[Morphologic Corneal Changes after Crosslinking for Keratoconus]. / Morphologische Hornhautveränderungen nach Crosslinking bei Keratokonus.

Keratoconus is a relatively common (1 : 2000) bilateral disease leading to a change in biochemical and biomechanical corneal structure as well as thinning and ectasia. For more than 10 years, crosslinking has been a therapeutic option in cases of progression. Using riboflavin and UVA-radiation, the anterior corneal stroma (300 µm) gets stiffened by crosslinking of collagen fibers. When protocols and limitations are adhered, the procedure is described to be effective and of low-risk. This review gives an overview about physiologic and pathologic changes in keratoconic corneas before and after crosslinking. Based on histopathologic examination, the current knowledge in published literature is reviewed and is complemented by our own investigations.

[Blepharitis - When to Perform Surgery?]. / Blepharitis - wann greifen wir zum Skalpell?

AIM: Meibomian gland dysfunction/blepharitis is usually a harmless inflammatory process of the lid margin. However, it can be the first sign of a malignant lesion. Patients/Results: Clinical and histological findings are illustrated for 8 patients with changes in the lid margin and with the differential diagnosis of blepharitis. CONCLUSION: Tumours of the lid margin can mimic blepharitis or induce meibomian gland dysfunction. Conversely, blepharitis can present in a nodular form, which is highly indicative of a neoplasm. In these cases, surgical excision with ophthalmopathological evaluation of the tissue is mandatory, in order to reach the correct diagnosis and to treat the patient appropriately.

[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.

[Routine investigation of foetal eyes--in what way and what for?]. / Routineuntersuchung fetaler Augen--wie und warum?

The investigation of foetal eyes not only allows for the observation of ocular development. It is supportive and sometimes even mandatory for the diagnosis of systemic and ocular syndromes. This review gives an overview about the investigation of foetal eyes, their assignment to developmental stages, challenges related to the investigation of foetal eyes, clinically relevant syndromes, and academic questions. The morphological development of the eye has been investigated since the 19th century and will not be covered in this article. The investigation of foetal eyes that have been collected during the routine paediatric autopsy, is complicated by artifacts. Artifacts are the result of autolysis, fixation, and mechanical manipulation. They have to be distinguished from genuine findings. Besides the search for findings such as coloboma or cataract, the morphological classification of the foetal eye is of importance. The anterior-posterior diameter allows for the diagnosis of microphthalmia. The case reports comprise Goldenhar's syndrome, MIDAS syndrome and others. In conclusion, the investigation of foetal eyes is often helpful and critical for paediatric diagnostics and should be performed with great care.

Learning from Alfred Wegener's pioneering field observations in West Greenland after a century of climate change.

The cryosphere in Greenland is currently undergoing strong changes. While remote sensing improves our understanding of spatial and temporal changes across scales, particularly our knowledge of conditions during the pre-satellite era is fragmented. Therefore, high-quality field data from that period can be particularly valuable to better understand changes of the cryosphere in Greenland at climate time scales. At Graz University, the last work-place of Alfred Wegener we have access to the extensive expedition results from their epic 1929-1931 expedition to Greenland. The expedition coincides with the warmest phase of the Arctic early twentieth century warm period. We present an overview of the main findings of the Wegener expedition archive and set it into context with further monitoring activities that occurred since, as well as the results from reanalysis products and satellite imagery. We find that firn temperatures have increased significantly, while snow and firn densities and have remained similar or decreased since. Local conditions at the Qaamarujup Sermia have changed strongly, with a reduction in length of more than 2 km, in thickness by up to 120 m and a rise in terminus position of approximately 300 m. The elevation of the snow line of the years 1929 and 1930 was similar to the one from the extreme years 2012 and 2019. Compared to the satellite era, we find that during the time of the Wegener expedition fjord ice extent was smaller in early spring and larger in late spring. We demonstrate that a well-documented snapshot of archival data can provide a local and regional context for contemporary climate change and that it can serve as the basis for process-based studies on the atmospheric drivers of glacier changes.

