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Purpose To analyze refractive and topographic changes secondary to Descemet membrane endothelial keratoplasty (DMEK) in pseudophakic eyes with Fuchs’ endothelial dystrophy (FED). Methods Eighty-seven pseudophakic eyes of 74 patients who underwent subsequent DMEK surgery for corneal endothelial decompensation and associated visual impairment were included. Median post-operative follow-up time was 12 months (range: 3–26 months). Main outcome measures were pre- and post-operative manifest refraction, anterior and posterior corneal astigmatism, simulated keratometry (CASimK) and Q value obtained by Scheimpflug imaging. Secondary outcome measures included corrected distance visual acuity (CDVA), central corneal densitometry, central corneal thickness, corneal volume (CV), anterior chamber volume (ACV) and anterior chamber depth (ACD). Results After DMEK surgery, mean pre-operative spherical equivalent (± SD) changed from + 0.04 ± 1.73 D to + 0.37 ± 1.30 D post-operatively (p = 0.06). CDVA, proportion of emmetropic eyes, ACV and ACD increased significantly during follow-up. There was also a significant decrease in posterior corneal astigmatism, central corneal densitometry, central corneal thickness and corneal volume over time (p = 0.001). Only anterior corneal astigmatism and simulated keratometry (CASimK) remained fairly stable after DMEK. Conclusion Despite tendencies toward a hyperopic shift, changes in SE were not significant and refraction remained overall stable in pseudophakic patients undergoing DMEK for FED. Analysis of corneal parameters by Scheimpflug imaging mainly revealed changes in posterior corneal astigmatism pointing out the relevance of posterior corneal profile changes during edema resolution after DMEK.

Purpose To evaluate the potential impact of rebubbling on the anterior segment parameters and refractive outcomes in patients with graft detachment following uneventful DMEK for Fuchs endothelial dystrophy (FED). Methods Retrospective institutional cohort study of comparing 34 eyes of 31 patients with rebubbling for graft detachment following Descemet membrane endothelial keratoplasty (DMEK) to 33 eyes of 28 patients with uneventful DMEK. Main outcome parameters were various corneal parameters obtained by Scheimpflug imaging, refractive outcome, corrected distance visual acuity (CDVA), and endothelial cell density (ECD). Results Anterior and posterior corneal astigmatism, corneal densitometry, central corneal thickness, and anterior chamber depth and volume showed no significant differences. Preoperative distribution of astigmatism axis orientations showed a high proportion of anterior corneal with-the-rule astigmatism (71%) in eyes requiring rebubbling. Mean postoperative cylinder in the rebubbling group (1.21 ± 0.85 D) was significantly higher compared to the controls (p = 0.04), while differences in spherical equivalent (SE) were insignificant (p = 0.24). Postoperative CDVA was 0.11 ± 0.11 in the control group compared to 0.21 ± 0.17 in the rebubbling group (p = 0.03). Eyes with subsequent rebubbling demonstrated a significantly higher endothelial cell loss (56% versus 37%) (p < 0.001). Conclusion Apart from higher cylinder values, refractive outcome and corneal parameters assessed by Scheimpflug imaging were comparable in eyes with rebubbling and controls. However, a reduced visual acuity and an increased endothelial cell loss should be taken into consideration prior to rebubbling especially in eyes with circumscribed graft detachment.

Zusammenfassung Hintergrund Die Ophthalmoskopie ist Bestandteil des medizinischen Curriculums, jedoch das Vermitteln der Inhalte oft unbefriedigend, da ein systematisches Lernen von Pathologien und deren Behandlungen dadurch erschwert ist, dass oftmals das passende Patientengut nicht zur Verfügung steht und dadurch gesunde Studenten einander untersuchen müssen. Aus diesem Grund haben wir eine Online-Plattform entwickelt, die in Kombination mit simulationsgestütztem Training sowohl das eigenständige als auch das angeleitete Lernen von Untersuchungsmethoden und Pathologien ermöglicht. Ziel der Arbeit Ziel der vorliegenden Arbeit war, ein Format für die Verbesserung der Lehre der direkten und indirekten Ophthalmoskopie im Studierendenunterricht zu evaluieren. Dabei wurden praktische Übungen an Virtual-Reality-basierten Simulatoren mit neu entwickelten und an den Lehrkatalog angepassten theoretischen Inhalten in der Online-Plattform EyesiNet verschränkt. Material und Methoden Die Studierenden bearbeiteten am ersten sowie am letzten Praktikumstag zufällig ausgewählte Fälle, die ihnen von den Eyesi Direct- und Eyesi Indirect-Simulatoren präsentiert wurden. Zwischen diesen beiden Einheiten konnten sie sich auf freiwilliger Basis mit den theoretischen Grundlagen typischer ophthalmologischer Krankheitsbilder im EyesiNet beschäftigen. Ergebnisse Eyesi Direct: Die Bewertung des Simulators ergab am ersten Praktikumstag für beide Gruppen keinen signifikant unterschiedlichen Wissensstand (p = 0,29). In der Gruppe OHNE Training (n = 54) ergab sich am letzten Praktikumstag mit p = 0,02 eine signifikante Verbesserung dieser Bewertung, jedoch mit einer geringen Effektgröße von 0,1. In der Gruppe MIT Training (n = 32) konnte mit p = 0,0004 eine hoch signifikante Verbesserung mit einer Effektgröße von 0,3 nach Rosenthal festgestellt werden. Eyesi Indirect: Die simulatorgestützte Bewertung ergab am ersten Praktikumstag keinen signifikanten Unterschied im Wissensstand der beiden Gruppen (p = 0,1). Nach dem Training schnitten zwar beide Gruppen etwas besser ab, jedoch ohne signifikanten Unterschied (OHNE Training p = 0,41/MIT Training p = 0,17). Diskussion Die Online-Plattform EyesiNet unterstützt beim Erlernen der wichtigsten Erkrankungsbilder. Lerninhalte werden reproduzierbar und auf für alle Lernenden standardisierte Weise zur Verfügung gestellt. Die Fertigkeiten der direkten Ophthalmoskopie sind hierbei deutlich schneller als die der indirekten Ophthalmoskopie zu erlernen.

