Effectiveness of hyaluronan on corneal epithelial barrier function in dry eye

AIMS/BACKGROUND—The aim of this study was to assess quantitatively the effectiveness of hyaluronan on corneal disruption in patients with dry eye. Corneal epithelial barrier function was evaluated by measuring fluorescein permeability using a slit-lamp fluorophotometer.
METHODS—11 patients with dry eye were assigned to this study. Hyaluronan ophthalmic solution (0.1% hyaluronic acid) was instilled five times a day to the right eye, in addition to the usual artificial tear solutions. The left eye received only the artificial tear solutions. Corneal barrier function was evaluated on the pretreatment day, and at 2 and 4 weeks after treatment. Fluorophotometry was used to measure fluorescein uptake at the central and lower corneal portions.
RESULTS—Two weeks after treatment, hyaluronan treated right corneas showed significant corneal epithelial barrier improvement in the lower portion, compared with the pretreatment day (p<0.025). Four weeks after treatment, the treated corneas showed significant improvement in the central corneal portion (p<0.025) and improvement in the lower portion, compared with the pretreatment day. The untreated left corneas, on the other hand showed no improvement during the course of the study.
CONCLUSION—This study suggests that hyaluronan is effective in the treatment of corneal epithelial disruption in dry eye.

     

Dry eye after haematopoietic stem cell transplantation

AIMS—To determine the incidence, natural course, and severity of dry eye occurring or worsening after haematopoietic stem cell transplantation (SCT).
METHODS—At a tertiary care hospital, 53 patients undergoing allogeneic or autologous SCT followed by at least 180 days of follow up were studied prospectively. Examination included grading of symptoms of dry eye, evaluation of ocular surface, tear break up time, and Schirmer tests with and without nasal stimulation. Meibomian gland secretion was also examined using a slit lamp while applying steady digital pressure.
RESULTS—Of the 53 patients, 44 received allografts. Half of these patients (22) developed dry eye or their pre-existing dry eye worsened after SCT, while none of nine autograft recipients did. Onset of dry eye was 171 (SD 59) days after SCT. Two types of dry eye occurred. One (n=10) was severe with ocular surface findings resembling Sjögren''s syndrome and reduction of reflex tearing soon after onset. A mild type (n=12) had unimpaired reflex tearing. Meibomian gland dysfunction (MGD) was more frequent and severe in patients with dry eye and chronic graft versus host disease (GVHD), and overall severity of dry eye was greater in patients with MGD and chronic GVHD.
CONCLUSIONS—Dry eye after SCT occurred only in allograft recipients, and was not evident in autograft recipients. The severe form of dry eye had a tendency to develop rapidly. Further study on the prediction and treatment of severe dry eye after SCT is necessary.

     

Natural history of recurrent erosion syndrome—a 4 year review of 117 patients

AIMS/BACKGROUND—Recurrent erosion syndrome encompasses a group of mixed aetiologies for which there are a number of methods of management which may influence the course of the disease.
METHODS—The outcomes of a cohort of patients initially treated with topical lubricants were studied. 117 consecutive patients presenting over 1 year with a history of recurrent erosions were enrolled, baseline characteristics were documented, and treatment with lubricants was initiated. Patients were surveyed 4 years later inquiring about symptoms and treatments required.
RESULTS—A total of 94 (80%) of the initial cohort were contacted. The mean age was 44 years and the sex distribution was 44 males to 50 females. The mean period of follow up was 48 months. 55 (59%) were still symptomatic with attacks occurring at a median frequency of 60 days. 13 patients (24%) complained of an episode at least every week and 28 patients (51%) suffered at least every month. The median pain score (analogue scale of 1-10) was 2.5. Seventy five per cent (n=21) of patients with epithelial basement membrane dystrophy (EBMD) were symptomatic compared with those with a traumatic aetiology among whom 46% (n=28) were symptomatic. This difference was significant (p=0.02). Those with EBMD were more likely to be continuing to use topical lubricants than the trauma group.
CONCLUSION—Patients with a traumatic aetiology are less likely to suffer chronic recurrent erosion syndrome than those with EBMD.

