Risk of lung cancer among masons in Iceland

AIMS/BACKGROUND: Deep lamellar keratoplasty (DLK) was performed to restore visual acuity in 120 eyes with corneal stromal opacification. DLK is believed to be an effective treatment in eyes in which endothelial cell function had been preserved, and in which there was no epithelial or stromal oedema. The purpose of this study was to evaluate the effectiveness of this treatment. METHODS: The stroma was excised to the extent that only Descemet's membrane remained, at least in the optical zone. Donor corneas of full, or almost full, thickness with Descemet's membrane removed, or which had been lathed to a thickness of 0.4 mm from the endothelial side, were attached by suturing. RESULTS: In 113 eyes which were observed for 6 months or more postoperatively in which average prospective visual acuity was 0.09, average postoperative visual acuity improved to 0.6. Specular microscopy 1 month postoperatively revealed average endothelial cell counts of 2225 (SD 659)/mm2, while 24 months postoperatively this value was 1937 (642)/mm2 (cell loss 13%). Puncturing of Descemet's membrane during surgery occurred in 47 of 120 eyes (39.2%), but after 12 months, there was no difference in visual acuity or number of endothelial cells between these eyes and those in which no puncturing had occurred. CONCLUSIONS: There was no postoperative endothelial rejection reaction with DLK, and restoration of postoperative visual acuity was quite adequate. Compared with penetrating keratoplasty, DLK allows endothelial cell counts to be maintained for a longer period. In addition, results can be expected to be more consistent over the long term with DLK.     

Evaluation of a 3-piece silicone intraocular lens with poly(methyl methacrylate) haptics

PURPOSE: To evaluate the safety and performance of a foldable silicone intraocular lens (IOL) in small incision phacoemulsification surgery. SETTING: Vaasa Central Hospital, Vaasa, Finland. METHODS: Phacoemulsification with primary implantation of a posterior chamber IOL was performed in 50 patients. All eyes were implanted with a CeeOn IOL (model 920, Pharmacia & Upjohn) with a silicone optic and poly(methyl methacrylate) haptics. The ease of folding, implanting, and unfolding the IOL in the bag were recorded. Visual acuity, postoperative complications, optic decentration, and optic tilt were measured at 5 postoperative visits. The IOLs were evaluated for haze and discoloration and the IOL surface, for inflammatory or pigment deposits. Follow-up was 12 months. RESULTS: In 44 of 50 cases, folding the IOL was easy, and in 46 of 50, unfolding the IOL was controlled. The mean follow-up was 11.45 months +/- 0.52 (SD). No postoperative complications occurred, and 96% of patients achieved a best corrected visual acuity (BCVA) of 0.5 or better and 56%, a BCVA of 1.0 or better. The IOL decentration was less than 0.25 mm in 89% of cases, and there was no optic tilt. The neodymium:YAG laser capsulotomy rate was 11%. CONCLUSION: Good visual outcome and excellent centration were achieved with the CeeOn model 920 IOL. It is therefore suitable for small incision cataract surgery. Because of the IOL's smooth, polished surface, the choice of instruments for folding and implantation is important.     

Results of excimer laser photorefractive keratectomy for the correction of myopia

PURPOSE: This report summarizes the authors' 3-year experience with excimer laser photorefractive keratectomy on 240 eyes of 161 patients. METHODS: With constant laser emission parameters, nitrogen flow across the cornea was used on 79 eyes, whereas 161 eyes had no nitrogen flow. Of the 240 eyes, 74 were operated on without suction ring fixation. Postoperative pain management included patching and oral analgesics in 77 eyes and the use of topical diclofenac or ketorolac and a therapeutic soft contact lens in 163 eyes. Follow-up ranged from 1 month (206 eyes) to 36 months (10 eyes). RESULTS: At 3 months, 88% (144 eyes) had uncorrected visual acuity of 20/40 or better; 86% (151 eyes) had corrected visual acuity to within +/- 1 diopter of intended correction, and 10% (17 eyes) lost two or more lines of best-corrected visual acuity. At 12 months, 89% (122 eyes) achieved uncorrected visual acuity of 20/40 or better, 79% (115 eyes) had corrected visual acuity to within +/- 1 diopter of intended correction, and 4% (6 eyes) lost two or more lines of best-corrected visual acuity. At 24 months, 92% (44 of 48 eyes) had uncorrected visual acuity of 20/40 or better, 86% (44 of 51 eyes) had corrected visual acuity to within +/- 1 diopter of intended correction, and 5% (2 eyes) lost two or more lines of best-corrected visual acuity. At 36 months, 90% (9 eyes) achieved an uncorrected visual acuity of 20/40 or better, 90% (9 eyes) had corrected visual acuity to within +/- 1 diopter of intended correction, and no eyes lost two or more lines of best-corrected visual acuity. CONCLUSIONS: The results obtained with one procedure are within accepted standards of accuracy for refractive surgery, and there is the potential for refinement of the final optical correction. Complication rates are low and are not vision threatening. They included increased intraocular pressure, epithelial "map dot" changes, and recurrent corneal erosion syndrome, "central islands," and others. Photorefractive keratectomy appears to be a safe procedure over the short and medium term.     