Hintergrund: Immunreaktionen wie eine sterile Endophthalmitis treten bei der intraokularen Anwendung von anti-VEGF Pr��paraten auf. Solche Verl��ufe sind selten, k��nnen jedoch schwerwiegende Folgen haben. Methoden: Es stellt sich der Fall eines 70-J��hrigen mit rezidivierender Endophthalmitis [zum vollst��ndigen Text gelangen Sie ��ber die oben angegebene URL]

Purpose To investigate short-term (3 months follow-up) changes in visual quality following Descemet membrane endothelial keratoplasty (DMEK) for Fuchs endothelial dystrophy (FED). Methods In this prospective institutional case series, 51 patients that underwent DMEK for FED were included. Assessment included the Quality of Vision (QoV) questionnaire preoperatively, at 1 month, and 3 months after surgery. Secondary outcome measures were anterior segment parameters acquired by Scheimpflug imaging, corrected distance visual acuity (CDVA), and endothelial cell density (ECD). Results Glare, hazy vision, blurred vision, and daily fluctuation in vision were the symptoms mostly reported preoperatively. All symptoms demonstrated a significant reduction of item scores for severity, frequency, and bothersome in the course after DMEK (P rs = 0.39; P = 0.03) and frequency (rs = 0.26; P = 0.02) as well as severity (rs = 0.27; P = 0.03) of blurry vision. CDVA and central corneal thickness (CCT) did not correlate with visual complains. Conclusions Following DMEK for FED, patient-reported visual symptoms assessed by the QoV questionnaire represent a useful tool providing valuable information on the impact of DMEK on visual quality that cannot be directly estimated by morphological parameters and visual acuity only.

To evaluate the characteristics of preoperative and postoperative astigmatism in patients having Descemet membrane endothelial keratoplasty (DMEK).Department of Ophthalmology, Goethe University, Frankfurt, Germany.Retrospective case series.Measurements were obtained using a Scheimpflug camera (Pentacam AXL) preoperatively and 3 months and 12 months postoperatively. Values of front and back astigmatism and total astigmatism in the central 4.0 mm diameter zone (TCA4) were analyzed.Fifty-three eyes of 45 patients were included. The prevalence of TCA4 above 1.0 diopter (D) was considerably higher (79%) and with-the-rule astigmatism was less frequent in this cohort of European patients with Fuchs endothelial dystrophy (mean age 65 years) than that reported in a meta-analysis of healthy European eyes. The TCA4 values correlated with anterior astigmatism preoperatively and postoperatively (P .001) and with posterior astigmatism at the 1-year follow-up (P .01). Although, no correlation was found between the preoperative and 1-year results for anterior astigmatism (P = .12), posterior astigmatism (P = .35), or total corneal astigmatism (P = .47), the difference in vector analysis between the two measurements was only 0.01 at 109 degrees, 0.03 at 98 degrees, and 0.02 at 157 degrees, respectively. However, the greater the difference between the preoperative TCA3 and preoperative TCA5 values, the greater the decrease in corneal astigmatism (P .001).The percentage of eyes with corneal astigmatism above 1.0 D was higher preoperatively and postoperatively in patients with Fuchs endothelial dystrophy than in a healthy population. Predicting postoperative astigmatism based on preoperative results is not possible; however, in eyes with a high difference between TCA3 and TCA5, a reduction in corneal astigmatism after DMEK is likely.

Purpose To investigate the efficacy and safety of Descemet membrane endothelial keratoplasty (DMEK) for corneal decompensation following primary Descemet stripping automated endothelial keratoplasty (DSAEK). Methods This was a retrospective case series of 15 patients that underwent DMEK surgery for corneal decompensation after failed DSAEK. Main outcome parameter was corrected distance visual acuity (CDVA) after DMEK and DSAEK. Secondary outcome measures included central corneal thickness (CCT), endothelial cell density (ECD), rebubbling rate, and primary graft failure after DMEK. Explanted DSAEK grafts were evaluated by light microscopy. Results The mean (±SD) time period between DSAEK and DMEK surgery was 15±8 months (range, 6-31 months). Preoperative CDVA was 1.72±0.62 (logMAR). After DMEK, CDVA improved significantly to 0.78±0.48 at 1 month and to 0.23±0.24 after 12 months (P=0.022). Visual acuity data after DMEK were significantly better compared to preoperative values. The average CCT after DMEK decreased significantly from 869±210 µm (preoperative) to 505±45 µm (1 month postoperative) (P

Eine frühe augenärztliche Mitbetreuung von intensivpflichtigen Patienten mit SARS-CoV-2 (Severe-Acute-Respiratory-Syndrom-Corona-Virus-2) Infektion ist sehr aufwendig, aber sinnvoll, um ophthalmologische Krankheitsbilder, wie z. B. den Lagophthalmus, zu verhindern. Die ophthalmologische Behandlung unterscheidet sich dabei nicht bei SARS-CoV-2-positiven und anderen intensivpflichtigen Patienten. Aufgrund der geringen Fallzahl unserer Beobachtungsstudie lassen sich bis dato keine spezifischen ophthalmologischen Krankheitsbilder in Zusammenhang mit der SARS-CoV-2-Infektion ablesen. Nennenswert ist jedoch das gehäufte Auftreten von Hyposphagmata bei intensivpflichtigen SARS-CoV-2-Patienten. Unklar bleiben weiterhin der Zusammenhang von okulären Symptomen bei SARS-CoV-2-Infektionen sowie das Auftreten in verschiedenen Krankheitsstadien. Daher sind weitere Studien für repräsentative Aussagen notwendig.

