[Eyelid surgery : Eyelid surgical techniques from a histopathological perspective]. / Lidchirurgie : Lidchirurgische Techniken aus histopathologischer Sicht.

Eyelid surgery and histopathology are closely related, especially in tumor surgery. Based on histological specimens from the archive of the Department of Ophthalmopathology, Eye Centre Freiburg, this article deals with the search for traces following eyelid surgery, and explains the respective clinical relevance for ophthalmologists involved in surgical and conservative treatment. Thermal, electrical and mechanical impacts on the tissue during tumor removal lead to histologically detectable artifacts. These must be kept to a minimum by the surgeon in order to ensure histological assessability and avoid adverse consequences for the patient. During the subsequent eyelid reconstruction, the eyelid architecture is changed depending on the surgical technique. Thus, after Hughes' operation a degeneration of the meibomian glands is histologically noticeable, which should be taken into account in the clinical aftercare of the patients. Suture material can lead to foreign body granulomas, which can be clinically misinterpreted as tumor recurrence. In contrast to foreign material, transplanted autologous tissue, such as cartilage or oral mucosa in the case of eyelid malposition, usually does not lead to chronic inflammation.

[Surgical management of firework-induced eyelid injuries]. / Lidchirurgische Versorgung von Feuerwerksverletzungen.

Fireworks injuries are frequently caused by malfunction or incorrect operation of fireworks. Injuries often affect the eyeball and the periorbit. After treatment of life-threatening bleeding, injuries of the eyeball have priority over the treatment of periorbital lacerations and burns. The aim of eyelid surgery in firework-related injuries is to prevent delayed damage, such as lagophthalmos, symblepharon, entropion with trichiasis, and keratinization of the conjunctiva of the eyelid and eyelid margin. The treatment requires a considerable amount of time and patience both for the elaborate surgical procedures as well as for the necessary healing and rest phases. Many patients, however, are left with serious visual impairments and stressful esthetic deformities, which result in considerable occupational and social impairments.

[Blepharitis component of dry eye syndrome]. / Blepharitiskomponente des trockenen Auges.

This review contains a compilation of long-standing and more recent relevant information on chronic blepharitis, especially in the context of dry eye disease regarding epidemiology, symptoms, clinical findings and pathophysiology. Chronic blepharitis often represents the underlying cause of dry eye disease but remains undetected and untreated in many cases; however, it can be a result of (hypovolemic) dry eye disease and leads to sometimes severe corneal complications, which are illustrated by material from our own patient archives. Recent findings regarding the lipid composition in the tear film in correlation with that of Meibomian gland secretions and the hypothesis of a biofilm as the basis of chronic blepharitis as a theoretical, not yet proven addition to the previously known pathophysiological factors, are discussed.

[Fusarium keratitis with dramatic outcome]. / Fusarienkeratitis mit dramatischem Ausgang.

BACKGROUND: Fungal keratitis is much less common in Europe than in Asia. Antifungal therapy can be applied topically as well as systemically and in advanced situations surgical intervention can become necessary. CASE REPORT: We present the case of a 60-year-old woman who suffered from Fusarium keratitis that showed progression to endophthalmitis following contact lens wearing. Due to numerous resistances against antimycotic drugs the eye had to be enucleated to prevent the pathogens from spreading. Histologically, major inflammatory activity could be detected but no causative organism could be found. The failure to detect a pathogen was in clear contrast to the clinical findings and was interpreted as being an overreaction of the immune response even after the Fusarium had been destroyed. CONCLUSION: If a fungal infection of the cornea is suspected, antimycotic therapy should be initiated as early as possible. In cases involving highly resistant pathogens the eye cannot always be saved.

[Treatment options for chronic blepharitis considering current evidence]. / Therapeutische Optionen bei chronischer Blepharitis unter Berücksichtigung der Evidenzlage.

The goal of the treatment of chronic blepharitis lies in the reduction of inflammation, which can be achieved by warming, mechanical, and immunomodulatory measures as well as acaricide medication in cases with pathogenetically relevant demodicosis.

[Intraocular Inflammation: Autoimmune or Infectious?]. / Intraokulare Entzündung: autoimmun oder infektiös?

