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Purpose To evaluate morphological alterations of meibomian glands (MGs) in the dry anophthalmic socket syndrome (DASS). Methods Fifteen unilateral anophthalmic patients wearing cryolite glass prosthetic eyes were enrolled. All patients with clinical blepharitis or other significant eyelid abnormalities were excluded. In vivo laser scanning confocal microscopy (LSCM) of the MGs in the lower eyelids both on the anophthalmic side and the healthy fellow eye was performed to quantify acinar unit density, acinar unit diameter, acinar unit area, meibum secretion reflectivity, the inhomogeneous appearance of the glandular interstice, and inhomogeneous appearance of the acinar walls. Results The lower eyelids of the anophthalmic sockets revealed a significant reduction of the acinar unit density (p = 0.003) as well as a significantly more inhomogeneous appearance of the periglandular interstices (p = 0.018) and the acinar unit walls (p = 0.015) than the healthy fellow eyelid. However, there were no significant differences regarding the acinar unit diameter, acinar unit area, and meibum secretion reflectivity of the MGs on the anophthalmic side compared to the healthy fellow eyelid (p ≥ 0.05, respectively). Conclusions The eyelids of anophthalmic sockets without clinical blepharitis demonstrate a reduced density of MG acinar units and a more inhomogeneous appearance of the periglandular interstices and the acinar unit walls. This can cause meibomian gland dysfunction contributing to DASS and suggests early treatment of these symptomatic patients, even in the clinical absence of any blepharitis signs.

Parry-Romberg syndrome is a rare disease characterized by slowly progressive atrophy affecting facial subcutaneous tissues, including the underlying muscles and osteocartilaginous structures. Various periocular, ocular, and neuro-ophthalmological manifestations have been described in Parry-Romberg syndrome. The most common periocular disorders include enophthalmos, eyelid, and orbit alterations. The most frequent ocular disorders include corneal and retinal changes, and the most common neuro-ophthalmological disorders involve optic nerve, ocular motor and pupillary dysfunction. Besides the characteristic facial abnormalities, systemic manifestations may occur, including neurologic, dermatologic, cardiac, endocrine, infectious, orthodontic, and maxillofacial disorders. So far, mainly brief case reports describe these ophthalmological findings. Therefore, we summarize the ocular, periocular, and neuro-ophthalmological findings in detail, describe diagnostic modalities, and outline therapeutic options.

Vascular endothelial growth factor A (VEGF) induces angiogenesis and vascular hyperpermeability in ocular tissues and is therefore a key therapeutic target for eye conditions in which these processes are dysregulated. In contrast, the therapeutic potential of VEGF’s neurotrophic roles in the eye has remained unexploited. In particular, it is not known whether modulating levels of any of the 3 major alternatively spliced VEGF isoforms might provide a therapeutic approach to promote neural health in the eye without inducing vascular pathology. Here, we have used a variety of mouse models to demonstrate differences in overall VEGF levels and VEGF isoform ratios across tissues in the healthy eye. We further show that VEGF isoform expression was differentially regulated in retinal versus corneal disease models. Among the 3 major isoforms — termed VEGF120, VEGF164, and VEGF188 — VEGF188 was upregulated to the greatest extent in injured cornea, where it was both necessary and sufficient for corneal nerve regeneration. Moreover, topical VEGF188 application further promoted corneal nerve regeneration without inducing pathological neovascularization. VEGF isoform modulation should therefore be explored further for its potential in promoting neural health in the eye., The alternative VEGF splice form VEGF188 promotes nerve regeneration in corneal injury and may provide a therapeutic to treat corneal blindness.

