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Background: This retrospective cross-sectional study aims to analyse the keratoconus (KC) stage distribution at different ages within the Homburg Keratoconus Center (HKC)., Methods: 1917 corneae (1000 patients) were allocated to decades of age, classified according to Belin's ABCD KC grading system and the stage distribution was analysed., Results: 73 per cent (n=728) of the patients were males, 27% (n=272) were females. The highest KC prevalence occurred between 21 and 30 years (n=585 corneae, 294 patients). Regarding anterior (A) and posterior (B) curvature, the frequency of A was significantly higher than B in all age groups for stage 0, 1 and 2 (A0>B0; A1>B1; A2>B2; p<0.03, Wilcoxon matched-pairs test). There was no significant difference between the number of A3 and B3, but significantly more corneae were classified as B4 than A4 in all age groups (p<0.02). The most frequent A|B combinations were A4|B4 (n=451), A0|B0 (n=311), A2|B4 (n=242), A2|B2 (n=189) and A1|B2 (n=154). Concerning thinnest pachymetry (C), most corneae in all age groups were classified as C0>C1>C2>C3>C4 (p<0.04, Wilcoxon matched-pairs test). For the best distance visual acuity (D), a significantly higher number of corneae were classified as D1 compared to D0 (p<0.008; D1>D0>D2>D3>D4)., Conclusion: The stage distributions in all age groups were similar. Early KC rather becomes manifest in the posterior than the anterior corneal curvature whereas advanced stages of posterior corneal curvature coincide with early and advanced stages of anterior corneal curvature. Thus, this study emphasises the necessity of posterior corneal surface assessment in KC as enabled by the ABCD grading system., Competing Interests: Competing interests: KX, SCG, SR, EZ, LH, TJ, UK, AL and BS declare that they do not have any financial disclosures in medicine. EF has received a travel grant to the Second and Third Ophthalmology Cystinosis Forum (Orphan Europe, Ulm, Germany) and an invitation to a seminar on presentation training organised by the Santen GmbH (Munich, Germany). TE was a member of the Institute of Experimental Ophthalmology, Saarland University Medical Center (Homburg, Germany), at the time of data collection and is now an employee of the Amiplant GmbH (Schnaittach, Germany)., (© Author(s) (or their employer(s)) 2021. No commercial re-use. See rights and permissions. Published by BMJ.)

Aim: The OA-1000 (Tomey, Japan) is a new optical biometer, which measures axial length (AL), anterior chamber depth (ACD), and central corneal thickness (CT) utilizing optical interference technology. The aim of this study was to prove the reproducibility which is considered fundamental for other clinical investigations., Methods: 55 healthy volunteers were enrolled in this study. For each measurement of AL, ACD, and CT the biometer is grabbing a sequence of 10 shots and mean value (mean) and standard deviation (SD) are displayed. Five consecutive measurements were performed and average and standard deviation were assessed. Cronbach's α was derived as a quality measure for reproducibility., Results: For AL measurement Cronbach's α was 1.000, for CT 0.999, and for ACD 0.979, respectively. Mean value for AL was 23.36 ± 1.03 mm, for ACD it was 3.60 ± 0.687 mm, and for CT it was 552.08 ± 29.70 μm, respectively. Standard deviation for AL was 0.013 ± 0.022 mm, for ACD 0.09 ± 0.11 mm, and for CT 2.18 ± 1.75 μm. One correlation was found between mean values for AL and ACD (R = 0.388, P = 0.005); no other correlations were found between mean values or values of standard deviation of AL, ACD, or CT., Conclusion: The OA-1000 shows an excellent reproducibility for measurement of AL, ACD, and CT and can be used in clinical practice.

A 4-year-old girl presented to our department with a pain and symptom-free elevated intraocular pressure (IOP) of 44 mmHg in both eyes and with enlarged corneal diameters. Megalocornea, buphthalmos and anterior megalophthalmos were discussed as differential diagnoses. Due to age-related normal morphological, functional and electrophysiological results of the optic nerve head and a very deep anterior chamber, anterior megalophthalmos was diagnosed. No topical treatment was initiated and close ophthalmological surveillance control was recommended. To the best of our knowledge megalophthalmus anterior has not up to now been described as associated with a pathological sensitivity to minor changes in lid muscle tension causing a sudden increase of IOD.

