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Sixty-seven patients undergoing allogenic bone marrow transplantation (BMT) were examined before and at regular intervals for up to 87 months (1-87 months, mean 18) after transplantation. Within a period of 1-39 months, 14 of these patients died (11 male, 3 female; age at BMT 16-46y). Five of these patients died within the first 100 days. They showed no eye involvement; three patients had intraretinal hemorrhage, in one case of squamous blepharitis and filiform keratitis developed during chronic graft-versus-host disease (GVHD). In contrast, 22 of 53 (41.5%) surviving patients (30 male, 23 female; age at BMT 1-47y) were found to have ocular involvement. Before BMT only two cases of retinal hemorrhage and central chorioretinal scars each were detected. During the stage of acute GVHD (up to day 100), nine patients were free of ocular manifestations. However, 16 of the 20 patients with chronic GVHD showed ocular involvement; 14 (70%) had reduced tearflow, ten had severe keratoconjunctivitis sicca, four suffered from sterile corneal ulcerations. Bilateral cataracts were detected in 11 patients, nine of whom only had minimal posterior subcapsular opacification, possibly resulting from highdose steroid medication. One additional case presented with bilateral multifocal recurrent chorioretinitis and panuveitis. The fundus lesions appeared some months after BMT (before cyclosporin-A treatment started) and recurred during systemic treatment. All patients undergoing allogenic BMT, especially when treated for severe chronic GVHD, require regular ocular observation to avoid complications such as keratoconjunctivitis sicca at an early stage, as late complications are often severe and hardly amenable to conservative or surgical treatment.

Precise lathing of epikeratoplasty lenticules is difficult to achieve with the cryolathe due to unpredictable expansion of the lathing tools and the corneal tissue during the freezing process. In addition, the procedure destroys all viable cells in the transplant thereby possibly contributing to the prolonged period of visual rehabilitation. Nonfreezing techniques using the microkeratome or the rotor-trephine, on the other hand, are technically demanding, can cause mechanical damage during cutting or fixation, and, have not given consistently reproducible refractive results. A new system is presented that allows a variable laser ablation of donor corneas into lenticules for aphakic and myopic epikeratoplasty, as well as for lamellar keratoplasty. With the help of a computer-controlled positioning system that uses high-precision micropositioning elements (both translation and rotational stages) the donor cornea is moved, epithelial side down, in a holding device in front of a focused excimer laser beam (ArF, λ = 193 nm). This photoablation lathing process assures the viability of the stromal cells in the lenticule in close approximation to the treated surface. The user friendly computer software allows the fast and convenient selection of a variety of parameters, such as the diameter of the optical zone, the shape of the wing zone, the refractive power, the central thickness of the lenticule and the overall contour of the transplant. The first laboratory data of lenticules prepared from human corneas with this "Excimer Laser Corneal Shaping System" are presented. [Refract Corneal Surg 1991;7:377-384.)