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We examined 19 eyes of 12 patients who had undergone penetrating keratoplasty utilizing the Castroviejo square graft technique. The visual acuities at the time of examination for inclusion in the study ranged from 20/30 to counting fingers. Of the 19 original square grafts, eight were judged clear centrally with varying degrees of peripheral stromal haze, and one was hazy. The remaining eight failed with varying degrees of irreversible corneal edema. The eight corneas obtained following repeat penetrating keratoplasty were studied with light and electron microscopy. The donor/recipient corneal stromal lamellae were continuous at the graft-host junction, particularly in the mid-stromal area. Disruptions in Descemet's membrane were present at the wound; transmission electron microscopy revealed differences in the composition of Descemet's membrane between the graft and the host. Two additional square grafts had failed, and the patients were awaiting keratoplasty. Nine of the 19 grafts were judged functionally clear, with six of the nine requiring contact lens correction.

To evaluate the effects of collagen shields on corneal epithelial healing following keratoplasty, we conducted a prospective study of 89 consecutive penetrating keratoplasty patients over a 9-month period, applying collagen shields in alternate cases. Eyes were evaluated on the first and on the eighth postoperative day. The appearance of the epithelium was graded on a scale from 0 to 4. Independent variables, such as donor age, patient age, patient and donor sex, death to preservation time, and donor time in K-Sol media prior to surgery, were also evaluated. Donor corneas treated with collagen demonstrated less epithelial staining and smaller epithelial defects on the first day following surgery. The results were evaluated with a Student's t test and were found to be significant (P less than 0.001). We conclude that the application of porcine collagen shields following keratoplasty is an effective means of encouraging reepithelialization of the graft.

We evaluated the efficacy of soluble ocular inserts made from porcine scleral collagen for the treatment of dry eye syndrome. The 22 patients enrolled in this pilot study were asked to grade their pretreatment symptoms and to document the frequency of artificial tear administration. Schirmer tests, fluorescein and rose bengal staining, and impression cytology of the conjunctival epithelium were also performed at the initial evaluation. Patients were evaluated in this fashion at 3-4, 6-8, and 18-20 weeks after initiation of treatment. We observed statistically significant improvement in symptomatology and reduced necessity for artificial tear administration. There was no significant change in rose bengal staining or impression cytology results. (The absence of objective findings suggests the possibility of a placebo effect.) These findings indicate that soluble collagen inserts may be useful in treating dry eye syndrome.