Background: The OA-1000 (Tomey, Japan) is a new optical biometer, which allows measurements of axial length (AL), anterior chamber depth (ACD) and corneal thickness (CT) due to partial coherence interferometry (PCI) technology. The aim of this study was to compare the OA-1000 results with those obtained with the IOLMaster and contact applanation A-scan ultrasonography., Methods: We examined 133 eyes of 75 patients with age related cataract. Mean age was 72.0 ± 9.5 years. Biometry measurements of AL and ACD were performed with the Tomey OA-1000 based on PCI, the IOLMaster based on PCI (AL) and slit projection (ACD), and the Tomey AL-3000 based on contact applanation A-scan ultrasonography., Results: Mean AL using the IOLMaster was 23.21 ± 1.08 mm, using the AL-3000 was 22.79 ± 1.04 mm, using the OA-1000 it was 22.97 ± 1.1 mm. Mean ACD using the IOLMaster was 2.99 ± 0.41 mm, using the OA-1000 3.40 ± 0.46 mm, using the Tomey AL-3000 it was 2.93 ± 0.43 mm. Mean difference between the AL and ACD measured with the OA-1000 and the IOLMaster was 0.22 ± 0.047 mm and 0.40 ± 0.33 mm, between OA-1000 and the AL-3000 it was 0.19 ± 0.23 mm and 0.47 ± 0.33 mm, and between IOLMaster and AL-3000 it was 0.42 ± 0.23 and 0.09 ± 0.36 mm. For AL the correlation coefficient R between IOLMaster and OA-1000 was 0.999, between IOLMaster and AL-3000 it was 0.976, between AL-3000 and OA-1000 it was 0.977. For ACD R between IOLMaster and OA-1000 was 0.735, between IOLMaster and AL-3000 it was 0.822, between AL-3000 and OA-1000 it was 0.716 (all p < 0.001)., Conclusions: Compared with other used clinical instruments the OA-1000 generates accurate results. Although differences were found, the OA-1000 provided results that correlated well with the values of IOLMaster and AL-3000.

Purpose: To evaluate the repeatability of corneal hysteresis (CH) and corneal resistance measurements as well as the consistency of the four shots within each measurement using the ocular response analyzer (ORA, Reichert Ophthalmic Instruments, Depew, NY) and to generate a pool of data of a normal population., Methods: A total of 45 eyes from 45 healthy volunteers without ocular pathologies and normal visual acuity were enrolled in this study. A sequence of five consecutive measurements was performed with each patient with the ORA. The biomechanical properties of the cornea in terms of CH and corneal resistance factor (CRF) were recorded, as well as the Goldmann-correlated IOP (IOPg) and cornea correlated IOP (IOPcc). The trend in each measurement sequence was analyzed and Cronbach's α was derived for the repeatability. The average of four shots within each measurement was compared with the best signal value (BSV) provided by the internal data processing of the ORA., Results: Mean value for CH was 11.58 and BSV was 11.55. For CRF, mean value was 11.21 and BSV was 11.28. No significant difference was found between the average value and the BSV of one measurement (p > 0.05). No significant difference was found between the average value and the BSV of the five consecutive measurements, only IOPg showed a significant difference (p = 0.017), average value of IOPg is higher than BSV. Within a sequence of five measurements for each individual, the average values of the four shots per measurement for IOPg and IOPcc are decreasing by 1.19 and 1.05 mmHg on average. The repeatability test revealed good results for CH and CRF (all α are higher than 0.9)., Conclusion: The ORA provides, beside intraocular pressure additional, information about the biomechanical properties of the cornea such as hysteresis and resistance. It proves to yield good repeatability for corneal hysteresis and resistance in normal subjects.

A 44-year-old patient with a known history of Crohn's disease come to our clinic with unilateral vision impairment, orbital pain, and papillary swelling. The patient was treated with methylprednisolone for 5 days. Differential diagnosis excluded ischemic, inflammatory, and tumor-related causes of the papillary swelling, which was more likely to be due to papillitis associated with the known presence of Crohn's disease. Under steroid treatment visual acuity increased from 0.1 to 0.5, and an evident improvement of the ophthalmological and neurological findings was observed. Papillitis in conjunction with Crohn's disease is a rare cause of papillary swelling and should be taken into consideration during differential diagnosis. The disorder responds to steroid therapy but does not avoid irreversible damage.

Background: The aim of this study was to analyze the distribution of total, corneal, and mainly internal human third- to sixth-order aberrations (HOA) and investigate possible correlations between wavefront errors and patient age., Patients and Methods: For this study 140 eyes of 140 subjects (age range 17-77 years) were measured three times each using Nidek Optical Path Difference scan. Mean value and standard deviation for each Zernike polynomial was computed for a 5-mm pupil diameter, and six different age groups were formed., Results: There was wide individual variation in the internal wavefront aberrations. The mean root-mean-square value for HOA was 0.4563 microm+/-0.296 microm. No positive correlation was found between Zernike polynomials and increasing age. In total spherical aberration however a significant difference was found between the 26-35-year and > or =56-year age groups (p=0.0002), as well as to internal and total coma (Z8) (p=0.0487 and p=0.0117, respectively)., Conclusions: The internal, corneal, and total wavefront aberrations varied widely among patients. Some significant differences were found between the age groups. No correlation between age and the internal, corneal, or total aberrations was found.