[Endothelial changes in posterior polymorphous corneal dystrophy]

Posterior polymorphous dystrophy of the cornea (Schlichting) was found in a 51-year-old male. In addition, the patient had a cerulean cataract and myopia. The PPD, which was thought to have been caused by endothelial degeneration, exhibited extremely variable expressivity. Of the patient's 3 children only the 19-year-old son, who is also myopic, has cerulean cataract; on specular microscopic examination he was also found to be suffering from endothelial changes.

Recurrence of lattice corneal dystrophy type 1 in the corneal grafts of two siblings

Amyloid was identified by light and electron microscopy within corneal grafts of two male siblings from a family with lattice corneal dystrophy type 1. These deposits indicate a recurrent disease within the donor tissue, and we believe this reflects an infiltration of the grafts by genetically abnormal host corneal fibroblasts. One of the patients developed bilateral recurrent disease in the grafts eight and 13 years after penetrating keratoplasty. His brother required a regraft 16 years after a penetrating keratoplasty. Although both of these patients required regrafts because of impaired visual acuity, the decrease in visual acuity in one case was not solely the result of reaccumulation of amyloid, but was at least in part caused by a plaque of fibrous tissue behind the cornea.

Richner-Hanhart's syndrome: ultrastructural abnormalities of epidermal keratinization indicating a causal relationship to high intracellular tyrosine levels

Richner-Hanhart's syndrome (corneal dystrophies, palmoplantar keratoses, and mental retardation) is caused by high levels of L-tyrosine in the blood, probably due to a defect of soluble tyrosine aminotransferase. Biopsies of skin lesions of 3 cases revealed peculiar ultrastructural changes that were not found in controls and have not been recorded before. Thickening of the granular layer and increased synthesis of tonofibrils and keratohyalin occurred in all cases. In the ridged palmar or plantar skin large numbers of microtubules and unusually tight packing of tonofibrillar masses were regularly demonstrable, the latter containing tubular channels or inclusions of microtubules. It is assumed that increased cohesion and tight packing of tonofilaments could prevent normal spreading of keratohyalin and result in its globular appearance. No crystal formation was observed in epidermal keratinocytes nor was there lysosomal damage. A biochemical model to correlate these ultrastructural findings to known biochemical and clinical features is proposed. It is suggested that excessive amounts of intracellular tyrosine enhance cross-links between aggregated tonofilaments and modulate the number and stability of microtubules.

The differential diagnosis of Descemet's tears (Haab's striae) and posterior polymorpous dystrophy bands. A clinicopathologic study

Band-like structures, clinically similar to Haab's striae, occur in posterior polymorphous dystrophy (PPMD) and are often confused with them. The difference in clinical appearance based on difference in histopathology allows a clear differentiation. The edge of Haab's striae are thickened, curled, and secondarily proliferate Descemet's membrane, while the area between the edge is thin and smooth. Posterior polymorphous dystrophy bands are the exact opposite. The band is a thickening of Descemet's membrane between the edges with thinner, more normal Descemet's membrane outside of them. PPMD bands may be associated with typical vesicles or appear as the only sign of dystrophy, even in the eyes of patients with a known family history.

Electron microscopic studies of primary band-shaped keratopathy and gelatinous, drop-like corneal dystrophy in two brothers

We present here a case of bilateral primary band-shaped keratopathy that changed into a gelatinous, drop-like dystrophy over two years. To our knowledge, this is the first such case reported in the literature. In the first examination of the right eye, histologic evidence revealed no amyloid deposits and the presence of disorganized collagen lamellae with a high-density amorphous substance. The left corneal disc, obtained two years after the first and second examinations, revealed an agglomeration of amyloid fibrils in the subepithelial portion.

Diagnosis of early lattice corneal dystrophy

Seven children from two unrelated families had lattice corneal dystrophy. Their ages ranged from 3 to 13 years at initial examination. The children were observed for an average of 35 months. Three distinct early slitlamp characteristics were found. The first characteristic was subepithelial white opacities that were discrete, round or ovoid, nonrefractile, nonstaining, variably sized (estimated at 0.1 to 0.5 mm), and larger than the previously reported minute refractile dots. The second finding was a diffuse axial anterior stromal haze that was either the initial sign or developed in conjunction with the other two characteristics. The third finding was anterior stromal dots and filamentary lines that were refractile on indirect slitlamp illumination and white on direct illumination. Knowledge of these three slitlamp characteristics in conjunction with examination of older family members wil facilitate the early diagnosis of lattice corneal dystrophy.

