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A female infant born at 28 weeks gestational age, weighing 570 g, developed retinopathy of prematurity (ROP) which progressed to threshold disease in one eye. Transscleral cryotherapy of the avascular peripheral retina resulted in complete clinical regression of the active ROP in that eye. The fellow eye continued to manifest subthreshold ROP. Histopathologic findings included a striking reduction of the cryotreated retina to a thin glial scar, with associated retinal pigment epithelium atrophy, denudation of Bruch's membrane, and extensive atrophy of the underlying choroidal vasculature, predominantly the choriocapillaris.

We report the light and electron microscopic findings from two eyes treated with argon laser peripheral iridoplasty (ALPI) for bilateral angle-closure glaucoma. The patient, a 45-year-old man, died from complications of acquired immunodeficiency syndrome 16 days following ALPI. Ocular pathologic findings included contraction furrow formation and proliferation of fibroblast-like cells, accompanied by collagen deposition on the iris surface, denaturation of stromal collagen, and coagulative necrosis of blood vessels within the anterior two thirds of the iris stroma. These findings suggest that heat shrinkage of collagen may be responsible for the short-term response to ALPI, and that contraction of the fibroblastic membrane may be responsible for its long-term effects. Additionally, the presence of coagulative necrosis of iris blood vessels suggests that overt treatment may result in iris necrosis. To our knowledge this is the first report of the histopathology of ALPI.

Compensatory hyperplasia of the corneal epithelium (CEH) has been observed histopathologically in animal and human eyes after excimer laser photoablative keratectomy, and has been implicated as a cause of variable refractive results and refractive regression after this procedure. Retrospective histopathologic analysis of routine keratoplasty specimens revealed CEH in 85 of 130 (65%) corneas with keratoconus, 18 of 36 (50%) corneas with chronic herpes simplex virus (HSV) keratitis, and 14 of 25 (56%) corneas coded as nonspecific scars. Mild CEH occurred apically and/or peripherally in keratoconus. Massive CEH (up to 200 microns thick) occurred in chronic HSV keratitis with irregular stromal loss. Our data indicate that CEH occurs frequently in several corneal diseases marked by stromal ectasia or loss. We postulate that stromal loss may contribute to CEH by providing relative protection against exfoliative shearing forces of superior eyelid closure. Our study complements previous reports that imply that CEH is a contributory factor in refractive regression after excimer laser photoablation.

This retrospective study examined demographic, clinical, and histopathologic factors in 24 traumatically ruptured globes that were enucleated at Wills Eye Hospital during a 2-year period. The majority of these injuries occurred in a violent assault setting with a blunt mechanism, during the evening and early morning hours, and in the fall and winter months. Most patients were black males, and 67% were substance abusers. Clinically, the initial visual acuity in 96% of the eyes was light perception or worse. Five of the eyes were enucleated primarily. Gross examination of the globes revealed that 92% of the wounds involved the sclera, 83% of the eyes had hyphema, and 71% of the lacerations were longer than 10 mm. Histopathologic examination demonstrated that the majority of eyes had fragmented or missing lenses, disrupted ciliary bodies, and detached choroids. Ninety-six percent of the retinas were detached. There was one case of acute endophthalmitis.

To assess for the possible development of a phototoxic lesion, we exposed five Dutch belted rabbit retinas to constant illumination with an implantable "chandelier" light source at maximal intensity for 1 hour. No clinically apparent lesion developed in any of the experimentally treated eyes by 48 to 72 hours posttreatment. Light and electron microscopic examination failed to reveal any of the characteristic changes of retinal phototoxicity. A control eye treated with a 20-minute exposure to a standard endoiluminator probe at maximal intensity held 2 mm from the retinal surface demonstrated typical light and electron microscopic phototoxic abnormalities, whereas a retina similarly treated with a 5-minute exposure was normal. We have confirmed that a standard endoilluminator probe can create a phototoxic lesion in the experimental setting. Furthermore, no phototoxicity from the sustained retinal exposure to a fixed, implantable light source for a clinically relevant duration could be demonstrated.

Signs of keratoconus, including Munson's sign, apical thinning, and Vogt's striae, developed in a 41-year-old woman 6 years after successful penetrating keratoplasty. Screening donor corneas for ectatic diseases may prevent such occurrences.

Anterior stromal puncture has recently been proposed as a new treatment for recalcitrant cases of recurrent corneal erosion. Concerns about the risks of corneal perforation and scarring, as well as doubts regarding its efficacy have prevented many patients from benefiting from this procedure. We introduce a new, inexpensive, commercially available instrument designed to standardize this technique, minimize scarring, and prevent corneal perforation. In a clinical trial involving 25 consecutive patients with recurrent erosions resistant to vigorous conservative treatment, the first 11 patients underwent stromal puncture in which a straight tuberculin needle was used; the following 14 were treated with a newly designed prototype needle. All patients in this series remained free of erosions after completion of stromal puncture, except for one woman with marked diffuse anterior basement membrane dystrophy, who went on to develop spontaneous bilateral erosions. Follow-up ranged from 2 months to 30 months (mean, 13 months). There were no complications of stromal puncture, and subjective and objective evaluations revealed no significant postoperative glare. Microscopic analysis of eye bank eyes subjected to anterior stromal puncture procedures demonstrated that the new prototype needle provided shallower penetration and thus less likelihood of perforation or excessive scarring than the straight needle. Also, postoperative discomfort and scarring appeared to be significantly less in patients treated with the prototype needle.

To investigate the contribution of endothelial dystrophy to the subsequent development of pseudophakic bullous keratopathy, we retrospectively reviewed the clinical records and histopathologic specimens of pseudophakic patients who had undergone penetrating keratoplasty for corneal decompensation. Conclusive evidence of endothelial dystrophy was found in a majority (18 of 27, 67%) of patients who developed pseudophakic bullous keratopathy following implantation of a posterior chamber intraocular lens. By contrast, the incidence in a comparable group of 51 pseudophakic bullous keratopathy patients with anterior chamber intraocular lenses was low (six of 51, 12%) (P less than 0.01). In analyzing the relative risk of post-surgical corneal decompensation, one cannot implicate a particular intraocular lens without considering pre-existing endothelial dystrophy.