[Salzmann's nodular degeneration. Mostly an epithelial corneal dystrophy]. / Salzmannsche noduläre Hornhautdegeneration. Meist eine epitheliale Hornhautdystrophie.

So-called Salzmann's nodular degeneration has been given a misleading position in the systematics of ophthalmology. The majority of cases of Salzmann's nodular degeneration are in fact a clinical entity fulfilling the criteria of epithelial corneal dystrophy involving Bowman's layer. As with all epithelial dystrophies Salzmann's nodular degeneration recurs after surgical removal. An analysis of Salzmann's original paper discloses that the etiological postulates (severe preceding keratitis, especially phlyctenular keratitis) have never been substantiated by direct observation but only suspected by indirect histopathological circumstantial evidence. This has long lost credibility and should never have been taken for real evidence. However, degenerative types of Salzmann's nodular degeneration besides the dystrophic type still exist but the etiology and pathogenesis of these degenerative types have not yet been sufficiently described. No distinction has been made in studies of Salzmann's nodular degeneration up to now between dystrophic and degenerative types which could render such publications worthless on re-evaluation. While therapy of Salzmann's dystrophy is usually simple even after recurrence this may be different with the degenerative forms. The many questions and inconsistencies which have long been noted with "Salzmann's degeneration" as it has been misunderstood, can only be answered and solved if dystrophy and degeneration are investigated separately in future studies.

Total protein concentration and T-cell suppression activity of aqueous humour before and after penetrating keratoplasty.

PURPOSE: We wished to determine whether immune privilege parameters assayed in aqueous humour (AqH) are relevant to the fate of penetrating keratoplasty (PK) in humans. METHODS: AqH was collected in 28 patients before PK (prospective cohort), in 6 patients with no history of graft rejection undergoing cataract surgery after PK (acceptors), in another 6 patients undergoing treatment of an acute endothelial immune reaction (rejectors), and in 65 controls undergoing uncomplicated cataract extraction. AqH was tested for total protein concentration and the ability to suppress T-cell activation. RESULTS: AqH protein concentrations of acceptors and rejectors post-PK were elevated (2.7 ± 0.8 and 2.7 ± 0.7 mg/ml, respectively) compared with pre-PK AqH level and cataract controls (1.0 ± 0.1 mg/ml, P = 0.01). All AqH samples suppressed T-cell activation, irrespective of source and timing of AqH removal. CONCLUSION: Assays of immune privilege markers in AqH suggest that PK surgery may result in a sustained loss of integrity of the blood-aqueous barrier. Although trends were evident, values of immune privilege markers determined pre- and post-PK were not statistically significantly different between the study groups. However, further prospective studies determining additional immune privilege markers have to be conducted in order to find out whether these markers might serve as predictive parameters for immune reactions following PK.

[Suture complications in penetrating keratoplasty]. / Fadenkomplikationen nach perforierender Keratoplastik.

BACKGROUND: Penetrating keratoplasty with mechanical trephines is currently standard treatment for corneal blindness. This operation requires graft suturing in contrast to the emerging posterior lamellar procedures. Loosening or rupturing of graft sutures can give rise to microbial infections or graft rejections. We investigate herein the incidence of suture-related graft infections, graft rejections and the percentage of resuturings in a large cohort after penetrating keratoplasty. PATIENTS AND METHODS: We reviewed the follow-up data of 2950 consecutive penetrating keratoplasties performed between 1988 and 2003. We counted suture loosening, suture rupturing as well as consecutive microbial infections or graft rejections. All grafts had been sutured with Hoffmann's double running cross stitch procedure. RESULTS: The percentage of suture loosening and suture rupturing totalled 5 % after 3 years (Kaplan-Meier estimation). Fourteen percent of this group experienced suture-related graft infections. Graft rejections occurred more often as well (30 vs. 22 % in the reminder without suture loosening, p < 0.01). A total of 8 % required resuturings within the first three postoperative years. However, nearly half (4 %) were performed for early postoperative leakage from the graft-host interface. A second accumulation of resuturings occurred between the 12th and 18th month after surgery. These operations mostly became necessary after graft protrusion/dehiscence following complete suture removal. Only 0.9 % of the complete group suffered from the aforementioned sequela of suture loosening. CONCLUSION: The overall percentage of severe sequalae from suture loosening or rupturing is as low as 0.9 %. This complication can thus be considered insignificant in comparison to, e. g., graft rejections that occur in every fifth patient. The sutures should not be removed completely before the first 18 postoperative months in conventional penetrating keratoplasty. This policy will most likely reduce the percentage of resuturings for graft protrusion or dehiscence following complete suture removal.

