SUMMARY The endothelium of the normal corneas of 67 human subjects was studied in vivo with the specular microscope in order to quantify the method as a means of sampling the cell density of the tissue. It was found that (1) axial cell counts of the endothelium are reproducible in the same cornea after an interval of time; (2) the cell counts of the centre and periphery of the same cornea are similar; (3) the axial cell counts of pairs of eyes are similar; and (4) there is a gradual reduction of cell number with increasing age. The significance of these data is discussed.

In his atlas of slit-lamp microscopy of the eye Vogt (I93i) described an unusual condition of fine brown radial lines on the anterior lens capsule in the mid-periphery behind the iris. Because pupillary membrane remnants were present in three patients he concluded that the striae represented persistent tunica vasculosa lentis-a view supported by Lugli (I933), Streiff (I935), Bischler (1939), Vogt (1942), and Bellows (i944) when reporting further examples of this condition. Cowan (I96I), however, suggested that some cases of 'retroiridic lines' might represent congenital deposition of pigment on zonular fibres. In the absence of any histological study, the precise nature of the pigmented lens striae remained unresolved.During the past two years one of us (GDS) saw a number of patients with these pigmented lens striae. Since their morphology and distribution seemed inconsistent with a diagnosis of persistent tunica vasculosa lentis we examined three of the lenses by electron microscopy. This paper correlates for the first time the clinical with the ultrastructural features of pigmented lens striae. Patients and methodsPigmented striae on the anterior lens capsule were seen in six women and one man aged between 5 and 87 years. Two of the patients had chronic glaucoma, one had a retinal hole, and four were in hospital for cataract surgery. The lenses from three of the patients with cataracts were processed for examination by electron microscopy.In the first patient chymotrypsin was used to dissolve the zonule before removal of the lens. The lenses of the other two patients were extracted without the use of this enzyme. The lens in one case was delivered with capsule forceps, taking care to grasp the capsule some distance away from the previously determined position of the pigmented striae. In the third patient the lens was removed with a cryoprobe, purposely freezing on to the capsule at the site where striae had been noted preoperatively.The extracted lenses were fixed immediately in

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SUMMARY Patients in a randomised controlled trial were chosen either to have iris clip lens implantation after intracapsular cataract extraction or intracapsular extraction only. They were assessed in terms of corneal thickness, postoperative epithelial oedema, and endothelial cell counts. All patients had 1 eye submitted to operation, which was carried out by the same surgeon. There was significantly greater increase in corneal thickness (P <0-05) on the 5th postoperative day in eyes which had lens implants (23 patients with intracapsular extraction and 19 with implant), but the difference between the 2 groups became insignificant at 1 month (17 patients in each group).Daily corneal thickness measurements and observations of epithelial oedema in a subgroup (20 patients divided equally into 2 groups) showed that postoperatively there was greater and more widespread corneal oedema after implant surgery. When the operated eye was compared with the unoperated eye, endothelial cell loss was significantly greater in those with implants (P<0-01) than in those with simple intracapsular extraction.Intraocular lens implantation after cataract exti-action has regained general acceptance and is now widely practised. The reported incidence of various complications differs considerably, but the incidence of intractable corneal oedema would seem to be greater than expected from simple cataract extraction. This is also a complication which may be related to the trauma of additional steps entailed in implant surgery. Binkhorst and Leonard (1967) reported initial results in 124 eyes, treated over a period of 7 years and did not observe a single case of intractable corneal oedema. Jardine and Sandforth-Smith (1974) had reported an incidence of 10 % in 70 cases. Pearce (1972, 1975), Jaffe and Duffner (1976), and Duffner et al. (1976) have reported an incidence of between 1P5 and 36y% of serious corneal oedema. Pearce (1975) also reported an incidence of 13 2y% of minor oedema which had not interfered with vision in the eyes studied.

Incidence and presentation A total of I02 patients believed to have suffered corneal exposure during sleep were collected over a two-year period. Sixty-eight cases were examined personally and details of those remaining were provided by colleagues working in the same department.The ages of the patients ranged from I7 to 82 years (average 42). Attacks had started at the age of 13 years in one patient, but for the whole series the incidence was highest in the third decade and slowly declined with increasing age.Patients typically presented early in the day within a few hours of waking with their symptoms. The symptoms consisted of soreness, pricking discomfort or sharp pain in one eye, often associated with watering and sometimes blurred vision. Some patients had awoken during the night with pain in one eye. Symptoms were most pronounced immediately after their onset and tended to improve spontaneously during the course of the day. The appearance of symptoms in both eyes together was uncommon, and in the eight patients in whom this occurred, symptoms were always more marked in one eye than the other. PREVIOUS ATTACKSThe number and pattern of attacks experienced by different patients varied. In 53 patients the presenting episode was their first and only attack, while in I8 there was a history of one or two previous The only factor of possible aetiological significance revealed by history was the taking of alcohol. Fifty-two patients admitted to having drunk alcohol during the previous evening, but in I9 the amount of alcohol involved was small. Twelve patients were calculated to have consumed the equivalent of between 50 and ioo ml pure alcohol, and i i patients had taken between ioo and 200 ml alcohol. Another io patients stated that they had been drinking heavily or had drunk more than usual. An association between alcohol and nocturnal lagophthalmos was recognized by four patients, all with a history of multiple attacks. A 3x-year-old man, in whom syrnptoms of nocturnal lagophthalmos had occurred intermittently for ij years, was seen after waking at 4.o am with a sharp feeling in the right eye. Examination revealed corneal on 12 May 2018 by guest. Protected by copyright.