Keywords: recurrent erosion syndrome; aetiology; chronicity     

CA 19-9 ELISA test: a new method for studying mucus changes in tears

AIMS—This study investigated mucus changes in the tears in various eye conditions using impression cytology. The quantity of mucins was measured by enzyme linked immunosorbent assay (ELISA) using the tumour marker CA 19-9. This assay quantifies the sialylated Lewis^a structure mainly associated with ocular mucins.
METHODS—Impression cytology was performed using a cellulose nitrate membrane, on 53 healthy patients, 50 glaucoma patients treated with β blockers, 24 patients suffering from dry eye syndrome, and 45 contact lens wearers. The tear film glycoproteins were eluted and CA 19-9 was measured.
RESULTS—CA 19-9 content expressed as kilo units (kU) per µg of tears was significantly decreased in dry eye syndrome (25.8 kU (SD 17.3)/µg) (p<0.05), glaucoma patients over 60 years (28.9 (19.5) kU/µg) (p<0.05), and contact lens wearers (28.4 kU (18)/µg) (p<0.05), when compared with healthy individuals (39.4 kU (22.2)/µg).
CONCLUSION—Impression cytology can be regarded as a valuable method for obtaining samples of glycoconjugates of mucin. The decrease of sialylated chains observed with this method confirms the hypothesis that some quantitative changes in the tear film may be encountered in ocular surface disorders.

Keywords: impression cytology; tears; glycoconjugate; sialic acid     

Factors associated with second eye cataract surgery

AIMS—To analyse the clinical and sociodemographic characteristics associated with second eye cataract surgery.
METHODS—An observational, longitudinal study of patients scheduled for first eye cataract surgery that did not involve a combined procedure was carried at two teaching hospitals and one non-teaching hospital in Barcelona, Spain. Patients were followed for 2 years after first eye cataract surgery to assess whether and when they had undergone second eye cataract surgery. Clinical characteristics, perceived health characteristics (perceived visual function and overall health status), and sociodemographic characteristics were compared between two patient groups—those with surgery in only one eye and those who had undergone surgery in both eyes by the end of the 2 year follow up period.
RESULTS—Of the 242 patients studied, 125 (51.7%) underwent second eye surgery during the 2 year observation period. Patients with visual acuity 6/18 (0.3) or worse in the second eye compared with those with visual acuity over 6/12 (0.5) and patients younger than 65 years compared with patients aged 65-74 were more likely to undergo second eye surgery (adjusted odds ratio 3.9 and 1.8, respectively). 52 (44.5%) patients in the only one eye surgery group had a visual acuity less than 6/18 (0.3) in the second eye.
CONCLUSIONS—Worse visual acuity in the second eye and younger ages are strongly associated with both eyes cataract surgery. There may be a potential increase of demand for this procedure in the near future since almost half of the patients with only one eye surgery presented a low visual acuity in the second eye.

     

Pulfrich's phenomenon in unilateral cataract

AIMS—To determine whether unilateral cataract causes a pathological Pulfrich's phenomenon.
METHODS—29 subjects with unilateral cataract and contralateral pseudophakia were assessed on their ability to perceive the Pulfrich phenomenon. Using a computer generated pendulum image, and graded neutral density filters, a series of forced choice trials were performed in which the subject was required to describe the direction of any apparent pendulum rotation. A pathological Pulfrich effect was said to occur when apparent rotation was perceived in the presence of a zero strength neutral density filter. The size of any pathological Pulfrich effect which was present was quantified by neutralising the perceived pendulum rotation with neutral density filters of varying strength placed before the better seeing eye.
RESULTS—20 out of 29 subjects were able to perceive apparent pendulum rotation when uniocular filtering was performed. In the group (n=12) which was tested both before and after cataract extraction with intraocular lens implantation, a statistically significant pathological Pulfrich effect was demonstrated preoperatively, compared with a group of normal control subjects. This effect was abolished after cataract extraction (p=0.009). The median size of the effect was equivalent to a 0.25 log unit neutral density filter over the non-cataractous eye. The subjects who were unable to perceive the Pulfrich phenomenon at all had a significantly greater difference in the visual acuity of each eye (p=0.045) and significantly worse stereoacuity than those who were able to perceive the effect (p=0.002).
CONCLUSIONS—Unilateral cataract can cause a pathological Pulfrich phenomenon. This finding may explain why some patients with unilateral cataract complain of visual symptoms that are not easily accounted for in terms of visual acuity, contrast sensitivity, or stereoacuity.

