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Introduction: Silicon oil or polydimethylsiloxane fluid is used in complicated retinal detachment surgeries. Although it displays an array of side effects like progressive vascularisation, silicon granules in corneal stroma and corneal decompensation, the lesser known band shaped keratopathy is visually endangering and requires a new management protocol, as was seen in our case. Case: A 15-year-old girl with vision 6/60 in both eyes diagnosed with bilateral congenital cataract and retinal detachment underwent microincision vitrectomy, lensectomy along with perfluorocarbon and intravitreal silicon oil injection in the right eye under general anaesthesia. Calcific band shaped keratopathy was seen after 8 months which began as fine dust like deposits coalescing to form a horizontal band. A neutral, autoclaved solution of 0.5% EDTA chelating agent was spread over the cornea and deposits scraped under aseptic precautions after removing the superficial epithelium. A bandage contact lens was placed to enable healing.

Aims: To study cases of corneal degenerations presenting to a tertiary eye care centre in central India with regards to their clinical profile, socio-demographic parameters, association with dry eye and their visual impairment at presentation. Materials and Methods: Cases of corneal degenerations presenting to our Cornea Clinic in a span of one year were identified and categorized. Details were noted regarding age, sex, socioeconomic status, residential locality, occupation, working conditions and prior ocular history. Dry eye assessment was done using Schirmer test and patients were sorted under various categories of visual disability. Results: We came across a total of 127 cases of corneal degeneration, among which the maximum number (74.80%) were of Arcus Senilis (95 cases), followed by 10.24% Spheroidal Degeneration (13), 7.09% Band Shaped Keratopathy (9), 5.51% Crocodile Shagreen (7), 1.57% Salzmann Nodular Degeneration (2) and 0.79% Terriens Marginal Degeneration (1 case). The mean age was 61.66 years and the male: female ratio was 1.89:1. Most cases belonged to low socioeconomic status (48.03%), urban locality (65.35%) and were involved in indoor work (67.72%), with the exception of spheroidal degeneration. Only 12.60% cases of degeneration had Schirmer 1 values suggestive of dry eye problem ( (32.28%) fell in Category 2 of visual disability (75% impairment), excluding the 33.86% of cases which had even Conclusion: The study sheds light on the profile of cases of corneal degenerations, some findings in accordance with the existing data and some not, in particular relevance to the current trend and the specified region. Keywords: Clinical profile, Corneal degenerations, Sociodemographic factors, Visual impact.

Background Juvenile idiopathic arthritis (JIA) is the commonest cause of uveitis in children. Uveitis is a significant cause of visual impairment in children with potential complications such as band keratopathy, cataract, posterior synechiae, glaucoma, cystoid macular oedema and a retinal problems. Following the initial treatment with topical and systemic corticosteroids, a wide variety of immunosuppressant agents have been used in the treatment of non-infective uveitis including methotrexate (MTX) and biologic therapy, most of which are administered parenterally. Mycophenolate Mofetil (MMF) is an oral immunosuppressant that inhibits the proliferation of T and B lymphocytes, which has been tried in children with uveitis with mixed results. We started using MMF in children seen in our paediatric uveitis clinic initially as a third line agent when the inflammation is not well controlled despite therapeutic doses of MTX and Adalimumab, as the NHS England Clinical Commissioning Policy does not recommend the use of Infliximab in uveitis not associated with JIA. Buoyed by some favourable result, we have since then used MMF as second line and even first line agent in children with uveitis. Methods Retrospective analysis of the clinical profile of children with uveitis on MMF at a tertiary paediatric rheumatology centre with focus on response to treatment. Results Of the 8 patients who received MMF, six (75%) were girls. Half of them (4/8) had idiopathic uveitis and the rest, associated with JIA. 2/8 patients had MMF as third line agent on top of MTX and Adalimumab, while five of them had it as second line agent on top of Adalimumab due to either MTX intolerance or needle phobia. One patient was started on MMF as first line agent following topical steroids. 6 (75%) of the patients responded/stayed in remission following the addition of/switch to MMF. Conclusion MMF has shown initial promise in the treatment of uveitis in children with uveitis in this small cohort, in line with some existing evidence. It was initially used in patients who were not keen on injections/intolerant to MTX or had failed all existing options. This is a small cohort of patients and we would welcome more research in this area. Conflicts of Interest The authors declare no conflicts of interest.