Presentation of 3 cases of intraocular inflammation: 1. 47-year old female patient with severe necrotising scleritis and uveitis with underlying granulomatous polyangiitis (formerly known as Wegener granulomatosis, in honour of the German pathologist Friedrich Wegener), known for 10 years. 2. 48-year old male patient with longstanding bilateral uveitis and granulomatous polyangiitis for 2 years. In the histopathological examination of the enucleation specimen, a retrolental tumour turned out to be a granuloma. 3. 57-year old male patient in status post renal transplantation with intraocular cellular infiltration suspicious for lymphoma, which surprisingly proved to be Toxoplasma gondii-associated uveitis. The clinical course and characteristic histological signs and therapeutic options are discussed.

[Morphological analysis of corneal refractive lenticules--is there a correlation with refractive results?]. / Ultrastrukturelle Analyse von Hornhautlentikeln nach fs-Lentikelextraktion gibt es einen Zusammenhang mit den refraktiven Ergebnissen?

BACKGROUND: ReLEx®flex is a corneal refractive procedure performed by removing corneal lenticules with a femtosecond (fs) laser system. Using electron microscopy, tissue parameters of extracted lenticules were analysed for potential correlations to the refractive results. Furthermore, the effect of previous contact lens (CL) wear on refractive stability (regression) was tested. PATIENTS AND METHODS: 19 lenticules from 11 patients (age 24-56 years, 8 f, 3 m) were prepared for EM. The central areas of the samples were photographed and the distance between the collagen fibres and their diameters were digitally measured. ANOVA analysis was used to correlate postoperative refractional stability with time of preoperative CL use, fibre diameter and the coefficient of variation (CV) of fibre distance. RESULTS: 14 of 19 lenticules were from patients who had worn CL preoperatively. The cumulative duration of CL wear averaged around 31.2 ± 35.5 thousand hours. Preoperative CL use significantly influenced the postoperative regression: the longer time patients had worn CL, the greater was the regression towards myopia (p = 0.01). Additionally, the morphological parameters collagen fibre diameter (p = 0.09) and CV of fibre distance (p = 0.07) had an impact on regression. CONCLUSIONS: Prolonged CL use and alterations in ultrastructural patterns affected the refractive stability after ReLExflex. Although the pathophysiological relationships between CL use, corneal morphological parameters, and refractive stability are still poorly understood, these findings could potentially be used as prognostic markers for postoperative refraction after ReLExflex.

[Update on corneal dystrophies: new insights following first publication of the IC3D classification]. / Update Hornhautdystrophien: Neues nach der Erstveröffentlichung der IC3D-Klassifikation.

In this review we summarise the new insights into corneal dystrophies following publication of the IC3D classification in 2008. Topics covered are new mutations, new clinical/histological phenotypes, first descriptions of known mutations in previously not mentioned ethnic groups, new dystrophic entities after modern corneal surgery and potentially new types of conservative therapy.

Visual outcome and histological findings following femtosecond laser-assisted versus microkeratome-assisted DSAEK.

BACKGROUND: The aim of this study was to compare the visual outcome of femtosecond laser-assisted Descemet stripping automated endothelial keratoplasty (DSAEK) to microkeratome-assisted DSAEK as well as to contrast precut versus surgeon-cut grafts. Histologic characterization of failed DSAEK grafts was performed in order to correlate ultrastructural changes with graft failures. METHODS: In this case control study, 47 cases of DSAEK were investigated in terms of visual acuity, keratometric astigmatism, spherical equivalent, endothelial cell count, and postoperative complications. We formed three groups: the femtosecondlaser-assisted DSAEK with precut grafts, the microkeratome-assisted DSAEK with precut and with surgeon-cut grafts. Mean follow-up was 6 months. In the case of graft failure, penetrating keratoplasty was performed, and the excised corneal buttons were investigated by light and electron microscopy. RESULTS: Microkeratome-assisted DSAEK lead to better visual outcome than femtosecond laser-assisted DSAEK. Keratometric astigmatism, spherical equivalent and endothelial cell count did not differ significantly between both methods. Precut and surgeon-cut grafts in microkeratome-assisted DSAEK did not show any significant difference regarding all upraised parameters. No definite histological correlate for graft failure following femtosecond laser-assisted DSAEK was found. CONCLUSIONS: Femtosecond laser-assisted DSAEK is not the method of choice, and needs further technical improvement. However, failed femtosecondlaser-assisted DSAEK grafts did not show significant histological changes related to the technique to explain reduced visual acuity. In microkeratome-assisted DSAEK, the preparation time point of the graft does not seem to influence the visual and optical outcome.