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Aims: Evaluation of a new surgical technique for the management of corneal ectasia with peripheral corneal involvement., Methods: Twelve eyes of 12 patients with corneal ectasias and peripheral corneal thinning requiring surgical intervention, including eight patients with combined keratoconus and PMD and four patients of keratoglobus, were enrolled for the study in a tertiary care hospital. All patients were contact lens intolerant and had a best corrected visual acuity (BCVA) /=20/60, and all patients had BCVA >/=20/80. The mean keratometry decreased from 57.54 (SD 6.89) D preoperatively to 46.36 (2.39) D (p = 0.003), and the mean spherical equivalent (SEQ) refractive error decreased from -7.8 (4.6) D preoperatively to 1.23 (1.88) D (p = 0.007). A significant decrease was also seen in mean refractive astigmatism which decreased from 5.93 (3.06) D preoperatively to 3.23 (1.14) D (p = 0.037)., Conclusion: Our technique of TILK is an effective surgical modality for the management of ectatic corneal dystrophies with peripheral corneal thinning.

Purpose: To evaluate the outcome of penetrating keratoplasty in patients with bilateral corneal blindness., Methods: Bilaterally blind patients who had undergone optical penetrating keratoplasty (PK) were evaluated on optical and refractive parameters and presence of complications if any. The results at 3 months, 6 months, and 1 year were compared with age-matched and indication-matched unilaterally blind controls., Results: The most common indication for surgery in both the groups was the presence of a corneoiridic scar. Best corrected visual acuity of > or =6/18 was seen in five (16.66%) patients in the study group and in 11 (36.66%) patients in the control group (P = 0.14). In all, 15 (50%) grafts in the study group and six (20%) in the control group failed (P = 0.03). The most common cause of failure was graft infection (40%) in the study group and post-PK glaucoma (20%) in the control group. The percentage of graft rejection as a cause of graft failure was the same in both the groups. A composite socioeconomic status scale based on family literacy and income suggested that 70% of the cases in the study group and 30% in the control group belonged to the low socioeconomic group (P = 0.004)., Conclusion: The outcome of optical penetrating keratoplasty in patients with bilaterally blinding corneal disease is poorer than those who are unilaterally blind. Low socioeconomic status may be a contributing factor for the poor outcome.

Aim: To study the results of surgical management of keratomalacia in children., Methods: A clinical case series of all children with keratomalacia, admitted to an Indian centre during the period from June 2000 to June 2001 is presented. The parameters evaluated were demographic data, systemic associations, and results of medical and surgical intervention., Results: 29 children with keratomalacia ranging from 2 months to 5 years of age (mean 1.8 (SD 1.4) years) were included in the study. All children belonged to families of lower socioeconomic status. 27 patients (93.1%) had not been immunised at all. The systemic diseases precipitating the onset of keratomalacia included measles (41.37%), pneumonia (31.03%), and acute diarrhoea (37.93%). 36 eyes (66.7%) had total corneal melting and 11 (20.3%) eyes had paracentral corneal melting. In 15 eyes (27.8%) an emergency tectonic penetrating keratoplasty was performed of which only five grafts (33.3%) remained clear at a mean follow up of 7.3 (6.8) months (range 3-24 months). Seven eyes underwent optical penetrating keratoplasty, of which four grafts (57.14%) remained clear at a mean follow up of 6.4 (3.6) months (range 3-12 months). None of these could achieve a visual acuity better than 6/60., Conclusions: Corneal grafting surgery in keratomalacia is associated with poor visual outcome.

Purpose: To review the causes, clinical features, course, histopathological and biochemical changes, diagnosis, andtreatmentof neurotrophic keratopathy., Methods: We reviewed the literature on neurotrophic keratopathy., Results and Conclusions: Neurotrophic keratopathy is a clinical entity which involves all degrees of degenerative corneal and conjunctival changes secondary to loss of sensory function in the nasociliary branch of the trigeminal nerve with or without decreased tear production. One of the commonest causes of loss of corneal sensation is herpes virus infection. The clinical course of neurotrophic keratopathy varies considerably. The corneal epithelium becomes diseased and breakdown occurs even in the absence of dessication, infection, and trauma. This stage, if not treated aggressively with ocular lubricants, tarsorrhaphy, or a bandage soft contact lens, will result in stromal lysis with or without perforation. Depending on the size and location of corneal perforation, procedures like the application of cyanoacrylate glue, penetrating keratoplasty, or conjunctival flap may be required.

There is an increasing demand for refractive surgery stemming from a heightened awareness among patients wearing spectacles or contact lenses. Cosmetic or occupational reasons prompt patients to seek the alternative option of refractive surgery.