[Ligneous conjunctivitis]. / Conjunctivitis lignosa.

CASE REPORT: We report the case of a 3-year-old female patient with therapy refractive recurrent conjunctivitis and membrane formation of the upper eyelid. After surgical removal the histological examination showed an image compatible with ligneous conjunctivitis. A manifest serum plasminogen deficiency (22 %) supported the diagnosis. TREATMENT: The treatment with corticosteroids, heparin-containing and fresh frozen plasma (FFP) eye drops, renewed surgical ablation with perioperative intravenous FFP administration and local cyclosporine A eye drops achieved a stable condition with low disease activity. CONCLUSION: The combination of these therapy approaches has been performed here for the first time and has not been described in the literature so far.

[Histological diagnostics of enucleated eyes]. / Histologische Befundung enukleierter Augen.

Enucleated eyeglobes represent a challenge for the pathologist, as their appraisal requires specific ophthalmological knowledge. Part 1 of this CME article dealt with macroscopic findings in eyeglobes, in order to facilitate adequate cutting planes to retrieve pathologies histologically. Part 2 which is presented here teaches basic histology of eye-specific tissues (e.g., cornea, anterior chamber angle, retina, and optic nerve). Theses structures show typical changes in blinded eyes. Knowledge of these changes, together with awareness of fundamental ophthalmic disease entities and surgical strategies (see part 1), will many times allow to deduce the pathophysiology that finally culminated in blindness and enucleation. Disease entities more closely discussed in this article include corneal ulcers, rubeotic secondary glaucomas, and chronic degenerative retinal diseases.

[Histological workup of enucleated eyes]. / Histologische Aufarbeitung enukleierter Augen.

The appraisal of enucleated eyes presents a particular challenge to pathologists. In German-speaking countries, this task has mostly been in the hands of ophthalmologists. It requires particular ophthalmologic knowledge including nosology, implants, surgical procedures, and nomenclature. This CME article teaches the basics needed for pathologic appraisal of enucleated eyes. The first part focusses on the macroscopic evaluation and describes the exterior and interior of the eye. Competent interpretation of the macroscopic findings is crucial to identify adequate cutting planes for histology. Anatomic landmarks on the globe's exterior and common section planes are described. Diseases that typically lead to enucleation will be explained in detail and illustrated with images. In the second part of this article, a histologic description of eye-specific tissue types is provided.

[Optical coherence tomography--high-resolution tissue imaging, but not histology!]. / Optische Kohärenztomografie--hoch aufgelöste Gewebedarstellung, aber keine Histologie!

Optical coherence tomography (OCT) is a non-invasive and fast method for retinal in vivo imaging. It was introduced in 1991 and became commercially available in 1996. With higher resolution spectral domain OCT (SD-OCT), all histological retinal layers can be identified with an axial resolution of 1-5 µm today. Numerous papers have correlated OCT and histological images of physiological retina from different species. Reliable attribution of the reflective bands in OCT images to histological layers has been facilitated even for those layers that are displayed differently in OCT and histology, particularly in the outer retina. In contrast, the correlation of OCT and histology of pathologically altered human retina has only rarely been described due to very limited histological availability. The studies that presented such a correlation on animal material were able to identify some artifacts of histological processing. They also showed that OCT reflectivity changes do not necessarily correlate with cell density in the retina, such that a retinal scar, which is rich in fibres, may appear isoreflective to surrounding healthy retina. This issue, however, has mostly been neglected. Morphometric analyses revealed significantly larger diameters in OCT images compared to histology of photocoagulation lesions. Obviously, OCT reflectivity changes indicate a different tissue condition than altered HE-staining properties in histology. While coarse retinal structure alterations may be located and followed very well with OCT, it is almost impossible to derive from an OCT image the histological change that causes the alteration on a cellular level. This leads to frequent misinterpretations of OCT images. This article aims to pinpoint the pitfalls of OCT interpretation with examples from the current literature, and it encourages the reader to be attentive and critical when interpreting OCT images.