[Clinico-pathological correlations: posterior compartment of the eye and orbit]. / Klinisch-pathologische Korrelationen: Befunde des hinteren Augenabschnitts und der Orbita.

Diseases of the posterior compartment and the orbit are characterised by histological findings, most of which can be reproduced clinically. Examples are the examination of calcifications in retinoblastoma by ultrasonography. In the present review, histological findings of tumour and other diseases of the posterior ocular compartment and the orbit are presented and correlated with the clinical pictures and imaging techniques: uveal melanoma, choroidal nevus, choroidal metastases, choroidal hemangioma, retinoblastoma, Coat's disease, sympathetic ophthalmia, pleomorphic adenoma (benign mixed tumour) of the lacrimal gland, dacryoadenitis, lymphoma, rhabdomyosarcoma, Langerhans cell histiocytosis, orbital metastases, and phthisical eyes. Histopathology is usually the gold standard for a definitive diagnosis. It is very important for residents and those in training to become familiar with clinico-pathological correlations as these provide insight in pathophysiological processes. Regarding ophthalmic surgery, ophthalmic pathology offers the possibility to study wound healing and complications. A close collaboration between clinicians and ocular pathologists allows for an optimised processing of the submitted tissue and diagnosis. Thus, pre- and postoperative care can also be improved. This outstanding knowledge that ophthalmologists have gained over the last decades and beyond, should be preserved and passed on to the next generations in order to maintain a high standard in ophthalmological care.

[Deficits of routine occupational therapy services in rheumatic diseases: results of the RheumaDat study]. / Defizite der ergotherapeutischen Routineversorgung bei rheumatischen Erkrankungen: Ergebnisse einer Auswertung der RheumaDat-Panel-Befragung.

The purpose of the present study is to describe the frequency and potential determinants of occupational therapy routine services in patients with rheumatic diseases. The study is based on a secondary analysis of the RheumaDat database. The results of the survey on 907 patients were analyzed regarding frequency of occupational therapy routine services and related sociodemographic and disease-specific variables. Approximately 8% of the study population received occupational therapy, patients with rheumatoid arthritis representing the largest proportion of these at 13%. Only patients with osteoarthritis showed a clear treatment pattern. Patients from this group receiving occupational therapy were older, had a longer duration of disease and were more affected. No clear appraisal of the therapy status in the rheumatoid arthritis or fibromyalgia group could be made. The results indicate shortages and the lack of a clear system in occupational therapy routine services in patients with different rheumatic diseases.

[The situation of ophthalmic pathology in Germany: the current status]. / Zur Situation der Ophthalmopathologie in Deutschland: eine aktuelle Bestandsaufnahme.

BACKGROUND: Ophthalmic pathology with its 150 year-old tradition is a subspecialty which since its beginning has contributed substantially to progress in ophthalmology. Nevertheless, deactivation or even termination of ophthalmopathological laboratories has occurred in the past years mainly due to economic pressure. In order to evaluate the situation and future perspectives of the existing, active laboratories in Germany and to ask for the kind of support desired from the Section for Ophthalmic Pathology of the German Ophthalmological Society (DOG) a survey was carried out using a questionnaire. RESULTS: The main results were as follows. 1. Specialised ophthalmic pathology is performed in Germany almost exclusively in laboratories integrated in university eye clinics. 2. There is close cooperation with institutes for pathology and dermatopathology. 3. The main focus is placed on the cornea, tumours of the eye and its adnexae, and the conjunctiva. 4. The number of ophthalmopathological specimens investigated per year is generally below 1000 and often below 500. 5. The diagnostic spectrum and equipment of the laboratories is generally good. 6. There are some deficits concerning ophthalmopathological education and the status of ophthalmic pathology within the clinics. 7. A considerable number of scientific publications is generated by the members of the laboratories. 8. At present there is only minimal fear that the own laboratory will be eliminated in the near future. 9. Ophthalmic pathology is established as an integral component of ophthalmology in patient care and, even more, in ophthalmic research. 10. The DOG-Section "Ophthalmic pathology" is requested to initiate stays in foreign laboratories, to initiate scientific multicentre studies, and to support activities dedicated to preserve the ophthalmopathological laboratories. DISCUSSION: For the first time valid data concerning the situation of ophthalmopathological laboratories in Germany have been collected. The information gathered can and should be used as an argument for the preservation and, if possible, even expansion of the occupation with normal and pathologic eye morphology at eye hospitals in and beyond Germany.