Anterior segment mesenchymal dysgenesis: probable linkage to the MNS blood group on chromosome 4

Thirty-seven blood samples were analyzed for linkage from members of a single family with an anterior segment mesenchymal dysgenesis (ASMD1) with variable expressivity affecting members of at least six generations. Maximum-likelihood analysis for linkage between ASMD1 and 14 biochemical and serological markers in the family showed a probable linkage between ASMD1 and the MNS blood group on the long arm of chromosome 4 (Z = 2.36 at a recombination fraction of .09).

[Anterior cleavage syndrome associated with endocrine orbitopathy (author's transl)]

A case of anterior cleavage syndrome in a 27-year-old female patient is described. It is remarkable for the unusual completeness and prominence of the symptoms. In addition to medodermal anomalies of the anterior segment (e.g., prominent ring of Schwalbe, posterior embryotoxon, peripheral anterior synechiae, hypoplasia of the iris stroma) the case also manifested microcornea, cataract, glaucoma, excessive myopia, partial anodontia vera with maxillary hypoplasia and telecanthus. It is the first time that Rieger's syndrome has been described in association with endocrine orbitopathy, caused by hyperthyroidism with isolated elevation of T3 in the blood serum and a soft struma. Possible genetic correlations and the role of the secondary glaucoma in the two syndromes are discussed.

Hereditary Fuchs' Dystrophy

We studied 102 individuals from 25 families in which at least one member was known to have Fuchs' endothelial dystrophy. We used slit-lamp examination, corneal pachymetry, and specular microscopy. We also examined pathology records which contained 79 cases of penetrating keratoplasties done solely for phakic Fuchs' dystrophy between 1940 and 1978. Although there was a marked predominance of females in our review of pathology records, our clinical study provided a more even sex distribution. There was a close correlation between the number of expected and observed affected first-degree relatives based on an autosomal-dominant mode of inheritance. We observed a fairly typical corneal pattern, beginning as a circumscribed area of central or paracentral cornea guttata, and thereafter expanding more horizontally than vertically with progression of severity. Fuchs' dystrophy appears to be a true corneal dystrophy with autosomal-dominant inheritance, a high degree of penetrance, and variable expressivity, with generally increased severity among females.

[Clinical appearance of corneal lattice-type dystrophy (author's transl)]

Autosomal dominant hereditary lattice-type corneal dystrophy is a purely corneal hereditary metabolic disturbance, i.e. a localized amyloidosis. The author describes the findings in a family presenting with this disease. The condition progresses slowly; three stages may be distinguished, namely stage A, characterized by paracentrally arranged reticular lattice lines; stage B, characterized by paracentral lattice lines and patchy central subepithelial opacifications, and stage C, distinguished by paracentral lattice lines and diffuse white central subepithelial opacifications. Frequently, lattice-type corneal dystrophy is accompanied by symptoms of a pseudo-inflammation, e.g., photophobia, epiphora, "red eye" and pain due to recurrent corneal erosions. With regard to penetrating keratoplasty, changes of the donor cornea after a certain period of latency may be observed lattice-type corneal dystrophy as a result of which three types of opacifications may occur: 1) peripheral lattice lines and spots in the stroma; 2) diffuse whitish subepithelial opacifications, and 3) recurrent straited eruptions of the corneal epithelium.

Posterior polymorphous dystrophy of the cornea (Schlichting). An unusual clinical variant

Three members of a family with dominant inherited endothelial dystrophy of the cornea are described. The father showed only subclinical disease with subtle endothelial blisters like those found in Schlichting's dystrophy. His daughter and grandson, however, both suffered from a peculiar, prominent, ring-shaped clouding of the cornea which progressed to severe edema, necessitating keratoplasty. Light, transmission, and scanning electron microscopy revealed an epithelial transformation of the endothelium. While the anterior banded part of Descemet's membrane was well-formed in the central cornea, it was missing in the periphery. This corresponded with the ring-shaped opacity and indicated a very early transformation of the endothelium in this area. We believe that this pedigree represents an unusual clinical variant of posterior polymorphous dystrophy of the cornea.

