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Hornhautnarben konnen die Sehleistung stark beeintrachtigen und zudem in der Behandlung sehr schwierig sein. Das Ziel dieser Studie war eine minimal-invasive Moglichkeit in der Therapie von kornealen Narben zu evaluieren und die Ergebnisse zu prasentieren. In diese retrospektive, interventionelle Studie wurden 4 Augen von 4 Patienten inkludiert, die in Folge eines Traumas eine Hornhautnarbe und irregulare Oberflache entwickelten. Diese wurden zwischen 2017 und 2020 mit einer topografiegesteuerten photorefraktiven Keratektomie (TG-PRK) behandelt. Das Abtragungsprofil wurde bei allen 4 Fallen mit dem CRS-Master (Zeiss, Jena, Deutschland) berechnet. Die Hauptzielgrosen waren der unkorrigierte und bestkorrigierte Fernvisus, die manifeste Refraktion und die korneale Regularitat durch topografische Aufnahmen. Das mittlere Alter betrug 34,75 ± 15,39 Jahre und die Nachbeobachtungszeit 6 Monate bei allen Patienten. In 3 Fallen wurde die volle subjektive Refraktion in einer Sitzung korrigiert. Ein Patient hatte eine Fehlsichtigkeit von +0,5 dpt. In diesem Fall wurde nur eine Glattung ohne zusatzliche Korrektur der Refraktion durchgefuhrt. Alle 4 Patienten zeigten eine Verbesserung des unkorrigierten (2 bis 3 Zeilen) und korrigierten (3 Zeilen) Fernvisus. Es traten keine Komplikationen wahrend und nach den Behandlungen auf, und es kam bei keinem Fall zu einer Reduktion der Sehscharfe. Mittels TG-PRK kann bei Patienten mit traumatischen kornealen Narben eine Verbesserung der Sehscharfe erreicht werden. Bei myopen Patienten kann in einer Sitzung auch der Grosteil der Fehlsichtigkeit korrigiert werden.

Purpose The aim of this study was to evaluate the efficacy, safety and predictability of transepithelial photorefractive keratectomy (TransPRK) for correcting myopia, astigmatism and hyperopia. Setting Department of Ophthalmology, Saarland University Medical Center, Homburg/Saar, Germany DESIGN:: Meta-analysis of retrospective or prospective studies METHODS:: Relevant studies were collected from Medline and included when meeting the following predefined criteria: randomized controlled trials, at least one of main outcome measures efficacy, safety or predictability and one common TRPK laser ("Schwind Amaris"). The parameters estimates and 95% confidence intervals (CI) were derived from random-effects meta-analysis to account for possible heterogeneity. Results Since hyperopia studies did not meet the inclusion criteria, the results are centered around myopia and astigmatism. Sixteen studies with a total of 1,924 treated eyes were included in the meta-analysis. The mean efficacy, safety and predictability had a probability of 94% CI=0.86-0.97, 0% CI= 0.00-0.03 and 89% CI=0.82-0.93, respectively. The mean correction index, difference vector and index of success had a value of 1.01 CI=1.01-1.02, 0.2 CI=0.06-0.34 and 0.12 CI=0.07-0.18, respectively. Conclusion This summary estimate shows that the TransPRK is highly effective, safe and predictable in correcting myopia and/or astigmatism.

The aim of excimer laser-assisted deep anterior lamellar keratoplasty (excimer-DALK) is, as in mechanical DALK, the treatment of keratectasia (keratoconus and pellucid marginal degeneration), stromal scars or stromal corneal dystrophy. A prerequisite for surgery is the absence of (pre‑) Descemet's scars and an intact endothelium.After excimer laser-assisted trephination to 80% of the corneal thickness at the trephination site, intrastromal air injection (so-called big bubble) and lamellar corneal preparation, a lamellar anterior transplantation of the endothelium-free donor tissue is performed. The technique combines the advantages of DALK and excimer laser trephination. We describe the steps of an excimer-DALK from the Homburg Keratoconus Center (HKC).Excimer-DALK is a viable treatment option for patients with intact endothelium. In cases of intraoperative perforation, conversion to excimer-perforating keratoplasty (PKP) with all the advantages of excimer laser trephination remains feasible.INDIKATIONEN: Ziel der Excimerlaser-gestützten DALK (Excimer-DALK) ist, wie bei der mechanischen DALK, die Behandlung von Keratektasien (Keratokonus und pellucide marginale Degeneration), stromalen Narben oder stromalen Hornhautdystrophien. Voraussetzung für die Operation ist die Abwesenheit von (prä)descemetalen Narben sowie ein gesundes Endothel.Nach der Excimerlaser-gestützten Trepanation auf 80 % der kornealen Dicke an der Trepanationsstelle, einer intrastromalen Lufteingabe (sog. „Big-Bubble“) sowie einer lamellären Hornhautpräparation erfolgt eine lamelläre anteriore Transplantation des endothelfreien Spendergewebes. Diese Technik kombiniert die Vorteile einer DALK und einer Excimerlaser-Trepanation. Wir beschreiben die Schritte einer Excimer-DALK aus unserem Homburger Keratokonus Center (HKC).Die Excimer-DALK stellt bei Patienten mit gutem Endothel eine gute Behandlungsmöglichkeit dar. Bei einer intraoperativen Perforation bleibt die Möglichkeit einer sog. Konversion zur Excimer-PKP mit allen Vorteilen der Excimerlaser-Trepanation.