Inflammatorische Prozesse des Auges gehören zu den häufigsten Entitäten in der Augenheilkunde. Die Anwendung antientzündlicher Substanzen ist daher für den Behandler eine zentrale therapeutische Option. Hierbei kommen zumeist aufgrund der guten Zugänglichkeit des Auges topische Applikationen zur Anwendung. Substanzgruppen wie Antiallergika, nichtsteroidale Antirheumatika, Glukokortikoide, Calcineurininhibitoren, Serumaugentropfen sowie neuere, noch in der Entwicklung befindliche Substanzen werden spezifisch sowohl in schmalen als auch in breiten Indikationsspektren eingesetzt, weshalb die Kenntnis der Wirkmechanismen und der potenziellen Nebenwirkungen von großer Bedeutung ist. Dieser Artikel soll einen Überblick über die derzeitig verfügbaren antiinflammatorisch wirksamen Substanzen geben, die topisch verabreicht werden können. Hierbei wird auf eine detaillierte Anwendungsbeschreibung (Dosis, Applikationshäufigkeit, Dauer usw.) in Bezug auf die einzelnen Krankheitsbilder bewusst verzichtet. Ziel ist es, dem Leser pharmakologisches Basiswissen mit direktem ophthalmologischen Bezug zu vermitteln.

In der Rekonstruktion groser durchgreifender Oberliddefekte hat sich die Bruckenlappenplastik nach Cutler-Beard etabliert. Ziel dieser Studie ist es, unsere Erfahrungen mit Technik, Komplikationen und Ergebnissen dieser Kutaneomuskulokonjunktivallappenplastik nach Tumorexzision darzustellen. Bei 18 Patienten wurde ein groser durchgreifender Oberliddefekt nach Tumorresektion mittels Cutler-Beard-Bruckenlappenplastik des Unterlides versorgt. Vier Patienten erhielten zusatzlich Spendersklera, 1 Patient kontralateralen Tarsus als Lidstabilisator. Chirurgisch erfolgreich konnte der Eingriff bei allen Patienten durchgefuhrt werden ohne Verletzung der Unterlidbrucke oder Infektion. Bei 3 der 13 Plastiken ohne zusatzlichen Lidstabilisator (23 %) kam es zu einem Oberlidentropium, das einen Revisionseingriff mit sekundarer Skleraimplantation erforderte. Die 5 primar mit Sklera- oder Tarsustransplantaten rekonstruierten Oberlider entwickelten keine Entropiumstellung. Die Cutler-Beard-Bruckenlappenplastik, die im Falle besonders ausgedehnter Defekte (> 75 % der Lidlange) mit der Transplantation von Stabilisationsersatzgewebe kombiniert werden kann, ist eine verlassliche Methode zur Rekonstruktion groser durchgreifender Oberliddefekte nach Tumorexzision.

To analyze potential alterations in corneal nerve morphology and function in different stages of Fuchs’ endothelial corneal dystrophy (FECD). Thirty eyes with FECD underwent in vivo confocal microscopy using the Heidelberg Retina Tomograph II (HRT II; Heidelberg Engineering, Heidelberg, Germany) and the Rostock Cornea Module (RCM) to quantify the morphology of the central subbasal corneal nerve plexus (total nerve length, total nerve number, number of main nerve trunks, number of nerve branches) as well as esthesiometry (using the Cochet-Bonnet esthesiometer) of the central cornea to determine central corneal sensation as a measure of nerve function. Findings were correlated with an age-matched control group of 30 healthy individuals. Comparisons to biomicroscopical stage of FECD, visual acuity and central corneal thickness were performed using Spearman correlation. Depending on slit-lamp examination, all 30 eyes were classified into FECD stage 1–4 (stage 1: six eyes; stage 2: 15 eyes; stage 3: six eyes; stage 4: three eyes). Total nerve length (ρ = −0.8, p

The VEGF-A family plays a crucial role in the induction of pathological corneal neovascularization. The role of the different VEGF-A isoforms during lymphangiogenesis is only little-known. Current anti-angiogenic therapies in the eye and other organs inhibit all VEGF-A isoforms, and have effects on both blood and lymphatic vessels. Here we investigate whether selective targeting of the isoform VEGF 165 is able to inhibit corneal lymphangiogenesis under inflammatory conditions.The mouse model of suture-induced corneal neovascularization was used to assess the antihem- and antilymphangiogenic effect of topically applied pegaptanib. Corneal blood and lymph vascularized areas were analyzed morphometrically. Furthermore, we analyzed the proliferative effects of VEGF A 121, 165, and 189 on blood and lymphatic endothelial cells (BEC/LEC) via a cell-proliferation assay.Pegaptanib significantly inhibited inflammatory corneal hemangiogenesis (p 0.01), but not lymphangiogenesis in vivo (p 0.05), both topically as well as systemically, in the inflamed cornea. In vitro, BECs were more susceptible to pegaptanib than LECs.Targeting VEGF-A 165 significantly inhibits hem- but not lymphangiogenesis, suggesting VEGF-A 165 to be critical for hem-, but dispensable for lymphangiogenesis, at least in the inflamed cornea.