Phototherapeutic keratectomy for granular and lattice corneal dystrophies at 1.5 to 4 years

BACKGROUND: The capability of the 193-nm excimer laser to ablate the cornea and to remove opacities and various other corneal diseases in a procedure called phototherapeutic keratectomy (PTK) has been demonstrated. In this study we evaluated the long-term results of PTK for treatment of granular and lattice corneal dystrophies. METHODS: Four eyes with granular or lattice corneal dystrophy were treated with a mean follow-up of 47.8 months (range, 36 to 58 months). Focal ablations of the central cornea with an ablation zone of 5.5 to 6.0 mm were performed. Ablation depth was 110 microns in three eyes and 140 microns in one eye. RESULTS: Removal of corneal opacities allowed for improvement in corrected visual acuity in all patients. Mean corneal thickness in the area of pathology decreased from 0.583 mm before surgery to 0.449 mm after surgery. Spherical equivalent of the manifest refraction measurements increased by a mean of +5.09 D. There were no major complications, but all patients developed slight haze. There was a hyperopic shift in three eyes. CONCLUSION: Our long-term results suggest that PTK is a safe and effective alternative to penetrating and lamellar keratoplasty in patients with granular or lattice corneal dystrophies.     

Endophthalmitis after filtering surgery with mitomycin

OBJECTIVE: To identify the incidence, causative organisms, and clinical outcomes of eyes with bleb-associated endophthalmitis after glaucoma filtering procedures with adjunctive mitomycin. METHODS: Retrospective analysis of 773 consecutive eyes that underwent glaucoma filtering surgery at the Bascom Palmer Eye Institute, Miami, Fla. The course of 609 eyes from 485 patients with a minimum of 3 months of follow-up were reviewed. RESULTS: Mean follow-up was 16.0 +/- 11.5 months (range, 3-48 months). Of the 609 eyes, 13 (2.1%) developed bleb-associated endophthalmitis an average of 18.5 +/- 13.2 months after surgery (range, 1-45 months). The incidence of bleb-associated endophthalmitis was significantly greater after inferior trabeculectomy (7.8% per patient-year) than after superior trabeculectomy (1.3% per patient-year) by Kaplan-Meier estimates (P = .02, log rank test). The cumulative incidence was 13% for inferior limbal blebs and 1.6% for superior limbal blebs. Nine (69.2%) of the 13 eyes were culture positive. Streptococcus sanguis and Haemophilus influenzae (6/13 [46.2%]) were the most frequent causative organisms. The mean increase in intraocular pressure after endophthalmitis treatment was 1.2 mm Hg, with a mean decrease in visual acuity of 1.42 logMAR units. Eight (61.5%) of the 13 eyes had a final acuity of 20/400 or better. CONCLUSIONS: The incidence of bleb-associated endophthalmitis after guarded filtering surgery performed with adjunctive mitomycin is higher than the reported rate in eyes undergoing filtering surgery without the use of antifibrotic agents (0.2%-1.5%). Inferior limbal trabeculectomy carries the highest risk of infection. Eyes with mitomycin blebs maintained excellent filtration capacity. However, after treatment of the infection, the visual outcomes were generally poor.     

