A severe course of corneal granular dystrophy can be present in the absence of evidence of a homozygous mutational status, or a novel mutation. Molecular genetic analysis revealed a new polymorphism in this patient. The histopathologic findings support the assumption of an epithelial origin of the granular corneal deposits. Phototherapeutic keratectomy and penetrating keratoplasty may improve vision, but cannot prevent recurrence of the disease.

Table 1 Clinical characteristics Age Sex VA Visual fields Visual hallucinations 79 F RE 20/20 Humphrey 24-2; constriction to 15 degrees; MD −16.68 dB "like dreaming while awake. . .water dripping from the ceiling" LE 20/25 Humphrey 24-2; complete loss of inferior nasal field; MD −12.61 dB 82 F RE 20/80 Humphrey 81-3 zone; 51/81 points not seen "A changing visual panorama. . .halls green with diamond-like pattern. . .blue flowers covering the bathroom. . .small red and grey tiles on the carpet. . .the walls looked like they were made of brick" LE FC Confrontation; FC ability in all but inferior nasal field 78 M RE 20/25 Humphrey 81-3 zone; 55/81 points not seen "I saw images of my bedroom wallpaper all over my house. . ." LE 5/200 Humphrey 81-3 zone; 50/81 points not seen 89 F RE 20/40 Humphrey 24-2; MD −3.14 People in the room that were not there. . .people or shadows standing near the elevator LE 20/40 Humphrey 24-2; MD −11.66 Dense inferior field defect VA = visual acuity; MD = mean deviation; FC = finger counting.

EKP was able to render PKP unnecessary in 32 of 36 eyes during the entire observation period. It was successful in permanently flattening the ectatic cornea and reducing astigmatism while restoring a symmetrical and smooth corneal surface. As a result, visual acuity improved considerably. In view of the young age of keratoconus patients needing surgery, and the fact that the lifetime of full-thickness corneal grafts is limited, EKP should be considered a valuable alternative to PKP in contact-lens-intolerant cases of keratoconus without central scarring.

Endogenous Aspergillus endophthalmitis is a devastating condition often associated with immunodeficiency. The pathogenesis of this entity implies the primary invasion of choroidal and retinal vessels. The lack of antifungal drugs with high blood-ocular permeability results in an extremely poor visual prognosis. Our histological examination indicates promising activity and ocular penetration of the new antifungal agent voriconazole.

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