1. Progress

1.1 Corneal and external diseases are the principal cause for ophthalmic referrals for primary medical care and one of the major causes of morbidity in hospital ophthalmology. Ocular surface disease leads to blindness because of the concomitant corneal ulceration that leads to corneal infection and/or corneal perforation. The three project areas targeted for study by the Corneal & External Disease service are the ocular service disorders, corneal transplantation and the genetics of anterior segment disorders. In all of these areas the principal researchers have set up collaborations, principally within the Institute of Ophthalmology but also with other universities where appropriate.

1.2 The ocular surface disease research programme

1.2.1 Ocular infections: A 15 year programme of research in the field of infectious diseases continues, centred on the epidemiology of bacterial and acanthamoeba keratitis and laboratory based studies into biomaterial related infections including both contact and intra-ocular lenses. We have identified risk factors amongst contact lens users who are now the most frequently affected group and a randomised control study demonstrating the efficacy of a new antibiotic that has substantially simplified the management of bacterial keratitis has been completed.

1.2.2 Inflammatory diseases. Allergic eye disease is a major cause of ocular morbidity worldwide. There has been a long track record of research in the field at Moorfields Eye Hospital and the Institute of Ophthalmology. This is now expanding in association with Professor Santa Ono at the Institute of Ophthalmology with the development of novel methods of reducing inflammation by drug therapy directed at breaking the cycle of cytokine induced inflammation.

1.2.3 Corneal ulceration: The role of metalloproteases in corneal extracellular matrix degradation is continuing in conjunction with Professor Khaw's wound healing group using in situ hybridisation to establish the cellular origins of matrix metalloproteinases (MMPs). These disorders cause corneal ulceration, are difficult to treat, and now potentially modifiable by inhibitors.

1.2.4 Dry eye is a common problem and following on form previous work on physiological tear substitutes in these disorders is a study on a novel non- biological tear substitute.

1.2.5 Ocular surface failure due to loss of corneal epithelial stem cells is one of the most severe results of ocular surface disease. We are setting up a laboratory at the Institute of Ophthalmology to provide a source of in vitro amplified corneal epithelium for clinical use as a service to patients and to promote basic studies in this exciting field.

1.3 The Corneal Transplantation programme

1.3.1 A Wellcome funded collaboration with the Imperial College Department of Immunology, on experimental corneal transplantation and graft rejection is now in a leading international position and will continue to receive external grant funding for the next four years.
1.3.2 We have carried out the only controlled study in keratoconus comparing deep lamellar with penetrating keratoplasty and are pursuing funding for a randomised controlled surgical trial and associated studies of both the technique and visual outcomes.

1.3.3 Many corneal disorders are inherited, including the rare corneal dystrophies and probably the common corneal ectasias of which keratoconus is the best known. A genetics clinic is being set up, with the support of all the medical staff responsible for these patients, to provide a genetic counselling service and to collect blood, from phenotyped patients, to feed into the molecular genetics programme headed by Professor Battacharya in the Institute of Ophthalmology. This will allow us to bring together out unique patient resource for the study of these diseases.