Longer-term visual outcome of eyes with retinopathy of prematurity treated with cryotherapy or diode laser

AIMS: Visual outcome of 66 eyes in 37 patients who had undergone treatment with either cryotherapy or diode laser for threshold retinopathy of prematurity was assessed. METHODS: 17 patients, representing 30 eyes treated with cryotherapy, were examined at between 56 and 98 months corrected age (median 68 months). 20 patients representing 36 eyes treated with diode laser, were examined at between 30 and 66 months corrected age (median 51 months). Structural outcome was categorised as: optimal--flat posterior pole; suboptimal--macular ectopia, optic nerve hypoplasia, retinal fold involving the macula, and retinal detachment involving the macula. RESULTS: Optimal structural outcome was, in the absence of amblyopia, associated with optimal visual acuity (of 6/12 or better) in all cases, with most eyes achieving a visual acuity of 6/9 or 6/6. Suboptimal structural outcome was invariably associated with suboptimal visual acuity. Amblyopia was present in eight out of 20 cryotherapy treated eyes and in five out of 26 laser treated eyes with an optimal structural outcome. Refractive errors were significantly less in laser treated eyes as was the incidence of anisometropic amblyopia. CONCLUSION: Eyes treated with either cryotherapy or diode laser for threshold retinopathy of prematurity with optimal structural outcome are associated with development of optimal visual acuity--that is, 6/12 or better. Treatment with either cryotherapy or laser does not in itself reduce the visual potential of these eyes.     

Deglutition in patients treated with reconstructive laryngectomy]

BACKGROUND: Chronic papilledema may lead to irreversible damage of optic nerve fibers. To preserve visual functions, a decompression of the optic nerve is recommended by means of a fenestration of the optic nerve sheath. In this study long-term results after optic nerve sheath fenestration in patients with idiopathic pseudotumor cerebri are reported. PATIENTS AND METHODS: 14 patients were re-examined 15 to 145 months (mean 62 months) after a fenestration of the retrobulbar optic nerve sheath on 23 eyes by a transconjunctival approach. Surgery was done to treat progressive visual loss or in severe obscurations. The patient's symptoms, visual acuity, visual fields, and ophthalmoscopic findings of the optic nerve head and the central fundus were compared to the preoperative status. RESULTS: Re-examination revealed improvement or stabilisation of objective and subjective findings in 17 eyes, one of them was operated on the more involved contralateral side only. Six eyes showed a recurrence of the papilledema without a functional change for the worse after an interval of 7 to 121 months. Three eyes of two patients ended up with optic atrophy and extensive visual loss. Preoperatively, these eyes had shown cotton wool spots in the optic nerve head and a rapid deterioration of vision. CONCLUSIONS: Fenestration of the retrobulbar optic nerve sheath can prevent further visual loss in most patients with pseudotumor cerebri, unless the eye has already become nearly blind. Postoperatively, ophthalmological controls are necessary at regular intervals because relapses after successful surgery can occur after months or years.     

Evaluation of Guamanian dental caries preventive programs after 13 years

The authors followed the collection of 77 eyes with glaucoma (54 eyes with POAG, 16 eyes with PACG and 7 eyes with CG) after ECCE or phacoemulsification with implantation of IOL. The patients were operated in 1990-1991 at the Ophthalmological Clinic FNKV and 3rd Medical Faculty in Prague. The authors evaluated IOP, therapy and visual acuity 6 weeks and 6 months after operation. After 6 months period IOP was decreased in average about 3 mmHg; in POAG the reduction was 1.9 mmHg and in PACG the reduction was 4.7 mmHg. In this time the authors also registered decreasing antiglaucomatous therapy at 38 eyes (i.e. 49.3% operated eyes). The reducing therapy represents 50% eyes with POAG and 69% eyes with PACG. The visual acuity is in 70% 6/6-6/12. Patients with PACG have more expressive postoperative effect. The authors draw the attention to late diagnosis CG, after successful operation the visual acuity is reduced on account of advanced changes of the optic disc.     

Compared optical performances of multifocal and monofocal intraocular lenses (contrast sensitivity and dynamic visual acuity)

The functional results (contrast sensitivity and dynamic visual acuity) of 19 multifocal (3M design) and 14 all polymethylmethacrylate biconvex monofocal intraocular lenses (IOLs), 6 mm in optical diameter were compared. Best corrected visual acuity was > or = 8/10 (Monoyer chart) Parinaud 2 in all cases. Major differences of functional performance in favour of monofocal IOLs were found outside standard conditions of vision (low contrast and illumination levels). A significant difference in contrast sensitivity was found for each spatial frequency in favour of multifocal IOLs (0.0016 < p < 0.05). Mesopic vision was statistically higher in the monofocal IOL group (p = 0.0015). Moreover, dynamic visual acuity allowed accurate evaluation of the difference in performance between these two models of implant. In view of these results multifocal IOLs should be reserved for patients with normal psychosensitive adaptation; an ocular pathology that could alter contrast sensitivity or mesopic vision is a contraindication for multifocal IOLs.     

