Faculty Bibliography

Eight aniridic patients with bilateral corneal scarring, vascularization, or edema underwent corneal transplantation in one or both eyes (11 eyes). Follow-up ranged from eight months to 5 1/2 years (average, three years). Six of 11 eyes (55%) had at least a two-line improvement in visual acuity and eight of 11 (73%) had at least one line of improvement. Best-corrected visual acuity was 20/200 or worse in nine of 11 eyes (82%), however. Postoperative complications included whorl keratopathy, persistent epithelial defects, central subepithelial scarring, peripheral vascularization with pannus, and graft rejection. Glaucoma was well controlled medically but five of nine patients (56%) with preexisting glaucoma needed an increase in medication for intraocular pressure control. Graft rejection occurred in seven of 11 eyes (64%) and three of these eyes required repeat transplantation

Computerized videokeratography may facilitate rigid gas permeable (RGP) contact lens fitting in post-penetrating keratoplasty (post-PK) eyes. We used the EyeSys Corneal Analysis System to create topographic maps of 19 post-PK eyes from October 1990 to April 1991. An initial trial lens was selected based on the average keratometric value from two separate topographic color maps. A standard protocol was used to select the initial trial lens on the basis of computer generated topographic keratometry readings. Final lens selection was based on clinical performance. A comparison of the base curve of the initial contact lens selected using computerized videokeratography and the base curve that would have been selected by standard keratometry showed a statistically significant difference (P = 0.02). Three month follow-up data were also evaluated. There was no statistically significant difference between the base curve of the initially dispensed contact lens and the base curve of the lens worn after 3 months. However, modifications in the fit were made in 9 of 19 patients. Two patients were RGP contact lens failures and were refit with SoftPerm lenses

We report two histopathologically proven cases of epithelial downgrowth in which the secondary glaucoma was controlled by a double-plate Molteno tube shunt and useful vision restored with a penetrating keratoplasty. The combination of a tube shunt and penetrating keratoplasty may be indicated to maintain useful vision in advanced cases of epithelial downgrowth associated with secondary glaucoma