Costs and financing. A cost calculation of an up-to-date eye bank in Germany.

PURPOSE: To estimate the averaged cost of processing a corneal graft for keratoplasty. METHODS: We estimated the total running costs of a German corneal bank for one year. All procurement-related expenses were calculated on the basis of 300 donors per year and a disavowal percentage of 50%. RESULTS: The running costs comprise of personnel (2 physicians, 2 technicians), amortization of equipment, laboratory costs, laboratory consumables, occupancy costs and quality management. Annual expenses total 584000 EUR. This aggregation divided by 300 corneal grafts released for transplantation results in a nominal charge of 1950 EUR per corneal graft. DISCUSSION: The DRG system in Germany (in-patients at a base rate of 1.0) refunds only 850 EUR, leaving a financial gap of 1100 EUR per keratoplasty. This financial burden is currently left over to the eye bank and/or the surgeon.

[HLA B27 seems to promote graft failure following penetrating keratoplasties for herpetic corneal scars]. / HLA B27 scheint Transplantatversagen nach Hornhautverpflanzung bei herpetischen Hornhautnarben zu fördern.

BACKGROUND: Herpes simplex virus (HSV) is the leading cause of infectious corneal blindness in the developed world. Eighty percent of the general population develop asymptomatic viral latency in the trigeminal ganglion following orofacial inoculation, but only 0.2% of all such orofacial inoculations are followed by recurrent corneal reactivation. Recurrences still threaten graft survival following penetrating keratoplasty, so that advance identification of patients at increased risk would be helpful in aftercare following penetrating keratoplasty. The HLA B27 phenotype is associated with increased susceptibility to genital HSV. However, no such association has been reported for herpetic eye disease. METHODS: The HLA phenotypes of 129 patients who underwent penetrating keratoplasties for herpetic corneal scars were available for retrospective analysis. Four of these patients were positive for HLA-B27. The 125 HLA-B27-negative patients served as controls. The mean follow-up was 2.2 years. We compared the frequencies of herpetic recurrence and graft failure in the two groups using the Kaplan-Meier method and applied log-rank statistics. RESULTS: After the average period of follow-up, 75% (three patients) of the HLA B27-positive patients experienced either graft failure or at least one reversible recurrence of the herpetic eye disease, as against only 25% of controls. This difference was highly statistically significant (p<0.01). CONCLUSION: This retrospective analysis suggests that the HLA B27 phenotype promotes recurrence of herpetic eye disease following penetrating keratoplasty. HLA B27-positive patients should be closely monitored, and the indications for prophylactic antiviral therapy should be viewed liberally in this group.

[Amniotic membrane transplantation and high-dose systemic cyclosporin A (Sandimmun optoral) for Mooren's ulcer]. / Amnionmembrantransplantation und hoch dosiertes systemisches Ciclosporin A (Sandimmun optoral) bei Ulkus Mooren.

