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Keratoconus is found in conjunction with many ocular and nonocular disorders. We describe five patients with concurrent keratoconus and corneal endothelial dystrophy.

This study involved a group of 407 patients (799 eyes) with pigment dispersion syndrome gathered from a glaucoma population of 9200 patients. The sex distribution was equal. The majority (65%) of patients were myopic. The incidence of retinal detachment was 6.4%. No patients were black, but 5 were mulatto. Approximately one-quarter of the patients wih pigment dispersion syndrome (31% of the men, 19% of the women) had glaucoma. The average age of onset of glaucoma was 15 years less than in control patients with chronic simple glaucoma. When both eyes were affected by glaucoma, the glaucoma was consistently more severe in the eye with the more heavily pigmented angle. The degree of iris transillumination was found to be of no importance in predicting the presence of glaucoma or the severity of trabecular pigmentation. The pressure in 66% of the eyes with pigmentary glaucoma was controlled medically. A higher percentage of patients with pigmentary glaucoma required surgery than patients in the control group with chronic simple glaucoma. Men with pigmentary glaucoma required surgery at a much earlier age than women with pigmentary glaucoma.

A retrospective study was performed to determine the long-term course of pseudoexfoliation (PEX) as it relates to both the development of elevated intraocular pressure and to the initial appearance of exfoliation material in normal fellow eyes of patients with PEX. Six hundred eighty patients seen from 1940 through 1980 were diagnosed as having PEX. Patients were excluded from long-term study if there was a diagnosis of glaucoma prior to examination at our institution (199 patients), if glaucoma was present at the time of diagnosis of PEX (40 patients), if there was a history of prior intraocular surgery or disease (19 patients), or if there was only one ocular examination performed (75 patients). The remaining 347 patients with initially normal intraocular pressures were followed over time and consisted of 225 patients with unilateral PEX and 122 patients with bilateral PEX (a total of 469 PEX eyes). Life table (actuarial) analysis was used for data evaluation. During the course of the study, 32 (14%) of the unilateral cases of PEX became bilateral. The cumulative probability of a normal fellow eye developing PEX increased over time, with a 6.8% cumulative probability in 5 years and a 16.8% cumulative probability in 10 years. Elevated intraocular pressure developed in 35 patients (44 eyes) during the study. The cumulative probability for eyes with PEX to develop elevated intraocular pressure was 5.3% in 5 years and increased to 15.4% in 10 years. These probabilities predict that patients with PEX have a higher incidence of developing elevated intraocular pressure than would be expected in patients without PEX of similar age.

I have described modifications that have evolved over the years in doing iridectomy with cautery and have reviewed some of my experiences with the method. All filtering operations leave a great deal to be desired. Each technique has certain advantages and disadvantages. A great advantage of the cautery procedure is its safety and simplicity. It is as effective in lowering pressure as most other procedures. Even if the operation fails to control pressure, little harm is done to the eye, and it can be repeated. One of the great advances in management of open-angle glaucoma in recent years has been the adoption of stringent indications for surgery. Surgery should not be advised until a thorough trial of maximal medical therapy has been made. In many instances, however, the pendulum has been allowed to swing too far. When medical treatment has failed, and the patient is faced with progressive loss of vision if control of pressure is not achieved, the ophthalmic surgeon should resist the temptation to procrastinate. Surgery should be done promptly and deterioration should not be allowed to occur. Should a cataract occur, it can be removed. Endophthalmitis can be prevented or cured by antibiotic therapy. Although filtering operations leave a great deal to be desired, when effective, they will preserve a functioning optic nerve.

The cause of aphakic glaucoma should always be determined because treatment must be directed towards the aetiological mechanism. We have defined early aphakic glaucoma as that occurring within the first 6 postoperative weeks and late aphakic glaucoma as occurring at any later time. Of the various causes of glaucoma in each category, among the most serious and challenging to treat are pupillary block and angle closure. These emanate from postoperative shallow or empty anterior chambers which are associated with wound fistula, choroidal detachment, or a combination of both. Other mechanisms producing aphakic glaucoma are inflammation, alpha chymotrypsin, epithelial downgrowth, and iris cysts. Pressure elevation unrelated to aphakic glaucoma may also result from intraocular tumours, recurrence of glaucoma secondary to uveitis, and undiagnosed preexisting primary glaucoma.

Preheating local anesthetic agents used for retrobulbar and facial nerve injection greatly decreases patient discomfort.

Late failure of a filtering cicatrix occurred in a patient who had had surgery to control the glaucoma associated with the iris nevus syndrome (Cogan-Reese). The internal surface of the filtration site, as well as the anterior chamber angle, proved to be lined by corneal endothelium that had laid down a new, thick basement membrane (Descemet). The new endothelium-basement membrane probably obstructed the flow of aqueous into the bleb. Endothelialization of a filtering bleb is not unique to the iris nevus syndrome; other causes are discussed.

