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Purpose To evaluate the results of sutureless amniotic membrane (AM) transplantation using fibrin glue for reconstructing corneal surfaces with partial limbal stem cell deficiency (LSCD). Design Retrospective noncomparative interventional case series. Methods Eleven eyes of nine patients that had LSCD with 120 degrees to almost 360 degrees of limbal involvement underwent superficial keratectomy to remove the conjunctivalized pannus followed by AM transplantation using fibrin glue. Additional sutureless AM patch (ProKera; Bio-Tissue, Inc, Miami, Florida, USA) was used in seven patients, and mitomycin C was applied on the cornea in four eyes and during fornix reconstruction in seven eyes. The surgery was repeated in three eyes for residual pannus. Results During a mean follow-up of 14.2 ± 7.7 months (range, six to 26 months), all eyes maintained a smooth and stable corneal epithelial surface without recurrent erosion or persistent epithelial defect, and showed less stromal cloudiness and vascularization. Best-corrected visual acuity improved in nine eyes (81.8%). Corneal epithelialization proceeded by epithelial growth over AM (n = 4), accompanied by dissolution of AM (n = 4) or a combination of both (n = 3). No complication was noted regarding initial or repeated uses of fibrin glue. Conclusion AM transplantation using fibrin glue appears to be a safe and effective method of restoring a stable corneal epithelium for cases with partial LSCD. This approach avoids the need of transplanting limbal epithelial stem cells.

• Purpose: To determine whether contact lens-related corneal pannus regressed when eyes were refitted with rigid gas-permeable contact lenses and to investigate the role of hypoxia as the putative origin of this complication. • Methods: Twenty-three eyes of 14 patients with corneal pannus were identified retrospectively from a referral practice population and were separated into two subgroups. One subgroup accepted refitting with rigid gas-permeable contact lenses or discontinued contact lens wear, and the other elected to continue wearing hydrogel or polymethylmethacrylate contact lenses. The response of pannus was observed by slit-lamp biomicroscopy and photographs and was compared between the two subgroups. One eye of each of six patients identified with bilateral corneal pannus secondary to daily wear of hydrogel contact lenses was selected at random. Duplicates of the hydrogel contact lenses worn by these eyes were obtained, and their peripheral oxygen transmissibility (Dk/L p ) values were compared with those of a control group of hydrogel contact lenses identical to those worn by another group of patients, matched by age, gender, and laterality to the study group, but who did not have corneal vascularization. • Results: Vascularization regressed in 14 eyes of nine patients refitted with rigid gas-permeable contact lenses and also in both eyes of one patient who discontinued contact lens wear. All seven eyes of five patients who declined refitting showed persistence or increase of pannus. The mean Dk/L p of the hydrogel contact lenses for six eyes with pannus was 3.8 × 10 −9 cm ml O 2 /s ml mm Hg; mean Dk/L p was 8.6 × 10 −9 cm ml O 2 /s ml mm Hg for the lens of the control eyes. This difference was found to be statistically significant (P = .028). • Conclusion: Peripheral, contact lens-induced hypoxia is a risk factor for corneal pannus, and conversion from hydrogel or polymethylmethacrylate contact lenses to daily wear rigid gas-permeable contact lenses in these eyes successfully reversed this complication.

Eight aniridic patients with bilateral corneal scarring, vascularization, or edema underwent corneal transplantation in one or both eyes (11 eyes). Follow-up ranged from eight months to 5 1/2 years (average, three years). Six of 11 eyes (55%) had at least a two-line improvement in visual acuity and eight of 11 (73%) had at least one line of improvement. Best-corrected visual acuity was 20/200 or worse in nine of 11 eyes (82%), however. Postoperative complications included whorl keratopathy, persistent epithelial defects, central subepithelial scarring, peripheral vascularization with pannus, and graft rejection. Glaucoma was well controlled medically but five of nine patients (56%) with preexisting glaucoma needed an increase in medication for intraocular pressure control. Graft rejection occurred in seven of 11 eyes (64%) and three of these eyes required repeat transplantation.

Methyl ethyl ketone peroxide is a commonly used catalyst in various industries. We studied 19 eyes with a single exposure to methyl ethyl ketone peroxide that developed clinical patterns of mild injury, moderate injury, severe injury, or delayed keratitis. Delayed methyl ethyl ketone peroxide keratitis may cause exacerbations and remissions of corneal and limbal disease lasting more than 20 years with palpebral and bulbar hyperemia equal to the initial chemical exposure. With repeat exacerbation, further pannus may occur, which can be associated with a poorer outcome. Based on the capability of methyl ethyl ketone peroxide to change DNA to a new weak antigen, we suggest possible methods of therapy to prevent or limit delayed methyl ethyl ketone peroxide keratitis. This proposed type of injury has important implications in studying various limbal and corneal diseases. A major factor in the severity of ocular injury was the length of time from exposure to methyl ethyl ketone peroxide to obtaining a topical ocular local anesthetic to perform adequate lavage.