Macular corneal dystrophy: failure to synthesize a mature keratan sulfate proteoglycan

Corneal specimens obtained during surgery from patients with macular corneal dystrophy and obtained at autopsy from control eyes were incubated in a medium containing radioactive precursors of glycoproteins and proteoglycans. Biosynthetically radiolabeled material was extracted and characterized by using molecular sieve chromatography and specific enzymes. Cells in control corneas synthesized both a chondroitin sulfate proteoglycan and a keratan sulfate proteoglycan similar to those present in monkey and bovine corneas. Cells in macular corneas synthesized a normal chondroitin sulfate proteoglycan but did not synthesize either keratan sulfate or a mature keratan sulfate proteoglycan. Instead, macular corneas synthesized a glycoprotein with unusually large oligosaccharide side chains. This glycoprotein was not detected in normal corneas and is slightly smaller than normal keratan sulfate proteoglycan. The failure to synthesize a mature keratan sulfate proteoglycan may produce corneal opacity and result in blindness. Because of evidence indicating that the corneal keratan sulfate proteoglycan is normally synthesized through a glycoprotein intermediate [Hart, G. W. & Lennarz, W. (1978) J. Biol. Chem. 253-5795-5801], macular corneal dystrophy may be a defect in glycoprotein processing.

Scanning electron microscopy of posterior polymorphous corneal dystrophy

An 8 1/2-year-old girl had posterior polymorphous dystrophy that required keratoplasty. Similar lesions were found in the patient's mother, thus establishing the genetic trend of the disease. Scanning electron microscopy studies showed areas of endothelial cell degeneration and multiple depressions or pits. These seemed the most advanced and characteristic lesions of posterior polymorphous dystrophy. Transmission electron microscopy studies in areas adjacent to the pits showed an abnormally developed Descemet's membrane covered by two or more layers of elongated endothelial-like cells. Cells over Descemet's membrane seemed to deposit some Descemet's membrane material and both fine and coarse collagen fibrils. Cells had prominent mitochondria, normal endoplasmic reticulum, and desmosomal attachments. Cytoplasmic fibrils and microvilli were usually found in cells lining the anterior chamber. Specular microscopy and scanning electron microscopy recorded the image of only the innermost cells and these appeared as endothelium.

Research into the pathogenesis of macular corneal dystrophy

The morphology and histochemical attributes of the lesions in macular corneal dystrophy have been well characterized and thus far found to be restricted to the cornea. This inherited metabolic storage disease is thought to be a localized mucopolysaccharidosis and an enzymatic defect in the degradation of corneal keratan sulphate is suspected. Studies on cell cultures of fibroblasts from diseased corneas have as yet failed to extend our knowledge about the pathogenesis of the disorder. Such investigations have included the use of acridine orange and metachromatic dyes, assays for lysosomal enzymes, biochemical analyses of cells and media, as well as kinetic studies on the synthesis and degradation of radioactive glycosaminoglycans. Despite the lack of supportive evidence, the cell culture data nevertheless remain consistent with the hypothesis that macular corneal dystrophy is a disorder of keratan sulphate I catabolism, since the synthesis of keratan sulphate by corneal fibroblasts normally decreases markedly in culture. Studies on corneal explants with macular dystrophy have provided significant positive information about this dystrophy. Freshly excised corneas with macular dystrophy synthesize considerably less keratan sulphate than normal corneas, while they produce excessive amounts of glycopeptides which still need to be characterized.

Protein AA and lattice corneal dystrophy

A 73-year-old woman underwent corneal transplantation because of lattice dystrophy. Histopathologic examination of the excised host cornea disclosed eosinophilic deposits that stained positively with Congo red and showed green birefringence with polarized light. Immunofluorescent examination showed protein AA and protein AP in the stromal deposits. To the best of our knowledge, this is the first report of protein AA and protein AP in the amyloid deposits of lattice corneal dystrophy.

Reis-Bücklers' (ring-like) dystrophy of the cornea

Reis-Bucklers' corneal dystrophy is an autosomal dominant disorder which primarily affects Bowman's membrane. Visual acuity begins to decrease around the age of 5 and continues to deteriorate over the next 20 years. The optometrist should be aware of the disorder so that the patient may be counseled regarding the genetic implications and should refer the patient to a corneal specialist when transplantation is required.