Purpose: To evaluate the relationship between the morphology and retinal function of macular microhole (MMH) variants. Materials and Methods: We evaluated 12 eyes of 11 patients with defects in the IS/OS junction of photoreceptor layer with SD-OCT. All patients underwent comprehensive ophthalmic examination including spectral domain optical coherence tomography (SD-OCT) and microperimetry. Results: The mean logMAR visual acuity in the affected eye was 0.15 ± 0.17 (range 0.00-0.5). Mean horizontal diameter of the MMH was 163 ± 99 μm; the mean retinal sensitivity in the area corresponding to the MMH was 13.79 ± 4.6 dB. Negative correlation was found between the MMH diameter and the retinal sensitivity (r = -0.65, p0 = 0.02). Three morphological patterns of MMH variants were recognized on SD-OCT, which did not differ in retinal sensitivities. Conclusion: We described and classified the MMH variants and made an assessment on the physiological functions using microperimeter.

Phototherapeutic keratectomy (PTK) is done regularly for anterior corneal diseases such as corneal dystrophies, corneal degenerations, scars, and band-shaped keratopathy. The various indications include both therapeutic and visual. The aim of this article is to discuss the therapeutic indications for PTK, the specific technique pertaining to a specific etiology, the various other procedures like amniotic membrane graft combined with PTK or PTK being done for recurrences in the grafts, and PTK done before cataract surgery when the anterior corneal pathology coexists with the cataract. Post PTK management such as healing of an epithelial defect, use of steroids in the post PTK period, recurrences of primary disease pathology, and infections, will be discussed. Methods of literature search: A Medline search was carried out for articles in the English language, with the keywords, phototherapeutic keratectomy, band-shaped keratopathy, spheroidal degeneration, scars, bullous keratopathy, and corneal dystrophy. The relevant references are mentioned here.

Purpose: To compare the status of corneal endothelium and central corneal thickness within the first four postoperative years after deep anterior lamellar keratoplasty (DALK) and penetrating keratoplasty (PK) in patients with keratoconus. Materials and Methods: Thirty-nine eyes (Group A) which had PK and 44 eyes (Group B) which had DALK for the treatment of keratoconus were included in this retrospective study. The endothelial cell density (ECD), the mean endothelial cell area and the coefficient of variation of cell area were assessed with a non-contact specular microscope, and the central corneal thickness (CCT) was measured with an ultrasound pachymeter. Results: Mean ECD loss rate at two years was 36.24% in Group A and 18.12% in Group B (P

Purpose: To evaluate the safety, efficacy and potential risks of Artiflex foldable iris-fixated phakic intraocular lens (pIOL) implantation for the management of myopia. Materials and Methods: Seventy-eight eyes of 40 consecutive patients with a mean spherical refraction of –11.70 ± 3.77 diopters (D; range –5.50 to –17.5 D) were included in this prospective, noncomparative, interventional case series. Main parameters assessed were uncorrected visual acuity (UCVA), best-spectacle corrected visual acuity (BSCVA), corneal topography (Orbscan II, BauchandLomb, Rochester, NY, USA), manifest and cycloplegic refractive errors, endothelial cell density (ECD) and applanation tonometry. Results: After 2 years, BSCVA was 20/40 or better in 82% of the eyes and UCVA was 20/40 or better in 84% of the eyes. After 1 month, 1 year, and 2 years, 51.3% (37 of 72 eyes), 58.9% (46 of 78 eyes) and 76.0% (38 of 50 eyes) of eyes gained 1 line or more of BSCVA, respectively. Compared to preoperative values, the mean endothelial cell loss was 2.6% at 1 month, 4.9% at 1 year and 7.4% at 2 years. Pigmented or non-pigmented precipitates were observed in17 eyes (21.7%) which were treated with topical corticosteroids. At the second postoperative year, pigmented precipitates persisted in nine eyes. However, this was not associated with a loss of BSCVA. Conclusion: The implantation of Artiflex pIOL is an effective surgical option for the management of high myopia. The most common complication observed within 2 years of follow-up was accumulation of pigmented precipitates with no effect on the final BSCVA.