Early ophthalmological care of patients in intensive care with SARS-CoV­2 (Severe-Acute-Respiratory-Syndrom-Corona-Virus-2) infections is very time-consuming; however, this approach might prevent other ophthalmological diseases, such as lagophthalmos. There is no difference in ophthalmological treatment between SARS-CoV­2 positive and other intensive care patients. Due to the small number of cases in our observational study, a specific ophthalmological clinical pattern related to SARS-CoV­2 infections cannot currently be identified; however, the increased occurrence of subconjunctival hemorrhage in intensive care SARS-CoV­2 patients is remarkable. It remains unclear how ocular symptoms in SARS-CoV­2 infections are related or how they occur in different stages of the disease. Therefore, further studies are necessary for representative statements.

AimTo define variables for the evaluation of keratoconus progression and to determine cut-off values.MethodsIn this retrospective cohort study (2010–2016), 265 eyes of 165 patients diagnosed with keratoconus underwent two Scheimpflug measurements (Pentacam) that took place 1 year apart ±3 months. Variables used for keratoconus detection were evaluated for progression and a correlation analysis was performed. By logistic regression analysis, a keratoconus progression index (KPI) was defined. Receiver-operating characteristic curve (ROC) analysis was performed and Youden Index calculated to determine cut-off values.ResultsVariables used for keratoconus detection showed a weak correlation with each other (eg, correlation r=0.245 between RPImin and Kmax, pConclusionsKeratoconus progression should be defined by evaluating parameters that consider several corneal changes; we suggest D-index and KPI to detect progression.

PURPOSE To compare results between standard and accelerated corneal collagen cross-linking (CXL) for the treatment of progressive keratoconus. METHODS We performed literature searches in PubMed, Cochrane Library, Web of Science, ISRCTN registry, ClinicalTrials.gov, and EMBASE for studies comparing conventional Dresden (C-CXL) and accelerated CXL (A-CXL). Outcomes were clinical results and changes in corneal properties. Weighted mean differences were used to evaluate the effects. RESULTS Here, 22 studies with 1158 eyes (C-CXL: 577 eyes; A-CXL: 581 eyes) were included. At the last follow-up, C-CXL was superior regarding minimum keratometry (p

Infektiose Entzundungen der Hornhaut (mikrobielle Keratitiden) stellen potenziell visusbedrohende Erkrankungen dar. Je nach Schweregrad und Verlauf konnen sie bis zum Verlust des Auges fuhren. Entscheidend fur das Sehvermogen ist, dass die Erreger schnell erkannt und zielgerichtet therapiert werden. Dieser Beitrag behandelt zunachst generelle klinische, diagnostische und therapeutische Aspekte mikrobieller Keratitiden und geht anschliesend auf die Besonderheiten bakterieller Keratitiden ein. In einem zweiten Teil werden klinische, methodische und therapeutische Besonderheiten von Keratomykosen und Akanthamobenkeratitiden besprochen [1]. Infectious inflammation of the cornea (microbial keratitis) represents a potentially vision threatening disease. Depending on the infectious agent and the course of the disease it can result in a complete loss of the involved eye. Early diagnosis and accurate treatment are mandatory to maintain a sufficient visual acuity. The purpose of this review is to highlight and discuss characteristic clinical features, diagnostic procedures, and therapeutic aspects of three major forms of microbial keratitis (bacteria, fungi, and acanthamoeba; the latter two in the 2nd part of this article).

Pilze und Akanthamoben stellen neben Bakterien wesentliche Ursachen fur die Entstehung infektioser Hornhauterkrankungen (mikrobielle Keratitis) und moglicher nachfolgender Erblindung des betroffenen Auges dar. Aufgrund weitgehend unspezifischer Gewebereaktionen, vor allem in den Fruhstadien der Entzundung, wird die Diagnose infektioser Hornhauterkrankungen oftmals erst verspatet gestellt. Insbesondere bei Akanthamoben sind Verwechslungen mit viralen (herpetischen) Keratitiden leicht moglich. Der behandelnde Augenarzt ist daher vor hohe diagnostische Herausforderungen gestellt. Fungi and acanthamoeba represent potential vision threatening causes of infectious corneal inflammation (microbial keratitis). Early and correct diagnosis of the disease is often difficult due to a lack of specific initial clinical findings. Especially acanthamoeba can easily be misdiagnosed for herpetic keratitis. Therefore, ophthalmologists need to be aware of relevant clinical, diagnostic, and therapeutic characteristics of fungal and acanthamoeba keratitis which will be described and discussed in the present review.

Purpose:This meta-analysis compares Descemet membrane endothelial keratoplasty (DMEK) with Descemet stripping automated endothelial keratoplasty (DSAEK) to evaluate their strength and weakness profiles.Design:Meta-analysis.Methods:We performed a meta-analysis and searched the peer-reviewed literatur

Es gibt verschiedene Entwicklungen und Erfindungen aus Deutschland, die nicht nur die hiesige, sondern die gesamte internationale Augenheilkunde beeinflusst haben – beginnend mit der Erfindung des Augenspiegels durch Hermann von Helmholtz 1850 uber die Grundung der augenheilkundlichen Zeitschrift Archiv fur Ophthalmologie durch Albrecht von Graefe im Jahr 1854 bis zur Entwicklung eines Netzhautchips durch Eberhart Zrenner und Kollegen mit ersten klinischen Daten im Jahr 2007. Auf obige und weitere Entwicklungen und die dahinterstehenden deutschen Ophthalmologen wird im Folgenden naher eingegangen.

PURPOSE To evaluate and compare power and axis orientation of anterior and posterior astigmatism in eyes with keratoconus with healthy eyes. METHODS In this retrospective cohort study, we examined 861 eyes of 494 patients diagnosed with keratoconus at the Department of Ophthalmology, University Hospital Frankfurt, and 256 eyes of 256 healthy individuals. Using a Scheimpflug device (Pentacam HR), we measured the magnitude and axis orientation of anterior and posterior corneal astigmatism, corneal thickness, and conus location. The results were compared between different stages of the disease according to the Amsler-Krumeich classification and the control group. RESULTS Magnitude of corneal astigmatism was 3.47 ± 2.10 diopters (D) on the anterior surface and 0.69 ± 0.40 D on the posterior surface in eyes across all keratoconus stages. We found a significant increase of anterior and posterior corneal astigmatism with progression of disease (P < 0.01, 1-way analysis of variance) and a significant correlation between anterior and posterior corneal astigmatism (r = 0.77, P < 0.01). In contrast to eyes of healthy individuals, in which posterior corneal axis alignment is vertical in most cases independent of anterior alignment, we found in eyes with keratoconus a match between anterior and posterior alignment when alignment was vertical in 97% of eyes, 46% when oblique and 61% when horizontal (Cohen kappa coefficient κ = 0.55, P < 0.01). With progression of disease, alignment of anterior and posterior corneal astigmatism became increasingly vertical. CONCLUSIONS In eyes with keratoconus, posterior axis alignment of corneal astigmatism is in line with alignment of the anterior surface in the majority of cases. Posterior astigmatism axis alignment could potentially be used in algorithms to support diagnosis and staging of keratoconus.