BACKGROUND: Mooren's ulcer is a rare, severe corneal autoimmune inflammation leading to blindness if treated insufficiently. High-dose systemic cyclosporin A (Sandimmun optoral) was shown to markedly reduce inflammation and stop corneal destruction. We report on three cases in which this immunosuppressive regimen required additional AM transplantation for complete healing. PATIENTS: One 37-year-old male (M) and two 49- (F1) and 58-year-old females (F2) presented with unilateral Mooren's ulcer in different stages of the disease, which deteriorated despite high-dose systemic cyclosporin A (Sandimmun optoral M, F1) or treatment with topical cyclosporin A 2 % (F2). After surgical removal of all grossly affected corneal stroma, amniotic membrane was made to cover the entire cornea and fixed with episcleral sutures in two patients (M, F2). In one patient (F1) a deep marginal ulcer was covered with a fitted AM glap. All patients were treated postoperatively up to 6 months with high-dose systemic cyclosporin A (Sandimmun optoral). Blood trough levels aimed at 150 to 200 ng/mL. Topical cyclosporin A was administered in addition in two patients (M, F2) postoperatively for at least 6 months. Due to incompatibility, one patient (F1) was treated with topical steroids instead. RESULTS: Follow-up time was 42 months (M), 50 months (F1) and 54 months (F2). All three eyes exhibited clinical healing with stable corneal surfaces thereafter. Depending on the stage of Mooren's ulcer at the time of surgery, visual acuity remained at hand motions in one patient (M) and recovered to 1.0 and 0.6, respectively, in two patients (F1, F2). CONCLUSION: Due to its anti-inflammatory potential, coverage by AM seems to trigger a therapeutic turnaround in cases of Mooren's ulcer which do not heal with intensive immunosuppressive regimens alone. In order to maintain or restore as much visual function as possible, additional amniotic membrane surgery should be performed early enough in the course of the disease.

[Bilateral large conjunctival tumours as primary manifestation of sarcoidosis--successful treatment with steroid-depot-injections]. / Beidseitige ausgeprägte konjunktivale Tumoren als Primärmanifestation einer Sarkoidose -- erfolgreiche Therapie mit Steroid-Depot-Injektionen.

INTRODUCTION: Ocular manifestations of sarcoidosis vary enormously. They include the conjunctiva, lacrimal gland, orbita, intraocular structures and eye-lid, either isolated or combined. We describe a female patient who presented with unusually large, bilateral conjunctival tumours as a primary manifestation of sarcoidosis. PATIENT: A 79-year-old white woman was referred to us for further management of a persisting "conjunctivitis", which had been refractory to treatment with multiple medications. Initial examination disclosed swollen eye-lids and bilateral large hard tumours of the inferior fornix. The obtained brush smear, which was cytopathologically evaluated, revealed epitheloid cells and multinucleate giant cells. After 4 weeks she developed three reddish-brown maculopapular lesions on her face. The subsequent biopsy from the left inferior fornix and the skin showed histopathologically a granulomatous epitheloid cell inflammation without central necrosis and without acid-proof bacilli. Therefore a sarcoidosis was included into the differential diagnosis. The systemic evaluation revealed no other manifestation. At first we tried to reduce the chronically inflammatory tumours with different immunomodulating local treatment forms. Only the repeated intralesional injection of a steroid depot showed a complete disappearance of all conjunctival and skin tumours. CONCLUSION: An isolated bilateral primary manifestation of sarcoidosis with large massive conjunctival tumours is very rare and clinically not typical. The non-invasive, cytopathological examination by means of brush smears offers a new perspective in the fast diagnosis of conjunctival manifestation of sarcoidosis. The tumours respond excellently to the intralesional injection of steroid depots.

[Significance of immediate affixation of a hard contact lens in the emergency treatment of severe alkali burns of the cornea (case report)]. / Die Bedeutung der frühzeitigen Aufklebung harter Kontaktlinsen in der Notfallbehandlung schwerer Alkaliverätzungen der Hornhaut (Fallbericht).

BACKGROUND: Severe alkali burns lead to massive limbal stem cell damage resulting in persistent epithelial defects, infiltration and stromal melting early in the disease process. A glued-on hard contact lens may serve as an "artificial epithelium" and protect the cornea from these complications. CASE REPORT: A 39-year-old male presented with severe lime burns in both eyes one week after injury. The right eye showed a totally denuded cornea and conjunctiva with circular paralimbic ischemia. In the left eye "only" two thirds of the cornea and adjacent conjunctiva and limbus were affected with less ischemia. Amniotic membrane transplantation was performed in both eyes but failed after four days already in the right eye. A hard contact lens was therefore glued on the right eye and allowed for visual acuity of 0.4 without correction in this primarily most heavily afflicted eye for 12 months duration. After removal of the contact lens, reepithelisation was quick, and function remained stable with addition of autologous serum eye drops. The primarily far less injured left eye, however, for which the amniotic membrane surgery was primarily judged to be adequate, could not be stabilised. The cornea perforated 4 weeks later necessitating a mini-keratoplasty plus a glued-on contact lens, and correctable vision never became better than 1/35. CONCLUSION: The clinical course confirms former observations that a glued-on hard contact lens is an effective treatment early after alkali burn and prevents the cornea from infiltration and melting. Moreover, two aspects merit consideration: first, with proper technique and timing of the gluing-on a patient may retain useful vision throughout the period of wearing the contact lens; second, for the long period during which the cornea was sealed by the contact lens, improper repopulation by conjunctival epithelium was inhibited, and proper corneal epithelium was given a chance for repopulation after recovery of the limbal area resulting in a stable surface and useful vision without additional keratoplasty measures.