A 69-year-old lady presented with complaints of decreased vision in left eye since one month. Best Corrected Visual Acuity (BCVA) was 6/18 in that eye. Fundus examination revealed non-central geographic atrophy and soft drusens at macula in both eyes. Temporal periphery of left eye revealed subretinal exudates with altered sub-RPE hemorrhage mimicking peripheral exudative hemorrhagic chorioretinopathy (PEHCR). Fundus Fluorescein Angiogram showed window defects at macula and blocked fluorescence at temporal periphery in left eye. However, Indocyanine green angiography (ICGA) revealed active peripheral choroidal polyps. The patient was successfully treated with intravitreal bevacizumab and ICGA-guided laser photocoagulation. 27 months after laser treatment, BCVA improved to 6/9. Rationale of consecutive anti-vascular endothelial growth factor (VEGF) treatment followed by more definitive laser photocoagulation is that anti-VEGF aids in resolution of subretinal fluid, thus making the polyp more amenable to focal laser photocoagulation which stabilizes the choroidal vasculature and prevents further leakage.

Wataru Kobayashi,1 Shunji Yokokura,1 Takehiro Hariya,1 Toru Nakazawa1–3 1Department of Ophthalmology, 2Department of Retinal Disease Control, Ophthalmology, 3Department of Advanced Ophthalmic Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan Background: The purpose of this study was to assess the effectiveness of 2% ethylenediaminetetraacetic acid (EDTA) for the treatment of band-shaped keratopathy.Methods: We studied 24 eyes of 16 patients with band-shaped keratopathy who underwent EDTA chelation treatment from April 1, 2011 to December 31, 2012. We compared preoperative and 1 month postoperative logarithm of the minimum angle of resolution (logMAR) best corrected visual acuity, intraocular pressure, and corneal curvature radius (K1, horizontal meridian; K2, vertical meridian; Km, average of K1 and K2). The Mann-Whitney U-test was used to determine the significance of differences.Results: There was a significant difference in preoperative and postoperative logMAR best corrected visual acuity (P=0.01). There were no significant differences in preoperative and postoperative intraocular pressure (P=0.24) or corneal curvature radius (K1, P=0.54; K2, P=0.49; Km, P=0.45).Conclusion: After 2% EDTA chelation treatment, post-operative logMAR best corrected visual acuity improved significantly. Moreover, since there was no significant difference in corneal curvature radius, there was little influence on corneal surface form. We believe that the results of our 2% EDTA chelation treatment were comparable with results obtained with 3.75% EDTA chelation treatment in previous reports. Two percent EDTA chelation is an effective treatment for band-shaped keratopathy and a useful method for any institution. Keywords: ethylenediaminetetraacetic acid, band-shaped keratopathy, phototherapeutic keratectomy, cornea