Corneal scars can severely impair visual performance and treatment can be challenging. The study aimed to evaluate a promising minimally invasive option in the treatment of corneal scars using transepithelial topography-guided ablation.This retrospective interventional study involved four eyes of four patients who developed corneal scarring and irregular surfaces due to trauma and were treated with topography-guided photorefractive keratectomy (TG-PRK) between 2017 and 2020. The ablation profile was calculated in all four cases using CRS-Master (Zeiss, Jena, Germany). The main outcome measures were uncorrected and best-corrected distance visual acuity, manifest refraction and corneal regularity by topographic images. The mean age was 34.75 ± 15.39 years and the follow-up time was 6 months for all patients.In three cases full subjective refraction was corrected in one session and one patient had a refractive error of +0.5 D. Only corneal surface smoothing without additional refractive correction was performed in this case. All four patients showed improvement in uncorrected (2-3 Snellen lines) and corrected (3 Snellen lines) distance visual acuity. No complications occurred during or after the treatment and there was no reduction of visual acuity in any case.The use of TG-PRK in patients with corneal scarring improves visual acuity in selected cases. In myopic patients most of the refractive error can also be corrected in a single session.HINTERGRUND: Hornhautnarben können die Sehleistung stark beeinträchtigen und zudem in der Behandlung sehr schwierig sein. Das Ziel dieser Studie war eine minimal-invasive Möglichkeit in der Therapie von kornealen Narben zu evaluieren und die Ergebnisse zu präsentieren.In diese retrospektive, interventionelle Studie wurden 4 Augen von 4 Patienten inkludiert, die in Folge eines Traumas eine Hornhautnarbe und irreguläre Oberfläche entwickelten. Diese wurden zwischen 2017 und 2020 mit einer topografiegesteuerten photorefraktiven Keratektomie (TG-PRK) behandelt. Das Abtragungsprofil wurde bei allen 4 Fällen mit dem CRS-Master (Zeiss, Jena, Deutschland) berechnet. Die Hauptzielgrößen waren der unkorrigierte und bestkorrigierte Fernvisus, die manifeste Refraktion und die korneale Regularität durch topografische Aufnahmen. Das mittlere Alter betrug 34,75 ± 15,39 Jahre und die Nachbeobachtungszeit 6 Monate bei allen Patienten.In 3 Fällen wurde die volle subjektive Refraktion in einer Sitzung korrigiert. Ein Patient hatte eine Fehlsichtigkeit von +0,5 dpt. In diesem Fall wurde nur eine Glättung ohne zusätzliche Korrektur der Refraktion durchgeführt. Alle 4 Patienten zeigten eine Verbesserung des unkorrigierten (2 bis 3 Zeilen) und korrigierten (3 Zeilen) Fernvisus. Es traten keine Komplikationen während und nach den Behandlungen auf, und es kam bei keinem Fall zu einer Reduktion der Sehschärfe.Mittels TG-PRK kann bei Patienten mit traumatischen kornealen Narben eine Verbesserung der Sehschärfe erreicht werden. Bei myopen Patienten kann in einer Sitzung auch der Großteil der Fehlsichtigkeit korrigiert werden.

Purpose To compare contrast acuity at different illumination levels, color vision, and the subjective visual impression in patients after bilateral cataract surgery with mixed implantation of a yellow-tinted intraocular lens (IOL) and an orange-tinted IOL. Setting Department of Ophthalmology, Hietzing Hospital, Vienna, Austria. Design Prospective case series. Methods Consecutive patients with age-related cataract had standardized small-incision cataract surgery with IOL implantation in the capsular bag. Patients were randomly assigned to receive a yellow Polylens Y30 in 1 eye and an Orange Series model PC 440Y in the contralateral eye. The main outcome measures were contrast acuity, color vision, and subjective visual impression. Contrast acuity was measured at illumination levels of 5.0 lux and 0.5 lux and contrast levels of 50.0%, 25.0%, and 12.5%. Color vision was assessed using the Heidelberg-multicolor anomaloscope, and the subjective visual impression was evaluated using a questionnaire. Results This study included 64 eyes of 32 patients. The intraindividual comparison showed no significant difference in contrast sensitivity at different contrast and illumination levels or in color vision. On questioning, 3 patients reported a difference in subjective color perception between the 2 IOL types. Conclusion There were no differences in contrast sensitivity or color vision between yellow-tinted IOLs and orange-tinted IOLs. Financial Disclosure No author has a financial or proprietary interest in any material or method mentioned.

PURPOSE: To evaluate the possible impact of a displaced corneal apex (point of maximum curvature) on visual results and tomographic parameters after small incision lenticule extraction (SMILE). METHODS: In this retrospective evaluation, eyes with uncomplicated SMILE for myopia correction were classified in two groups based on their preoperative distance between the corneal apex and corneal vertex (corneal intercept with the patient's line of sight) of 1 mm or greater (large A-V distance) or less than 1 mm (small A-V distance). All surgeries were performed during the early learning curve of two surgeons. Visual outcome parameters included uncorrected (UDVA) and corrected (CDVA) distance visual acuity, manifest refractive spherical equivalent (MRSE), and refractive astigmatism 3 months postoperatively. Scheimpflug-derived tomographic outcome parameters included mean keratometry value, root mean square higher order aberrations (RMS HOAs), and optical zone decentration. RESULTS: The study comprised 94 eyes of 48 patients: 44 eyes in the large A-V distance group and 50 eyes in the small A-V distance group. Preoperative and postoperative RMS HOAs were significantly higher in the large A-V distance group than in the small A-V distance group ( P = .002 and .008, respectively). Postoperative CDVA was significantly better in the small A-V distance group ( P = .014). There were no statistically significant differences in postoperative UDVA, MRSE, refractive astigmatism, mean keratometry value, and optical zone decentration. CONCLUSIONS: After SMILE, CDVA was significantly worse in eyes with a preoperatively displaced corneal apex compared to eyes with a more central corneal apex. However, good visual results were achieved in both groups. [ J Refract Surg. 2018;34(7):460–465.]