A patient had Fuchs heterochromic iridocyclitis of approximately 17 years' duration. Histologically, keratic precipitates, iris atrophy, rubeosis iridis, discontinuous rubeosis of the anterior chamber angle, a chronic nongranulomatous iridocyclitis, and trabeculitis were noted. The cause of the glaucoma probably is a combination of rubeosis of the anterior chamber angle and trabeculitis.

Two patients had biopsy-proven linear scleroderma, associated with a pigmentary abnormality of the anterior segment of the eye. One patient had heterochromia iridis, atrophy of the upper eyelid, a typical coup de sabre lesion, and a markedly asymmetric pigmentary glaucoma. The second patient had bilateral scalp involvement, paresis of the extraocular muscles, blepharoptosis, and heterochromia iridis.

The various of primary glaucoma are described in the form of an atlas with regard to their anatomy and treatment after a basic treatment of the gonioscopic conditions. The single illustrations show the chamber angle in the various possibilities of the course of narrow-angle glaucoma (interval or pre-glaucoma, acute congestive glaucoma and chronic congestive glaucoma) and the appropriate medical and surgical suggestions for therapy. In the same way the special anatomical points of the anterior segment in wide-angle glaucoma and its therapy are described pictorially.

The water drinking test was performed on 122 glaucoma suspect patients using the standardized Schiotz tonometer and Goldmann applanation tonometer. Additionally, the tonography was performed on 12 glaucoma suspect patients before the water test and on 69 glaucoma suspect patients after the water test. Our results showed that the most accurate test is the applanation water test. However, the accuracy of tonography was also increased if the tonography was performed after the water drinking test. The evaluation of the water drinking test only by Schiotz tonometer was not satisfactory. By using the applanation tonometry the sensitivity of the water test could be improved by 70%.

A 36-year-old white man with congenital ichthyosis and a history of a posterior uveitis beginning at age 8 presented with an unusual corneal opacity. At age 26 bilateral central corneal opacities were noted consisting of fine interlacing white lines forming a reticulum at the level of Bowman's membrane. A faint brown background tint of the basal epithelium was also present. Over the next 10 years the opacity progressed only slightly, with some mild superficial scarring of the underlying corneal stroma. The visual acuity remained good. This corneal pattern appeared virtually identical to the superficial reticular degeneration of Koby. As described by Koby in 1927, this rare corneal degeneration is characterised as a painless, slow, progressive development of a central fine, white reticulum at the level of Bowman's membrane. This rare corneal degeneration probably represents an atypical form of band keratopathy.

Results of 1000 consecutive intracapsular cataract extractions done by the same surgeon over a 21-month period are reviewed. Cataracts were removed using a technique that included loupe magnification, cryoextraction, and nonabsorbable suture material.

Senile entropion is a common cause of ocular discomfort. Medical treatment is ineffective for it and a definitive operation generally is required. Many surgical procedures are available, but most of them are not effective. The operation described in this paper was devised by one of us (H.G.S.) 9 years ago, employing a modification of the Schimek procedure. It has the advantage, however, of fixation of the sutures to the periosteum of the lateral orbital rim and thus provides firm support for the lid septum. The operation is simple, safe, and takes little more. Even if entropion recurs, the operation can be repeated with no damage to the lid.

Fourteen patients (ten women, four men) with iris nevus (Cogan-Reese) syndrome, all having unilateral glaucoma, were studied clinically. Many had corneal edema, and all had changes in the iris consisting of one or more of the following: iris whorls or nodules or both, atrophy of iris stroma, heterochromia (the darker iris usually involved), or ectropion uveae. All had peripheral anterior synechias. Material for histological study was available from ten patients and showed a nonmalignant diffuse nevus of the anterior surface of the iris. An overgrowth of endothelium and Descemet membrane extending onto the iris surface may be a characteristic part of the process. Patients tended to be women in middle age. Conservative treatment avoiding enucleation is advised. Whenever a patient with suspected iris nevus syndrome or essential iris atrophy is subjected to glaucoma surgery, a biopsy specimen of the iris should be obtained for histological study.

A 70-year-old man had a rapid growth of a pigmented eyelid lesion, previously stationary for at least 50 years. Because of the suspicion of malignant melanoma, the lesion which resembled a cutaneous horn was excised. Histologic examination demonstrated a benign epithelial tumor, inverted follicular keratosis.

The clinicopathologic findings in an eye from a 40-year-old man with essential iris atrophy are reported. Noteworthy is the proliferation of corneal endothelium and a laying down of a new Descemet (cuticular) membrane over the trabecular meshwork and in areas of anterior peripheral synechiae formation over the pseudoangle. The histologic characteristics favor a vascular cause for the condition, but the evidence is circumstantial.

We used a safe and simple surgical technique in the management of persistent filtering cicatrices after cataract extraction. The edematous, friable filtering cicatrix was excised entirely and a healthy fornix-based conjunctival flap was sutured over the fistula. Invariably, the fistula was very small, usually only large enough to admit a 27-gauge needle. Of the 27 eyes treated with this technique, there were two failures, but no other complications.