Some individuals with keratoconus are at high risk of developing acute corneal hydrops. These patients could be managed more aggressively to reduce their risk of developing this complication of their disease.

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A 55-year-old Caucasian woman presented with a 1-week history of left eye redness and blurred vision. Her medical history included previous small bowel resection and ileostomy for ischaemic bowel. Ophthalmic examination revealed a left corneal ulcer requiring hospital admission for intensive topical antibiotics. Overnight she became systemically unwell and was diagnosed with urinary tract infection requiring intravenous antibiotics. Her corneal condition deteriorated resulting in corneal perforation, which required a surgical gluing procedure. Despite surgery, the cornea perforated on two further occasions. At this stage, vitamin A deficiency (VAD) was suspected, due to the corneal melting response that was occurring. VAD was subsequently confirmed by serology and had occurred in this case due to malabsorption as a result of short bowel syndrome caused by previous small bowel surgery. The patient was treated with intramuscular vitamin A and eventually made a good visual and systemic recovery.

1 report on their trial of machine perfusion versus static storage of kidneys from deceased donors. The benefit of machine perfusion 2 is probably that it ensures a uniform distribution of preservation fluid throughout the organ, which is better than a single flush.Perhaps this benefit can be illustrated best by our experience with a series of 38 poorly preserved kidneys obtained at our center from 19 donors after cardiac death, all of whom had undergone femoral cannulation and were Maastricht category II or III donors. 3 (Patients in Maastricht category III generally had a misplaced cannula.) In these donors, the kidneys were blue and poorly perfused at laparotomy, and these indicators did not improve with a single flush after recovery. On the basis of standard criteria, these organs were not suitable for transplantation; however, after machine perfusion, only four kidneys were not transplant ed. The appearance and flow were improved by means of machine perfusion, and this method of preservation resulted in 10 dual and 14 single kidney transplantations.Machine perfusion may improve the appearance and usability of kidneys that otherwise would not be transplanted. 4

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