Purpose To evaluate whether hyperopic patients with short axial length and high dioptric intraocular lens (IOL) power can achieve a higher depth of focus after implantation of a monofocal spherical or aspheric IOL than emmetropic patients. Setting Department of Ophthalmology, Medical University Graz, Graz, Austria. Design Prospective case series. Methods Patients presenting for cataract surgery were divided by calculated IOL power into a hyperopic (≥22.0 diopters [D]) or emmetropic (18.0 to 21.5 D) groups and received an aspheric (Tecnis ZA9003) or a spherical IOL (Sensar AR40e). Postoperative measurements included corrected (CDVA) and uncorrected (UDVA) distance visual acuities, distance-corrected intermediate (DCIVA) and near (DCNVA) visual acuities, root-mean-square values of corneal and total eye higher-order aberrations and spherical aberrations, and photopic and mesopic contrast sensitivity. Results Sixty-two eyes of 62 patients were enrolled in this study, 34 eyes (15 hyperopic, 19 emmetropic) in the aspheric IOL group and 28 eyes (14 hyperopic, 14 emmetropic) in the spherical IOL group. The UDVA, CDVA, and contrast sensitivity did not differ significantly between the 2 IOL groups, whereas the DCIVA and DCNVA were significantly better in the spherical IOL group (P = .004 and P = .001, respectively). No significant differences were found in DCIVA and DCNVA between hyperopic patients and emmetropic patients with aspheric or spherical IOLs. Conclusions Implantation of a monofocal spherical IOL resulted in an increased depth of focus without significant degradation of distance visual acuity or contrast sensitivity. There were no differences in the depth of focus between hyperopic eyes and emmetropic eyes.

PURPOSE: The aim was to produce 2 tissue microarrays (TMAs) for keratoconus (KC) corneas and to evaluate the expression of stress-related markers, epidermal growth factor receptor (EGFR), and 8-oxo-2'-deoxyguanosine (8-OHdG), in KC corneas. METHODS: The corneal buttons of 66 patients with KC were included in both TMAs; 10 Fuchs endothelial corneal dystrophy (FECD), 20 normal autopsy corneas, and 32 nonocular tissue cores served as controls. The expression of immunolabeling for EGFR and 8-OHdG in KC corneas was compared with those of the controls by TMAJ software using an H-score index. To further interpret our findings, pig eyes under different preservation conditions were stained for the same markers. RESULTS: With 2 TMAs, we designed an effective model to investigate KC corneas at the protein level. The EGFR in epithelial cells showed significant upregulation in KC specimens compared with that in FECD controls (P = 0.009), and this was also higher in autopsy controls compared with that in KC corneal samples (P = 0.0002). The 8-OHdG in epithelial cells was elevated in KC samples compared with that in the FECD specimens (P = 0.03), whereas autopsy controls showed higher levels compared with those shown by the KC corneal samples (P < 0.0001). Immunohistochemical staining intensities for both markers in pig corneas correlated with increased time to fixation. CONCLUSIONS: TMAs simultaneously enable efficient, high-throughput analysis of tissue samples. The upregulation of EGFR and 8-OHdG protein levels in KC epithelium compared with FECD controls implicates oxidative stress in KC corneas. The expression of these stress markers is increased depending on the time to preservation, which may explain the increased levels of these markers in autopsy control corneas.

Phakic intraocular lenses (IOLs) are gaining popularity for refractive surgeons, since these IOLs are easy to implant and can correct high ametropia up to 20 D. However, these implants can still lead to reversible and irreversible complications, even years after implantation. This review gives a short overview about the different kinds of phakic IOLs, the advantages and disadvantages of these lenses and the pre- and post-operative examinations. Most of the angle-supported phakic IOLs have been abandoned from the market few years after launching. Two anterior chamber IOLs and one posterior chamber IOL—the iris-clip IOL ‘Artisan/Verisyse’ (Ophtec, Netherlands/Abbott, USA), the angle supported IOL ‘Cachet’ (Alcon, USA) and the ‘implantable collamer lens’ (Staar, USA), are commercially available at the moment. Phakic IOLs are a good option for the treatment of high myopia, but exact preoperative examination of the patient and consistent post-operative controls including endothelial cell count are mandatory to reduce the risk of long-term complications.

Background Recently, intraocular lenses (IOLs) with a blue light filter have been introduced to protect the retina from age-related macular degeneration (AMD) after cataract extraction. A reduction of longitudinal chromatic aberration by filtering blue light may enhance patient's visual function. In this study we compared subjective and objective parameters of visual function following implantation of blue light filter (yellow) IOLs and IOLs of the same design without filter. Patients and methods 21 patients (21 eyes) underwent implantation of an IOL with a blue light filter (AF-1 UY, Hoya, Japan), 22 patients (22 eyes) received an IOL without blue light filter (AF-1 UV, Hoya, Japan). Patients were examined three months postoperatively for uncorrected and best corrected spectacle visual acuity, mesopic and photopic contrast sensitivity, colour vision and subjective quality of vision by a standard questionnaire. Results Eyes with blue light filter IOLs did not show any significant difference in any parameter analysed when compared to eyes without the blue light filter IOL. Subjective quality of vision was considered to be high by all patients and no significant difference was observed between the two IOL groups. Conclusion The visual function of patients with blue filter IOLs is not significantly different to those without blue light filter IOLs. Since blue light filter IOLs did not show any functional disadvantage, but potentially protect the macula from AMD, blue light filter IOLs may be considered as a reasonable alternative to traditional IOLs, especially in eyes with a high risk for the development of macular degeneration.