[Histological findings in bilateral asymmetrical vasoproliferative retinal tumor]. / Histologie bei bilateral asymmetrischem vasoproliferativem Tumor der Retina.

We present a case of a bilateral vasoproliferative tumor of the retina in a young man. The first symptom was visual impairment due to vitreous hemorrhage. The right eye showed small tumors which were successfully treated by repeated cryocoagulation, photocoagulation and bevazicumab injection. The tumor in the left eye was larger and eventually led to a painful secondary glaucoma. After enucleation, this tumor was examined histologically and immunohistochemically. The clinical and histological differential diagnoses and therapeutic options are discussed.

[Histological findings in an irradiated choroidal melanoma]. / Histologische Diagnostik eines bestrahlten Aderhautmelanoms.

BACKGROUND: Histological findings of choroidal melanomas after proton beam irradiation have been reported for complicated cases after enucleation. We present specimens of a tumor after transretinal probe excision. PATIENT AND METHODS: One year after irradiation, the biopsy was examined histologically. RESULTS: The specimens showed pigmented, spindle-shaped cells staining positively for Melan-A and HMB-45. Ki-67 showed low proliferation. Caspase-3 staining was normal. CONCLUSIONS: The melanoma still contained vital and even single proliferating cells, but regressed afterwards without additional therapy.

[A new haploscopic test device excludes blinking induced monocular perception]. / Ein neues haploskopisches Testverfahren verhindert monokulare Perzeption durch Blinzeln.

BACKGROUND: Haploscopic tests like the pola-test are used to detect functional loss of vision, aggravation or simulation. They aim at confusing the tested person about the relation of disparate monocular visual perceptions to the right and left eyes. The haploscopic confusion can be overcome easily by single sided blinking. Other investigators have faced this problem by presenting optotypes very briefly, thus excluding blinking artefacts. We introduce a new device for shutting off the optotype projection whenever blinking occurs. MATERIALS AND METHODS: A newly developed mechanism slightly presses small lever-switches onto each upper eyelid of a test person while performing the pola test. The levers move up and down following eyelid movements. Lid closure triggers a shut off of the optotype projector. The device was tested on 30 persons. RESULTS: The device worked properly on 59/60 eyes. 24/30 persons did not realize the haploscopic confusion at the beginning, but 6/30 did right away. 18/30 would not realize the haploscopic confusion even after some experience. CONCLUSIONS: The new device worked on nearly all patients and effectively kept most of them from overcoming the haploscopic confusion. It is a useful upgrading for haploscopic tests, making them applicable even in repeated examinations. It should be helpful to detect single-sided functional loss of vision.

[Solar retinopathy: follow-up examinations with optical coherence tomography (OCT) and microperimetry]. / Retinopathia solaris: Verlaufsbeobachtung mit optischer Kohärenztomografie (OCT) und Mikroperimetrie.

BACKGROUND: Solar retinopathy is a phototoxic damage to the central retina. It may cause visual deterioration and a central scotoma with reading difficulties, that usually fade with time. Morphological and functional changes can be very subtle and are often inadequately detected by standard examinations. PATIENTS AND METHODS: The more affected, left eye of a 41-year-old female patient was examined clinically, by optical coherence tomography (OCT 3) and by MP 1-microperimetry during a 6-month follow up after gazing at a partial eclipse. RESULTS: At all times visual acuity was reduced to 0.7 causing visual deterioration. OCT examinations showed a subfoveal damage of decreasing extent, which was still detectable after 6 months. The retinal affection resulted in a persistent microscotoma of decreasing depth. CONCLUSION: OCT 3 and MP 1-microperimetry are able to detect the morphological and the functional damages in solar retinopathy at a level of sensitivity good enough to produce correlating results which allow the detection of subtle changes during follow-up.