OBJECTIVE: To assess the efficacy of the VISX 20:20 excimer laser for phototherapeutic keratectomy (PTK) for band keratopathy. DESIGN: A prospective assessment of subjective and objective parameters associated with both the treatment and the disease. SETTING: This study was undertaken in a specialist clinic receiving many tertiary referrals at a specialist teaching hospital in a capital city. PATIENTS: Twenty-one eyes of 21 patients attending the corneal clinic with band keratopathy elected to undergo PTK. RESULTS: Although restricted to a single diagnosis, the patients proved to be heterogeneous with regards to visual potential and pain. All patients with visual potential had a subjective improvement in vision after treatment, and objective improvement was documented in over half. A shift to hypermetropia, by a mean of 2.4 D was seen. Where pain was the indication for treatment, all patients had markedly reduced or no symptoms after therapy. CONCLUSIONS: Excimer laser PTK with the VISX 20:20 laser is a highly effective, minimally invasive, out-patient treatment for band shaped keratopathy, which is likely to be the most common of the superficial corneal opacities and corneal surface disorders with pain which can be considered for PTK.

The association of macular detachment with posttraumatic macular hole is a known but rare occurrence. Spontaneously occurring resolution of the detachment and closure of the macular hole has been reported only once in the literature. We describe a similar rare event in a young male, the documentation of which was done serially by microperimetry (MP) and optical coherence tomography (OCT). A 17-year-old male presented with a decrease in vision following a closed globe injury to the left eye. A coexisting macular hole and macular detachment were detected in the affected eye. Serial follow-up with OCT and MP documented complete resolution of the macular hole and the macular detachment within 1 week of presentation. The case highlights that spontaneous resolution of traumatic macular hole and related macular detachment may occur and a waiting period is advisable before undertaking any corrective surgical procedure. The pathophysiologic mechanisms of causation and the resolution of posttraumatic macular hole-related retinal detachment are discussed.

This clinical study reports on an unusual start of a band-shaped keratopathy in a patient with diabetic nephropathy on dialytic treatment. The earliest corneal manifestations were centrally located small greyish-white disc-shaped lesions evenly distributed in the interpalpebral area in the left eye. Later a typical peripheral band-shaped keratopathy developed. In the course of the observation period the peripheral keratopathy rapidly spread towards the centre, finally resulting in a complete band-shaped keratopathy in which only the most central original disc-shaped lesions could be identified. Serum calcium and phosphorus concentrations were markedly elevated at the time of the progression of the band-shaped keratopathy but no tertiary hyperparathyroidism was present.