[Ranking of systemic steroids after normal-risk keratoplasty. Results of a randomized prospective study]. / Stellenwert der systemischen Steroidtherapie nach Normalrisikokeratoplastik. Eine randomisierte prospektive Pilotstudie.

BACKGROUND: The aim of this study was to evaluate the efficacy of sole application of topical steroids after normal-risk keratoplasty. PATIENTS AND METHODS: This randomized prospective clinical study assessed 40 patients who had undergone penetrating normal-risk keratoplasty. Twenty patients were treated exclusively with prednisolone acetate 1% eye drops 5x/day for 6 months postoperatively. Another 20 patients additionally received systemic fluocortolone 1 mg/kg body weight per day tapered within 3 weeks postoperatively. The main outcome measures included clear graft survival, ratio of graft rejection, and side effects. RESULTS: The mean postoperative follow-up was 18+/-9 months. Three graft rejections were observed in the group receiving only topical steroids. Two graft rejections were observed in the group administered combined systemic and topical steroid therapy. None of the patients has developed irreversible graft failure so far. CONCLUSION: Sole topical steroid application seems to be an effective immune prophylaxis in patients undergoing penetrating normal-risk keratoplasty.

[Long-term results of homologous penetrating limbokeratoplasty in total limbal stem cell insufficiency after chemical/thermal burns]. / Langzeitergebnisse der homologen perforierenden Limbokeratoplastik bei totaler Limbusstammzellinsuffizienz nach Verätzungen/Verbrennungen.

BACKGROUND: Since 1991 homologous penetrating limbokeratoplasty has been performed in 32 patients with severe limbal stem cell insufficiency following chemical/thermal burns. The long-term results considering the effects of HLA matching are presented for the first time. PATIENTS: All patients received systemic cyclosporin A and/or mycophenolate mofetil in the postoperative course. In 9 patients grafts with 0-1 HLA mismatches in the HLA A, B and DR loci, in 6 patients grafts with 2-6 mismatches and in 17 patients untyped grafts were used. Long-term clear graft survival was estimated according to Kaplan and Meier. RESULTS: Five years postoperatively, 50% of the grafts with 0-1 mismatches, 32% of the grafts with 2-6 mismatches and 18% of the untyped grafts were centrally clear (log-rank-test, p>0.05). CONCLUSIONS: Although statistically not significant, HLA matched grafts seem to deliver better results than untyped grafts in penetrating limbokeratoplasty. Improvement of matching strategies and immunosuppression may possibly further improve current results.

FTY720 prolongs clear corneal allograft survival with a differential effect on different lymphocyte populations.

BACKGROUND: FTY720 is a potent immunomodulator with unique effects on lymphocyte homing and has recently proved to be safe and effective in renal transplantation in man. The authors investigated the potency of FTY720 in inhibiting allograft rejection in the rat model of orthotopic allogeneic penetrating keratoplasty. METHODS: Penetrating keratoplasties were performed using Fisher rats as donors and Lewis rats as recipients or donors: group 1 (n = 10), allogeneic control; group 2 (n = 10), Lewis/Lewis syngeneic control; group 3 (n = 9), mycophenolate mofetile (MMF) 40 mg/kg; group 4 (n = 10), FTY720 1.2 mg/kg; group 5 (n = 8), FTY720 0.3 mg/kg. Four animals from each group were sacrificed for immunohistological evaluation on day 14. Medication in the therapy groups was given for 18 days. RESULTS: The mean (SD) rejection free graft survival time was 11.3 (0.8) days for the allogeneic control (group 1), 24.6 (2.5) days for group 3 (MMF), 44.5 (5.7) days for group 4 (FTY720 1.2 mg/kg), and 35.3 (5.7) days for group 5 (FTY720 0.3 mg/kg) (p<0.05). The allogeneic control showed a dense infiltration with CD4+, CD8+, CD161+ (NK-cells), CD25+ (IL2 receptor), and macrophages. In the therapy groups the density of infiltrating CD4+, CD8+, CD161+ (NK-cells), and CD25+ (IL2 receptor) cells was notably reduced compared with the allogeneic control (p<0.05). In group 5 however, the reduction of infiltration by CD4+ cells was higher than the reduction of infiltration by CD8+ (p<0.05) and CD161+ (NK) cells. DISCUSSION: Oral immunosuppression with FTY720 significantly prolongs corneal allograft survival in this transplant model. The results suggest that FTY720 has a different effect on certain lymphocyte populations. CD4+ cells seem to be more affected than CD8+ cells and NK-cells.