     

Long term effect of hypermetropic anisometropia on the visual acuity of treated amblyopic eyes

AIM—To evaluate the effect of the extent of hypermetropic anisometropia on the long term visual acuity results in amblyopic eyes following their treatment by occlusion.
METHODS—The visual acuity of 86 patients, who had been treated for unilateral amblyopia by occlusion of the fellow eye and followed up at least to the age of 9 years, was examined 6.4 years, on average, after cessation of treatment. Patients were divided into two groups—those with a small amount of hypermetropic anisometropia, where the spherical equivalent difference between the eyes ranged between 0 and +1.50 dioptres, and those with a large amount of hypermetropic anisometropia, where the difference was +1.75 dioptres or greater.
RESULTS—Deterioration of visual acuity after cessation of occlusion treatment occurred in 51% of the patients in the group with a small amount of anisometropia and in 75% of the patients in the group with a large amount. At cessation of treatment, the average visual acuity in both groups was 20/40+. At the long term follow up examination, however, the average visual acuity was 20/40− and 20/70, respectively. This difference was statistically significant.
CONCLUSIONS—Hypermetropic anisometropia greater than 1.50 dioptres appears to be a risk factor for deterioration of visual acuity in the long term, following treatment of amblyopic eyes by occlusion of the fellow eye.

Keywords: amblyopia; hypermetropic anisometropia; strabismus     

Long term course of tear gland function in patients with keratoconjunctivitis sicca and Sjögren's syndrome

AIMS—To assess the course of tear gland function of patients with keratoconjunctivitis sicca (KCS) associated with primary (KCS-PSS) or secondary Sjögren's syndrome (KCS-SSS), and of patients with KCS not related to Sjögren's syndrome (KCS-NS).
METHODS—In 106 patients with dry eye an ophthalmic diagnosis of KCS was made. Subsequent evaluations revealed a diagnosis of KCS-PSS in 31, KCS-SSS in 19, and KCS-NS in 56 patients. Follow up assessments have been performed 10-12 years after initial diagnosis.
RESULTS—At baseline and at follow up tear gland function tests were worse in patients with KCS-PSS compared with the other forms of KCS. At follow up in the KCS-SSS patient group the tear gland function variables returned to marginal normal limits. In contrast with expectation, a marked improvement of the tear gland function variables in the KCS-NS patient group was noted.
CONCLUSIONS—In KCS-PSS patients tear gland function is characterised by a steady state situation. In KCS-SSS patients the normalisation of tear gland function variables most probably reflects a remission of the underlying disease. In view of the overall improvement in KCS-NS patients the term age related KCS should be avoided.

     

Evidence that upregulation of serum IGF-1 concentration can trigger acceleration of diabetic retinopathy

BACKGROUND—Acute reduction of chronic hyperglycaemia can accelerate early diabetic retinopathy. In adolescent patients with Mauriac's syndrome, this phenomenon is related to an upregulation of subnormal serum IGF-1 levels.
AIM—To obtain longitudinal data on serum IGF-1 and retinopathy status in poorly controlled adult insulin dependent (type 1) diabetic patients without Mauriac's syndrome, in whom hyperglycaemia is reduced by intensive insulin therapy.
METHODS—Four patients with chronic severe insulin deficiency and early microangiopathy were studied prospectively. Changes in plasma glucose, HbA_1c, serum IGF-1 levels, proteinuria, retinopathy, and clinical status were followed up closely.
RESULTS—Reducing hyperglycaemia from >16 mmol/l (equivalent to HbA_1c >11%) to <10 mmol/l (HbA_1c <8%) within 5 months increased serum IGF-1 levels by 70-220%. While proteinuria and symptomatic neuropathy regressed, retinopathy progressed from the mild to the severe non-proliferative stage with maculopathy (n=4), and to the proliferative stage (n=1). Laser coagulation was commenced upon the appearance of sight threatening macular oedema (n=4).
CONCLUSION—Upregulation of serum IGF-1 preceding retinal deterioration in these patients suggests a cause-effect relation, consistent with earlier experimental and clinical data.

Keywords: diabetes mellitus; macular oedema; metabolic control; intensive therapy; glycated haemoglobin A_1c; growth factors     