Calcific band-shaped keratopathies are characterised by calcium deposits in Bowman´s membrane and in the superficial stromal layers of the cornea. They occur from localized ocular inflammatory disease and from systemic disease that causes hypercalcemia and/or hyperphosphatemia. Local application of phosphate-containing eye drops as well as intracameral phosphate-containing irrigation solutions are further mentioned to cause corneal calcification. Intracameral r-TPA (recombinant tissue plasminogen activator) sometimes causes irreversible corneal calcification. Whether the phosphate-containing buffer to r-TPA or r-TPA itself is responsible for corneal calcification has not been tested to date. The aim of this study was to observe the effects on the cornea following intracameral injection of phosphate buffer and the importance of the structural integrity of the corneal endothelium. The anterior chambers of rabbit eyes were injected with phosphate buffer of different concentrations. To examine a possible effect of an endothelial dysfunction, a circumscribed mechanical lesion of the corneal endothelium was performed in a defined manner on a second group. The control group only received the endothelial lesion. Slit lamp examinations were performed over a period of one month followed by histological examination of representative specimen. Calcium deposits were proven by von Kossa staining. Corneal calcifications occurred in eyes with and without mechanical endothelial lesion. Deposits of calcium salts were found subepithelial and in the superficial stromal layers of the cornea. In eyes with an endothelial lesion the total amount of phosphate needed to cause an opacification might be slightly lower than in eyes without endothelial injury. Corneal calcification can be caused by intracameral injection of phosphate buffer. A mechanical lesion of the corneal endothelium is not required. In eyes with an endothelial lesion the total amount of phosphate needed to cause an opacification may be slightly lower than in eyes without endothelial injury., Kalzifizierende Bandkeratopathien zeichnen sich durch eine Ablagerung von Kalziumsalzen in der Bowman-Membran und den oberflächlichen Stromalamellen der Hornhaut aus. Äthiopathogenetisch kommen verschiedene auslösende Faktoren in Betracht. Neben primären Erkrankungen des Auges und Systemerkrankungen, die Veränderungen im Kalzium- und Phosphatstoffwechsel bewirken, spielt auch die intraokulare sowie topische Anwendung von phosphathaltigen Präparaten eine Rolle. R-TPA (rekombinanter Gewebeplasminogenaktivator) ist ein gentechnisches herge-stelltes Enzym, welches Plasminogen in Plasmin spaltet und sowohl zur Lyse ansonsten therapierefraktärer Fibrinreaktionen in der Vorderkammer, als auch zur Behandlung von submakulären Blutungen in der Ophthalmologie Verwendung findet. Im Zusammenhang mit der Anwendung von r-TPA ist vereinzelt über das Auftreten von kalzifizierenden Bandkeratopathien berichtet worden. Ob für die Genese dieser Art von Keratopathie r-TPA als Einzelstoff oder eventuell auch die als Solvens verwendete stark phosphathaltige Pufferlösung verantwortlich ist, konnte bis jetzt nicht mit letzter Sicherheit geklärt werden. In vorliegender Arbeit sollte der Hypothese nachgegangen werden, inwiefern eine Phosphatbeladung der Vorderkammer eine Kalzifizierung der Hornhaut hervorrufen kann und welche Bedeutung dabei der zellulären Integrität des Hornhautendothels zukommt. In einem Kaninchenmodell wurden die Vorderkammern der Versuchstiere mit absteigenden Konzentrationen einer handelsüblichen Phosphatpufferlösung und somit unterschiedlichen absoluten Phosphatmengen beladen. Um mögliche Einflüsse einer gleichzeitig bestehenden Schrankenstörung auf die Genese einer bandförmigen Keratopathie zu untersuchen, wurde das Endothel in einer zweiten Versuchsgruppe vor der Phosphatbeladung mechanisch mit einer Kanülenspitze auf definierte Weise verletzt. Kontrolltiere erhielten lediglich eben erwähnte Endothelinzision. Kontrollen erfolgten jeweils am ersten postoperativen Tag sowie in wöchentlichen Abständen mittels Spaltlampenuntersuchung in medikamentöser Mydriasis. Nach Ablauf des Beobachtungszeitraumes erfolgte die exzitationslose Tötung der Versuchstiere und eine Enukleation der Bulbi. Der Nachweis von Kalziumsalzen erfolgte durch die von Kossa-Färbung an repräsentativen Hornhautdünnschichtschnitten. Sowohl bei Hornhäuten mit als auch bei Hornhäuten ohne Endothelinzision konnten dabei Kalzifizierungen nachgewiesen werden. Diese traten überwiegend subepithelial und in den oberflächlichen Stromalamellen auf. Bei der in vorliegender Arbeit durchgeführten Versuchsreihe zeigte sich, dass Hornhäute mit einer mechanischen Endothelschädigung nach Beladung der Vorderkammer mit Phosphat bereits bei etwas niedrigeren Mengen Kalzifizierungen entwickelten als Augen ohne Endothelläsion. Korneale Kalzifizierungen im Sinne von Bandkeratopathien lassen sich durch intrakamerale Injektion von phosphathaltigem Puffer auslösen. Dabei ist eine Schrankenstörung im Sinne einer operativ vorgenommenen Endothelinzision nicht zwingend erforderlich. Lediglich scheint bei vorgeschädigtem Endothel die Phosphatmenge, die benötigt wird um eine Kalzifizierung hervorzurufen, geringer zu sein als an Augen mit intakter Endothelschicht.