Inheritance of endothelial dystrophy of the cornea

64 families containing a proband with corneal endothelial dystrophy were examined in order to study the hereditary nature of the disease. Data concerning the frequency of occurrence, severity of the disease, ratio of affected females to males, relationship of the disease with age, and other factors were the subject of a previous report. 7 pedigrees which reflect features of endothelial dystrophy within the 64 families are presented. These features include multiple females in a family being affected, multiple consecutively affected generations, the occurrence of offspring with disease more severe than the parent, and endothelial decompensation (edema) at a relatively young age (less than 40 years of age). The importance of examining family members whenever possible rather than relying on history alone is emphasized. A statistical analysis of the inheritance pattern was performed. Endothelial dystrophy does not seem to follow a strict autosomal dominant pattern even though superficial inspection suggests autosomal dominant inheritance (both males and females affected, successive generations affected, 38% of relatives over the age of 40 years affected). Even though we were unable to determine a specific genetic mode of inheritance in these 64 families with endothelial dystrophy, we do feel that endothelial dystrophy is at least in part an inherited disease. Future investigations might prove sex-linked dominance, genetic heterogeneity, the influence of environmental factors, or a multifactorial etiology.

Unilateral lattice dystrophy of the cornea

Five cases of unilateral and 1 case of bilateral lattice dystrophy of the cornea in 1 family are reported. The diagnosis was made on the basis of the characteristic clinical appearance. The unilateral lesions were generally asymptomatic and required no treatemnt.

[Corneal distrophy of Groenouw type I and chromosomic delection (22p-) in one family (author's transl)]

Authors report a family in which three members presented a type I Corneal Distrophy of Groenouw; two of them also presented a delection of short arms of a 22 chromosome, while the third presented the delection but not the corneal distrophy. The absence of relationship between the corneal distrophy and the 22 delection in this family proves that the latter is a familial marker, not being the cause of the disease.

Familial amyloidosis with cranial neuropathy and corneal lattice dystrophy

Five siblings of a Danish family with slowly progressive involvement of the trigeminal, facial, glossopharyngeal, accessory, and hypoglossal nerves beginning at the age of 55-65 years were examined. All had asymptomatic corneal lattice dystrophy. Clinical and electrophysiological investigations also showed evidence of slight neurogenic involvement of the limbs. Conduction velocity along sensory nerves was normal but amplitude of sensory potentials was severely reduced suggesting an axonal affection which was confirmed by sural nerve biopsy. The neuropathy was secondary to amyloidosis revealed by skin and sural nerve biopsies.

Inheritance of Fuchs' combined dystrophy

The inheritance pattern of Fuchs' combined corneal dystrophy is not confirmed. Published pedigrees fail to demonstrate a 50% segregation and sex ratio. They include no more than two generations of affected individuals and indicate a strong, female predilection. The pedigree we will present shows 16 affected persons in four generations. The ratio of affected to unaffected and men to women is 1:1. Penetrance is apparently 100%. Nine of the affected are under 50 years of age; four are subteen age. Light and electron micrographs of corneal tissue from three patients in three different generations are consistent with the diagnosis of Fuchs' dystrophy. Fuchs' dystrophy can therefore be established as a classic autosomal dominant pattern.

[Importance of heredity in ophthalmology (author's transl)]

On the basis of his studies on Fabry's disease, the dyscephalic syndrome of François, the ligneous conjunctivitis and the macular dystrophy of the cornea the author stresses the importance of heredity in ophthalmology.

Congenital hereditary corneal dystrophy associated with esotropia

A family is described in which four of six siblings have congenital hereditary corneal dystrophy associated with esotropia. All cases had been erroneously diagnosed as and operated on for congenital glaucoma. The hereditary aspect of this association is discussed.

Punctiform and polychromatic pre-Descemet's dominant corneal dystrophy

A new type of pre-Descemet's corneal dystrophy is described. The opacities are punctiform, polychromatic, of uniform size, and evenly distributed over the whole cornea. The diagnosis is made only by slit lamp because there is no visual impairment. The disease is hereditary and follows the autosomal mode of inheritance with a high percentage of penetrance, expressivity, and specificity in 4 successive generations, in which 8 affected members were observed among a total of 46.

[Familial congenital dystrophy of the corneal stroma: Turpin's syndrome (author's transl)]

In 1939, R. Turpin and al. described cases of hereditary and congenital corneal opacities in three generations of one family. The members of this family have since been followed-up regularly by the author, examination of the corneas of the grandmother and the grand'daughter made by electron microscopy, the morphology compared, and an attempt made to establish the progression of the lesion. It so happened that at the same time, witschel and al. published (June, 1978) the results of their examination of the American members of the same family. Their conclusions were the same, in that this familial congenital dystrophy of the cornea is mainly stromal and differs therefore from familial congenital endothelial dystrophies. The author's analysis is complementary to theirs.