Background Corneal (lymph) angiogenesis is a predominant risk-factor for immune rejection after transplantation. Techniques to regress pre-existing pathological corneal lymphatic vessels prior to transplantation are missing so far. Therefore we analysed the possibility to regress corneal lymphatic vessels by photodynamic therapy (PDT), after intrastromal verteporfin injection. Methods Combined hemangiogenesis and lymphangiogenesis was induced in female BALB/c mice using the murine model of suture-induced inflammatory neovascularisation. Thereafter, the treatment group received an intrastromal injection of verteporfin (controls: phosphate buffered saline (PBS)) followed by PDT. Corneas were excised at different time points (1 day, 5 days and 10 days) after PDT and corneal whole mounts were stained with CD31 and LYVE-1 to quantify hemangiogenesis and lymphangiogenesis. Results Whereas blood vessels showed no significant reduction after PDT, lymphatic vessels could significantly be reduced with PDT after intrastromal verteporfin injection: 1 day after PDT, lymphatic vessels were reduced by 62% (p=0.20). After 5 days and 10 days, lymphatic vessels were reduced by 51% and 48% (p Conclusions This study for the first time shows that PDT after corneal intrastromal verteporfin injection can selectively regress lymphatic vessels. This may become a new ‘preconditioning strategy’ to reduce pre-existing corneal lymphatic vessels prior to transplantation and thereby reduce allograft rejection in high-risk patients.

Posterior lamellar keratoplasty has been demonstrated to be a successful, increasingly applied surgical method to replace diseased endothelial cells of the human cornea. Potential immune reactions may occur following DMEK or DSAEK with different clinical phenotypes, reasons, and risk factors that accompany graft failure. In addition in this chapter the clinically relevant yet only rudimentarily investigated development of dry eye disease following posterior lamellar keratoplasty is outlined.

Einleitung: Darstellung antiangiogener und antilymphangiogener Therapiestrategien zur Verbesserung des Transplantatuberlebens nach Keratoplastik. Methoden: PubMed-Literaturubersicht und eigene klinische und experimentelle Daten. Ergebnisse: Es gibt 3 Ansatze zur Verbesserung des Transplantatuberlebens durch antiangiogene Therapie: (a) primare Pravention durch Verhinderung der Angiogenese im Rahmen kornealer Erkrankungen, (b) sekundare Pravention durch Regression vorhandener stromaler kornealer Gefase vor der Transplantation und (c) tertiare Pravention durch Hemmung der postoperativen Neovaskularisation. Schlussfolgerung: Moderne antiangiogene und antilymphangiogene topische Therapien scheinen in der Lage zu sein, das Transplantatuberleben bei perforierender Keratoplastik gerade im Hochrisikobereich zu verbessern.

