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Purpose To compare a transconjunctival single-plane sclerocorneal incision with 2 tiny conjunctival cuts at both ends and a clear corneal incision (CCI) in cataract surgery. Setting Department of Ophthalmology, Institute of Clinical Medicine, University of Tsukuba, Ibaraki, Japan. Methods Patients having routine cataract surgery were randomly divided into 2 groups based on incision type; that is, transconjunctival single-plane sclerocorneal or CCI. The incidence of intraoperative ballooning of the conjunctiva (chemosis) and the percentage of eyes that required stromal hydration to securely close the wound in each group were recorded and compared. Results Each group comprised 61 eyes (61 patients). No eye in the transconjunctival sclerocorneal group and 6 eyes (9.8%) in the CCI group developed intraoperative conjunctival chemosis ( P = .027, Fisher exact probability test). Corneal stromal hydration was required in 2 eyes (3.3%) and 15 eyes (24.6%), respectively ( P = .001). Conclusion The transconjunctival single-plane sclerocorneal incision was effective and combined the merits of CCI incisions and sclerocorneal incisions. Financial Disclosure No author has a financial or proprietary interest in any material or method mentioned.

To describe the histopathology of the cornea in microphthalmia with linear streaks (MLS) syndrome.Two patients with MLS syndrome underwent penetrating keratoplasty. This study describes the histopathology and investigates immunophenotype of the corneal extracellular matrix by using keratan sulfate and collagen type III antibodies.Clinical examination revealed bilateral sclerocornea and characteristic skin changes. By light microscopy, central corneal stroma in both patients showed vascularization and irregular thick collagen lamellae typical of sclerocornea. In addition, corneal thinning, anterior synechiae, and the absence of the Descemet membrane were noted, which was suggestive of Peters anomaly. Diffuse and intense anti-keratan sulfate staining and minimal anti-collagen type III stromal staining were seen in both corneal buttons.The cornea in MLS may clinically resemble sclerocornea. Histologic features resemble those previously described in sclerocornea and also seen in anterior segment dysgeneses. Keratan sulfate and collagen type III labeling suggests that the corneal extracellular matrix resembled cornea and not sclera.

An 8-month-old caucasian girl with monosomy 21 and sclerocornea underwent bilateral penetrating keratoplasties. Both light and electron microscopic studies were performed on the corneal buttons. Light microscopy revealed variable and abnormal corneal thickness with the peripheral cornea being thinner than the center, lack of Bowman's layer, irregular stromal lamellae, stromal vascularization, markedly underdeveloped or absent Descemet's membrane, and marked attenuation of the endothelium. Electron microscopy demonstrated basal epithelial cells with a thin epithelial basement membrane residing directly on stromal lamellae without intervening Bowman's layer. Stromal collagen fibrils were irregular in size measuring 38-69 nm in diameter. We believe this to be the first report of corneal transplantation and the second reported case of sclerocornea in a patient with monosomy 21.

Small incision cataract surgery has several advantages over conventional surgery, including faster postoperative visual rehabilitation. We evaluated 100 consecutive cases of no-stitch, small incision surgery with a square sclerocorneal tunnel and a flexible intraocular lens. Permanent self-sealing of the wound seemed to increase intraoperative safety considerably. With the specific incision used, corneal trauma and irrigation fluid outflow were minimal. Refraction and K-readings stabilized within the first postoperative week, which is when most eyes attained best final visual acuity. No early peak or protracted drift of astigmatism occurred. Minimally leaking wounds in three eyes were left unsutured; a transient filtering bleb was observed in two of these eyes after resorption of an intracameral air bubble. Our results support the theoretical concept and justify the use of no-stitch, small incision surgery.

Eleven patients with blue sclera, limbus-to-limbus corneal thinning, hypermobile joints, and consanguineous parents were examined between January 1983 and September 1991. The clinical diagnosis was consistent with the Ehlers-Danlos syndrome type VI phenotype in all patients. A "halo" sign at the limbus was present in all patients. Corneal rupture occurred in seven patients (nine eyes) either spontaneously or following minimal trauma. Acute hydrops occurred in three patients. Bilateral microcornea was present in one patient and two patients had a unilateral increased corneal diameter as a result of secondary glaucoma after trauma. Peripheral sclerocornea was present bilaterally in five patients. Curvature abnormalities included cornea plana, keratoconus, and keratoglobus.

The effect of incision length, location, and shape on the structural integrity of the globe was examined using finite element analysis by comparing the radial deformation of the corneoscleral tissue adjacent to the incision. The results show that incision length had the greatest adverse effect, 12 mm incisions causing deformations an order of magnitude higher than the distension of the intact globe at 20 mm Hg. The least structural disturbance was produced by 3 mm scleral pocket incisions.

Four patients with rheumatoid arthritis had cataract extraction with implantation of an intraocular lens (IOL). Postoperatively three patients developed progressive scleromalacia perforans. All three cases required patch grafting of the sclera and two of them developed progressive melting of the sclera and graft. The fourth case involved progressive corneal melting with extrusion of the IOL despite treatment with penetrating keratoplasties. All four cases developed retinal detachments with loss of vision and three of the eyes were subsequently enucleated. We describe each case and discuss the clinicopathologic correlations of this condition. The need for careful evaluation of rheumatoid arthritis patients with cataract surgery and IOL implantation is emphasized.

We report a case in which a severe corneoscleral burn occurred during phacoemulsification surgery. The equipment-tuning process was uneventful and routine surgery was expected. Severe tissue injury occurred because the anterior chamber collapsed momentarily and the phaco tip touched corneoscleral tissue. We discuss mechanisms by which this type of injury may occur and the likely cause in our case. We also suggest methods to reduce the incidence.

We describe a technique for implanting sutured posterior chamber intraocular lenses. Results of a small series using this technique in different clinical situations with at least 12 months follow-up are presented.

We report a case of bilateral cornea plana and sclerocornea in a 14-year-old boy with recessive epidermolysis bullosa dystrophica. This is the first reported association of these anomalies. Bilateral cataracts were present at initial presentation. These spontaneously reabsorbed over the subsequent 18 months.

Purpose We present a clinicopathologic case report of sclerocornea with the intent of showing the usefulness of ultrasound biomicroscopy (UBM) and the correlation of histopathologic findings. Methods An infant with congenital bilateral sclerocornea was seen for an evaluation under anesthesia. Dense opacification of both corneas prevented adequate examination of both anterior and posterior segments of the eye. UBM was performed preoperatively with subsequent corneal transplantation of the left eye. The corneal button was submitted for histopathologic examination. Results Preoperative UBM proved helpful in assessing the status of the cornea as well as the anterior chamber and its structures. Findings on histopathologic examination correlated well with the results on UBM and confirmed the diagnosis of sclerocornea. Conclusion We recommend the use of UBM in assessing opacified corneas to assist in obtaining a diagnosis, to highlight potential associated structural anomalies, and to help guide decisions regarding surgical management.