Meretoja syndrome. Lattice dystrophy of the cornea with hereditary generalized amyloidosis

The clinical history as well as the general and ophthalmic pathology of a woman with the Meretoja type of hereditary systemic amyloidosis and lattice dystrophy of the cornea is described. Extraocularly, amyloid could be demonstrated in all the arterial walls, the peripheral nerves and in the glomeruli; intraocularly, amyloid was seen in the cornea and the sclera.

Reis-Bückler's dystrophy

A case of Reis-Bückler's dystrophy in a 36-year-old man is reported. Its clinical aspect is compared with its histological and ultrastructural features. The slight reticular opacities situated superficially in the central part of the cornea, immediately beneath the epithelium, correspond to dark, irregular deposits. These replaced the basal membrane and Bowman's membrane and are composed of granular material, glycogen granules, and short fibers. These short, curved, osmiophilic fibers whose diameter is approximately 130 A are also located inside the anterior stromal lamellae. These deposits seem to be the characteristic feature of this particular and rare dystrophy, stated as by Hogan. Their nature and origin are discussed.

Corneal dystrophies. II. Endothelial dystrophies

In general, endothelial dystrophies present three types of clinical manifestations: 1) production of collagenous tissue posterior to Descemet's membrane which appears as cornea guttata, polymorphic excrescences or gray sheets; 2) a disrupted endothelial mosaic in specular reflection; and 3) corneal edema as a reflection of decreased endothelial barrier and pump functions. In this review, the authors discuss three endothelial dystrophies -- Fuchs', posterior polymorphous and congenital hereditary. They describe the clinical, histopathologic and biochemical features, and illustrate each dystrophy with a composite drawing. Dystrophies of the epithelium, Bowman's layer, and stroma were reviewed separately in the September-October 1978 issue of this journal.

Corneal endothelial dystrophy. A study of 64 families

A prospective study was undertaken during an 18-month period with 64 families who had endothelial dystrophy. Two hundred twenty-eight relatives were examined. Of those older than the age of 40, 38% were affected. Women were affected more severely and 2.5 times more frequently than men. The disease showed a strong familial tendency: there was one family in which three generations were affected and 16 families in which two generations were affected. There were four families that had members with edema in two generations. There was no association between edema in a parent and edema in a child. The proportion of relatives affected and the severity of involvement increased with age. Fifty-three probands and 18 relatives had endothelial dystrophy with edema (Fuchs' dystrophy). Of these 71, one had glaucoma.

[Primary hereditary cristalline corneal dystrophy of Schnyder. Histopathology and ultrastructure (author's transl)]

The present study consists of light- and electron-microscopic examination of excised cornea in a case of lipid keratopathy (Schnyder) in which a perforating keratoplasty was performed. It demonstrates the deposition of cristalline and non-cristalline substances in the corneal epithelium as well as the anterior half of the corneal stroma. Histiocytic elements infiltrate the subepithelial connective tissue. Bowman's membrane is conspicuously almost totally missing. The paper concludes with a discussion of the above findings.

Corneal dystrophies. I. Dystrophies of the epithelium, Bowman's layer and stroma

Most corneal dystrophies are autosomal dominant, bilateral disorders that primarily affect one layer of an otherwise normal cornea, progress slowly after their appearance in the first or second decade, and are not associated with a systemic disease. Epithelial basement membrane dystrophy and Fuchs' endothelial dystrophy are seen commonly by the general ophthalmologist; fleck, posterior polymorphous, granular or lattice dystrophies are seen more rarely, and others may never be seen in general office practice. While the distinctive clinical appearance of most corneal dystrophies allows accurate diagnosis, the integration of slitlamp findings with histopathologic and biochemical findings aids in the understanding of the clinical observations and provides a more rational basis for therapy. Transmission electtron microscopy is the most accurate method of histopathologic diagnosis. Epithelial dystrophies usually manifest intraepithelial cysts and abnormal basement membrane. In stromal dystrophies, an abnormal substance accumulates within the keratocytes or among the collagen fibrils; it may be an excess normal metabolite (like glycosaminoglycans in macular dystrophy), a material not usually present (like amyloid in lattice dystrophy), or a substance of unknown composition (like hyaline in granular dystrophy). Each dystrophy is illustrated with a composite drawing. Endothelial dystrophies will be reviewed separately in a second article.