Purpose To analyze the relationship between storage time of split donor tissue and outcomes after deep anterior lamellar keratoplasty (DALK) and Descemet's membrane endothelial keratoplasty (DMEK). Design Retrospective analysis of a nonrandomized, consecutive, interventional case series. Participants One hundred ten eyes with anterior stromal disease suitable for DALK and 110 eyes with endothelial disease suitable for DMEK underwent surgically successful split cornea transplantation combining both procedures within 7 days after splitting. Methods Split donor storage times (splitting to grafting) and total storage times (death to grafting) were correlated with the 1-year functional and morphologic outcomes after DALK and DMEK surgery using a Spearman correlation coefficient and a Mann–Whitney U test. Main Outcome Measures Best spectacle-corrected visual acuity (BSCVA), endothelial cell density, and complication rates within 12 months of follow-up. Results The mean split donor storage time was 35±47 hours (range, 0–162 hours) after splitting for anterior donor grafts and 21±40 hours (range, 0–158 hours) for posterior grafts. The mean total storage time was 352±108 hours (range, 108–678 hours) for anterior lamellas and 339±109 hours (range, 96–630 hours) for posterior lamellas. One year after DALK, the mean BSCVA was 20/30 (range, 20/50–20/20), endothelial cell loss was 8% (range, 2%–16%), and the complication rate (Descemet's folds, epitheliopathy, loose sutures) was 18%. One year after DMEK, the mean BSCVA was 20/25 (range, 20/40–20/16), endothelial cell loss was 41% (range, 17%–63%), and the complication rate (partial graft detachment) was 62%. For DALK and DMEK, no significant association was observed between split donor storage time as well as total storage time and BSCVA ( P ≥0.409), endothelial cell loss ( P ≥0.236), or complication rate ( P ≥0.647) within 1 year of follow-up. Conclusions Anterior and posterior donor tissue may be stored safely for up to 1 week in organ culture before use in DALK and DMEK surgery. This simplifies the clinical feasibility of split cornea transplantation to reduce donor shortage and cost in corneal transplantation in the future. Financial Disclosure(s) The author(s) have no proprietary or commercial interest in any materials discussed in this article.

To present a new treatment modality for recurrent corneal melting in a patient with a Boston type I keratoprosthesis (B-KPro) including in situ corneal cross-linking (CXL) and lamellar keratoplasty (LKP) as combined treatment.Case report.Our report concerns a 27-year-old man whose case history involved a severe chemical burn of his left eye. After failed penetrating keratoplasty and limbal stem cell transplantation, the patient underwent B-KPro implantation. Starting 1 month after surgery, recurrent corneal melting around the B-KPro developed, which was eventually treated by combining LKP, amniotic membrane transplantation, and in situ CXL. Optical coherence tomography imaging and follow-up for 12 months showed stable corneal healing without new melting or erosion. The ultraviolet A treatment did not seem to damage the material of the B-KPro.In situ CXL using riboflavin and ultraviolet A light combined with LKP and amniotic membrane transplantation can be an effective management option to treat recurrent corneal melting after B-KPro implantation.

PURPOSE In patients with small-fiber neuropathy (SFN), noninvasive diagnostic tests that allow accurate monitoring of disease progression are urgently needed. The aim of this study was to assess corneal trigeminal small sensory nerves and immune cells by in vivo corneal confocal microscopy (CCM) in SFN. METHODS In this prospective single-center study, 14 patients with histologically confirmed SFN were analyzed. CCM parameters [corneal nerve fiber density (NFD); the total number of nerves, main trunks, and branches; nerve tortuosity; and dendritic cell density] were compared with 14 age-matched healthy controls and correlated with clinical symptoms, disease course, and histopathological findings. RESULTS Corneal NFD (15,489.3 ± 5927.6 μm/mm² vs. 22,687.1 ± 4328.7 μm/mm²; P = 0.001) and the total number of nerves (10.4 ± 4.6/frame vs. 18.5 ± 4.8/frame; P < 0.0001) were significantly reduced in patients with SFN. In contrast, nerve tortuosity was significantly increased (2.2 ± 0.3 vs. 1.7 ± 0.5; P = 0.02). Corneal NFD did not correlate with intraepidermal NFD (ρ = -0.158; P = 0.5) or clinical symptoms (cold P = 0.1; prickling P = 0.2; burning P = 0.8; formication P = 0.7; stabbing P = 0.4; rubbing 0.1; pressure P = 0.1). The average dendritic cell density was increased in SFN (33.5 ± 57.5 cells/mm² vs. 16.1 ± 13.7 cells/mm²) but did not reach significance (P = 0.7). CONCLUSIONS CCM provides parameters that reliably indicate injury to sensory afferents of the trigeminal nerve in patients with SFN. Our data suggest that CCM may serve both as a noninvasive diagnostic test and as a surrogate marker in SFN.