Purpose: To report a case of autoimmune keratitis in a patient with mycobacterium tuberculosis (MBT). Methods: An 84-year-old male with pulmonary tuberculosis (TB) was admitted with chronic, non-healing bilateral ulcerations of the inferior peripheral cornea associated with stromal and subconjunctival nodules. Results: Clinical examination revealed circumscribed peripheral corneal ulceration with whitish nodules in adjacent stromal and subconjunctival tissue. Microbiological cultures of the corneal tissue were negative for MBT and other microbial pathogens; however, enzyme-linked immunosorbent assay (ELISA) of blood and corneal samples showed significantly elevated levels of IgM and IgA against MBT. In addition to systemic anti-tuberculosis therapy, the patient was treated topically with Polyspectran® eye drops, Dexamethasone eye drops, and Bepanthen® ointment, for 2 weeks. Both eyes showed dramatic improvement after 2 weeks. Conclusion: The present report demonstrates that MBT is able to initiate delayed autoimmune response within the corneal tissue during an intensive phase of anti-tuberculosis treatment. Keywords: Ocular tuberculosis, Scrofulous keratitis, Phlyctenule, Autoimmune response

PURPOSE To evaluate Scheimpflug corneal densitometry (CD) in patients undergoing secondary Descemet membrane endothelial keratoplasty (DMEK) after previous Descemet stripping automated endothelial keratoplasty or DMEK surgery. METHODS This was a retrospective institutional case series of 37 eyes of 37 patients. Two secondary DMEK groups, group 1A (n = 12 DMEK after Descemet stripping automated endothelial keratoplasty), group 1B (n = 11 repeat DMEK), and group 2 (n = 14 primary DMEK for Fuchs endothelial dystrophy) were formed. CD was obtained preoperatively, 1, 6, and 12 months postoperatively. In addition, corrected distance visual acuity, central corneal thickness, and endothelial cell density were assessed. RESULTS A significant decrease in grayscale units was observed in the 0- to 2-mm and 2- to 6-mm zones in all groups. For the 0- to 2-mm zone, values decreased from 49.11 ± 17.96 preoperatively to 22.87 ± 5.24 at 12 months (group 1A), from 45.16 ± 9.22 to 24.53 ± 14.21 (group 1B), and from 27.90 ± 8.30 to 16.64 ± 1.51 (group 2) (P < 0.01). Group 2 showed significantly lower grayscale units than groups 1A and 1B preoperatively and 12 months postoperatively in the 0- to 2-mm and 2- to 6-mm zones. Significant correlations of CD and corrected distance visual acuity were found in groups 1A and 1B in the 0- to 2-mm zone at 12 months. There were no significant correlations between CD and central corneal thickness postoperatively. CONCLUSIONS A decrease in CD could be demonstrated in secondary DMEK. Nevertheless, CD values remained significantly higher than in controls. This might point out the relevance of secondary corneal structural changes.

Purpose To investigate the efficacy and safety of Descemet membrane endothelial keratoplasty (DMEK) for corneal decompensation following primary Descemet stripping automated endothelial keratoplasty (DSAEK). Methods This was a retrospective case series of 15 patients that underwent DMEK surgery for corneal decompensation after failed DSAEK. Main outcome parameter was corrected distance visual acuity (CDVA) after DMEK and DSAEK. Secondary outcome measures included central corneal thickness (CCT), endothelial cell density (ECD), rebubbling rate, and primary graft failure after DMEK. Explanted DSAEK grafts were evaluated by light microscopy. Results The mean (±SD) time period between DSAEK and DMEK surgery was 15±8 months (range, 6–31 months). Preoperative CDVA was 1.72±0.62 (logMAR). After DMEK, CDVA improved significantly to 0.78±0.48 at 1 month and to 0.23±0.24 after 12 months (P=0.022). Visual acuity data after DMEK were significantly better compared to preoperative values. The average CCT after DMEK decreased significantly from 869±210 µm (preoperative) to 505±45 µm (1 month postoperative) (P

Bishr Agha, Mehdi Shajari, Anna Slavik-Lencova, Thomas Kohnen, Ingo Schmack Department of Ophthalmology, Goethe-University, Frankfurt am Main, Germany Purpose: To evaluate if repeat Descemet membrane endothelial keratoplasty (DMEK) is appropriate to achieve functional improvements in patients with corneal decompensation from secondary graft failure after primary DMEK.Methods: This is a retrospective monocentric cohort study including 13 eyes of 13 patients with repeat DMEK for corneal decompensation following primary DMEK. Eyes with primary DMEK only and comparable preoperative corrected distance visual acuity (CDVA) served as control. Main outcome parameter was CDVA. Secondary outcome measures were central corneal thickness (CCT), endothelial cell density, and rebubbling rate (RR).Results: The average time interval (±SD) between primary and secondary DMEK was 12.5±6 months. Preoperative CDVA (logMAR) was 1.97±0.90 in the repeat DMEK group and 1.38±0.92 in the primary DMEK group. At 6 months, both groups showed significant improvement in visual acuity (repeat DMEK group, 0.49±0.35, P0.05). The RR was23% (n=3) in both groups.Conclusion: Repeat DMEK is a useful therapeutic approach in the setting of corneal decompensation following primary DMEK. Functional results of repeat DMEK, visual acuity in particular, are comparable to patients with single DMEK only. Keywords: DMEK, repeat DMEK, corneal edema, corneal transplantation &nbsp