Sir, I read with interest the article entitled “Assessing Framingham cardiovascular risk scores in subjects with diabetes and their correlation with diabetic retinopathy” by Damkondwar, et al.[1] I want to raise certain issues concerning the validity of the results obtained in the said study. Sir, say, A (Framingham scores in type II diabetics), B [Cardiovascular Disease (CVD) risks in type II diabetics] and C (diabetic retinopathy) are three entities and if one wants to correlate B with C by measuring A, then A and B must have undoubted pre-existing correlation. But in the said study, it was admitted “There is no longitudinal study from India which can suggest whether the scores underestimate or overestimate the CVD risk among subjects with type II diabetes”. It was even not mentioned whether the cross-sectional data obtained in the study were in conformity with the Framingham study or not. Therefore when the standard (Framingham scores) was not standardized (validated) for CVD risks in Indian diabetic population, how can Framingham scores and/or CVD risks be correlated to diabetic retinopathy? Framingham cardiovascular risk score is notoriously known for its high interethnic variability.[2,3] In fact it is often said that Framingham cardiovascular risk score correlates well only in the race from where it is actually evolved. The authors themselves mentioned that in the United Kingdom Prospective Diabetic Study (UKPDS), the Framingham scores underestimated the 10-year risk of CVD in type II diabetics by 32%. Therefore, the said scores though being globally investigated are not globally accepted for application. Hence mentioning Framingham scoring as ‘global risk assessment tool’ and advocating interaction between treating physician/cardiologist and the ophthalmologist on its basis (in the ‘Abstract’ of the said article) is probably not warranted. The results of the study were not compared with other compatible Indian cross-sectional study, in which Framingham scoring was used. Authors’ estimation of 10-year CVD risks in Sankara Nethralaya – Diabetic Retinopathy Epidemiology and Molecular Genetic Study (SN – DREAMS 1) i.e., in the study in question was 33.5%, whereas that estimated by The Indian Atherosclerosis Research Study (IARS) group was only 5.32%.[3] Although the inclusion criteria of the two studies were different (type II diabetes in SN – DREAMS 1 and genetic predisposition in IARS), however, both the criteria were found to have similar CVD risk potentials in the Framingham's cohort and hence tend to be compatible.[4,5] Correlating CVD risks with risks of diabetic retinopathy lacks biological plausibility. While cardiovascular diseases in diabetes are macrovascular in origin, retinopathy is microvascular, and each has distinct and different set of major etiological factors. While cardiovascular diseases are predominantly due to atherosclerosis, retinopathy is predominantly due to glucose dysregulation. That diabetes increases the risk of atherosclerotic diseases by two to three folds is an established fact[5] but the reverse, that is, role of atherosclerotic factors like cholesterol, LDL etc., in the causation of retinopathy is not as clear. Neither any article showing such correlation was cited in the ‘discussion’ section. Therefore, while investigation to this effect is laudable, a hypothetical explanation of this association was expected, and in the absence of explanation, needless to say, the strength of association had been weakened further.

Aim : To compare the bacterial contamination of the anterior chamber (AC) between manual small incision cataract surgery (SICS) and phacoemulsification (Phaco). To study the conjunctival flora and bacterial contamination of AC between well-controlled diabetics and non-diabetics. Materials and Methods : Three hundred and sixty-eight patients were randomized to manual SICS and Phaco. Sixty-eight patients were excluded for not completing follow-up or for intraoperative complications like posterior capsule rupture. One hundred and fifty patients in each group were finally analyzed. Conjunctival swabs were taken on admission, after one day of topical ofloxacin and 15 min after 5% Povidone Iodine (PI) instillation. AC aspirate at the end of the surgery was also cultured. Results : Fifty-six (18.66%) patients had positive conjunctival swab on admission which was reduced to 19 (6.33%) with topical ofloxacin and to five (1.66%) with instillation of 5% PI. AC contamination in both manual SICS and Phaco was 0.66%. The conjunctival flora in diabetics was similar to non-diabetics. None of the diabetics had AC contamination. Statistical analysis was performed by Chi-Square test (with Yates' correction). Conclusion : Statistically significant reduction in conjunctival flora was achieved with topical ofloxacin and 5% PI instillation and AC contamination in both manual SICS and Phaco was minimal (0.66%). Well-controlled diabetics who underwent cataract surgery in this study had similar conjunctival flora and AC contamination as non-diabetics.