Retrocorneal membranes can occur after trauma or surgery and remain as a therapeutic problem in graft failure after penetrating keratoplasty. We report for the first time the finding of a retrocorneal membrane in Descemet stripping automated endothelial keratoplasty (DSAEK) in a young woman who underwent Baerveldt shunt implantation for iridocorneal endothelial (ICE) syndrome.Clinical examination, preoperative and postoperative slit lamp-adapted optical coherence tomography of the anterior segment, and immunohistochemical staining and electron microscopic analysis of the stripped Descemet membrane were performed.A 25-year-old woman presented with decline of visual acuity because of the formation of a retrocorneal membrane after Baerveldt shunt implantation for ICE syndrome. Visual acuity improved after DSAEK from 20/200 to 20/63, whereas intraocular pressure did not change in the 6-month postoperative follow-up. Histological and ultrastructural analysis showed a massive retrocorneal membrane. Immunohistopositivity for α-smooth muscle actin, cytokeratin 7, and pan-cytokeratin suggests a metaplastic endothelial origin of this membrane.The exact origin of the retrocorneal membrane found in this case in ICE syndrome after Baerveldt shunt implantation cannot be clarified, but DSAEK is an effective treatment to improve visual acuity in this situation.

PURPOSE The aim of this study was to describe novel, flap-based tattooing techniques for the treatment of disfiguring corneal scars in blind eyes. METHODS Several new modifications of intrastromal corneal tattooing techniques were performed in 6 patients. In corneas with a low risk of perforation, a large limbus-to-limbus lamellar flap was prepared, and the tattooing dyes were spread over the entire stromal bed. After additional puncturing of the dyes into the stroma, the flap was closed and sutured ("large flap technique"). In fragile corneas where convenient preparation of a large flap was not possible, a central small flap was prepared, and the "pupil" was tattooed in analogy ("small flap technique"). Afterward, the corneal periphery corresponding to the "iris" was tattooed, either by puncturing or injecting the dye into peripheral intrastromal tunnels ("tunnel technique"). RESULTS Two eyes were tattooed using a large flap, and 4 eyes were tattooed using a small flap. Here, the corneal periphery of 3 eyes was tattooed by puncturing, whereas 1 eye was tattooed using the tunnel technique. All tattooing procedures were performed without complications and with good cosmetic results. CONCLUSIONS These novel, flap-based tattooing techniques are alternatives to previously reported procedures and can be adapted to the individual corneal constitution. Further, the tunnel technique is an easy-to-perform method that provides good tattooing results.

Recent studies have identified diminishment of corneal nerves as another hallmark of Fuchs endothelial corneal dystrophy. This study aimed to analyze changes in corneal nerves after Descemet membrane endothelial keratoplasty (DMEK).Twenty-five patients were assessed for nerve alterations preoperatively and 1 week, 4 months, and 20 months after DMEK surgery. Morphology of the central subbasal nerve plexus was quantified by in vivo confocal microscopy.The total nerve length (481.2 ± 81.9 vs. 1536.0 ± 123.8 μm per frame, P0.0001), total nerve number (2.2 ± 0.3 vs. 7.2 ± 0.5 per frame, P0.0001), number of main nerve trunks (1.8 ± 0.2 vs. 3.5 ± 0.3 per frame, P0.0001), and number of nerve branches (0.5 ± 0.2 vs. 3.7 ± 0.4 per frame, P0.0001) were significantly decreased 1 week after DMEK compared with preoperative measurements. Ten months postoperatively, corneal nerves recovered to preoperative values. Central corneal sensation significantly reduced postoperatively (5.1 ± 1.0 vs. 6.0 ± 0.0, P = 0.001), but recovered during follow-up (10 months: 6.0 ± 0.0).DMEK diminishes the density and the function of subbasal corneal nerves early after transplantation. However, a complete recovery of corneal nerve density and function up to preoperative values occurs within 4 to 10 months.