Evolution of C4 photosynthesis in response to changes in carbon and oxygen concentrations in the atmosphere through time

This work is a survey of 82 cases of keratoconus which have been followed up for 1 to 12 years. Among them only 66 were fitted with contact lenses. The contra-indications for them are: 1. a better visual acuity with spectacles than with contact lenses, 2. advanced cases (4th degree of Amsler) whose fitting is impossible, 3. unilateral keratoconus, 4. associated diseases such as trachomatous pannus, allergic kerato-conjunctivitis. Hard corneal lenses are now in use in most of the cases. Scleral lenses are much less used than they were 10 years ago, owing probably to the great improvement of the corneal lenses during this time. These hard corneal lenses have a short Ro (4 to 7 mm), an overall diameter between 8 and 11 mm, and an optic diameter of 5 mm. They are fitted under fluorescein control. The mobility must be good too. One case was fitted with soft lenses. The visual acuity is good and so is the tolerance: 80% of the patients wear their lenses 10 hours a day or more. Contact lenses do not affect the progression of keratoconus thus finally a keratoplasty must be performed in many cases. After the operation a contact lens is very often necessary, but its daily wearing time must be divided by two, to avoid corneal neo-vascularisation. Soft corneal lenses may be used in some cases of keratoconus. They are indicated when the hard lenses are no longer tolerated and before a keratoplasty. The base curves of these soft lenses are not related to the radii of the conic cornea. In most of the cases they are between 7.50 and 8.60 mm. The diameter is large: 14 or 15 mm. The lenses must not move too much: 1 mm up or down when the patient blinks. The edge of the lens must not depress the bulbar conjunctiva and there must be no air bubble under the lens. In many cases a cylindrical spectacle lens is necessary to obtain a good visual acuity. Some authors prefer to fit a hard corneal lens over the soft one: this is the "piggy back" method. Sometimes keratoconus has appeared in patients already fitted during several years to correct a myopic astigmatism. It is not clear whether these keratoconus have been produced or not be the contact lenses.     

Residual symptoms and signs after untreated acute optic neuritis. A one-year follow-up

PURPOSE: To study the symptoms and signs one year after optic neuritis. METHODS: Seventy population-based untreated patients, (44F, 26M; median age 35 years, range 14-48 years) were eligible for study, but the 11 bilateral cases were excluded. Among 59 patients participating in a one-year follow-up of the visual function, 58 answered a questionnaire. RESULTS: At follow-up 59% of the patients complained of visual impairment, though 49% of these patients had a Snellen visual acuity of 6/9 or better. The affected eyes showed decreased visual acuity in 34%, decreased contrast sensitivity in 63%, an abnormal score in 40% with the Lanthony D-15 desaturated panel, and in 13% with the Ishihara test, prolonged latencies of VEP in 58%, and decreased amplitudes of VEP in 41%. CONCLUSIONS: All tests except for VEP correlated significantly to the degree of perceived visual impairment. Subjective visual complaints and more sensitive tests than visual acuity should be used to evaluate the visual function following optic neuritis.     

Correlation between cerebral visual impairment and magnetic resonance imaging in children with neonatal encephalopathy

To identify brain lesions most often associated with cerebral visual i mpairment (CVI) after neonatal encephalopathy and to evaluate the prognostic value of MRI for visual outcome, the authors reviewed visual assessments and brain MRI of 80 infants and young children with documented perinatal hypoxic-ischaemic and/or haemorrhagic insults. MRIs were classified according to the severity of lesions at the optic radiations and at the visual cortex; visual acuity was tested with the acuity card procedure. Among the 48 children found to have a CVI, 42 had moderate to severe lesions of the optic radiations and 19 had lesions of the visual cortex. In both cases visual acuity was statically correlated with MRI grading, but the damage at the optic radiations was the better predictor. Early detection of abnormal MR findings in the visual cortex and especially, at the optic radiations may indicate which infants with neonatal encephalopthy should receive longitudinal visual assessment and specific rehabilitation and educational management.     

Multifocal implants of 3 optic zones: optical performance and clinical functional results

PURPOSE: Evaluation of multifocal IOL (three optical zones). METHODS: Twenty patients were implanted. Main outcome measures were: uncorrected and best corrected distance and near acuity, brigthness acuity test, contrast acuity with differents methods: Pelli-Robson Chart, Gradual System, and spatial visual integration (SVI). RESULTS: Uncorrected visual acuity was restored in 94% of cases. Contrast sensitivity was preserved with the Pelli-Robson chart test but a loss of contrast sensitivity was found with the multifocal IOL with the Gradual system and the SVI in comparison with monofocal IOL. CONCLUSION: Multifocal IOL (three optical zones) allows a good restoration of both near and far visual acuity but a decrease in contrast sensitivity was detected.     