[Pilomatrixoma of the ocular adnexae: clinical and histologic analysis (13 cases)]. / Pilomatrixom der okulären Adnexe: Klinische und histologische Aufarbeitung von 13 Fällen.

BACKGROUND: Pilomatrixoma (calcifying epithelioma of Malherbe) is a rare benign tumour originating from the matrix of the hair root. In this study, we evaluated the clinical and histopathological characteristics of all the respective tumour specimens submitted to our laboratory since 1997. PATIENTS/MATERIALS AND METHODS: We reviewed the clinical and histologic findings of 13 pilomatrixomas localised to the ocular adnexae. Paraffin sections were stained with H&E and PAS and, in addition, immunohistochemistry was performed using markers for macrophages (CD68), for proliferative activity (Ki67), and for proliferation/apoptosis (CAS/CSE1L). RESULTS: All 13 pilomatrixomas were of reddish-livid colour and localised on the upper eyelid and/or near the eyebrow. The patients ages ranged from 4 to 84 years without preference for either gender. In 3 cases the correct diagnosis was made intraoperatively, while no pilomatrixoma was diagnosed prior to surgery. The most frequent false diagnoses were retention cyst (n = 3), atheroma (n = 2), and abscess (n = 2). There was no tumour recurrence in any of the cases within the time period presented. All 13 pilomatrixomas demonstrated the characteristic histology with areas of basophilic islands, shadow cells, calcification and a chronic granulomatous inflammation with foreign body giant cells in varying amounts. Immunhistochemical staining with anti-Ki67 and anti-CAS/CSE1L indicated a regular cellular maturation of the basophilic cells. No correlation was found between any of the histological or immunohistochemical markers and clinical parameters such as size, age and gender of the patient and duration of tumour presence prior to surgery. CONCLUSIONS: This case series represents one of the largest published so far, and underscores that pilomatrixoma can appear at any age. While it is usually not recognised clinically, it should be considered in the differential diagnosis especially for tumours of the upper eyelid. Our immunohistochemical findings support the basically benign nature of a pilomatrixoma but also point to the chronic inflammatory stimulus that can lead to complications after incomplete removal.

Lack of augmentation of tumor spectrum or severity in dual heterozygous Men1 and Rb1 knockout mice.

To identify possible genetic interactions between the mechanisms of tumor suppression of menin and pRb, we intercrossed mice with targeted deletions of Men1 and Rb1, and compared tumor development in cohorts of animals carrying single or dual mutations of these tumor-suppressor genes. In mice lacking one copy of Men1, pancreatic islet and anterior pituitary adenomas are common. In animals lacking one copy of Rb1, intermediate pituitary and thyroid tumors occur at high frequency, with less frequent development of pancreatic islet hyperplasia and parathyroid lesions. In mice heterozygous for both Men1 and Rb1, pancreatic hyperplasia and tumors of the intermediate pituitary and thyroid occurred at high frequency. Serum measurements of calcium and glucose did not vary significantly between genotypic groups. Loss of heterozygosity at the Rb1 locus was common in pituitary and thyroid tumors, whereas loss of menin was observed in pancreatic and parathyroid lesions. The tumor spectrum in the double heterozygotes was a combination of pathologies seen in each of the individual heterozygotes, without decrease in age of onset, indicating independent, non-additive effects of the two mutations. Together with the lack of increased tumor spectrum, this suggests that menin and pRb function in a common pathway of tumor suppression.

[Malignant melanoma of the conjunctiva]. / Malignes Melanom der Bindehaut.