Aim: To study the indications, risk factors, postoperative course, and long-term survival of corneal transplants done for optical purposes. Design: Retrospective case series. Materials and Methods: Data were obtained by reviewing the records of 181 patients operated at our institute (H.V. Desai Eye Hospital) between October 2005 and October 2007 for optical penetrating keratoplasty. Patients with less than one year of follow up, pediatric cases, therapeutic, tectonic, and lamellar keratoplasties were excluded. Kaplan Meier survival analysis was used to calculate median survival time of grafts and to see correlation between nine variables viz. age, gender, corneal vascularization, previous failed grafts, previous Herpes Simplex keratitis, post-perforation corneal scars, donor tissue quality, graft size, type of surgery and follow-up. These variables were also used for univariate and multivariate analysis using Cox Proportional Hazard Regression Modeling. Results: Median survival of the cohort was 27 months (95% confidence interval: 20.47-33.52). One- and two-year survival rates were 65% and 52.5%, respectively. Median survival was significantly lower in poor prognosis cases (14 months) than good prognosis cases (27 months, P = 0.0405). Graft survival was lower in vascularized corneas (18.55 months, P = 0.030) and in post-perforation corneal scars (17.96 months, P = 0.09, borderline significance). Multivariate analysis showed that the same factors were predictive of graft failure. Conclusion: Long-term survival of grafts at our center is different from centers in western world. More high-risk cases, paucity of excellent quality donor corneas, and differences in patient profile could be the contributory factors.

We report two siblings with the rare entity of familial calcific band-shaped keratopathy (BSK). Detailed ophthalmic and systemic investigations failed to reveal any underlying causative pathology. Topical disodium ethylenediamine-tetraacetate (EDTA) was applied for 30 min to all four eyes. In addition the right eye of the younger sibling required a superficial keratectomy. An improvement in corneal clarity was seen in the immediate postoperative period in both siblings. Histopathology of the keratectomy specimen revealed linear extracellular sub-epithelial granular calcium deposits. However, an early recurrence was noted in all four eyes at four weeks postoperatively. We report the second instance in the English literature of this entity. Band-shaped keratopathy presenting without an obvious etiology merits a complete systemic and ophthalmic workup. Patients with familial idiopathic BSK could be cases with poor prognosis for treatment with EDTA due to an early recurrence of the disease.

Presumptive primary band-shaped keratopathy was described in a 35-year-old man and his 62-year-old paternal uncle. Lamellar keratoplasty was performed in one eye in each of these patients. The light and electron microscopic studies were carried out on both corneal specimens. Histologic stains for calcium were negative. Noncalcific band-shaped keratopathy was confirmed by electron microscopic findings too. Electron-dense globular deposits were found in the region of Bowman's membrane and superficial stroma. These may be characterized as a secondary form of spheroidal degeneration.

IT IS difficult to evaluate the incidence of endogenous uveitis in children. Many excellent texts do not even mention the age incidence of uveitis, and few adequate statistics are given in the literature. Basing a judgment on the statistics that have been presented, one must conclude that active uveitus is not often seen before the late teens. Blegvad, 1 in 1941, in a series of 896 patients with iridocyclitis, found only 20 to be under the age of 15 years. In Guyton and Woods's 2 careful study, published the same year, only 7 of 562 patients with uveitis were 9 years of age or less, while 59 patients were aged 10 through 19 years, more of these being probably in the second half of the second decade than in the first. Marchesani, 3 in 1949, found 17 of 451 patients with iridocyclitis to be under the age of 15 years.