Purpose The existence of genetic variations in a number of cytokines has been considered to influence susceptibility or relate to disease severity in various autoimmune diseases. Among these, single-nucleotide polymorphisms (SNPs) of the tumor necrosis factor α (TNF-α) promoter at nucleotides -308 and -238 are considered to be protective against inflammation in HLA-B27–positive individuals, whereas the SNP at position -857 has been associated with disease development in anterior uveitis. We investigate a hypothesized association between the TNF-α -857 C-to-T, -308 G-to-A, and the TNF-α -238 G-to-A SNPs and the presence of HLA-B27–associated uveitis. Design Retrospective case–control study. Participants One hundred fourteen Caucasian patients with HLA-B27–associated uveitis were studied. Mean age of patients was 44.9±14 years (range, 16–81), and mean duration of HLA-B27–associated uveitis was 115.6±104 months (range, 6 months–51 years). Eighty-six patients (75.4%) suffered from an additional systemic manifestation of the disease. Sixty-three unrelated healthy HLA-B27–positive blood donors and 88 unrelated healthy HLA-B27–negative individuals served as controls. Methods Genotypes were determined by polymerase chain reaction. Main Outcome Parameters Association of genotypes at positions -857, -308, and -238 of the TNF-α gene with disease development. Results Frequencies of the TNF-α -308GA and TNF-α -238GA genotypes were significantly lower in patients with HLA-B27–associated uveitis (6.1% and 0%, respectively) when compared with the HLA-B27–negative control group, 23% at -308 ( P = 0.003), and 7.9% at -238 ( P = 0.0003). When compared with healthy HLA-B27–positive controls, a significantly lower frequency of the TNF-α -238GA genotype was found among patients (6.3%, P = 0.015). The frequency of the TNF-α -308GA genotype was also found to be lower in patients than among HLA-B27–positive control subjects, without, however, reaching statistical significance (6.1%, P = 0.07). No difference in frequencies was seen among the different groups for the SNPs at position -857. Conclusion Our data suggest that HLA-B27–positive individuals show a higher susceptibility towards development of an intraocular inflammation in the presence of an A allele at nucleotide -238 and, to a lesser degree, at nucleotide -308 of the TNF-α gene promoter.

In this study we compare the ability of self-inactivating Human Immunodeficiency Virus 1 (HIV-1) and Equine Infectious Anaemia Virus (EIAV)-based vectors to mediate gene transfer to rabbit and human corneas and to a murine corneal endothelial cell line. Both vectors were pseudotyped with vesicular stomatitis virus-G (VSV-G) envelope and contained marker transgenes under the control of an internal CMV promoter. For specificity of action, the heterologous promoter in the EIAV-vector was exchanged for an inducible E-Selectin promoter, previously shown to regulate gene-expression in a plasmid system. We show that EIAV is more efficient than HIV in transducing human and rabbit corneal endothelial cells. Rabbit corneal endothelial cells are transduced in higher quantity than human corneal endothelial cells. In the inducible system, however, we detected impairment between the vector and its internal E-Selectin promoter. Instead of controlled transgene expression or silencing of promoter activity, the U3-modified long-terminal-repeats (LTR) impaired the conditional activity of the E-Selectin promoter. Significant transgene expression was seen without stimulation of the inducible promoter. We show efficient transduction by lentiviruses of a corneal endothelial cell line and of full thickness corneas from different species, confirming that those vectors would be appropriate tools for gene therapy of selected corneal diseases. However, the modification within the U3-LTR did not adequately allow regulated transgene expression. These findings have important implications for vector design for diagnostic or therapeutic opportunities.

Purpose To investigate the influence of graft storage time on corneal allograft survival in high-risk and low-risk patients. Design Comparative retrospective nonrandomized clinical trial. Participants Overall, 193 patients with 210 corneal allografts were classified as high risk or low risk for corneal allograft rejection on the basis of recipient corneal neovascularization and number of ipsilateral transplants. Methods Data from 3 groups were evaluated. The first group received fresh (no storage in culture medium) corneas, the second received corneas of donor storage time less than 7 days in minimum essential medium (MEM) at 37° C, and the final group received corneas stored in MEM longer than 7 days. Recipients were analyzed for development of immune rejection according to storage time of the corneal tissue. Corneal allograft survival rate was determined with Kaplan–Meier survival analysis. The log-rank test was used to determine statistical significance. Main outcome measures Risk of reversible and irreversible allograft rejection in corneas stored at various intervals in high-corneal and low-corneal transplant patients. Results High-risk corneal allograft recipients had a significantly prolonged allograft survival when the tissue was stored for 7 days or greater, compared with recipients receiving fresh tissues. Patients at low risk of corneal allograft rejection also showed a tendency for prolonged survival, although not statistically significant ( P = 0.06). Conclusions Storage of corneal tissue may reduce the frequency of allograft rejection, especially in high-risk patients.

Uberpruft wurde die diagnostische Aussagekraft der Oktreotidszintigraphie bei Verdacht auf aktive endokrine Orbitopathie. Eine prospektive Studie an 23 Patienten mit endokriner Orbitopathie wurde durchgefuhrt. Vier Stunden nach intravenoser Gabe von 3 mCi 111 Indium Oktreotid wurden SPECT-Aufnahmen durchgefuhrt. Die Resultate wurden wahrend einer Nachbeobachtungsperiode von 17±6 Monaten mit dem klinischen Zustand der Patienten korreliert. Die Oktreotidszintigraphie war in 15 Fallen pathologisch positiv und in 8 Fallen negativ. Zwolf Patienten mit positiver Oktreotidszintigraphie unterzogen sich erfolgreich einer immunsuppressiven Behandlung mit Zeichen der Regression. In 3 Fallen verweigerten die Patienten eine immunsuppressive Behandlung. Patienten ohne pathologische Oktreotidaufnahme unterzogen sich keiner Behandlung. Oktreotidszintigraphie stellt eine diagnostische Hilfe zur Beurteilung einer endokrinen Orbitopathie dar. Da diese im akuten Stadium behandelt werden muss, sollte eine Oktreotidszintigraphie bei subakuten Fallen durchgefuhrt werden, um die Indikationsstellung einer immunsuppressiven Behandlung zu vereinfachen.