Background Peripheral corneal graft detachment after Descemet9s membrane endothelial keratoplasty (DMEK) is a frequently occurring postoperative complication. The natural course of these persistent peripheral detachments over time is not known. Methods 166 patients were surveyed by slit-lamp-adapted optical coherence tomography (SL-OCT) directly after surgery, during first postoperative week, 4 weeks, 3, 6 and 12 months, postoperatively. Patients with a persistent peripheral graft detachment 4 weeks after DMEK (n=16) were observed for their spontaneous course up to 1 year postoperatively. Results Persistent graft detachments could be characterised into two phenotypes: peripheral roll (n=11; 69%) and laminar detachment (n=5; 31%). Maximal length of the detachment did not change in peripheral rolls during observation period (12 months vs 4 weeks, 578±122 µm vs 593±106 µm, p=0.74), whereas laminar detachments spontaneously attached to the host9s stroma (12 months vs 4 weeks, 0 µm vs 1088±295 µm, p≤0.001). Central corneal thickness and (peripheral) corneal thickness above the detached area did not significantly change in either group. Conclusions Persistent peripheral graft detachments after DMEK occurred in 10% of patients and had two distinct OCT-phenotypes. Peripheral rolls did not change during the first 12 months, postoperatively. By contrast, peripheral laminar detachments attached spontaneously even months after surgery. Corneal thickness reduction was only observed above peripheral laminar detachment, but not above peripheral rolls.

Dear Editor, Graft preparation is a challenging step during posterior lamellar keratoplasty in Descemet membrane endothelial keratoplasty (DMEK) [1–4]. Here, the 15-μm-thick endotheliumDescemet membrane layer (EDM) is manually stripped off the donor cornea before it is inserted into the host’s anterior chamber. For better visualization, the EDM is usually stained with trypan blue 0.06 % (VisionBlue, DORC [Dutch Ophthalmic Research Center] International BV, Zuidland, The Netherlands) [5]. However, the intraocular use of dyes such as trypan blue carries the risk of undesirable side effects, as these dyes may have cytotoxic properties [6, 7]. Indeed, various studies have shown cytotoxic effects of trypan blue on corneal endothelial cells [6–8]. Therefore, there is a need for less toxic dyes for use during lamellar transplant surgery. Phacodyne is a newly available dye for ophthalmic surgery that contains 1 % soluble lutein and only 0.04 % trypan blue (Peschke Medizintechnik GmbH, Waldshut-Tiengen, Germany) [9]. The purpose of this study was to analyze differences in staining properties of Phacodyne compared with VisionBlue, and to investigate potential cytotoxic effects of trypan blue and lutein on corneal endothelial cells. This experimental study was carried out at the Department of Ophthalmology, University of Cologne, Germany. The study adhered to the tenets of the Declaration of Helsinki, and was approved by the institutional review board. In order to compare staining properties of the analyzed dyes, four corneal donor buttons were placed endothelial side up into a Hanna punch block (MORIA Inc., Doylestown, PA, USA) and covered with either Phacodyne (n=2) or VisionBlue (n= 2) for staining of the EDM for 1 min. The dyes were subsequently removed, and pictures of the stained EDMwere taken using a surgical microscope (OPNI LUMERA 700; Carl Zeiss Meditec, Inc., Oberkochen, Germany). For analysis of endothelial cell toxicity, seven corneal rims, after stripping of the central Descemet membrane for standard DMEK surgery using VisionBlue, were quartered into four equal pieces, placed into a 12-well plate, and then incubated with either VisionBlue (n=14) or Phacodyne (n=14) to ensure that the same location was measured. Endothelial cells on the quartered rims (after the central Descemet was stripped off) were counted prior to staining and after 15 and 30 min of incubation, using light microscopy (Zeiss Axio Vert 25, AxioVision 2.05; Carl ZeissMeditec, Inc., Oberkochen, Germany). Statistical analysis was performed using the Mann–Whitney U test, and a p value

