium is strikingly involved with intracytoplasmic vacuolated storage material with relative noninvolvement of the corneal stroma and endothelium. Additionally, it has been noted that epithelial removal results in corneal clarity. We treated a 28-month-old patient with mucolipidosis IV with conjunctival transplantation with donor conjunctiva from an unaffected sibling. Improved corneal clarity resulted and has persisted with a follow-up of one year.

Natural killer cells against human corneal endothelium.

Human corneal endothelial cell monolayer preparations were incubated with fresh nonadherent peripheral blood lymphocytes. Vital and supravital staining and direct immunofluorescent techniques were used to analyze lymphocyte binding, endothelial cell viability, and the phenotypes of the lymphocyte populations binding to endothelial cells. Spontaneous lymphocyte-endothelial cell conjugate formation appeared maximal after six hours of incubation (86 lymphocytes per 1,000 endothelial cells). Cytotoxicity assays showed decreased endothelial viability after exposure to the lymphocytes when compared to controls incubated in media alone. The binding-lymphocyte population was a large granular nonadherent lymphocyte lacking surface immunoglobulin and stained positively for Leu-11 antigen, a surface marker expressed by natural killer cells. These data demonstrate that nonsensitized peripheral blood lymphocytes recognize and kill corneal endothelial cells in vitro. Thus, the lymphocyte subpopulations responsible for the destruction of corneal endothelial cells have functional and phenotype characteristics similar to natural killer cells and may be important participants in corneal graft injury.

Aphakic extended-wear contact lenses after penetrating keratoplasty.

Fifteen aphakic eyes in 15 selected patients who underwent penetrating keratoplasty were successfully fitted with extended-wear contact lenses three to 42 months postoperatively. After an average follow-up of 17 months, there was no graft edema, no microbial corneal ulcers, and no episode of graft rejection. Three eyes developed minor (1 to 2 mm) graft neovascularization; the neovascularization was stable and did not require discontinuation of the contact lenses. Fourteen of the 15 patients had postoperative visual acuities of 20/70 or better; the one patient whose visual acuity was worse than 20/70 had a clear graft but also had senile macular degeneration.

Retinal involvement in Morquio's syndrome (MPS IV).

Prior to this report, pigmentary degeneration of the retina had been described in four of the six types of mucopolysaccharidosis (MPS). However, it had not been described in Morquio's syndrome. To the authors' knowledge, the case presented represents the first patient with Morquio's syndrome demonstrating ophthalmoscopic and electrophysiologic abnormalities. The patient demonstrated arteriolar narrowing, as well as an increased photopic b-wave implicit time, decreased scotopic b-wave amplitude, and a slightly abnormal electro-oculogram (EOG). At 43 years of age, this patient represents the oldest individual with Morquio's syndrome tested electrophysiologically. It is proposed that the retinal involvement in the disease is mild but progressive and therefore perhaps is not seen in younger patients but becomes apparent in older persons with Morquio's syndrome.

The keratoprosthesis: improved biocompatibility through design and surface modification.

Due to poor biocompatibility, the success of keratoprostheses has been limited. We compared a newly-designed PMMA intracorneal keratoprosthesis, covalently coated with type-I collagen, with an identical, uncoated keratoprosthesis were retained for 15 months, the uncoated implants had more extensive adjacent corneal melting, greater inflammatory response, and more epithelial downgrowth than their collagen-coated counterparts. Electron microscopy showed that stromal collagen fibers had attached to the surface of the coated implants, but not to that of the uncoated ones. Intracorneal keratoprostheses covalently coated with type-I collagen may offer superior biocompatibility and become significantly incorporated into corneal tissues.

The adjustable slide knot--an alternate technique.

A new method of typing an adjustable slide knot is presented. This knot retains the advantages of previously described slide knots and does not show undue slippage. This technique allows additional precision of wound closure in ophthalmic microsurgery.

Surgical management of cataract associated with chronic uveitis.

