J.A. Fogle

Tissue Adhesive Arrests Stromal Melting in the Human Cornea

The direct early application of cyanoacrylate adhesive to a prepared ulcer bed and adjacent basement membrane, followed by placement of a bandage lens, gave good results in ten patients with corneal ulceration. The patients had ulceration with keratitis sicca, herpes keratitis, and other surface diseases. Progressive melting was arrested in all cases, and concurrent adjunctive therapies were used as indicated. The technique is quick and simple.

Defective Epithelial Adhesion in Anterior Corneal Dystrophies

Experimental and pathologic studies implicated the role of the epithelial basement membrane and its associated hemidesmosomes and anchoring fibrils in mediating tight adhesion between corneal epithelium and stroma. We evaluated the ultrastructural quality of basement membrane complexes in patients with Reis-Bücklers dystrophy, Cogans microcystic dystrophy, and nontraumatic recurrent erosion who presented with clinically significant erosive symptoms. Despite the variable clinical and histopathologic appearances among these dystrophies, incompleteness of basement membrane complexes apparently was a common fault shared by these erosive disorders. Such basic incompetence at the basement membrane level can both provoke and sustain erosions, while the more individual pathologic manifestations of a given anterior dystrophy may be of less primary significance.

An Unusual Case of Ocular Involvement in Primary Systemic Nonfamilial Amyloldosis

A case of primary amyloidosis with vitreous involvement was diagnosed by study of a specimen obtained by pars plana vitrectomy. Vitreous opacities had been interpreted clinically as a vitreous hemorrhage. Medical evaluation after study of the vitreous specimen failed to demonstrate evidence of amyloidosis, although postmortem examination 19 months later established the systemic diagnosis of nonfamilial systemic primary amyloidosis. Both eyes were obtained postmortem. Amyloid involvement of the vitreous, retina, and choroid was found. There was also amyloid deposition in the trabecular meshwork, although the intraocular pressure was normal. Amyloid was deposited along the anterior, pupillary, and posterior surfaces of the iris. The histochemistry, ultrastructure, and treatment of this condition are discussed.

Damage to Epithelial Basement Membrane by Thermokeratoplasty

To determine the effects of thermokeratoplasty (TKP) on the basement membrane complexes of the corneal epithelium, transmission electron microscopy was performed on the corneal buttons of five patients with failed TKP and on two normal corneas and five corneas with keratoconus that were immediately treated by TKP (acute TKP). The consistent findings of thermal dissolution of basement membrane after acute TKP and persistent defects of basement membrane complexes many months after therapeutic thermokeratoplasty were significant. Given the potentially damaging effects of thermokeratoplasty on the epithelial basement membrane, faulty epithelial adhesion should be anticipated after thermokeratoplasty and should be treated aggressively, possibly with careful prophylactic use of bandage hydrophilic contact lenses.

Peripheral Peters' anomaly: a histopathologic case report.

The clinical and pathologic findings of a case of congenital bilateral, peripheral corneal leukoma associated with iris coloboma and anterior subluxation of the lens are reported. The changes in the region of keratolenticular apposition include partial absence of Bowmans membrane, stromal vascularization and thinning with large-diameter collagen fibrils, and absence of Descemets membrane and endothelium. The authors postulate that dysembryogenesis of the tertiary vitreous, with iris coloboma, resulted in apposition of the lens to cornea during the second and third month of gestation and that this apposition resulted in the observed peripheral corneal abnormalities.