Purpose This study aims to analyze the feasibility of Descemet membrane endothelial keratoplasty (DMEK) in the management of corneal endothelial decompensation in eyes with glaucoma implants. Case report A 62-year-old male with bullous keratopathy after trabeculectomy and Baerveldt shunt implantation for contusion glaucoma of the right eye (case 1) underwent surgical tube trimming with a DMEK procedure. A 54-year-old male with Descemet stripping automated endothelial keratoplasty (DSAEK) failure and dislocation in the presence of an Ahmed glaucoma valve and an artificial iris in the right eye (case 2) was treated by removal of the DSAEK graft and subsequent DMEK procedure. In both eyes, the DMEK graft could be successfully inserted, unfolded, positioned in front of the glaucoma tube, and attached to the host stroma by air injection into the anterior chamber. Postoperatively, both corneas cleared with complete graft attachment and stable glaucoma tube position. After 3 days, peripheral graft detachment occurred in case 1 and was managed successfully with one intracameral air reinjection. Case 2 revealed intraocular pressure (IOP) elevation up to 30 mm Hg in the immediate postoperative period, treated successfully by antiglaucoma medications. Within 1-year follow-up, visual acuity improved from hand movements to 20/63 and 20/32, respectively; endothelial cell density decreased by 36% and 42%, respectively; and the IOP ranged between 7 and 14 mm Hg in both cases without treatment. Conclusions Descemet membrane endothelial keratoplasty seems to be feasible in the management of corneal endothelial decompensation in eyes with glaucoma implants. Graft attachment, IOP, and endothelial cell density should be followed up closely.

When performing ultra-thin Descemet's stripping automated endothelial keratoplasty (UT-DSAEK), the quality of the stromal interface and stromal thickness seem to be critical for visual outcome. The aim of this study was to investigate whether additional osmotic deswelling prior to UT-DSAEK improves the quality of the cut surface and leads to a more reliable and deeper cut in UT-DSAEK ("OSMO-UT-DSAEK").Seventeen human donor corneas not usable for transplantation were used in this experiment. After standard deswelling with culture Medium II, ten corneas were randomly assigned to be additionally deswollen within THIN-C medium. The other remaining seven corneas were put back into culture Medium II. All corneas were placed in an artificial anterior chamber system (Moria); a double path cutting procedure using a microkeratome (Moria) was then performed. Corneal thickness was measured by ultrasound biomicroscopy and in paraffin-embedded slides, followed by histological grading of the cut surface.Stromal interface smoothness significantly improved after preconditioning in THIN-C medium (Pearson P = 0.019). The correlation of the corneal thickness obtained by UBM (mean 706 ± SD 208 μm) and histology (mean 530 ± SD 159 μm) was not significant (Pearson r = 0.11, P0.05, mean difference 247, 95 % CI [+50;+304]). We found no significant correlation between the microkeratome setting and the actual thickness of the lenticule measured in histological analysis in both media as well as for the first and second cut (first cut: Pearson r = 0.9, P = 0.1, 95 % CI [-10;+96], second cut: Pearson r = 0.9, P = 0.4, 95 % CI [-10;+22]).Preconditioning of corneas with THIN-C medium significantly improved the quality of the graft interface in UT-DSAEK, but did not significantly improve the cut precision of the microkeratome.

Purpose: Ranibizumab (Lucentis®) is a Fab-Fragment of a recombinant, humanized, monoclonal VEGF (anti-vascular endothelial growth factor) antibody. This study analyzed the ability of topical Ranibizumab to inhibit lymphangiogenesis in addition to hemangiogenesis after acute corneal inflammation in vivo. In addition, the effect of Ranibizumab on the proliferation of human lymphatic endothelial cells (LECs) and blood endothelial cells (BECs) in vitro was studied. Methods: The inhibitory effect of Ranibizumab on LECs and BECs was studied in vitro using a proliferation enzyme-linked immunosorbent assay (ELISA) assay. To study the in vivo effects of Ranibizumab, the mouse model of suture induced inflammatory corneal neovascularization was used. Study mice received topical Ranibizumab as eye drops. After 1 week excised corneas were stained with LYVE-1 and CD31. Hemangiogenesis and lymphangiogenesis were analyzed morphometrically by using a semiautomatic method based on the image analyzing program Cell^F. Results: An antiproliferative effect of Ranibizumab was seen in vitro on both human BECs and LECs with a significance of p