[Factors influencing corneal endothelium in organ cultures during transport]. / Einflussfaktoren auf das Hornhautendothel in Organkultur während des Transports.

PURPOSE: Experiments were performed to evaluate to what extent low temperature and mechanical shock are tolerated by the endothelium of corneal grafts in organ culture. METHODS: A total of 40 paired corneal grafts were kept in organ culture for 7-28 days at 34.5 degrees C. After this period, the grafts were divided into 8 groups: (A(1)) organ culture at 20 degrees C for 12 h, thereafter organ culture at 34.5 degrees C for 7 days: (A(2)) control for group A(1) maintained at 34.5 degrees C over the whole culture period: (B(1)) organ culture at 10 degrees C for 12 h, thereafter organ culture at 34.5 degrees C for 7 days: (B(2)) control for group B(1) maintained at 34.5 degrees C over the whole culture period: (C(1)) mechanical shock exerted 100 times (>100 g), thereafter organ culture at 34.5 degrees C for 7 days: (C(2)) control for group C(1) maintained at 34.5 degrees C over the whole culture period with no mechanical shock: (D(1)) organ culture at 10 degrees C for 12 h, mechanical shock exerted 100 times (>100 g) and then organ culture at 34.5 degrees C for 7 days: (D(2)) control for group D(1) maintained at 34.5 degrees C over the whole culture period with no mechanical shock. Endothelial evaluation was performed immediately before and at the end of the final culture period. RESULTS: The following values for loss of endothelial cells were obtained: A(1) 5.7%+/-6.9, A(2) 4.3%+/-15.9, B(1) 10.4%+/-14.4, B(2) 7.2%+/-14.0, C(1) 7.2%+/-6.3, C(2) 0.7%+/-13.4, D(1) 3.7%+/-7.6, D(2) 1.1%+/-7.4. CONCLUSIONS: According to these experiments, lowering the temperature to 10 degrees C over a period of 12 h and/or mechanical shock above 100 g exerted 100 times did not seem to affect the endothelium of corneal grafts in organ culture.

[Posterior chamber lens implantation after penetrating keratoplasty. Is this partly responsible for late transplantation failure?]. / Hinterkammerlinsenimplantation nach perforierender Keratoplastik. Mitursache für das späte Transplantatversagen?

BACKGROUND: Posterior chamber lens implantation (PCL) after penetrating keratoplasty (pKp) might contribute to late endothelial graft failure due to intraoperative damage of graft endothelium or due to PCL-associated facilitation of chronic endothelial cell loss. PATIENTS AND METHODS: A total of 55 eyes were retrospectively selected. By means of exponential regression analysis, individual annual relative endothelial cell loss was calculated. Six patients were pseudophakic prior to pKp (group A). Due to advanced cataracts in 18 patients (group B) a combined operation (triple-procedure) had been initially performed. Of the remaining 31 eyes. 17 underwent PCL implantation after a mean of 1.5+/-1.2 years post pKp during follow-up (group C). The remaining 14 eyes remained phakic during follow-up (group D). RESULTS: A statistically significant difference between the groups was not observed for the follow-up period or duration of culture ( p=0.14; Kruskal-Wallis-Test). Graft failures during follow-up were also not observed. CONCLUSION: From these preliminary results, cataract surgery does not seem to promote late endothelial failure after pKp.