Background One of the drawbacks of the currently available vectors for gene therapy is the lack of selectivity in gene delivery. We have therefore investigated a strategy to generate immunoliposomes to target non-viral vectors to cell surface receptors on endothelium. Materials and methods We have developed a novel method of coupling antibodies (Abs) to liposomes complexed to DNA, using mild heat treatment to aggregate the immunoglobulin G (IgG). The interaction of plasmid DNA, liposomes and Abs was measured using a gel retardation assay and a resonant mirror biosensor. The size of the transfection complex was determined by light scattering, and the binding and internalization of the complex to cells was followed using flow cytometry. The transfection ability was tested on cell lines and primary cells in vitro and human corneal or vascular tissues ex vivo. Results The interaction of antibodies with liposomes is relatively stable (t1/2 ≅ 45 min). The size of the liposome, Ab and DNA complex was found to be around 500 nm in 4% BSA. The addition of anti-transferrin receptor Abs increased the internalization of the liposome-DNA complex into cells. Abs against both transferrin receptor and E-selectin were shown to augment transfection efficiency of liposomes to cell expressing the appropriate antigens. They are also shown to be efficient in mediating gene delivery to corneal and vascular tissues ex vivo. Conclusions We have shown that our novel vector is capable of in vitro and ex vivo gene delivery to cells and human tissues including cornea, artery and vein. In particular, an Ab against E-selectin was effective at selectively delivering genes to activated endothelial cells expressing the adhesion molecule. Such a strategy will have applications for targeting these tissues prior to transplantation or autologous grafting, and, in the longer term, may allow in vivo targeting of gene therapy to inflammatory sites. Copyright © 2002 John Wiley & Sons, Ltd.

Hintergrund. Lokalanasthetikamissbrauch ist ein seltenes Erkrankungsbild und klinisch manchmal schwer zu diagnostizieren. Patient. Ein 45-jahriger Arzt mit 30-jahriger Kontaktlinsenanamnese und rezidivierenden kornealen Erosionen wurde mit dem klinischen Bild einer ringformigen Keratitis mit massiven Schmerzen vorgestellt. Es wurde die Diagnose “Akanthamobenkeratitis” gestellt und eine Therapie mit Gentamycin, Pentamidin isethionat und Hexamidin eingeleitet. Sechs Wochen nach Therapiebeginn wurde eine perforierende Keratoplastik durchgefuhrt. Postoperativ entwickelte sich ein zunehmendes Ectropium uveae mit fehlender Irismotilitat und dichter Katarakt. Erneut auf eine Eigenmedikation angesprochen, gab der Patient zu, “sporadisch” Lokalanasthetika verwendet zu haben. Die histologische Untersuchung ergab ein Hornhautulkus mit geringem frischen entzundlichen Infiltrat. Im Stroma waren wenige vitale Zellen erkennbar, ebenso im Endothel. Akanthamoben konnten keine nachgewiesen werden. Schlussfolgerung. Lokalanasthetikamissbrauch kann das Bild einer Akanthamobenkeratitis vortauschen, und bei Patienten mit Ringkeratitiden und massiven Schmerzen ohne ein Ansprechen auf die Therapie sollte auch an Lokalanasthetikamissbrauch gedacht werden.

Purpose To report outcome, complications and safety of retropupillary fixated iris-claw intraocular lenses in a pediatric population. Design Retrospective study. Patients and Methods Ten consecutive pediatric patients (15 eyes) underwent placement of retropupillary fixated iris-claw intraocular lenses between October 2007 and July 2013 at the Department of Ophthalmology, Medical University Graz and General Hospital Klagenfurt, Austria. Postoperative visual acuity and complications were analyzed. Results Median final best-corrected visual acuity improved by 0.12 logMAR from preoperative baseline. Mean postoperative spherical equivalent was -0.05 ± 1.76 D. No serious complications were observed intra- or postoperatively during the entire follow-up period of up to 40 months. One patient experienced a haptic disenclavation with IOL subluxation immediately after a car accident. Conclusion Our study demonstrates that iris-claw intraocular lens implantation behind the iris is safe in children with lack of capsular support and yields excellent visual outcome with low complication rate.

A 78-year-old male patient with unilateral exudative macular degeneration developed endogenous endophthalmitis 11 days after carotid endarterectomy. The endophthalmitis could not be treated by intravitreal application of antibiotics. The patient underwent vitrectomy and systemic application of vancomycin. Six days later, the eye was quiet and the patient was discharged with a visual acuity of 0.9 logMAR. Patients with exudative macular degeneration have a higher risk for developing endogenous endophthalmitis after vascular surgery of the carotid arteries and prolonged postoperative application of systemic antibiotics might be considered in these patients.