BACKGROUND: Malignant melanoma of the conjunctiva is a rare tumour. Early disease stages may be difficult to distinguish from benign lesions such as pigmented nevi or primary acquired melanosis. We describe the therapeutic procedure and histological findings in two patients and review the epidemiology and pathogenesis of malignant conjunctival melanoma. Two female patients (84 and 85 years old, respectively) presented with a pigmented tumor close to the limbus with surrounding conjunctival pigmentation and involvement of the cornea. RESULTS: Following complete excision of the tumour, conjunctival malignant melanoma arising from primary acquired melanosis was diagnosed histologically. Subsequent treatment with mitomycin C eye drops was initiated. There was no recurrence of the tumor within the follow-up period (24 and 6 months). DISCUSSION: Patients with primary acquired melanosis need to be reviewed on a regular basis to detect malignant transformation at an early stage.

[Collision tumor]. / Kollisionstumor.

A 65-year-old woman presented with a painless, partially pigmented and partially hyperkeratotic tumorous lesion on the lower eye lid. Histopathologic findings of the wedge resection showed a collision tumor of a highly differentiated squamous cell carcinoma and a fibrosing basal cell carcinoma. Collision tumors involving these two components are rare, particularly in the periocular region.

[Rare presentation of a scleral nevus with progression in size]. / Seltene Präsentation eines skleralen Nävus mit Größenprogredienz.

A 52-year-old male caucasian patient presented with a limbal subconjunctival pigmentation of unknown origin with progressive enlargement over the past years. Differential diagnoses included a malignant melanocytic lesion; therefore, an excisional biopsy was performed. Prior investigations showed no ciliary body or anterior chamber angle involvement. Histological and immunohistochemical analysis revealed the rare diagnosis of a scleral nevus. The clinical, histological and immunohistochemical findings as well as the relevant differential diagnoses are discussed.

[Comprehensibility of online-based patient education material in ophthalmology]. / Die Lesbarkeit von onlinebasierten Patienteninformationen in der Augenheilkunde.

BACKGROUND: Investigations have shown that the internet as a source of information in medical issues is increasing in importance. For most patients information delivered or supported by hospitals and universities is considered to be the most reliable, however, the comprehensibility of available information is often considered to be wanting. Comprehensibility scores are formulae allowing a quantitative value for the readability of a document to be calculated. OBJECTIVE: The purpose of this study was to assess data by analyzing the comprehensibility of medical information published on the websites of departments for ophthalmology of German university hospitals. We investigated and analyzed medical information dealing with three eye diseases with potentially severe irreversible damage. METHODS: The websites of 32 departments for ophthalmology of German university hospitals were investigated. Information regarding cataracts, glaucoma and retinal detachment (amotio retinae) were identified and analyzed. All information was systematically analyzed regarding comprehensibility by using the analysis program Text-Lab ( http://www.text-lab.de ) by calculation of five readability scores: the Hohenheim comprehensibility index (HVI), the Amstad index, the simple measure of gobbledygook (G-SMOG) index, the Vienna non-fictional text formula (W-STX) and the readability index (LIX). RESULTS: In 59 cases (61.46 %) useful text information from the homepage of the institutions could be detected and analyzed. On average the comprehensibility of the information was identified as being poor (HVI 7.91 ± 3.94, Amstad index 35.45 ± 11.85, Vienna formula 11.19 ± 1.93, G­SMOG 9.77 ± 1.42 and the LIX 54.53 ± 6.67). CONCLUSION: In most of the cases patient information material was written far above the literacy level of the average population. It must be assumed that the presented information is difficult to read for the majority of the patients. A critical evaluation of accessible information material seems to be desirable and available texts should be amended.

[Neovascular glaucoma: aetiology, pathogenesis and treatment]. / Neovaskularisationsglaukom: Atiologie, Pathogenese und Therapie.