Improvement of graft prognosis in penetrating normal-risk keratoplasty by HLA class I and II matching.

BACKGROUND: Owing to contradictory results, HLA matching in penetrating keratoplasty still is equivocal. Different surgical techniques in multicentre studies, missing risk differentiation in high-risk situations, and faulty HLA typing can be identified as main reasons for these contradictory results. In this monocentre study, the value of HLA class I and II matching (A, B, DR loci) was examined in a homogeneous group of 418 normal-risk keratoplasty patients using serological typing techniques for HLA class I and immunogenetic typing techniques for class II. METHODS: Penetrating normal-risk keratoplasty was performed in two groups of patients (group I with 0-2, group II with 3-6 mismatches in the A/B/DR loci). All surgery was carried out by three experienced surgeons according to a standardized scheme. Furthermore, postoperative therapy and controls were standardized. There were no statistically significant differences between the two study groups with regard to the number of ABO or H-Y compatibilities, patient age, patient gender, ratio of previous intraocular surgery, ratio of triple procedures, indication for surgery, follow-up period, donor age, donor gender, post-mortem time of the graft, and endothelial cell density of the graft at the end of organ culture. All HLA typing was performed in a quality-controlled laboratory, serologically for HLA class I (A and B loci) and immunogenetically for HLA class II (DR locus). RESULTS: At 4 years postoperatively, the ratio of clear and rejection-free graft survival was 92% in group I and 66% in group II (Kaplan-Meier estimation, log rank test, P=0.03). Monovariate analysis in the Cox model gave no influence of solitary HLA class I or II matching, but only an influence of combined HLA class I and II matching (P=0.03). CONCLUSIONS: In this monocentre study with proper typing techniques, the beneficial effect of HLA class I plus II matching on clear and rejection-free graft survival could be demonstrated in a homogeneous group of normal-risk keratoplasty patients.

PCR for varicella zoster virus genome negative in corneal epithelial cells of patients with Thygeson's superficial punctate keratitis.

PURPOSE: To find out if varicella zoster virus is the causative agent of Thygeson's superficial punctuate keratitis. METHODS: Epithelial cells were harvested from the punctuate epithelial lesions 9 patients with Thygeson's superficial punctate keratitis. After DNA extraction polymerase chain reaction was carried out with varicella zoster virus primers. RESULTS: All samples were negative with regard to varicella zoster virus genome. CONCLUSIONS: This result suggests that varicella zoster virus is most probably not the causative agent of Thygeson's superficial punctate keratitis.

Endotoxin in storage medium of human corneal grafts and clinical course after penetrating normal-risk keratoplasty.

PURPOSE: It is well known that endotoxins in storage medium may stimulate cytokine production and expression of adhesion molecules as well as endothelial damage in human corneal grafts. It has been supposed that endotoxin exposure of corneal grafts may, therefore, cause immune reactions and lead to reduced endothelial cell count after penetrating keratoplasty. It was the purpose of this prospective study to evaluate if this hypothesis is true. METHODS: A consecutive series of 274 samples of sterile organ culture storage medium from 274 human corneal grafts was collected between August 1998 and February 1999 and tested for endotoxin using Limulus amebocyte-lysate assay (LAL) after 7 days of organ culture. Threshold endotoxin level was set at 1.0 U/ml. A total of 161 grafts were transplanted and 113 were discarded. Within the 161 corneas transplanted, 62 were grafted to normal-risk patients and 99 to high-risk patients. Only normal-risk keratoplasty patients were included in the study and followed for at least 10 months. Immune reactions, graft failures, and postoperative endothelial cell counts were recorded. RESULTS: The mean endotoxin level in organ culture medium of all transplanted grafts was 1.07+/-2.96. Mean endotoxin level in organ culture medium of discarded grafts was 1.68+/-5.76, with 71 samples being below and 42 above the threshold of 1.0 U/ml called endotoxin-negative and endotoxin-positive, respectively. In all 36 culture medium samples from the 62 grafts transplanted to the group of normal-risk keratoplasty patients were endotoxin-negative and 26 endotoxin-positive. An influence of endotoxin levels on incidence of immune reactions, graft failure, and postoperative endothelial cell counts could not be revealed in patients with normal-risk keratoplasty. CONCLUSION: Low endotoxin levels in storage medium neither seem to promote immune reactions nor to contribute to postoperative chronic endothelial cell loss in normal-risk keratoplasty patients.