We report the results of conjunctival scrapings done in 234 eyes of 127 patients presenting with acute, chronic, or recurrent conjunctivitis. Although some patients had the classic features of superior pannus, Herbert's pits, conjunctival follicles, and tarsal distortions, others presented in a more subtle fashion mimicking allergic, viral, and bacterial diseases of the eyes. These scrapings were subjected to rapid diagnostic techniques and culture studies for the identification of chlamydial infections. The correlation between the clinical and laboratory diagnosis was studied. Of the 127 patients, 44 were culture positive for Chlamydia. Of these, only 19 had been clinically suspected to have chlamydial ocular disease, whereas the others were diagnosed to have bacterial, viral, allergic, or other diseases. This higher rate of Chlamydia detection is probably a reflection of endemicity of this infection in India. This article highlights the possible underdiagnosis of chlamydial ocular disease in the outpatient department and emphasizes the importance of microbiological evaluation in patients with atypical or chronic ocular surface disease.

Pannus was present in all stages of trachoma throughout a series of 31 cases. The biomicroscopic picture of the normal and pathologic limbus is described; that of trachomatous pannus being quite characteristic and useful for differential diagnosis. From the Department of Ophthalmology, State University of Iowa Hospital and College of Medicine. Read before the Colorado Congress of Ophthalmology at Denver, June 22, 1933.

The cases successfully treated with a conjunctival flap included ulcer, perforation of the cornea, and inveterate pannus. The advantages of this treatment are rapid healing and prompt relief from pain. Read at the annual meeting of the American Ophthalmological Society, Quebec, June 27, 1927.

For the eyes of laboratory animals, B. monocytogenes possesses a remarkable infectivity, most severe for guinea pigs, less so for rabbits and monkeys. The severe type of reaction, as it occurs experimentally in guinea pigs, consists of an acute conjunctivitis, exudate, and turbidity and vascularity of the cornea. Pathologically, the infection is characterized by a massive infiltration of the conjunctiva and cornea with monocytes, and by the appearance of congested capillaries which give the appearance of pannus in the cornea. Although the infection remains localized in the inoculated eye, a study of the circulating blood revealed occasional instances of a distinct mononucleosis which did not, however, parallel the clinical symptoms. Animals recovered from an eye infection, exhibited some local resistance to subsequent reinfection with the organism. From the Bacteriological Laboratories of the Oscar Johnson Institute, Washington University, School of Medicine. Conducted under a grant from the Commonwealth Fund of New York City.

Experiments in the therapeutic use of pepsin made in the Ophthalmic Clinic of the John Casimir University of Lwow, Poland, directed by Professor A. Bednarski, are here reported. The trials were made in lid diseases due to cicatrices in trachomatous pannus and in turbidity of the vitreous. In pannus and deforming infiltration of the tarsus it was found a helpful remedy. In diseases of the vitreous the benefit was less certain. First presented to the meeting of Polish Oculists in 1924.

This article does not lend itself to abstracting, as the substance of it is a comprehensive review of the entire subject. In discussing the difficulties in making an early diagnosis of trachoma, the author states that the slitlamp has been the means of advancing the date of earliest, correct, differential diagnosis and that pannus indisputably belongs in the picture of true trachoma. Presented in part at the Academy of Ophthalmology and Oto-Laryngology in Montreal, Canada, September 21, 1932, under the title, "Recent developments in trachoma investigations." From the Department of Ophthalmology, Washington University, St. Louis, Missouri.

A resumeof results obtained by leading students of trachoma in experimental inoculation of M. rhesus monkeys with B. granulosis is given. Four of five monkeys in which folliculosis was produced by the author yielded B. granulosis. The disease differs from human trachoma mainly in the absence of pannus. The author concludes that etiologic relationship of this organism to human trachoma can never be established by monkey experimentation. From the Departments of Ophthalmology and Bacteriology. University of Colorado School of Medicine.