Human antiretinal antibodies in toxoplasma retinochoroiditis

BACKGROUND/AIMS—Toxoplasma retinochoroiditis (TR) is an important cause of blindness and visual morbidity, affecting young adults. It has been postulated that some of the retinal damage observed in TR is due to antiretinal autoimmune mechanisms.
METHODS—Humoral antiretinal autoimmunity in TR was investigated by indirect immunofluorescence (IIF) on normal human cadaveric retina and by a human retinal S-antigen ELISA. 36 patients with TR were separated on clinical grounds into those with first recurrence of disease (n=18) or those with multiple recurrences (n=18). Patients were also segregated into those with active (n=28) or quiescent disease (n=8). Serum from 16 normal controls (six with positive toxoplasma serology and 10 without) with no evidence of eye disease and 12 patients with idiopathic retinal vasculitis (IRV) were also tested.
RESULTS—Sera from 34 of the 36 patients (94%) with TR demonstrated photoreceptor layer reactivity by IIF contrasting with six of 16 normal controls (p= <0.001) and three of 12 IRV patients (p= <0.001). Titres of antiphotoreceptor antibody were also higher among TR patients than controls. Sera from 27 of the 36 TR patients, 10 of 16 normals, and nine of 12 retinal vasculitis patients possessed anti-human retinal S-antigen antibodies at a titre of 1:400 or more as assessed by ELISA (p= >0.05). Antiretinal autoantibody as detected by IIF did not run in parallel with S-antigen reactivity.
CONCLUSIONS—The data indicate that the extent of antiretinal reactivity within TR is not accounted for by anti-S-antigen antibodies alone. This remarkably high prevalence of antiphotoreceptor antibody in TR as opposed to that found in either healthy or disease controls suggest that these antibodies may be co-pathogenic in toxoplasma retinochoroiditis.

Keywords: retinochoroiditis; toxoplasma; immunofluorescence; autoimmunity     

Grid laser photocoagulation for macular oedema in uveitis or the Irvine-Gass syndrome

AIMS—To determine the effect of modified macular grid photocoagulation in patients with refractory macular oedema due to uveitis or cataract extraction.
METHODS—In this study 20 patients with macular oedema underwent modified macular grid laser photocoagulation and were followed by means of standardised examinations (day 0, months 2, 6, and 12) consisting of best corrected visual acuity and fluorescein angiography.
RESULTS—The mean visual acuity increased from 0.16 before to 0.3 after laser treatment (p=0.013), and fluorescein leakage was significantly reduced (p=0.005). Visual prognosis was influenced by duration of the uveitis, not by sex or age.
CONCLUSION—Modified macular grid laser photocoagulation had a beneficial effect on macular oedema caused by uveitis or the Irvine-Gass syndrome. A prospective, randomised study is needed to determine the exact place of modified macular grid photocoagulation in the treatment of patients with inflammatory or postsurgical macular oedema.

Keywords: macular grid photocoagulation; Irvine-Gass syndrome; macular oedema     

Cryotherapy and laser treatment for acute retinopathy of prematurity: refractive outcomes, a longitudinal study

BACKGROUND—Infants who require treatment for threshold retinopathy of prematurity are at increased risk of developing refractive errors. Following the introduction of laser treatment for threshold disease, the clinical impression was that the degree of myopia was reduced compared with cryotherapy.
METHODS—A longitudinal study was carried out of refractive error at 3 and 12 months in 19 patients undergoing cryotherapy and 15 patients undergoing laser treatment.
RESULTS—At 3 months the median spherical equivalent refractive error in the right eye was −3.25 dioptres after cryotherapy and +0.25 dioptres after laser therapy (similar results left eye). The median spherical equivalent refractive error in the right eye at 12 months was -5.25 dioptres following cryotherapy and -0.50 dioptres after laser (similar results left eye). There was a statistically significant difference in median spherical refractive error between the therapies at 3 months and 12 months (p<0.05 Wilcoxon rank sum) in both eyes.
CONCLUSION—Laser therapy is associated with lower degrees of myopia during the first year of life, which is clinically significant in terms of visual performance and development.

     

Impression cytology in Down's syndrome

AIM—To evaluate both the number and the average distribution of goblet cells, which are responsible for the production of the mucin layer of the tear film, in the bulbar conjunctiva of patients with Down's syndrome. Previous research had used the ferning test to indicate an alteration in Down's syndrome, but had not determined which film layer was involved.
METHODS—The presence of goblet cells in the bulbar conjunctiva of 30 subjects (15 with Down's syndrome, and 15 normal control subjects) was evaluated using impression cytology.
RESULTS—A marked reduction of goblet cells was found in the Down's syndrome group (81.4 per mm²) when compared with the control group, where (209.8 per mm²) was found.
CONCLUSION—The deficit observed appears to be the cause of the tear film alterations observed in Down's syndrome. In turn, this may often lead to the formation of dry spots, and to consequent frequent infections of the anterior segment of the eye. While it is further hypothesised that the alteration of the conjunctival epithelium in Down's syndrome may be due to an altered metabolism of some element or elements, such as vitamin A, further research will be necessary to corroborate this.

