 All right, well thank you, that was really interesting. I'm Adam Guess, I'm one of the cornea fellows. I'll just be presenting briefly the patient that hopefully most of us had a chance to see upstairs. This will just be a brief presentation about that patient. Hopefully we can get some input from the audience about this patient. So I'll just be presenting the patient that we saw upstairs, one of our cornea patients and hopefully we can get some input from the audience about management on this patient. Our patient is a 22 year old woman with a, she was referred to Dr. Mifflin. She has a history of Ehlers-Danlos syndrome type six which was diagnosed at birth. Eight months ago, this patient sustained injury to her right eye after having a syncopal episode. She was at a restaurant, passed out and hit her eye on the edge of one of the booths. She sustained a ruptured globe at that time and she had surgical repair about a day and a half later. The repair was described as difficult by the surgeon both due to, as you can imagine, due to the thin superior sclera. She also was noted to have posterior pressure from carotidals at that time. So at this time, eight months later, she has an uncorrected visual acuity of 2,500. She pinholes the 2,080 and that's, she sees 2,300 with a minus 10 spherical correction. Our pressure's normal. Her pupil is superiorly dissented as you see but it was reactive with no APD. The AC was deep and quiet. Her lens is clear and centered and she does have this large superior staphyloma with scleral thinning and underlying uveal prolapse. Her retinal exam was within normal limits except for the superior uveal prolapse. I'll show you a few more images here. Here's another image demonstrating the thin superior sclera and a slit image here demonstrating just how thin this tissue is. Penicamp imaging was done and showed a thin corneal thickness essentially and you see 431 there just inferior to central. And also you'll note that she has 12 diopters with the rural corneal astigmatism and you see on the tangential curvature that she's very steep superiorly. So a very abnormally shaped cornea which is contributing to her poor vision. So in summary, we wanted to talk a little bit about what could be done surgically for this patient. Before we do that, I'll just present a few slides about this condition, Ehlers-Danlos type six. The type that she has is called the kypho scoliotic type and in fact this patient did have scoliosis. She's had four back surgeries to repair that. Some of the features that are common, it's an autosomal recessive condition. The bluish sclera due to scleral thinning, limbis to limbis corneal thinning is almost universal. Ocular fragility which I'll go into more depth on is very common and patients also often have hypermobile joints and hearing loss is another common feature. The deficit in this condition is thought to be lysolhydroxylate although it seems that other collagen defects may also cause this condition. In two different studies by Cameron and Biglon, most of the patients in these studies, there was about 10 patients in one and 12 in the other study experienced globe rupture, 63 to 70% by the age of 18 which to me was a staggering number and the mean age of the first globe rupture in these patients was 5.2 years of age. Many of the patients they described had very minimal trauma, you know a small twig hitting the eye or rubbing the eye lightly and usually it was corneal rupture that occurred. The surgical repair in these patients was described as difficult as you might imagine. There was a lot of cheese wiring of sutures. Ocular contour abnormalities are universal in these patients. Charitaglobus is common, peripheral sclerocornia. Charitometry values can range from under 40 to over 60 and changes of anywhere from three to six diopters in a single year have been described so that the corneas can change quite quickly also. Here's a list of some of the pathologic changes that occur. This image was from the Cameron paper and it was a patient who had had a limbis to limbis epicaritoplasty which was followed by a penetrating caritoplasty. So you see on top there the epicaritoplasty and then below the second asterisk is the patient's corneas. You see how very thin that is and you can see some of the other abnormal changes that can occur absent. Bowman's layer, stromal thinning, disorganized stromal lamellae or decimates membrane abnormalities. The best treatment for this patient's prevention of protective glasses just because corneal rupture or scleral rupture is so common. And as I mentioned, unfortunately, patients have been described to have globe rupture without any trauma at all even with protective lenses in place. So it's a very difficult situation. As I mentioned, limbis to limbis epicaritoplasty has been described for providing tectonic support for flattening the cornea for reducing irregular astigmatism. So for our patient, we wanted to get some input from the audience about treatment options. One would perhaps be a contact lens. This patient hasn't had contact lens fitting. She was wearing contact lenses prior to this but they don't fit currently on her right eye. Should we consider surgical repair? Perhaps a scleral patch graft. Should we consider repairing the iris? Maybe a purse string type suture repair to the iris. And the other thing we talked about would collagen crosslinking have any role? Lysol hydroxylase is actually an enzyme that crosslinks collagen and that's what is thought to be missing in these patients. So I'd like to sort of open it up to getting some input from the audience as to what we should be thinking about with this patient. Dr. Olsen? Oh yeah, so her other eye is normal. It sees well. She was 20, 25 with her contact on.