[Functional results after autologous rotational keratoplasty. A retrospective study]. / Funktionelle Ergebnisse nach autologer Rotationskeratoplastik. Eine retrospektive Analyse.

BACKGROUND: Autologous rotational keratoplasty is a therapeutic option in patients with central corneal scars. Its advantage compared to allogeneic procedures is the absence of immunologic destruction. In this retrospective analysis, long-term results are presented. PATIENTS: Since 1988, autologous rotational keratoplasty was performed in 19 patients. The trephine size varied between 7.0 mm and 9.0 mm. Mean follow-up was 7.1+/-4.6 years. RESULTS: In 16 of the patients, the graft center remained clear during the entire follow-up period. Visual acuity improved from 0.25+/-0.16 preoperatively to 0.34+/-0.27 postoperatively with spectacles and to 0.43+/-0.3 with contact lenses. The mean postoperative astigmatism was 6.41+/-3.87 dpt with irregular components in six patients. CONCLUSION: Only a few postoperative graft complications were observed. Especially in patients with a markedly elevated risk for immune reactions (e.g., small infants), autologous rotational keratoplasty is a safe alternative to allogenic procedures.

Detection of oestrogen receptors (ER) alpha and beta in conjunctiva, lacrimal gland, and tarsal plates.

PURPOSE: Lack of Oestrogen and androgen may be of importance in the pathogenesis of keratoconjunctivitis sicca (KCS). The signal of Oestrogens is transmitted via specific Oestrogen receptors (ER). It was the purpose of this study to evaluate the expression of ER alpha and ER beta in tear-producing tissues. METHODS: Reverse transcriptase-polymerase chain reaction (RT-PCR, ER alpha + beta) and immunohistochemical evaluation (ER alpha only) were performed for ER detection and localization in tissue samples of bulbar conjunctiva (20 samples of 20 patients undergoing cataract surgery), tarsal plates (14 samples of 12 patients undergoing eye lid surgery), and lacrimal glands (20 samples of 13 cornea donors). RESULTS: Messenger RNA ER alpha was identified via RT-PCR in all tissue samples with variable expression, ER beta predominantly in lacrimal gland tissue. Immunohistochemical staining for ER alpha was negative in most cases, probably due to the thermolability of ERs and very small sample sizes. CONCLUSIONS: The detection of ER alpha and ER beta mRNA expression supports the concept of a receptor-based effect of Oestrogen in these tissues contributing to KCS. This may encourage therapeutical efforts including topical Oestrogen administration.

[Atopic keratoconjunctivitis: probably a risk factor for the development of conjuntival carcinoma]. / Atopische KeratokonjunktivitisWahrscheinlich ein Risikofaktor für die Entstehung von Bindehautkarzinomen.

BACKGROUND: Almost half of the patients with atopic dermatitis experience chronic inflammation of the eyelids, the conjunctiva and the cornea. Chronic inflammation is a possible cause for the development of malignancies, especially if associated with some kind of immunological defect as in atopic patients. So far, a correlation between atopic conjunctivitis and conjunctival malignancies has not yet been reported. Here, we present 7 atopic patients with conjunctival carcinoma or carcinoma in situ detected between February 2000 and August 2001. PATIENTS: All 7 patients had a long history of atopic dermatitis and chronic of inflammation of the conjunctiva and cornea. In all patients smears were examined by cytology and DNA cytometry. Furthermore, in 6 of the 7 patients a histopathological examination of conjunctival biopsies was performed. RESULTS: In 4 of the 7 patients invasive conjunctival carcinoma and in 2 carcinoma in situ were detected. Cytology and cytometry revealed conjunctival carcinoma or carcinoma in situ in the remaining patient. Histopathological examination could not be performed since the patient refused to have a conjunctival biopsy. CONCLUSIONS: These results suggest that atopic keratoconjunctivitis might be a risk factor for the development of conjunctival carcinoma.