A simple technique for removal of recurring granular dystrophy in corneal grafts

A 63-year-old man and his 24-year-old son developed recurrences of granular dystrophy in their three corneal grafts within three years after surgery. We regrafted one of the son's corneas. Histologic examination of the corneal button removed during surgery showed an avascular connective tissue layer with the histochemical characteristics of granular dystrophy interposed between the epithelium and Bowman's layer. In the remaining two corneal grafts, we fixed the globe with corneal forceps and removed the opaque dystrophic layer by separating it from the cornea with a spatula. Postoperatively, all three corneal grafts were once more transparent.

Adult polycystic kidney disease and lattice corneal dystrophy: occurrence in a single family

Most ophthalmologic disorders reported with renal cystic disease have been associated with either medullary cystic disease or juvenile nephrophthisis. A family we investigated demonstrated two previously unreported autosomal dominant disorders: adult polycystic kidney disease and lattice corneal dystrophy.

Congenital hereditary stromal dystrophy of the cornea

Cornea from patients in two separate pedigrees showing dominant inheritance of a congenital nonprogressvie corneal clouding were examined by light and electron microscopy. The characteristic changes of abnormal corneal lamellae were widely and rather uniformly distributed throughout the stroma. The remaining corneal layers were normal. The findings are consistent with a diagnosis of congenital hereditary stromal dystrophy of the cornea, which differs greatly on both histologic and clinical grounds from the entity known as congenital hereditary endothelial dystrophy of the cornea.

Central thickness in corneal disorders

In the single individual the central corneal thickness (CCT) shows only small variations. Therefore CCT has been studied in a number of corneal diseases in order to investigate if this dimension might contribute to the diagnosis or to the understanding of the pathogenesis. Normal CCT was found in hereditary dystrophies with the exception of the macular dystrophy of Groenouw (type II), which showed a significantly reduced thickness. Reduced CCT was found in chronic degenerations of leutic, tuberculous or indefinite nature. Marginal degenerations of Fuchs-Terrien type also showed reduced CCT. The possible role of abiotrophic processes in this corneal thinning is dicussed. Endothelial dysfunction is indicated by increased CCT. This occurs in bullous keratopathy and in many acute disorders. Vascularisation of the cornea does not preclude the occurrence of normal or even reduced thickness.

[Bilateral hereditary corneal dermoid (author's transl)]

The opportunity to follow the descendants of a family carrying the defect of a bilateral corneal lesion already described in the literature has led the authors to recommend surgical treatment and the lesions have been studied by light and electron microscopy. The two diagnoses are discussed: scleocornea and dermoid. They retain the latter diagnosis and give their reasons.

Clinical differentiation of recessive congenital hereditary endothelial dystrophy and dominant hereditary endothelial dystrophy

Our review of previously published reports and familial cases revealed that corneal clouding in autosomal recessive congenital hereditary endothelial dystrophy was present at birth or within the neonatal period. Further, corneal changes with time were minimal, nystagmus was often present, and there were no other signs or symptoms. Patients with autosomal dominant endothelial dystrophy usually had clear corneas early in life; corneal opacification was slowly progressive, nystagmus was infrequent, and photophobia, as well as epiphora, may have been the first indications of the dystrophy. As there is usually little or no congenital evidence of the dominant type, "infantile" or "autosomal dominant" hereditary endothelial dystrophy would be more appropriate names for the dominant variant.

Postoperative recurrence of Reis-Bücklers' corneal dystrophy

A 68-year-old white man with a documented family history of Reis-Bücklers' corneal dystrophy had a penetrating keratoplasty of the right eye in 1962. In 1977, vision decreased and foreign body sensation returned. Examination indicated a Reis-Bücklers' dystrophy that had appeared in the graft 15 years after the transplant.

Recurrence of Reis-Bücklers' corneal dystrophy in a graft

A 46-year-old white woman had Reis-Bücklers corneal dystrophy; the disease had recurred in a corneal transplant within ten years of transplantation.

Cholesterol turnover in hereditary crystalline corneal dystrophy of Schnyder

A patient with hereditary crystalline corneal dystrophy of Schnyder required penetrating keratoplasty because of poor visual acuity. Blood cholesterol was labeled with 14C-cholesterol and 11 days later a penetrating keratoplasty was done. At the time of surgery, corneal levels of cholesterol were much higher than serum levels, showing that cornea is an active site for the uptake and storage of cholesterol in this disorder.