A 14-month-old girl had inclusion conjunctivitis although there had been no signs or symptoms that required medical attention in her first year. By 2 1/2 years of age, the child had extensive pannus and corneal scarring that severely reduced vision. The infection was caused by a genital strain of Chlamydia trachomatis, TRIC type E, that was probably acquired at birth. Although genitally transmitted chlamydial strains normally cause a self-limiting inclusion conjunctivitis in areas where trachoma is not endemic, this case illustrates that they may occasionally cause severe trachoma. Possibly local idoxuridine (IDU) treatment (administered to this patient before the correct diagnosis was made) contributed to the severity of this infection.

This method evolved from modifications of tarsectomy has something in common with the old operation of peritomy for pannus, and yields very favorable results as here reported.

In February 1938 Dr. Fred Loe, of Rosebud, S. D., notified us of his successful treatment of trachoma in Indian subjects with sulfanilamide, the details of which he has recently published. 1 Favorable results were also reported by Lian. 2 After obtaining marked improvement with this treatment in certain isolated cases and rapid cure in 2 cases of experimental trachoma in baboons, we decided to test the drug on a series of persons with previously untreated active follicular trachoma in whom corneal progress could be followed by means of the slit lamp and the corneal microscope. Accordingly, we selected 14 Apache Indian children with active follicular trachoma, 12 to be treated and 2 to be kept untreated as controls. All children had pannus and exhibited corneal activity, as evidenced by dilated pannus vessels, subepithelial infiltrates and fluorescein-staining punctate epithelial lesions. Typical epithelial cell inclusions, characteristic of active trachoma, were demonstrated

The report of a case of trachoma experimentally induced in a human subject who had previously been inoculated with Bacterium granulosis several times, in an attempt to test its pathogenicity for the human conjunctiva, with negative results. The case here reported ran a typical course, developed pannus, was positive for Prowazek-Halberstaedter bodies, and resisted treatment. From the laboratories of the Pasteur Institute of Tunis and the Department of Ophthalmology, College of Medicine, State University of Iowa.

A man exposed to mustard gas in action suffered burns of the face and severe conjunctivitis. The corneas became steamy followed by opacity of the left. Four years afterwards there was photophobia, conjunctival hyperemia, pannus and epiphora.

We used wide-field specular microscopy to examine 60 eyes with clinically evident corneal epithelial abnormalities in vivo. The progression of epithelial edema from early basal edema to later bullous changes and eventual subepithelial fibrovascular ingrowth was observed in 35 eyes. Three eyes with filamentary keratitis displayed a protruding mucoid filament or actual mucus incorporation into the epithelium with surrounding distortion of superficial cells. Abnormally shaped and interdigitated epithelial cells were present as a result of trophic ulceration caused by herpes simplex keratitis. The Fleischer ring of keratoconus was microscopically evident as basal cells outlined by ferritin deposits. Surface epithelial cells in this disorder were elongated and contained increased numbers of dark cells in more severe cases. The raised granular lesion of Thygeson's superficial punctate keratitis and subepithelial deposits in cases of basement membrane dystrophy were also observed. Invading fibrovascular tissue was identified in superficial pannus.

A 5-week-old boy with Peters' anomaly was found to have an interstitial deletion of the long arm of chromosome 11; no developmental delays or dysmorphic features were evident. His right cornea was enlarged and opaque with extensive pannus formation; the anterior chamber, iris, and lens were not visible. The left eye showed a central opacity and a superficial pannus; the optic disk and macula could not be visualized. He underwent bilateral corneal transplantation. Histologic examination of the corneal buttons confirmed the diagnosis. The potential genetic mechanisms in this case included a gene for this autosomal recessive disorder on the long arm of chromosome 11, generalized disruption of the embryogenesis of the anterior segment as a result of the deleted material, or simple autosomal recessive inheritance unrelated to the chromosomal deletion.

It has been established by previous inves­ tigators that common laboratory animals are refractory to trachoma and that only pri­ mates contract the disease. After the etiologic agent became available through cultiva­ tion in yolk sacs of embryonated eggs, ex­ perimental trachoma in monkeys with the organisms propagated in eggs was reported by Thygeson and associates. They reported that the experimental disease was not ac­ companied by pannus, cicatrization or major involvement of the upper tarsus and, in these respects, it differed sharply from human trachoma. Inclusion conjunctivitis in man has been considered to be different from trachoma clinically, in that it affects mainly the lower conjunctivas, does not cause pannus or con.junctival scars and has a tendency to run a more acute but shorter course. In addition, it is epidemiologically different from tracho­ ma in that it is associated with genital infec­ tion. The organisms of inclusion conjunctiv­ itis can be cultivated by similar egg tech­ niques. Again, experimental eye disease can be produced only in primates and is report­ ed to be generally more severe than trachoma. As in the case of experimental trachoma, no pannus or scars have been re­ ported.