Mittels radioaktiv markiertem Oktreotid kann man Somatostatinrezeptor exprimierende Zellen, wie zum Beispiel aktivierte T-Lymphozyten, in vivo nachweisen. In dieser Arbeit untersuchten wir die Sensitivitat der Oktreotidszintigraphie zur Diagnosestellung aktiver endokriner Orbitopathie (EO). 25 Patienten mit Verdacht auf aktive EO wurden in eine prospektive Studie aufgenommen. Der klinische Status wurde nach der „Werner Klassifizierung“ (NOSPECS) dokumentiert. Die Single photon emission computed tomography (SPECT) Untersuchung wurde 4 Stunden nach i.v. Applikation von 3mCi 111 Indium-Oktreotids durchgefuhrt. Die Ergebnisse der Oktreotidszintigraphie wurden mit der Klinik der Patienten wahrend einer Nachbeobachtungszeit von 12 ± 5.9 Monaten verglichen. Die statistische Korrelation wurde mittels Spearman Correlation Test durchgefuhrt. Die Oktreotidszintigraphie war in 17 Fallen positiv und in 8 Fallen negativ. 14 Patienten mit positiver Oktreotidszintigraphie wurden therapiert und es trat eine Regression der Symptomatik ein. 3 Patienten mit positiver Oktreotidszintigraphie lehnten jegliche Therapien ab. In zwei Fallen blieb der klinische Status konstant und in einem Fall kam es zur Verschlechterung der Symptomatik. Patienten mit negativer Oktreotidszintigraphie wurden nicht therapiert und in nur einem Fall kam es zur Zunahme der Orbitopathie. Die Oktreotidszintigraphie zeigte eine hohe Sensitivitat bei der Diagnose der aktiven EO (Rho = 0,94; p < 0,0001). Mittels Oktreotidszintigraphie ist eine gute Differenzierung zwischen subakuter und chronisch-fibrotischer EO moglich. Da eine immunsuppressive Therapie nur in der aktiven Phase einer EO zielfuhrend ist, ist die Durchfuhrung dieser Untersuchung in unklaren Fallen empfehlenswert, um die Indikation zur Therapie zu erleichtern. Using radiolabeled octreotide in patients with Graeves’ Ophthalmopathy (GO), tissues expressing somatostatin receptors, e.g. activated T-lymphocytes, can be visualized. In this study the diagnostic accuracy of orbital octreotide uptake in patients with presumed active GO was evaluated. A prospective study of 25 patients suffering from presumed active GO was done. In all cases the clinical state was documented using Werner’s classification (NOSPECS). Single photon emission computed tomography (SPECT) images were obtained 4 hours after iv injection of 3mCi 111 Indium octreotide. The results were correlated with the patients clinical state during a follow-up of 12 ± 5.9 months. Statistical correlation was performed using nonparametric Spearman Correlation test. Octreotide scintigraphy was positive in 17 and negative in 8 cases. 14 patients with positive octreotide scintigraphy underwent immunosuppressive treatment and showed a clinically positive response with regression of symptoms. In three cases the patients refused immunosuppressive treatment. Whereas in two cases no worsening of the symptoms appeared, one patient suffered from an increase of clinical symptoms. Patients without pathologic orbital octreotide uptake did not undergo any treatment bul discomfort increased in one case only. Octreotide scintigraphy showed a high sensitivity in evaluating the state of activity in GO (Rho = 0.94; p < 0,0001) Octreotide scintigraphy is a useful too! to determine the activity state of GO when the patients clinical evaluation does not reveal a difference between subacute or chronic fibrotic state. Since GO must be treated in the active phase, octreotide scintigraphy should be performed in uncertain cases of active GO to make the indication for immunosuppressive treatment easier.

Das Epithel ist die einzige korneale Zellart, welche bekannterweise die ABO Blutgruppenantigene exprimiert. Da retrospektive Studien eine verminderte Abstosungsreaktion nach ABO kompatibler Hornhauttransplantation verdeutlichen, untersucht diese Arbeit das Ausmas der ABO Blutgruppenexpression in erkrankten Hornhauten.

Purpose This study compares the influence of different corneal preservation media on HLA-DR positive corneal Langerhans cells (LCs). Methods Using fluorescence-associated immunohistochemistry, corneal sections were stained for HLA-DR antigens after preserving corneal-scleral discs in three different storage media: organ culture medium, Optisol and McCarey-Kaufman medium. HLA-DR positive LCs were present in corneal epithelium and upper stroma of fresh corneas. Results A storage period of even 3 days had a significant influence on the number of HLA-DR positive corneal LCs. The number of LCs decreased at the limbus from 15.3 ± 4.1 LCs/0.25 mm2 to 11.8 ± 1.2 LCs/0.25 mm2 (p

TNFalpha inhibitors are more widely used in the treatment of intraocular inflammation, thus ophthalmologists should become aware of possible adverse events, associated with this form of treatment. Herein we report two cases of cutaneous adverse events in uveitis patients treated with infliximab. In one patient, the primary outbreak of pustular psoriasis was observed after her third infusion. A second patient developed impetigo contagiosa induced by Staphylococcus aureus. Thus patients undergoing treatment with infliximab should be monitored carefully since dermal infections and pustular psoriasis, which may be triggered by streptococcal infection, may occur under this regime.

Background: Corneal HLA-DR antigens are going to be lost during organ culture storage. This study investigated if this phenomenon is based on down-regulation of the HLA-DR antigen, or on a loss of the HLA-DR-positive corneal Langerhans cells (LCs).

