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Background: A retrospective evaluation was undertaken of eyelid reconstruction with amniotic membrane or oral mucosal membrane transplantation in patients with lower lid cicatricial entropion after orbital surgery., Patients and Methods: Seven patients (four women) were treated with a scar tissue dissection and an amniotic membrane or mucosal membrane transplantation between 2003 and 2006 (Five amniotic membrane grafts and two oral mucosal membrane grafts). In selected cases additional procedures like a lateral tarsal strip operation, a tarsal fracture, or the reinsertion of the lower lid retractors were performed., Results: All patients showed a favourable postoperative result with a good anatomic correction of the entropion and a regression of the preoperative disturbances. All the grafts took well. Two patients had to be reoperated twice and one patient three times as a result of a relapse of the cicatricial entropion. However, as well in these patients the anatomical and functional result was favourable at the end., Conclusions: The difficult scar dissection with the subsequent amniotic membrane or oral mucosal membrane transplantation seems to be an appropriate procedure to reconstruct complicated cicatricial entropion after orbital surgery.

Purpose: The aim of this communication is to report enophthalmos as a possible new adverse effect of topical bimatoprost treatment., Patients and Methods: A retrospective case series of five glaucoma patients under long-term topical bimatoprost treatment was evaluated. Documentation with photo and Hertel exophthalmometry was reviewed., Results: In all five patients a deep lid sulcus, reduced infraocular fat pads and enophthalmos-suspicious Hertel values were found (mean 11.9 mm; SD 2.4). Other aetiologies for enophthalmos were excluded anamnestically and by clinical examination., Conclusion: Bimatoprost may lead to an alteration of the eyelid with deepening of the lid sulcus and may also be responsible for an iatrogenic orbital fat atrophy. A possible mechanism of action might be the induction of apoptosis of orbital fibroblasts with a remodelling of the extracellular matrix. Prospective studies are necessary to confirm this cross-sectional observation.

Background: The purpose of this retrospective study was to analyze the outcome of amniotic membrane transplantation (AMT) performed at the University Eye Clinic Bern during the last 12 months., Patients and Methods: Nine men (62.4 +/- 16.7 yrs.) and four women (78.3 +/- 22.3 yrs.) were treated with an AMT and grouped according to the ophthalmologic diagnosis: Group A, chronic corneal surface defect without limbal stem cell deficiency (n = 8); Group B, conjunctival fornix reconstruction (n = 7); Group C, filtering bleb defect (n = 2)., Results: 11/17 (65 %) AMT's performed in 14 eyes of 13 patients showed a favorable postoperative result after a mean follow-up time of 8.7 (+/- 2.9) months. In Group A (chronic corneal surface defect) 4/8, in Group B (conjunctival fornix defect) 7/7 and in Group C (filtering bleb defect) 0/2 showed an improvement of the basic ocular problem. 4/8 patients from Group A and 7/7 patients of Group B showed postoperatively a strong reduction of the ocular inflammation., Conclusions: In the present small study, favorable results were achieved in patients with chronic corneal surface defects without limbal stem cell deficiency and conjunctival fornix defects following AMT. In patients with fornix defects, the AMT seemed to be a valuable alternative to the more complicated transplantation of mouth- or nose mucous membrane. The two eyes with filtering defects failed.

Background: Purpose of this retrospective study was to analyse the outcome of deep lamellar keratoplasty., Patients and Methods: The records of 9 patients with deep lamellar keratoplasty were reviewed. Age, sex, systemic diseases, indication for surgery, pre- and postoperative visual acuity and findings, visual acuity and findings at last follow-up and complications were noted., Results: Nine eyes of 9 patients have been operated with the "big bubble" technique described by Anwar. Indications for operation were keratoconus (4), keratoglobus (1), central corneal scar after keratitis (3) and after alkali burn (1). In 3 cases the intraoperative technique had to be changed to penetrating keratoplasty. The preoperative visual acuity was 0.2 to 0.3. All 9 patients showed a postoperative improvement of visual acuity: best corrected from 0.3 to 0.8. In one eye particles in the interface were found. At last follow-up all grafts were clear. There were no postoperative complications., Conclusions: The results demonstrate that deep lamellar keratoplasty is a technically difficult procedure, in 3 out of 9 patients the operation method failed. The postoperative course after deep lamellar keratoplasty did not show any severe complications. The patients who had to be changed to penetrating keratoplasty were not disadvantaged in respect of the final result (visual acuity and findings). The postoperative visual acuities after deep lamellar keratoplasty and after penetrating keratoplasty were comparable. Despite the small number of patients and the relatively short observation period, we noticed that after deep lamellar keratoplasty the sutures could tendentially be removed earlier and thus the duration of topic steroids therapy was shorter compared to penetrating keratoplasty.

This article reviews operation techniques and indications for the surgical correction of ametropia. The author also explains and lists the anomalies of refraction. The limitations of the methods as well as open questions for the future are discussed.

Background: Central corneal pathologies can lead to an irreversible decrease of best corrected visual acuity if not diagnosed and treated appropriately. This article reviews the differential diagnosis of central corneal opacities in the newborn, of central infectious corneal ulcers, and the therapy of sterile, central keratolysis., Material and Methods: Authors' personal experience and review of the literature., Results: Flow charts for diagnosis and treatment strategy have been elaborated., Conclusions: Corneal opacities in newborns create an emergency situation. In order to treat successfully and avoid or diminish amblyopia, it is imperative to rule out congenital glaucoma. The aetiology of central corneal ulcers should always be confirmed by positive cultures to be able to treat specifically. When the standard topic therapy fails, one has to consider rare bacteria, parasites, virus, or patients' compliance. The treatment of central sterile keratolysis in rheumatoid arthritis must be intensive and immunosuppression has to be performed early enough in the course of prevent the formation of a descemetocoele or spontaneous corneal perforation.

Problem: The reasons for corneal graft failure during the first postoperative year were examined., Patients and Methods: The functional and morphological parameters were recorded prospectively on 210 eyes with penetrating keratoplasty postoperatively after 1, 4 and 12 months., Conclusions: 1 month postoperatively one graft, 4 months after surgery 5 grafts, and 12 months after keratoplasty 15 grafts had failed. The reasons were: 3 cases of irreversible rejection, 4 retrocorneal membranes, 4 persisting corneal erosions with ulceration, and 4 stromal infections (3 Herpes, 1 Akanthamoeba). During the first postoperative year, in our patients corneal graft rejection was a rare event accounting for 3 of 15 graft failures with an incidence of 1.4% in all grafts studied.

Purpose: To investigate with confocal microscopy the cornea of diabetics type I and II., Material and Methods: Thirty eyes of 10 patients with diabetes mellitus type I, 10 with d.m. type II, and 10 of controls were entered in the study. Eyes with corneal or anterior segments pathologies were excluded. In-vivo corneal morphology was studied using a confocal microscope., Results: Cell density of basal epithelial cells, anterior stromal keratocytes, and endothelial cells did not differ significantly between the groups. In the diabetic groups polymorphy of both epithelial and endothelial cells was noted. Abnormal stromal nerves were also noted in 2 cases., Discussion: Our findings support previous studies on corneal epithelial and endothelial morphology in diabetic patients. The corneal stroma appears to be affected only in its nerves, although in few cases.