Eight eyes in five patients with cataracts associated with chronic uveitis were operated upon with instrumentation designed for vitreous surgery. A clear visual axis with improvement in visual acuity was achieved in all cases. There were no major operative complications. Vitrectomy instrumentation provides improvements over conventional techniques in the management of these difficult surgical cases.

Transient myopia following isosorbide dinitrate.

A 38-year-old white woman consistently developed transient myopia following the administration of isosorbide dinitrate (Isordil). The myopia was associated with a decreased amplitude of accommodation, a reduction of the AC/A ratio and was eliminated by cycloplegia. Ciliary spasm secondary to the ingestion of this medication is proposed as a possible explanation for the transient myopia. To our knowledge, this case represents the first case of transient myopia following isosorbide dinitrate administration.

Clinical experience and grading of amiodarone keratopathy.

Eighteen patients receiving the cardiac drug amiodarone were followed prospectively for the development of amiodarone keratopathy. Seventeen of 18 patients (94%) developed characteristic epithelial keratopathy in at least one eye within three months of the initiation of therapy. The pattern of the epithelial deposits was noted to undergo progressive changes in configuration as a function of the duration of amiodarone therapy. These evolving changes are well defined and allow development of a grading system for amiodarone keratopathy. A grading system as well as a proposed mechanism for evolving pattern of the keratopathy are presented.

Posterior capsule opacification in extracapsular cataract extraction and the triple procedure: a comparative study.

We retrospectively studied 330 consecutive cases, comparing the incidence of posterior capsule opacification after 279 extracapsular cataract extractions (ECCEs) or phacoemulsifications and posterior chamber intraocular lens (PC-IOL) insertions, with the incidence of opacification following 51 combined corneal transplantations, cataract extractions, and PC-IOL insertions (ie, triple procedures). Opacification developed less frequently following the triple procedure than after cataract extraction alone (9.8% vs 36.2%, respectively; P < .001). Opacification also developed later following the triple procedure. The mean length of time before capsular opacification after cataract extraction alone was 24.3 months, while a mean of 45.6 months elapsed before opacification developed after the triple procedures (P < .05). Delineation of the mechanisms contributing to these outcome differences may provide a means of reducing the incidence of or preventing posterior capsule opacification after cataract surgery.

In vitro demonstration of human natural killing of keratocytes and corneal epithelium.

Cultured human corneal keratocytes or fresh human lamellar corneal epithelial sections were used as target cells in a monolayer cytotoxicity assay. Fresh allogeneic nonadherent peripheral blood mononuclear cells were incubated with the corneal-cell populations and assayed for lymphocyte binding and target-cell cytotoxicity by acid-violet-49 vital staining. Primary keratocyte populations bound lymphocytes, and there was subsequent keratocyte dye uptake. Corneal epithelium did not show either binding or lymphocyte-mediated cytolysis. These data suggest that nonspecific and spontaneous lymphocyte-mediated cytolysis of keratocytes occurs in vitro and that the responsible lymphocyte subpopulation has functional activities and cellular morphology characteristic of the natural-killer cell. This activity may play a role in initiating specific corneal-graft rejection.

Intraocular lenses. Experience at the Wilmer Institute.

A series of 614 primary intraocular lens (IOL) implantations performed at the Wilmer Institute during the past six years by two surgeons were reviewed. Progressive corneal endothelial cell loss and an increased rate of late-onset corneal edema were detected in the group with the Morcher (European) four-loop iris-clip Binkhorst IOLs. A higher rate of clinically significant cystoid macular edema (CME) developed in eyes with the American-manufactured four-loop Binkhorst lens, presumably from chronic iritis caused by contaminants on the IOLs. Our short-term results with the American-manufactured Shearing-type IOLs implanted at the time of extracapsular cataract extraction are encouraging, with 99% of cases achieving 20/40 vision or better, excluding those with known macular degeneration of amblyopia. A continued conservative approach to IOL implantation is recommended.