Hintergrund: Das HLA-DR-Antigen nimmt in der Transplantationsimmunologie eine Schlusselrolle ein. Die Organkulturlagerung fuhrt zum Verlust HLA-DR-positiver kornealer Langerhans-Zellen. Die voriegende Arbeit untersucht die Bedeutung einer verlangerten kornealen Lagerzeit fur den Erfolg einer perforierenden Keratoplastik. Patienten und Material: 84 Patienten mit 99 perforierenden kornealen Transplantationen wurden retrospektiv untersucht. Wir unterteilten das Patientenkollektiv in 2 Gruppen: Die Patienten aus der Gruppe 1 erhielten Spendermaterial mit einer durchschnittlichen Hornhautlagerzeit von 1,9 Tagen (±1,4), die Lagerzeit in Gruppe 2 betrug 9,8 Tage (±4,7). Ergebnisse: Nach 18 Monaten waren bei den Hochrisikopatienten in der Gruppe 1 34,4% (±8,7), in der Gruppe 2 69,2% (±12) (p

Atopic dermatitis is the most common chronic inflammatory skin disease among children in industrialized countries. The prevalence is recorded to be up to 20% in children. Phototherapy with ultraviolet B (UVB) is an effective form of treatment with a low complication rate. Here we report on a patient with atopic dermatitis who underwent UVB treatment to the facial area including the eyelids and who developed severe keratitis with facial erythema. The symptoms diminished within a few days under topical steroid treatment. Although phototherapy seems to be a safe treatment procedure for atopic dermatitis, patients undergoing UVB treatment should be informed about possible side effects if the eyes are not fully closed during treatment. The use of protective eye shields should be considered, since UVB might induce long-term corneal damage and early onset of cataract.

Intraocular lens (IOL) power calculation following laser refractive surgery is still one of the most challenging aspects in cataract surgery. This study was initiated to investigate the application of true net power (TNP; Pentacam, software version 6.02r10, Oculus, Germany) in IOL power calculations in eyes with prior laser refractive surgery. Our data contribute to the notion that the TNP of the Pentacam is a reliable alternative to determine the IOL power in cases where the historical data are missing. Based on our data, we recommend implementing the TNP to obtain the true corneal power and thus, reliable IOL power calculations.

To examine the refractive and visual outcome of laser-assisted subepithelial keratomileusis (LASEK) with mitomycin C(MMC) in eyes with myopic astigmatism ≥2.00 diopters (D). This study comprised 82 eyes of 82 consecutive patients (37 male, 45 female; mean age at surgery 34.7 ± 9.0 years) with preoperative topographic astigmatism ≥2.00 D and mean preoperative spherical equivalent (SE) −4.50 ± 1.13 D. To assess whether the refractive results differed with the amount of corrected sphere, the data were separated by preoperative SE thereby defining two groups with SE

Phototherapeutic keratectomy (PTK) is an acceptable technique to treat recurrent erosion syndrome. Its disadvantage is postoperative pain. We present a modified technique to reduce the immediate pain from removal of the epithelium after PTK. Nine patients with recurrent erosion syndrome had PTK with epithelial reflap (similar to laser-assisted subepithelial keratectomy) and contact lens application. The follow-up was 6 months. No patient reported severe postoperative pain. Three of 9 patients reported mild pain during the first 24 hours postoperatively. The best spectacle-corrected visual acuity was 0.40 to 0.63 logMAR on the first postoperative day and 0.80 to 1.00 logMAR after a week. No patient developed recurrent erosion.

PURPOSE: To report an immunohistochemically proven case of a coinfection of the retina by Epstein-Barr virus and cytomegalovirus in a patient with acquired immunodeficiency syndrome (AIDS). DESIGN: Interventional case report. METHODS: Postmortem evaluation of retinal tissue of a 45-year-old female AIDS patient with atypical fibrinous iridocyclitis and vitritis in course of a cytomegalovirus retinitis in the left eye was performed for evidence of dual infection with cytomegalovirus and other herpes group viruses. Immunohistochemical examination with double-staining techniques and antibodies against Epstein-Barr virus and cytomegalovirus was used. RESULTS: In the retina of the left eye, cells reacting with antibodies against cytomegalovirus and cells stained with antibodies against Epstein-Barr virus were detected in the layer of ganglionic cells and the inner granular cell layer. CONCLUSION: Epstein-Barr virus coinfection should be taken into consideration in unusual cases of necrotizing cytomegalovirus retinitis in AIDS patients.

PURPOSE Uveitis is a major cause for visual impairment. Inflammation-related gene polymorphisms have previously been shown to confer susceptibility to different types of uveitis. Recently, IL-2 receptor alpha (IL2RA, also called CD25) and IL-7 receptor alpha (IL7RA) gene variants (rs2104286, rs12722489, and rs6897932) have been identified to play an essential role in the pathogenesis of immune-mediated diseases. Their role in uveitis, however, has not yet been studied. The present study was set to investigate a hypothesized association of these gene polymorphisms and the presence of either intermediate or HLA-B27-associated acute anterior uveitis. METHODS One hundred forty-five patients with HLA-B27-associated acute anterior uveitis (AAU), 84 patients with intermediate uveitis, 132 HLA-B27-negative controls, and 61 HLA-B27-positive controls were enrolled. Determination of genotypes was done by polymerase chain reaction. RESULTS The frequency of carriers of the minor allele for rs2104286 was significantly lower in patients with intermediate uveitis compared with HLA-B27 positive and negative controls combined (P = 0.006). Frequencies of the minor allele for rs2104286 did not differ significantly in patients with HLA-B27-associated uveitis (28.3%) when compared with HLA-B27-negative controls (24.2%; P = 0.29) and HLA-B27-positive controls (30.3%; P = 0.72). The rs12722489 and rs6897932 polymorphisms were not significantly associated with either investigated uveitis entity (P > 0.005). CONCLUSIONS These findings suggest an association of the rs2104286 polymorphism with intermediate uveitis, but not with HLA-B27-associated acute anterior uveitis. Because this polymorphism was associated with multiple sclerosis in previous studies, the authors suggest possible parallel pathways between multiple sclerosis and intermediate uveitis but not HLA-B27-associated uveitis.