Neovascular glaucoma, as a typical secondary glaucoma, is due to ocular or (earlier) systemic diseases. The formation of a fibrovascular membrane on the anterior surface of the iris (rubeosis iridis) and extending into the chamber angle leads to irreversible obliteration of the outflow system, with a corresponding rise in intraocular pressure. The most frequent cause is retinal ischaemia resulting either from vascular occlusion or from diabetic alterations. The differential diagnosis must include acute angle-closure glaucoma and uncontrolled open-angle glaucoma. Treatment is aimed at eliminating the actual cause or at least reducing the risk factors (e.g. by retinal laser coagulation), or consists in cyclodestructive procedures. Medicamentous therapy comprises anti-inflammatory agents (steroids, cycloplegic agents) and substances that reduce the production of aqueous humour (carbonic anhydrase antagonists, beta blockers). In the near future, antiangiogenic medication might be another effective option. For end-stage neovascular glaucoma, the implantation of drainage devices is also discussed.

[Recurrent keratoconjunctivitis]. / Rezidivierende Keratokonjunktivitis.

BACKGROUND: Molluscum contagiosum is a highly infectious viral disease of the skin and mucous membranes. These lesions are found particularly often in children and young adults and are generally self-limiting. Nevertheless, molluscum contagiosum lesions in close vicinity to the eyes should be actively removed if they cause conjunctival or corneal irritation. CASE REPORT: We report the case of a 14-year-old boy who was treated for approximately 9 months for recurrent chronic keratoconjunctivitis with corneal neovascularization. Careful inspection of the eyelids revealed molluscum contagiosum. After removal of the lesions on both sides, short-term anti-inflammatory therapy and long-term surface lubrication, a gradual improvement was observed so that an almost complete visual recovery was achieved. CONCLUSION: In long-standing keratoconjunctivitis refractory to treatment, special attention should be paid to the possible presence of molluscum contagiosum, particularly in children and the lesions should be promptly removed.

[Orbital metastasis of a previously unknown lung carcinoma mimicking posterior ischemic optic neuropathy]. / Orbitale Metastase eines bis dato unbekannten Lungenkarzinoms mit klinischem Aspekt einer posterioren ischämischen Optikusneuropathie.

A 65-year-old patient presented with increasing loss of vision in the right eye. A relative afferent pupillary defect as well as visual field perimetry deficits in an otherwise unremarkable eye led to the presumed diagnosis of ischemia of the optic nerve; however, further imaging revealed an extensive necrotic bronchial carcinoma in the left upper lobe metastasizing to the orbit with compression of the optic nerve. The clinical and histological features are discussed with respect to possible primary origins of orbital metastases.

Immunoreactivity against tau, amyloid precursor protein, and beta-amyloid in the human retina.

PURPOSE: Increased immunoreactivity (IR) of beta-amyloid and the amyloid-associated proteins tau and amyloid precursor protein (APP) in the brain have been linked to the pathogenesis of neurodegenerative disorders such as Alzheimer's disease. However, the expression of these proteins has not been investigated in the normal or diseased human retina. METHODS: Using immunohistochemical techniques, we examined the distribution and age-related changes of anti-tau-1, anti-tau-2, anti-APP, and anti-beta-amyloid IR in the human retina at various ages (n = 24), in retinitis pigmentosa (RP, n = 6), and in age-related macular degeneration (ARMD, n = 10). RESULTS: Tau-1 immunoreactivity was intense in the inner retinal layers and did not change with age or in RP. Eyes with ARMD showed less intense staining but exhibited a similar distribution. Tau-2 IR was faint and did not change with age but was mildly increased in the retinal pigment epithelium (RPE) of eyes with RP and in the retina of eyes with ARMD. APP IR was most prominent in the ganglion cell and nerve fiber layer, and it appeared to increase in ganglion cells of older persons and in RPE cells of eyes with RP and ARMD. Beta-amyloid IR was only detected focally in sub-RPE deposits in eyes from older persons. CONCLUSIONS: The proteins investigated in this study are present in the human retina. The staining pattern of tau is different from the brain, but it shows no age-related changes. The increased immunoreactivity of APP in retinal ganglion cells of older eyes and in RPE cells of eyes with RP and ARMD, as well as the patchy staining of beta-amyloid within sub-RPE deposits, might indicate a relationship of these proteins to retinal aging and possibly to retinal degeneration in RP.