Trauma after radial keratotomy and photorefractive keratectomy

A 25-year-old man sustained bilateral ocular trauma from an explosion, which resulted in ocular injuries from the blast, mineral projections, and heat. Before the accident, the patient had eight-incision radial keratotomy in the left eye followed 1 week later by photorefractive keratectomy in the right eye. After the accident, the left cornea had a full-thickness rupture of four incisions; the fellow cornea had a full-thickness laceration from a mineral projection. Five months after the accident, the left eye had an uncorrected visual acuity of 20/25; the right eye did not achieve an acuity of 20/200 until 20 months after the accident.     

Changes in 31P-relaxation times during organ preservation: observations on cold stored human donor livers

PURPOSE: To compare the clinical outcome of phacoemulsification and foldable silicone intraocular lens (IOL) implantation through a 3.0 mm temporal clear corneal incision and 3.0 mm superior scleral tunnel incision. SETTING: Department of Ophthalmology, Yodogawa Christian Hospital, Osaka, Japan. METHODS: Eighty cataractous eyes of 78 patients with pre-existing against-the-rule (ATR) astigmatism were recruited for this prospective, randomized study. The patients were assigned to one of the two groups. Data on uncorrected and corrected visual acuities, keratometry, flare intensity measurement, and central cornea endothelial cell count were evaluated preoperatively and at 2 days, 1 week, and 1 and 3 months postoperatively. RESULTS: Although the pre-existing keratometric cylinder decreased in the temporal clear corneal incision group and increased in the superior scleral tunnel incision group, the amount of cylinder shift was not significantly different. Mean scalar shift of keratometric cylinder in the corneal incision group was 1.19 diopters (D) at 2 days postoperatively, 0.86 D at 1 week, and 0.56 D at 3 months and in the scleral incision group, 1.09 D at 2 days, 0.76 D at 1 week, and 0.65 D at 3 months. Eighty percent of the eyes in each group achieved an uncorrected visual acuity of 20/40 or better from the second day postoperatively. No statistically significant difference in visual rehabilitation or other parameters was noted between the groups throughout the study. Complications including corneal endothelial cell loss and wound incompetence requiring suturing were observed in the temporal clear corneal incision group. CONCLUSIONS: Both incisions offered satisfactory clinical results, but the superior scleral tunnel incision resulted in fewer complications. Minimal corneal keratometric change induced by a 3.0 mm incision was not related to uncorrected visual rehabilitation.     

Retinal ganglion cell layer and visual function in a patient with optic disc drusen

BACKGROUND: To correlate the retinal ganglion cell pattern to visual acuity and visual field data in a patient with bilateral optic disc drusen, a quantitative clinicopathological study was carried out. METHODS: Both retinae of a patient with optic drusen were whole-mounted. Retinal ganglion cell counts were made using a sampling scheme covering the whole retina and compared to the findings in 10 normal retinae. Relative ganglion cell reduction in the drusen retinae was correlated to clinical data. RESULTS: The total retinal ganglion cell count was reduced from 1244858+/-98736 in normal retinae to 305319 on the right and 527571 on the left eye with optic disc drusen. Large ganglion cells had a better chance of survival. Parafoveal ganglion cell loss was 57% for the right and 36% for the left eye, while visual acuity was 0.8 and 1.0 respectively. The mean light sensitivity loss increased from the centre (6.2 dB) to paracentral (9.9 dB), mid-peripheral (13.7 dB) and outer peripheral (15.0 dB) retina, while ganglion cell losses were smallest in outer peripheral retina (21.9%), followed by central (53.0%), mid-peripheral (70.9%) and paracentral retina (87.7%). CONCLUSION: These data validate Frisén's theory on central retinal resolution and provide the structural basis for the clinical rule that low visual acuity should not be attributed to disc drusen. Automated light sense perimetry gives an inadequate picture of retinal damage caused by optic disc drusen.     