Purpose: To compare limbal and pars plana silicone oil removal (SOR) in aphakic eyes and to evaluate the acute effect of silicone oil flow to the corneal endothelium. Methods: Sixteen aphakic patients with silicone oil endotamponade requiring SOR were recruited for this prospective study and randomly scheduled for limbal or pars plana SOR. The central corneal thickness (CCT), visual acuity (VA) and intraocular pressure were measured preoperatively, on the first postoperative day and 4 months after surgery. Endothelial cell density (ECD) was measured preoperatively and at the end of follow-up. The in vitro study was performed on ten enucleated porcine eyes. Corneoscleral discs were prepared and fixed on artificial anterior chamber followed by 2.5-mm limbal incision and 5-ml silicone oil injection in six cases and 5 ml balanced salt solution (BSS) in four cases. Results: The ECD decreased by 239.2 ± 86.7 (13.9%) and 86.7 ± 22.4 cells/mm2 (5%) after limbal (n = 8) and pars plana SOR (n = 8), respectively (p

BACKGROUND Ciliary body melanoma is often diagnosed too late and therefore has a poor prognosis. The circular infiltration of the iridocorneal angle by malignant cells can lead to secondary glaucoma, often misdiagnosed as pigmentary glaucoma. MATERIAL AND METHODS In a 40-year-old patient the diagnosis "atypical pigmentary glaucoma" was made due to elevated intraocular pressure and pigmentation of the iridocorneal angle; no changes were present in the iris. In a second case pronounced pigmentation of the chamber angle and secondary glaucoma led to the clinical diagnosis of a ring melanoma and resulted in enucleation of the globe. RESULTS In the first case, increasing pigmentation of the chamber angle over 4 weeks led to the presumed diagnosis of a ring melanoma. Histopathological evaluation confirmed the diagnosis of a ring melanoma of the ciliary body. In the second case histology revealed retinal detachment with intraocular bleeding without intraocular melanoma. The pigmentation in the lower part of the chamber angle was due to hemosiderosis. CONCLUSION Diagnosis of ciliary body melanomas may be difficult in some cases due to its similarity to other eye diseases. The differential diagnosis of malignant melanoma of the ciliary body should be considered in cases of unilateral pigmentary glaucoma.

Aim To evaluate visual quality and postoperative results as well adverse events in myopic patients undergoing I-CARE anterior-chamber angle-supported phakic intraocular lens (IOL) implantation. Design A retrospective, non-randomised, case series. Participants Data on 29 eyes (16 patients) receiving I-CARE phakic IOL for high myopia (–11.66±3.3) were analysed. Methods The IOLs were implanted between 2003 and 2006 at the Department of Ophthalmology, Medical University, Graz, Austria. The mean follow-up was 51.7±16 months (17–78 months). Main outcome measures The authors measured uncorrected visual acuity (UCVA) and best-corrected visual acuity (BCVA); patients underwent slit-lamp examination, corneal topography, Scheimpflug imaging and measurement of endothelial cells (EC). Results The mean UCVA and BCSVA were 0.63 and 0.94 decimal after 1 year. Endothelial cell loss was the most serious adverse event observed. The mean EC loss was 2%, 9%, 17%, 21%, 33% and 47% after 1 year (n=17), 2 years (n=20), 3 years (n=17), 4 years (n=17), 5 years (n=12) and 6 years (n=3), respectively. Eight IOL explantations were made due to severe EC loss 3–6 years after implantation. Other serious complications included one patient with Urrets–Zavalia Syndrome (one eye). Conclusion Implantation of the I-CARE phakic-IOL is not a safe method for the correction of high myopia due to serious endothelial cell loss that might occur in a high number of patients. Patients with these IOLs should be followed up at least every 6 months, and the IOL should be explanted, once the EC count drops to less than 2000 cells/mm 2 .

Background: Lattice dystrophy is an autosomal-dominantly inherited disease. A mutation of the gene coding for kerato-epitheline has been found in patients with this stromal dystrophy. In codon 124 a Guanine to Adenine mutation of the nucleotide 417 has been described. We looked for this mutation in a family with lattice dystrophy treated in our clinic.

Mycotic infections of the eye continue to be an important cause of ocular morbidity. Etiological factors and symptoms are useful for the diagnosis of fungal infections. Mycotic keratitis may be seen after trauma with vegetable material, or in previously diseased eyes. The most common pathogens are Candida, Fusarium, Aspergillus. Clinical features, like the pyramidal Hypopyon, can differentiate fungal from bacterial infections. Mycotic Endophthalmitis refers to intraocular inflammation caused by Candida, Aspergillus, and Cryptococcus. Exogenous mycotic endophthalmitis follows intraocular surgery or trauma. Endogenous mycotic endophthalmitis is frequently an ocular manifestation of a systemic disease. Early diagnosis should be made to ensure prompt initiation of antifungal therapy, to prevent visual loss.

Purpose The genetic background for the concomitance of uveitis and other autoimmune diseases remains elusive. Here the role of two IL2RA gene variants (rs11594656 and rs12722495) was investigated in intermediate uveitis and HLAB27 acute anterior uveitis. Materials and Methods One hundred fifty-nine patients with HLAB27 acute anterior uveitis, 85 patients with intermediate uveitis, 138 HLAB27 negative controls and 100 HLAB27 positive controls were recruited for this case-control study. Main outcome measures were genotype distribution and allelic frequencies determined by polymerase chain reaction. Results The frequencies of carriers of the minor allele at rs11594656 and rs12722495 were significantly different in patients with intermediate uveitis compared to HLAB27 positive and negative controls combined (p