Infectious inflammation of the cornea (microbial keratitis) represents a potentially vision threatening disease. Depending on the infectious agent and the course of the disease it can result in a complete loss of the involved eye. Early diagnosis and accurate treatment are mandatory to maintain a sufficient visual acuity. The purpose of this review is to highlight and discuss characteristic clinical features, diagnostic procedures, and therapeutic aspects of three major forms of microbial keratitis (bacteria, fungi, and acanthamoeba; the latter two in the 2nd part of this article).Infektiöse Entzündungen der Hornhaut (mikrobielle Keratitiden) stellen potenziell visusbedrohende Erkrankungen dar. Je nach Schweregrad und Verlauf können sie bis zum Verlust des Auges führen. Entscheidend für das Sehvermögen ist, dass die Erreger schnell erkannt und zielgerichtet therapiert werden. Dieser Beitrag behandelt zunächst generelle klinische, diagnostische und therapeutische Aspekte mikrobieller Keratitiden und geht anschließend auf die Besonderheiten bakterieller Keratitiden ein. In einem zweiten Teil werden klinische, methodische und therapeutische Besonderheiten von Keratomykosen und Akanthamöbenkeratitiden besprochen [1].

Pilze und Akanthamöben stellen neben Bakterien wesentliche Ursachen für die Entstehung infektiöser Hornhauterkrankungen (mikrobielle Keratitis) und möglicher nachfolgender Erblindung des betroffenen Auges dar. Aufgrund weitgehend unspezifischer Gewebereaktionen, vor allem in den Frühstadien der Entzündung, wird die Diagnose infektiöser Hornhauterkrankungen oftmals erst verspätet gestellt. Insbesondere bei Akanthamöben sind Verwechslungen mit viralen (herpetischen) Keratitiden leicht möglich. Der behandelnde Augenarzt ist daher vor hohe diagnostische Herausforderungen gestellt.Fungi and acanthamoeba represent potential vision threatening causes of infectious corneal inflammation (microbial keratitis). Early and correct diagnosis of the disease is often difficult due to a lack of specific initial clinical findings. Especially acanthamoeba can easily be misdiagnosed for herpetic keratitis. Therefore, ophthalmologists need to be aware of relevant clinical, diagnostic, and therapeutic characteristics of fungal and acanthamoeba keratitis which will be described and discussed in the present review.

PURPOSE: To report a case of interface fluid syndrome after LASIK in a patient with Fuchs' corneal endothelial dystrophy treated with Descemet membrane endothelial keratoplasty (DMEK). METHODS: Case report. RESULTS: A 74-year-old patient presented with interface fluid syndrome and was treated with DMEK. Its complications in the form of partial graft detachment and cystoid macular edema were successfully managed by rebubbling and topical treatment, respectively. The treatment led to amelioration of both visual acuity and patient satisfaction. At the examination 6 months after DMEK, the cornea was clear and corrected distance visual acuity improved to a satisfactory level. CONCLUSIONS: Interface fluid syndrome can develop many years after LASIK as a result of corneal endothelial decompensation and can be effectively treated with DMEK. Close postoperative monitoring of patients is paramount to intervene therapeutically in case of transplant detachment or development of cystoid macular edema requiring further surgical or conservative management. [ J Refract Surg. 2017;33(5):347–350.]

Purpose To evaluate potential differences in the quality of vision after implantation of a blue light–filtering intraocular lens (IOL) and an ultraviolet (UV) light–filtering IOL. Setting Department of Ophthalmology, Ruhr-University, Bochum, Germany. Design Prospective randomized cohort study. Methods Patients with age-related cataract had bilateral standardized small-incision Kelman phacoemulsification-based cataract surgery with implantation of a blue light–filtering IOL (Oculaid PC 440Y Orange Series) in 1 eye and a UV light–filtering IOL (Oculaid PC 430 Elite Series) in the other eye. Outcome measures included scotopic and photopic corrected distance visual acuity (CDVA) and photopic uncorrected distance visual acuity (UDVA), color discrimination, and contrast sensitivity with and without glare. A questionnaire was used to assess patient satisfaction. Postoperative follow-up visits were scheduled at 1, 3, and 6 months. Results Twenty-two patients (44 eyes) completed the study. There were no statistically significant differences in UDVA, CDVA, or contrast sensitivity with or without glare between the 2 IOL groups. Color discrimination was significantly decreased in eyes with blue light–filtering IOLs compared with UV light–filtering IOLs, except along the red–green axis (P=.118). No subjective differences in color or light perception were found. Conclusions Both IOL types provided similar postoperative visual function except color perception, which was slightly better in eyes with a clear IOL. Although differences were not clinically significant, information about potential disturbances in color vision might be provided before implanting an orange blue light–filtering IOL. Financial Disclosure No author has a financial or proprietary interest in any material or method mentioned.

PURPOSE To evaluate the rate of donor corneas misidentified as recipients of previous laser in situ keratomileusis (LASIK) surgery in the eye banks. METHODS One hundred sixty-one donor corneas identified as having had previous LASIK surgery from 15 eye banks were sent to the Emory Eye Center between January 2002 and August 2005. Determination of the previous LASIK surgery was made from the medical history and/or slit-lamp examination in the contributing eye bank. Histologic examination of the corneas was performed to confirm the diagnosis. RESULTS Information regarding the decision making was available in 155 corneas out of 161. Among 155 corneas, 16 donor corneas (10.3%) revealed no evidence of previous LASIK surgery in the histology. The rate of misidentified corneas as having previous LASIK was 13.5% in history only group (10 of 74) and 18.2% in those determined by the slit-lamp examination only (4 of 22). In corneas determined by both history and slit-lamp examination, the misidentified rate decreased to 3.4% (2 of 59). CONCLUSIONS There is approximately a 10% rate of misidentified post-LASIK corneas in eye banks. A decision made by both history and slit-lamp examination decreases the misidentification rate compared with using only either method alone.

