Recurrent keratoconus 40 years after keratoplasty

Recurrent keratoconus is a corneal dystrophy that degrades the optical function of the corneal graft. Recurrence of keratoconus after keratoplasty has been reported previously in some scattered case reports, but the aetiology is still unclear. This report describes the case of a 74-year-old white woman, who presented recurrent keratoconus 40 years after keratoplasty. Ophthalmological and videokeratographic data are presented. The patient obtained satisfactory vision with soft contact lenses, and recurrent keratoconus remained stable during a 2-year period. Recurrent keratoconus generally has a moderate to severe effect on visual performance, but contact lenses usually optimise visual acuity. In cases in which the visual defect is severe, a second penetrating keratoplasty should be considered.     

Normal values and standard deviations for pupil diameter and interpupillary distance in subjects aged 1 month to 19 years

Normal values of pupil diameters and interpupillary distances (PDs) were measured in a population of 1311 subjects (in 4294 visits) ranging from 1 month of age to slightly over 19 years of age. Subjects in this study were recruited from birth announcements in a local newspaper for a developmental vision project. Pupil sizes were measured photographically when the corneas were illuminated by 15.9 +/- 0.5 lux ambient illumination (i.e. under mesopic conditions). Interpupillary distance was measured with an interocular distance rule while the subject fixated an object at 0.66 m distance. These PD measurements were corrected for systematic measurement errors and to an infinite viewing distance using radii of ocular rotation based on age-dependent axial lengths. Means and S.D. were calculated for age, pupil diameter and PD for each 1-year group of male and female subjects. The second order regression equation for average pupil size as a function of age was determined: [males pupil diameter (in mm) = 5.83 +/- 0.181*age in years - 0053*age in years2, r2 = 0.897; female pupil diameter = 5.40 + 0.285*age in years - 0.0109*age in years2, r2 = 0.945]. The dierence between male and female pupil sizes (mean male - female = 0.13 mm) was marginally not significant (p < 0.054). The average corrected PDs as a function of age were found to approximate another second-order regression equation: (males PD = 43.36 + 1.663*age in years - 0.034*age in years2, r2 = 0.986; females PD = 41.76 + 1.891 *age in years - 0.052*age in years2, r2 = 0.986). Male PD was wider than female PD by an average of 1.58 mm (p < 0.0003). As expected, the results of this study were similar to a preliminary investigation conducted by Thunyalukul et al. [Invest. Ophthalmol. Vis. Sci. 37 (1996) S731] on a portion of the present data set, and also very similar to data from another study of comparable racial composition using a different measurement method [Pryor, Pediatrics 44 (1969) 973]. It was concluded that pupil diameter and PD increase more gradually than axial length of the eye in the first few years of life. The normal values and S.D. for both pupil size and PD determined in this study have important clinical implications as well as applications in the optical industry.