Visual acuity modeling using optical raytracing of schematic eyes

PURPOSE: We developed a methodology to predict changes in visual performance that result from changes in the optical properties of the eye. METHODS: Exact raytracing of schematic eyes was used to calculate the point spread function and the modulation transfer function of the visual system. The Stiles-Crawford effect, photopic response, diffraction, and the retinal contrast sensitivity are included in the model. Visual acuity was predicted by examining the modulation of the resultant retinal image of a bar target and by determining when the modulation falls below a threshold value. Visual acuity was predicted for refractive errors ranging from 0 to 5 diopters and for pupil diameters ranging from 0.5 to 8 mm. RESULTS: Visual acuity predictions were compared to clinically found Snellen visual acuities and were found to be highly correlated (r2 = .909). CONCLUSIONS: This modeling technique shows promise as a means of evaluating clinical and surgical procedures before undertaking clinical trails.     

Visual outcome and prognostic factors after magnetic extraction of posterior segment foreign bodies in 40 cases

AIMS: To evaluate the clinical features as well as the visual and anatomical outcome in eyes with magnetic posterior segment foreign bodies, to identify prognostic factors after removal using an electromagnet. METHODS: The records of 40 patients with posterior segment foreign bodies were retrospectively reviewed for 6 years (1989-94). Post-traumatic cataracts and secondary retinal detachments were treated using conventional surgical techniques. Pars plana vitrectomy was used only for late complications. The mean follow up was 30 months (6-71). Clinical factors were studied using univariate analysis. RESULTS: The most common findings before treatment of these 40 eyes were lens wound, hyphaema, vitreous haemorrhage, and retinal impairment. The foreign body was in the vitreous (85%) or minimally embedded in the retina (15%). Initial visual acuity was worse or equal to 20/40 in 70% of the cases. Subsequent to surgical treatment, a cataract was reported in 60% of the patients. Postoperative complications included retinal detachment (15%) and phthysis (5%). The prognosis was worse in cases with intraocular foreign body of largest diameter > or = 3 mm, an initial visual acuity less than 20/200, or the presence of post-traumatic retinal detachment. Presence of initial intravitreous haemorrhage, hyphaema, or intraocular tissue prolapse did not appear to affect the prognosis. CONCLUSION: The long term visual acuity results indicated that wound repair associated with conventional magnet extraction in an emergency is a viable treatment for posterior segment magnetic foreign bodies in this selected group. At the time of diagnosis, size of foreign body (< 3 mm) and initial visual acuity > or = 20/200 were predictors of good visual outcome after primary magnetic extraction.     

Do routine antibiotics after loop diathermy excision reduce morbidity?

AIMS: To determine functional results after unilateral and bilateral cataract surgery in children with different aphakic optical correction. METHODS: In this retrospective study, we evaluated visual acuity and binocular vision in 107 children who underwent cataract surgery during the 10 year period from 1985 to 1995. Aphakia was corrected by an intracapsular intraocular lens (IOL), spectacles or contact lenses. RESULTS: Mean visual acuity was > 20/40 (< 0.3 log MAR) with normal binocular vision in 58 children over 7 months of age operated on for bilateral cataracts. Pseudophakic eyes regained visual acuity > 20/63 (< 0.5 log MAR) more often (90%) than aphakic eyes (46%) (p < 0.001). Binocular vision was also achieved more often after IOL implantation (p < 0.001). Visual outcome of early bilateral cataracts was less satisfactory in children with abnormal foveolar function. For 49 children who had surgery for unilateral cataracts, prognosis was poor when surgery was performed before the age of 7 months. For cataract surgery in older children (> or = 7 months) mean visual acuities were better with IOL implantation (p < 0.05). CONCLUSION: Cataract surgery with unilateral and bilateral IOL implantation can provide a beneficial effect on final visual outcome in children who are operated on before abnormal foveolar function develops.     

Penetrating keratoplasty for bullous keratopathy

A retrospective review for bullous keratopathy in our hospital from 1985 to 1992 was studies. Among the cases with bullous keratopathy, 14 were performed with antiglaucoma operation and cataract extraction, 12 that experienced a contusion or penetrating trauma history underwent cataract operation. IOL implantation seen in 3 patients, 4 cases were associated with vitreous contact to cornea after cataract extraction, the other 4 cases had advanced glaucoma. Besides, there were 1 case of Fuch's endothelium dystrophy, ICE syndrome and severe herpes simplex keratitis, respectively. The preoperation visual acuity of them was all less than finger count. The follow-up was 3 months to 5 years. The results showed the grafts of 28 cases (70%) were clear, 7 cases (17.5%) semi-clear, 5 cases (12.5%) opaque. Postoperatively, all of the patients escaped from the pain and 22 cases achieved a visual acuity of 0.02-0.7. Some good advice in treatment of bullous keratopathy were proposed.