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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.

Four patients from families in Pennsylvania, Massachusetts, and Argentina were diagnosed clinically as having granular dystrophy. Results of pathologic examination of the corneal buttons from each patient after penetrating keratoplasty confirmed granular deposits in the anterior third of the stroma. Amyloid was demonstrated within some of these granular deposits by Congo red staining with birefringence and dichroism and by electron microscopy. In addition to the morphologically granular deposits, numerous fusiform deposits identified as amyloid by histochemistry and electron microscopy and morphologically identical to those seen in lattice corneal dystrophy were detected deep to the granular deposits. It was further shown that the histochemical pattern of staining of the granular material by a series of lectins was similar to that present in corneas with lattice dystrophy. Although a relationship between these patients cannot be definitively proven, each family traces its origins to the Italian province of Avellino.

We present four cases of Terrien's marginal degeneration that developed spontaneous ruptures in Descemet's membrane resulting in corneal hydrops. In all cases, the hydrops was characterized by a clear intracorneal pocket of aqueous humor rather than by stromal clouding. In two cases, the pocket extended peripherally to form a conjunctival filtering bleb. Although a lamellar corneal patch graft was used in one case for severe astigmatism, hypotony, and impending perforation, most cases were merely observed without treatment.

Based on their own study of nine corneas with clinically documented posterior poly- morphous dystrophy and a review ofthe literature, the authors describe the morphologic features of this entity. Study by phase contrast light microscopy and transmission and scanning electron microscopy found that changes were primarily in the endothelium and consisted of endothelial cell degeneration and loss with focal fibroblastic and epithelial-like cell transformation. Secon- dary alterations of Descemet's membrane were seen; they consisted ofabnormal lamination with deposition ofabnormal collagen material, particularly in the posterior collagen layer, and forma- tion of guttate excrescences and pits. (Surv Ophthalml 29:139-147, 1984)

Twenty-three patients who underwent penetrating keratoplasty were evaluated preoperatively for potential retinal acuity utilizing the Randwal Laser Interferometer and the Mentor Potential Acuity Meter. When compared with Snellen visual acuity during the early postoperative period (1-6 months), both instruments were useful as qualitative predictors of macular function when used in the presence of mild to moderate corneal edema. The laser interferometer was somewhat more accurate in the severe cases of corneal edema.

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.

In an ongoing series of reviews of the available texts in subspecialty areas of ophthalmology, Dr Arthur Boruchoff has examined the area of cornea and external diseases. Dr Boruchoff's survey takes the form of a letter written to the ophthalmologist just beginning practice. Daniel M. Albert, MDBook Review Editor June 1988 Dear New Ophthalmologist, Congratulations on finishing your ophthalmology residency and entering the real world of practice. You asked for my opinion about books in the area of cornea and external disease written in the past ten years that would be most useful in your practice. You pointed out that there are five categories you would like available in your office library, namely (1) a generalized comprehensive textbook, (2) a book to help in differential diagnosis, (3) a text to cover corneal infections, (4) a practical text covering corneal and adnexal surgery, and (5) a comprehensive textbook on refractive