Background: To report the histopathological findings after photodynamic therapy (PDT) in eyes obtained postmortem with choroidal neovascularisation (CNV) secondary to age-related macular degeneration (AMD). Methods: Two eyes were obtained postmortem from two patients with CNV secondary to AMD. Both of the patients had been treated with PDT. Serial sections through the posterior poles were obtained and stained with haematoxylin-eosin, periodic acid-Schiff, Masson trichrome or phosphotungstic acid haematoxylin (PTAH). Two-dimensional reconstructions were prepared and compared with fluorescein angiograms. Results: The interval between PDT and death was 3 months and 17 months in each patient, respectively. Light-microscopic examination showed that CNV enveloped with retinal pigment epithelium (RPE) in both eyes. The average size of the CNV was 550×280 µm. One eye had combined (subRPE/subretinal) growth pattern CNV, and the other eye had both type I (subRPE) and combined growth pattern CNV. All specimens contained fibrous proliferation and patent vascular channels within the CNV, and there was no thrombus formation within the vascular channels. No apparent abnormalities in the choroid were observed by light microscopy. Conclusions: Although involution with fibrous tissue proliferation occurred, PDT did not result in permanent occlusion of the vascular channels in the CNV. Our findings indicate that PDT may accelerate involution of CNV, thus limiting its size and preserving photoreceptors.

Prolapse of subconjunctival intraconal orbital fat is a rare cause of an intraorbital mass lesion. Over the past several years, we have seen a number of cases in which this prolapsed fat was confused pathologically with a neoplasm of adipocytic lineage, specifically pleomorphic lipoma and atypical lipomatous neoplasm (well-differentiated liposarcoma). We report the clinical, histopathologic, and immunohistochemical findings in 21 specimens from 17 patients, all of whom presented with prolapsed intraconal orbital fat. All specimens were routinely examined and processed for light microscopy. Immunohistochemistry for CD34, CD68, S100 protein, vimentin, alpha-smooth muscle actin, and Ki-67, and Giemsa, Masson trichrome, and alcian blue histochemical stains were performed. Clinical and follow-up information was extracted from a chart review. The mean age (+/-SD) of the patients was 65.6+/-11.9 years (range: 41 to 85 y); 2 were women and 15 were men. Subconjunctival prolapsed orbital fat was localized in the superotemporal quadrant or lateral canthus around the rectus muscle below the lacrimal gland. The lesions were unilateral in 10 and bilateral in 7 patients. No recurrence was clinically evident over a mean (+/-SD) follow-up time of 2.5+/-3.2 years (range: 1 mo to 13.5 y). Histopathologically, all specimens showed an admixture of mature fat, fibrous septae lacking hyperchromatic cells, adipocytes with intranuclear vacuoles (Lochkern cells), multinucleated giant cells with a wreathlike configuration of normochromatic nuclei (floret cells), and varying numbers of histiocytes, lymphocytes, plasma cells, and mast cells. "Control" sections of normal orbital fat showed occasional Lochkern cells but lacked floret cells. By immunohistochemistry, the floret cells expressed only CD34 and vimentin, whereas the Lochkern cells expressed CD34, S100 protein, and vimentin. We conclude that subconjunctival herniated orbital fat commonly contains multinucleated floretlike giant cells, fibrous septae, and Lochkern cells, features that may result in diagnostic confusion with pleomorphic lipoma and atypical lipomatous neoplasms. Importantly, specific diagnostic features, such as aggregates of bland spindled cells associated with wiry collagen, as seen in pleomorphic lipoma, and enlarged hyperchromatic cells within fibrous septae, as in atypical lipomatous neoplasms, are entirely absent in herniated orbital fat. Multinucleated floret cells present in prolapsed orbital fat likely represent a reactive phenomenon, as they are not present in normal orbital fat.

Purpose The study was conducted to create a rapidly developing and reproducible animal model of subretinal choroidal neovascularization (CNV) that allows a time-dependent evaluation of growth dynamics, histopathologic features, and cytokine expression. Methods C57BL/6 and chemoattractant leukocyte protein-2 deficient (∆Ccl-2) mice were studied. Mice received single or combined subretinal injections of cultured retinal pigment epithelium (RPE; C57BL/6-derived), polystyrene microbeads, or phosphate buffer solution (PBS). Fluorescence angiograms were performed over a period of 3 weeks. Mice were euthanized on post inoculation day 3, 7, 10, 14, or 21, and their eyes were evaluated by light, confocal, and electron microscopy. Results CNV membranes occurred in all study groups with an overall incidence of 94.3%. They extended in the subretinal space through central breaks in Bruch’s membrane. CNV lesions were characterized by dynamic changes such as initiation, active inflammatory, and involution stages. CNV thickness peaked around PI day 7 and was greater in mice that received combined injections of RPE and microbeads or RPE cells alone. Small lesions developed in the control groups (microbeads or PBS only), in ∆Ccl-2, and old C57BL/6 mice. Variable expression of cytokines and growth factors was detected within the membranes. Conclusions Our murine model represents a reliable approach inducing CNV growth by subretinal injection of either RPE cells alone or RPE cells and microbeads. The development of CNV lesions is a dynamic process that relies in part on macrophage trafficking and age.

