Three therapeutic lamellar grafts.

INDICATIONS for lamellar corneal grafts are somewhat more numerous than those for penetrating keratoplasty, and Paufique, Sourdille, and Offret (1948) mention, besides the usual optical reason for replacing a corneal scar, tectonic, preparatory, aesthetic, and therapeutic indications. This last, designed to interrupt the course of chronic and recurrent corneal disorders, is of peculiar interest, because, although it possibly provides the widest field of application of lamellar grafts, its rationale is less well understood. It is possibly for this reason that its employment depends even more on its proven successes than does keratoplasty performed on other indications. The idea of utilizing the trophic effects of a graft in this way is attributed to Filatov, in whose theory of " biogenic stimulants " it played but a small part, and it is perhaps because the success of other applications of this theory (e.g., the use of subconjunctival injections of cod liver oil or implantations of placenta in the treatment of various forms of ocular disease) has not been as great as one had been led to expect that the therapeutic functions of the corneal graft have received less attention than might have been expected. On the continent of Europe the therapeutic value of lamellar grafts was first demonstrated in France, notably by Paufique (1947, 1948), and Paufique and Bonnet (1948), and the largest series ofreported cases (41) comes from his clinic (Hugonnier-Clayette, 1949). In Great Britain cases have been reported by Black (1949), Foster (1950), and Rycroft and Romanes (1952), and this effect of grafting was treated in some detail by Lister (1951) in his review of keratoplasty. The purpose of this paper is to add three more illustrative cases to those mentioned.