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Recurrence of a corneal dystrophy after keratoplasty can occur in multiple dystrophies, including macular, granular, and lattice dystrophies. We treated two unrelated patients who had documented posterior polymorphous dystrophy and who, in previously clear grafts, developed haziness in the zone of Descemet's membrane, which led to graft failure. Histologic examination of the keratoplasty specimen showed changes typical of posterior polymorphous dystrophy.

Four patients with symptomatic superior limbic keratoconjunctivitis underwent resection of the superior bulbar conjunctiva. One of these patients also underwent a tarsal conjunctival resection in the other eye. Three of the patients had previously been treated by various regimens without resolution; the fourth had had no prior treatment. All four patients had immediate and continued relief of the ocular symptoms after the superior bulbar conjunctiva was excised. The patient who underwent tarsal conjunctival resection experienced only short-term relief. We studied the conjunctival tissue by light and transmission electron microscopy. Both techniques revealed abnormalities related to the bulbar conjunctival surface with keratinization of the epithelium, acanthosis, degeneration of the nuclei, and intracellular accumulation of glycogen. Inflammatory cells were minimally present. The tarsal conjunctiva appeared essentially normal.

We studied seven cases of severe gram-negative microbial keratitis associated with the use of contaminated topical ocular medications. Five cases involved Pseudomonas aeruginosa, one involved Serratia marcescens, and one involved Proteus mirabilis. In each case the same organism was cultured from corneal scrapings and from the medication. Either prednisolone acetate (one case) or timolol maleate (seven cases) was implicated in all instances.

We studied results of 124 keratoplasties in 100 keratoconus patients; 61 men and 39 women varying in ages from 11 to 69 years with an average age of 30 years. Twenty-four patients had bilateral grafts with a 27% incidence of rejection, and 76 patients had unilateral grafts with a 13% incidence of rejection (P less than .01). Data analysis of the first year after the graft of first eyes and subsequent years after the graft of first and second eyes, however, revealed a nearly fourfold increase of rejections following second grafts, with a 17% increased chance of rejection for the first graft after the second was implanted. Only two of the bilateral and two of the unilateral grafts were irreversibly lost because of graft reaction. The major complication was the formation of posterior subcapsular cataract, which occurred in approximately 32% of the patients. The final postkeratoplasty visual acuities were significantly improved. In the patients who did not develop a cataract, 86% achieved visual acuity of 6/12 (20/40) or better. In the patients who did develop cataracts, 68% achieved visual acuity of 6/12 (20/40) or better.

Six patients with persistent corneal epithelial defects that failed to improve with standard therapy were treated with topical fibronectin in a phase I uncontrolled trial. Fibronectin was purified from autologous plasma by affinity chromatography and administered topically, 0.5 mg/ml five times a day, for three weeks. Complete reepithelialization was achieved in five patients: three healed three to 17 days after initiation of treatment while two healed one to two weeks after discontinuation of topical fibronectin. No side effects were observed. Over a follow-up period of three to 18 months, two recurrences were noted.