To evaluate the effects of corneal edema on human donor corneas that had previous LASIK using a laboratory model with histologic and ultrastructural correlations.Experimental study.Thirty human eye bank corneas from 15 donors (mean age +/- standard deviation, 49.9+/-8.9 years) who had had previous LASIK surgery (2-8 years before death).The corneas were mounted in an artificial anterior chamber and the corneal endothelium was perfused for up to 5.0 hours with 0.9% saline solution (endothelial cell damage group) or BSS Plus at a pressure of 15 mmHg (control group), or BSS Plus at a pressure of 55 mmHg (high-pressure group). The corneas were evaluated by confocal and specular microscopy before, during, and at the end of the experimental period. Subsequently, the specimens were evaluated by light and electron microscopy.Corneal thickness, reflectivity, histology, and ultrastructure.Endothelial cell damage resulted in an increased (141.5+/-38.8 microm) total corneal thickness relative to controls (52.3+/-33.7 microm), whereas high pressure resulted in a decreased thickness (24.8+/-14.1 microm) relative to controls. This ultimately was due to swelling of the LASIK interface in both groups and swelling of the residual stromal bed (RSB) in the endothelial cell damage group or compression of the RSB and, possibly, the flap in the high-pressure group. A significant increase in corneal reflectivity at the LASIK interface occurred in both groups, primarily due to varying degrees of fluid accumulation and associated hydropic keratocyte degeneration, as well as increased corneal reflectivity in the RSB only in the endothelial cell damage group.After LASIK surgery, edematous corneas preferentially hydrate and swell in the paracentral and central interface wound, commonly resulting in a hazy corneal appearance primarily due to keratocyte hydropic degeneration. More severe corneal edema is characterized by the formation of an optically empty space corresponding to an interface fluid pocket. The spectrum of interface fluid syndrome can be described in 3 stages.

Purpose To report four cases of optic nerve neuropathy in three children treated with periocular carboplatin injections for unilateral or bilateral intraocular retinoblastoma. Design Retrospective, observational case series. Methods setting : University-based Ophthalmology Practice. study population : Four eyes of three children with retinoblastoma enucleated after nonsuccessful multimodality treatment including periocular carboplatin injections. observation procedures : The enucleated eyes were routinely processed and evaluated by light microscopy. A retrospective chart review of all four cases was performed. Results Three enucleated eyes (Reese-Ellsworth groups III and VB) were obtained from two children with bilateral multifocal retinoblastoma, and one eye (Reese-Ellsworth group IIB) was harvested from a child with unilateral retinoblastoma. All affected eyes underwent three to seven periocular carboplatin injections before enucleation. Additional treatment modalities included systemic chemotherapy, transpupillary thermotherapy, transscleral cryotherapy, and external beam radiotherapy. Histopathologic evaluation of the enucleated eyes revealed focal areas of ischemic necrosis or atrophy of the optic nerve along with dystrophic calcification and mild inflammation in the surrounding fibrovascular adipose tissue. Conclusions Periocular injections of carboplatin may be a useful treatment approach in the management of patients with advanced intraocular retinoblastoma and may minimize systemic side-effects. However, ophthalmologists and pediatric oncologists should be aware of potential marked local complications with periocular carboplatin delivery, including ischemic optic neuropathy. Modifying the injection site/location (for example, subtenon space) or adding other delivery routes adjuncts (for example, fibrin sealant) deserves further study.

A 69-year-old man developed stromal edema and a pocket of fluid in the laser in situ keratomileusis (LASIK) interface wound in the left eye after acute endothelial cell loss from complicated trabeculectomy. He eventually required penetrating keratoplasty along with cataract surgery. Histologic examination of the corneal button showed an edematous 720 microm central residual stromal bed, a 54 microm empty space at the level of the central interface wound, and a 154 microm LASIK flap. The endothelial cell count was 0 to 2 cells per high-power field, corresponding to a cell density of 450 to 500 cells/mm(2). Four years after LASIK, the central interface wound was susceptible to forming a pocket of serous fluid after the corneal endothelial function was compromised.

PURPOSE: To measure the cohesive tensile strength of human LASIK corneal wounds. METHODS: Twenty-five human eye bank corneas from 13 donors that had LASIK were cut into 4-mm corneoscleral strips and dissected to expose the interface wound. Using a motorized pulling device, the force required to separate the wound was recorded. Intact and separated specimens were processed for light and electron microscopy. Five normal human eye bank corneas from 5 donors served as controls. A retrospective clinical study was done on 144 eyes that had LASIK flap- lift retreatments, providing clinical correlation. RESULTS: The mean tensile strength of the central and paracentral LASIK wounds showed minimal change in strength over time after surgery, averaging 2.4% (0.72?0.33 g/mm) of controls (30.06?2.93 g/mm). In contrast, the mean peak tensile strength of the flap wound margin gradually increased over time after surgery, reaching maximum values by 3.5 years when the average was 28.1% (8.46?4.56 g^mm) of controls. Histologic and ultrastructural correlative studies found that the plane of separation always occurred in the lamellar wound, which consisted of a hypocellular primitive stromal scar centrally and paracentral Iy and a hypercelIu lar fibrotic stromal scar at the flap wound margin. The pathologic correlations demonstrated that the strongest wound margin scars had no epithelial cell ingrowth ? the strongest typically being wider or more peripherally located. In contrast, the weakest wound margin scars had epithelial cell ingrowth. The clinical series demonstrated the ability to lift LASIK flaps without complications during retreatments up to 8.4 years after initial surgery, correlating well with the laboratory results. CONCLUSIONS: The human corneal stroma typically heals after LASIK in a limited and incomplete fashion; this results in a weak, central and paracentral hypocellular primitive stromal scar that averages 2.4% as strong as normal corneal stroma. Conversely, the LASIK flap wound margin heals by producing a 10-fold stronger, peripheral hypercelIuIa r fibrotic stromal scar that averages 28.1% as strong as normal corneal stromal, but displays marked variability. [J Refract Surg. 2005;21:433-445.]

Purpose: We sought to demonstrate the histopathologic and ultrastructural features of conjunctival foreign body granulomas because of synthetic fibers and to compare them to other cases published in the literature. Methods: A 2- and a 7-year-old girl were referred for the surgical removal of slow-growing unilateral inferior conjunctival masses with a lack of primary trauma or surgery. In this report, we describe the light and electron microscopic findings of the 2 cases and review the literature of similar cases using the Medline database. Results: Histopathologic and ultrastructural examination of both specimens revealed a granulomatous inflammatory cell response, including histiocytes and multinucleated foreign body giant cells around acellular, uniform sized, oval to round birefringent fibers with manufacturing artifacts. Thirteen other patients with conjunctival synthetic fiber granulomas were identified from the literature. Conclusions: On the basis of the findings in our cases and the review of literature, it appears that conjunctival synthetic fiber granulomas are not a rare entity but are not recognized frequently by ophthalmologists. The most reliable clinical sign to suggest this diagnosis is the presence of a unilateral inferior conjunctival mass in a child or adolescent. Histopathologic and ultrastructural evaluation appears to be the only way to specifically diagnose this condition with certainty.

