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We analyzed pre- and postoperative corneal endothelial photographs of 33 intraocular lens patients and found an average endothelial cell density loss of 14%. Twenty-six cataract patients, similarly examined, showed a 13% mean endothelial cell loss. In 14 of the intraocular lens patients, a second postoperative evaluation of the central endothelium, at a later date, revealed a trend toward continuing cell loss. Our results indicate fewer endothelial cells were lost after intraocular lens implantation than has been previously reported. This may be accounted for by our considering only patients with normal corneas for lens implantation, and by our constant maintenance of the anterior chamber with an air bubble during lens implant surgery.

Using the Binkhorst four-loop intraocular lens, we began a trial of intraocular lens implantation in 1975. We compared the operative and postoperative complications and the visual results of 100 implant cases during a two-year period to those of 100 age-matched aphakic control cases. Although the additional steps of lens implantation resulted in more operative and postoperative complications in the intraocular lens group, the visual results were good and were the same for both groups at an average follow-up of 12 months. Because the long-term follow-up results of implant cases are unknown, we recommend a conservative approach to selection of patients for intraocular lens implantation.

A 27-year-old white man had endogenous Candida endophthalmitis with fungi in the vitreous cavity, presumably caused by hematogenous spread related to drug abuse, and was treated by pars plana vitrectomy and antifungal medications administered systemically after surgery. There was no evidence of other systemic involvement, and excision of fungi from the vitreous cavity confirmed the clinical diagnosis and determined the sensitivity of this fungus to antifungal medications. The fungus was sensitive to flucytosine (5-FC), which the patient received orally since it was less toxic to body tissues than amphotericin B. The intraocular infection cleared rapidly after vitrectomy, and visual acuity returned to 6/5 (20/15).

We developed a reliable method for measuring corneal regeneration in humans with noninvasive, readily available photographic techniques. We then used this method prospectively to compare the rates of primary corneal regeneration after surgery in a series of 27 diabetic and nondiabetic patients. The rates of corneal epithelial regeneration were not significantly different when diabetic patients were compared with nondiabetic patients. A tendency toward recurrent epithelial defects was confirmed in the diabetic patients, however.

Insulin-depleted, normal rabbit corneal epithelium was incubated in vitro in tissue culture medium containing high concentrations of glucose (35 mM). These short-term incubations showed that the epithelium took up glucose equally whether or not insulin had been added to the medium, indicating that corneal epithelium is an insulin-insensitive tissue. Sorbitol accumulation showed that the normal corneal epithelium has a sorbitol pathway which can be activated in the presence of high intracellular glucose. The low level of sorbitol accumulation in these normal epithelia is probably not osmotically significant.

Pigmentation of the posterior corneal surface results either from endothelial phagocytosis of free melanin pigment or from the presence of iris melanocytes, iris pigment epithelial cells, or pigment-containing macrophages on the posterior corneal surface. Although this is occasionally seen clinically, it is more often noted at histopathologic evaluation after operative or accidental ocular trauma. Three cases of posterior corneal pigmentation by iris melanocytes are reported. In one case, the pigmented membrane was the major cause of considerable visual impairment and was documented with clinical photographs and specular microscopy. By light and electron microscopy, all three cases were consistent with findings of posterior corneal pigmentation by iris stromal melanocytes that had acquired endothelium-like morphologic characteristics. We also consider the possible contribution of these melanocytes to posterior collagen layers of the cornea.

We studied prospectively 20 consecutive eyes of 17 patients who underwent penetrating keratoplasty for pseudophakic corneal edema. Copeland intraocular lens implants were retained in all cases initially, although one implant was subsequently removed. The visual results were analyzed at 12 and 24 months. With a minimum of 12 months follow-up, 65% of eyes saw 20/40 or better, while 80% saw 20/80 or better. By 24 months, 80% saw 20/40 or better, while 95% saw 20/80 or better. Post-keratoplasty refractive surgery, consisting of relaxing incisions and/or wedge resections, was performed in six eyes.

A 62-year-old white female was found to have a small, flat pigmented choroidal tumor. After fluorescein angiography and a positive P-32 test, the eye was enucleated for presumed malignant melanoma. Histologically, the tumor proved to be a choroidal nevus with a break in Bruch's membrane and a subretinal-pigment-epithelial neovascular membrane.

Four recent reports have described the clinical appearance of fine needle-like opacities in the corneal stroma of six patients. In five of these patients these developed in a corneal graft. Histologically, all the corneal buttons had bacterial ingrowth between the stromal lamellae, with a striking lack of inflammatory response. We report a patient in whom this process occurred following penetrating keratoplasty. Intensive topical antibiotic treatment failed, and she underwent a second, successful, penetrating keratoplasty. Postoperatively, this patient has maintained good vision with no recurrence for over three years. Histologic and ultrastructural study of the corneal button revealed viable and nonviable gram-positive cocci with a marked paucity of inflammatory infiltrate.

A distinctive subepithelial keratopathy developed in four adult patients with Crohn's disease (granulomatous ileocolitis). Small, bilateral, symmetrical subepithelial, and anterior proliferative infiltrates and scarring were present 2 to 3 mm inside the entire corneoscleral limbus. Vision was not affected because the lesions spared the central cornea. The mechanism is not known and the lesion should be regarded as a distinct clinical sign of Crohn's disease.