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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.

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.

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.