We describe an unusual case of composite lymphoma (CL) in the orbit. The clinical history and biopsy specimen of an 82-year-old woman with a right orbital mass were evaluated. The orbital biopsy contained a dense lymphocytic infiltration and nodules of large lymphocyte that immunostained positive for CD20. Flow cytometric immunophenotyping showed two distinct populations of cells, confirming the diagnosis of a simultaneous follicular lymphoma (FL) and chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL). The patient was treated with CD20 antibody (rituximab) and is in remission at 3 months follow-up.

Purpose To evaluate the histopathology and ultrastructure of corneas developing ectasia after LASIK or photorefractive keratectomy (PRK). Design Retrospective case series. Participants Thirteen specimens from 12 patients undergoing corneal transplantation for progressive ectasia after LASIK (12 specimens) or PRK (1 specimen) were obtained for histopathologic and ultrastructural evaluation. Methods All 13 ectatic corneas were submitted in formalin for light microscopy. Nine specimens were bisected, and the second half was placed in 2.5% glutaraldehyde for transmission electron microscopy (TEM). Main Outcome Measures Corneal histopathology, ultrastructure, and pathophysiology. Results Light microscopy of the post-LASIK specimens showed corneal epithelial hypoplasia and occasional foci of epithelial hyperplasia, Bowman's layer breaks, a normal stromal thickness of the LASIK flap, a normal thickness of the hypocellular primitive stromal scar, a thinned residual stromal bed (RSB), and larger than normal artifacteous interlamellar clefts in the RSB of the ectatic region. The post-PRK specimen showed similar findings with the addition of a thinned hypercellular fibrotic stromal scar. TEM showed thinning of the collagen lamellae and loss of lamellar number in the RSB of post-LASIK ectasia corneas or throughout the entire corneal stromal bed in the post-PRK ectasia cornea, with the posterior aspect of the corneal stroma being most affected. Conclusions Histopathologic and ultrastructural studies suggest that interlamellar and interfibrillar biomechanical slippage occurs when the cornea becomes ectatic after LASIK or PRK in the postoperative stress-bearing regions of the corneal stroma. This 2-phase chronic biomechanical failure process is similar to that seen in keratoconus. Composite sciences classify this chronic biomechanical failure process as interfiber fracture. Financial Disclosure(s) The authors have no proprietary or commercial interest in any materials discussed in this article.

Purpose To evaluate the effects of corneal edema on human donor corneas that had previous LASIK using a laboratory model with histologic and ultrastructural correlations. Design Experimental study. Participants Thirty human eye bank corneas from 15 donors (mean age ± standard deviation, 49.9±8.9 years) who had had previous LASIK surgery (2–8 years before death). Methods The corneas were mounted in an artificial anterior chamber and the corneal endothelium was perfused for up to 5.0 hours with 0.9% saline solution (endothelial cell damage group) or BSS Plus at a pressure of 15 mmHg (control group), or BSS Plus at a pressure of 55 mmHg (high-pressure group). The corneas were evaluated by confocal and specular microscopy before, during, and at the end of the experimental period. Subsequently, the specimens were evaluated by light and electron microscopy. Main Outcome Measures Corneal thickness, reflectivity, histology, and ultrastructure. Results Endothelial cell damage resulted in an increased (141.5±38.8 μm) total corneal thickness relative to controls (52.3±33.7 μm), whereas high pressure resulted in a decreased thickness (24.8±14.1 μm) relative to controls. This ultimately was due to swelling of the LASIK interface in both groups and swelling of the residual stromal bed (RSB) in the endothelial cell damage group or compression of the RSB and, possibly, the flap in the high-pressure group. A significant increase in corneal reflectivity at the LASIK interface occurred in both groups, primarily due to varying degrees of fluid accumulation and associated hydropic keratocyte degeneration, as well as increased corneal reflectivity in the RSB only in the endothelial cell damage group. Conclusions After LASIK surgery, edematous corneas preferentially hydrate and swell in the paracentral and central interface wound, commonly resulting in a hazy corneal appearance primarily due to keratocyte hydropic degeneration. More severe corneal edema is characterized by the formation of an optically empty space corresponding to an interface fluid pocket. The spectrum of interface fluid syndrome can be described in 3 stages.

PURPOSE To analyze the amounts and distributions of nonsulfated and sulfated keratan sulfate (KS) and chondroitin/dermatan sulfate (CS/DS) disaccharides in the interface wound of human postmortem LASIK corneas in comparison with normal control corneas. METHODS Corneal stromal tissue samples from central and paracentral hypocellular primitive stromal interface scars of human LASIK corneas and from similar regions of normal control corneas were collected by laser capture microdissection (LCM) and subsequently were digested with specific glycosidase enzymes. Digests were directly analyzed by electrospray ionization tandem mass spectrometry (ESI-MS/MS). RESULTS Concentrations of both monosulfated GlcNAc(6S)-beta-1,3-Gal (MSD2) and disulfated Gal (6S)-beta-1,4-GlcNAc(6S) (DSD) KS disaccharides from the LASIK interface scars were significantly lower than in normal control corneal stromas. No significant difference was found for the concentration of nonsulfated (NSD) KS disaccharides in LASIK interface scars compared with normal controls. The concentration of DeltaUA-beta-1,3-GalNAc(6S) (Deltadi-6S) CS/DS disaccharides from the LASIK interface scar was significantly higher than normal corneal stroma, whereas concentrations of DeltaUA-beta-1,3-GalNAc(4S) (Deltadi-4S) and nonsulfated Deltadi-0S CS/DS disaccharides demonstrated no significant differences from normal corneas. CONCLUSIONS The profiles of KS and CS/DS disaccharides in LASIK interface scars are significantly different from those in normal cornea stromal tissue, as revealed by LCM and ESI-MS/MS.