     

Retinal detachment in AIDS: long term results after repair with silicone oil

AIMS—To study the long term results of vitrectomy and silicone oil injection in AIDS patients with retinal detachment due to viral retinitis.
METHODS—A consecutive series of 83 eyes in 75 AIDS patients who were treated with vitrectomy and silicone oil for retinal detachment due to viral retinitis was studied prospectively and followed until the last patient in the series had died.
RESULTS—Median postoperative survival was 6 months, but 20% of patients survived 12 months or more. Whereas best corrected visual acuity was 20/100 or better in over half the patients 1-2 months after operation, there was a distressing decrease in acuity by 6 months, owing to a variety of factors. Patients operated on before macular detachment did not have significantly better postoperative vision than those operated within a week after macular detachment. Almost all patients who had already lost vision in the fellow eye and many who had cytomegalovirus retinitis in the fellow eye with retention of good vision had their quality of life improved by the surgery in that the operated eye eventually became the better seeing eye. In no patient whose fellow eye was normal and free of retinitis, however, did the operated eye ever become the better eye.
CONCLUSIONS—Although the majority of patients recovered macular vision in the first 1-2 months after operation, there was a gradual decline in acuity thereafter, sometimes without obvious cause. The results of this series suggest that it may be reasonable to postpone surgery until the macula detaches and that patients whose fellow eye is free of retinitis with normal vision are unlikely to have their quality of life improved significantly by the surgery.

     

Knowledge, attitudes, and self care practices associated with age related eye disease in Australia

AIM—To determine the level of correct knowledge about common eye disease and attitudes towards blindness prevention and treatment, and how these factors influence self care practices in a population based sample.
METHODS—A cluster random sample of the Victorian population was interviewed. The study population comprised residents aged 40 years of age or older living in five randomly selected Melbourne metropolitan suburbs and four randomly selected rural areas of Victoria. Questions were asked to ascertain each person's knowledge of common age related eye disease—that is, cataract, age related macular degeneration (AMD), and glaucoma. A subsample of the population was also asked questions to determine their attitudes to blindness prevention and treatment. All respondents were asked the year of their last visit to an eye practitioner.
RESULTS—A total of 3184 (89%) eligible residents were assessed. Sex (females), age (younger people), higher levels of education (secondary, trade, or tertiary education), recent visit to an eye practitioner (within the past 2 years) and English spoken at home appeared to be significant predictors of knowledge of common age related eye conditions. Younger people believed blindness prevention and blindness treatment were the highest priorities compared with other diseases; people who spoke English at home and people with knowledge of common age related eye disease also considered blindness treatment to be the highest priority compared with other diseases. People with a previous diagnosis of age related eye disease, older people, females, people with correct knowledge of common eye diseases, and those who spoke English at home were significantly more likely to be under eye care. No interaction was found between knowledge and positive attitudes to self care practices.
CONCLUSION—These data show that there is a large gap in the public's knowledge and understanding of eye disease that will need to be understood for eye health promotion activities.

Keywords: knowledge; attitudes; eye diseases; cross sectional studies     

Effects of protease inhibitors on the course of CMV retinitis in relation to CD4+ lymphocyte responses in HIV+ patients

AIM—To gain insight into the course of CMV retinitis (CMVR) in AIDS patients receiving protease inhibitors (PI), and to evaluate whether certain patterns of CD4 response are indicative of the clinical outcome and the risk of recurrence.
METHODS—15 consecutive AIDS patients receiving maintenance therapy for CMVR were included in a prospective observational cohort study at the university hospital between July and October 1996. Patients were evaluated for signs of CMVR activity and intraocular inflammation. CMVR recurrence was defined as the primary clinical endpoint. Follow up was performed until July 1997. No patient was lost to follow up. Clinical outcome was related to CD4+ lymphocyte counts, which were monitored every 6 weeks. Highly active antiretroviral treatment regimen including PI was started at study entry.
RESULTS—All recurrences (n=7) were in patients who failed to have a sustained increase in CD4 counts, whereas CMVR remained inactive during a follow up of 42-52 weeks in those who were able permanently to restore their CD4 values to 100×10⁶/l or more (n=5). The remaining three patients died after 12, 16, and 50 weeks, respectively, without recurrences. All relapses of CMVR were seen after 6-16 weeks, and at CD4 counts well below 100×10⁶/l.
CONCLUSIONS—The beneficial effects of PI treatment correlate with the pattern of CD4 response. Sustained increases in CD4 counts achieved in the first 16 weeks of treatment are associated with a prolonged period of CMVR quiescence. Poor initial response is associated with a high risk of CMVR recurrence.

Keywords: AIDS; cytomegalovirus retinitis; HAART; protease inhibitors     

Movement hyperacuity in childhood amblyopia

BACKGROUND—Amblyopia results in deficits in a number of visual functions in both the amblyopic and dominant eye. The present work describes oscillatory movement displacement thresholds (OMDT) in childhood amblyopia.
METHODS—The OMDT from the dominant and amblyopic eyes of 50 orthoptic patients (aged 74 (SD 16) months) were compared with those from a group of 24 controls (79 (21) months). OMDT were measured using a forced choice staircase procedure. Subjects were asked to identify which of the computer controlled monitors displayed the oscillating stimulus. Visual acuity and stereoscopic responses were noted from clinical records.
RESULTS—Amblyopic children demonstrating stereopsis showed no significant OMDT deficit in the amblyopic eye. Those children having no stereopsis had elevated OMDT in the amblyopic eye (p<0.05). Results suggest that the dominant eye of children with amblyopia may also have a pattern of visual development which is anomalous (difference in correlation coefficient with age; p <0.05).
CONCLUSION—OMDT deficits demonstrated in some amblyopic eyes indicate that amblyopia is incompletely described by its "clinical" definition. Results suggest that the dominant eye in those with unilateral amblyopia may not be "normal".

Keywords: amblyopia; children; vision; movement hyperacuity; stereopsis     

Retinal detachment following excimer laser

AIMS—To report the clinical presentation, surgical management, and outcome of retinal detachment following excimer laser.
METHODS—Retrospective analysis of retinal detachments observed in 11 eyes of 10 myopic patients who had previously undergone photorefractive keratectomy (PRK) or phototherapeutic keratectomy (PTK) by excimer laser.
RESULTS—Symptoms of visual loss in two eyes were initially attributed to corneal haze. In 10 of 11 eyes visualisation of the retinal detachment and causative break was possible despite mild corneal haze and optical aberrations caused by the refractive laser procedure. Retinal reattachment was achieved in all 11 eyes though one eye required four surgical interventions.
CONCLUSION—This is the first published report to describe an association between retinal detachment and previous excimer laser treatment. The association would appear to reflect the predisposition of myopes to retinal detachment. Clinicians should be aware of potential retinal pathology in patients undergoing PRK.

     

A clinic based survey of blindness and eye disease in Cambodia

AIMS—To survey the spectrum of eye disease presenting to rural eye clinics in Cambodia.
METHODS—A total of 1381 patients seen consecutively at 13 eye clinics were examined and the findings recorded.
RESULTS—231 (16.7%) were bilaterally blind (visual acuity <3/60 in both eyes); 263 (19%) were unilaterally blind, and 169 (12%) had low vision (visual acuity <6/18 in the better eye). Cataract was the commonest cause of visual loss in all three categories and was responsible respectively in 69%, 40%, and 55% of each group. Trachoma was diagnosed in 13% of patients. Thirty three of them needed lid surgery for trichiasis.
CONCLUSION—With the difficult practical and political situation in Cambodia there seems little prospect of making substantial inroads into the backlog of avoidable blindness in the near future.

     

Corneoscleral transplantation for end stage corneal disease

AIM—To describe the prognosis and complications of corneoscleral transplantation in the management of end stage eye disease.
METHODS—A case series is presented of 23 patients who have undergone corneoscleral transplantation (11 mm). Patients were examined for visual acuity, intraocular pressure, recurrence of disease process, epithelialisation of the graft, signs of rejection, and other potential complications.
RESULTS—14 patients retained their eye, with six maintaining a clear graft. Vision ranged from 6/30 to no perception of light. 13 patients developed glaucoma (range 25-69 mm Hg), with six patients requiring surgical intervention. 12 patients required tarsorrhaphy to promote epithelialisation. Only two grafts resulted in typical rejection.
CONCLUSIONS—The technique of corneoscleral transplantation can salvage otherwise end stage eye disease, but the results are poor with respect to maintenance of vision. These patients need careful follow up because of potential complications of glaucoma, epithelial defects, rejection, and recurrence of disease.

Keywords: corneoscleral graft; end stage corneal disease; sclerokeratoplasty