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Chrysovalantis Sourlis,1 Berthold Seitz,1 Mathias Roth,2 Loïc Hamon,1 Loay Daas1 1Department of Ophthalmology, Saarland University Medical Center, UKS, Homburg/Saar, Germany; 2Department of Ophthalmology, Heinrich-Heine University Düsseldorf, Düsseldorf, GermanyCorrespondence: Loïc Hamon, Department of Ophthalmology, Saarland University Medical Center, UKS, Homburg/Saar, Germany, Tel +49-6841-1622387, Fax +49-6841-1622400, Email loic.hamon@uks.euPurpose: The purpose of this study was to assess the impact of early diagnosis using in vivo confocal microscopy and early therapeutic penetrating keratoplasty (TPK) on the outcomes of severe cases of fungal keratitis.Methods: This retrospective single-center study included 38 patients (40 eyes) with fungal keratitis who presented between December 2013 and February 2020. Preoperative, intraoperative, and postoperative parameters were recorded to assess the role of early correct diagnosis and early surgical therapy on visual acuity outcome and enucleation rate during follow-up.Results: The mean patient age was 51 years (71% females). The initial external diagnosis was correct in 20 cases (50%). The mean time from symptom onset until admission to our department was 46.8 ± 68.0 (median 28.5) days. The mean time to correct diagnosis after admission to our department was 1 day with in vivo confocal microscopy (IVCM). IVCM was performed in 38 cases, of which 36 (sensitivity: 94.7%) were positive for fungal infection. Twenty-seven out of 40 (67.5%) eyes received a TPK 4.2 ± 3.9 days after admission, with a mean graft size of 8.9 ± 1.9 mm. Three eyes (7.5%) were enucleated. The corrected distance visual acuity of the entire study population increased from 2.0 ± 1.2 LogMAR to 0.96 ± 1.17 LogMAR.Conclusion: In vivo confocal microscopy is a powerful tool for the early detection of fungal organisms in infectious keratitis. An early TPK with a large graft helps to eradicate the infection timely and results in a favorable visual acuity outcome and lower enucleation rate, especially when treating filamentous fungi.Keywords: fungal keratitis, in vivo confocal microscopy, penetrating keratoplasty

Background With the increasing demand for corneas, eye banks must optimize the tissue donation, collection, and selection process. This retrospective monocentric study analyzed the approval rates for corneal donation and the origin of and reasons for discarding donor corneas from 2010 to 2019. Methods Data included the number of deceased, approval or rejection by the family for corneal donation and contraindications. Corneal grafts were included from all deceased persons who were full-body and multi-organ donors at the Saarland University Medical Center (UKS) and from external institutions. Additional analyzed parameters included endothelial cell count (ECC), blood sample serology for infections, and conjunctival swab testing . Results A total of 1748 corneoscleral buttons were harvested from 10,265 deceased persons (17% with no contraindication) at the UKS between 2010 and 2019, with a consent rate of 23.3%. The number of explants increased from 136 in 2010 (15% of the deceased, total = 925) to 251 in 2019 (21%, total = 1214). Both the general and department-specific data showed similar percentages for corneal donation over the years, with intensive care and palliative units recently providing the most corneas. The increase in the number of corneas processed by the cornea bank over the years (368 in 2010 compared with 857 in 2019) was linked both to a better internal supply in 2010 (262, 71.2% of the total) compared with 2019 (519, 60.6%) and to an external supply by reinforcement of cooperation with external hospitals, including Luxembourg in 2010 (106, 28.8% of the total) compared with 2019 (338, 39.4%). A total of 195 of 377 corneas (52%) were discarded in 2009 compared with 260 out of 715 (36%) in 2019. The main reasons for discarding were low ECC (36% of discarded corneas in 2009; 11% in 2019), positive conjunctival swab (11% in 2009; 13% in 2019), and blood sample serology (6% in 2009 and in 2019). Conclusion Despite an increasing number of donors, the demand for corneas is still rising. Improved cooperation with internal departments and with external clinics has led to an increasing number of explanted corneas. The main reason for discarding corneas was low ECC, followed by a positive conjunctival swab for fungal or bacterial contamination and serology. Increased donation rates and continued improvements in collection and selection processes are necessary to cover the high demand for corneas.

Zusammenfassung Hintergrund und Ziel Intrakorneale Ringsegmente (ICRS) sollen die Progression des Keratokonus (KK) aufhalten. Diese Aussage zur Progression erfordert jedoch Kenntnisse über die Reproduzierbarkeit der angewendeten Messverfahren. Ziel dieser Studie war es, die Reproduzierbarkeit tomographischer Parameter in Augen mit Keratokonus (KK) nach femtosekundenlasergestützter INTACS-Implantation (fs-INTACS) zwischen 2 Hornhauttomographen zu vergleichen. Patienten und Methoden 19 KK-Augen wurden eingeschlossen. 5 Messungen wurden mit dem Scheimpflug-Tomographen Pentacam HR und dem optischen Kohärenztomographen (VA-OCT) Casia 2 durchgeführt. Zielgrößen waren die Reproduzierbarkeit und die Vergleichbarkeit der Messungen von (1) keratometrischem Brechwert der Hornhautvorder- und (2) -rückfläche, (3) maximalem keratometrischem Brechwert, (4) zentraler Hornhautdicke und (5) Hornhautdicke an der dünnsten Stelle zwischen beiden Geräten. Ergebnisse Die mittlere Differenz (Pentacam minus VA-OCT) von (1), (2), (3), (4) und (5) lag bei 0,67 dpt, 0,41 dpt, 3,4 dpt, 1,5 µm und 11,8 µm. Die mittlere SD der 5 Wiederholungen für (1), (2), (3), (4) und (5) lag bei 0,20 dpt/0,20 dpt, 0,10 dpt/0,07 dpt, 0,75 dpt/0,5 dpt, 6,5/2,4 µm (p = 0,007) und 7,3 µm/1,9 µm (p = 0,001) für Pentacam/Casia 2. Cronbach’s α war für alle Geräte und Parameter besser als 0,98. Schlussfolgerung Casia 2 und Pentacam ermöglichen beide eine zuverlässige Beurteilung der Hornhautbrechkraft bei KK nach fs-INTACS-Implantation. Die Reproduzierbarkeit war nur für die Hornhautdickenmessung mit Casia 2 signifikant besser. Pentacam zeigte signifikant höhere Werte für die Brechkraft der Hornhautvorder- und Rückfläche und misst signifikant dicker an der dünnsten Stelle im Vergleich zu Casia 2.

Hintergrund: Im letzten Jahrzehnt ist die Anzahl der Descemet Membrane Endothelial Keratoplasty (DMEK) Prozeduren bei Endotheliopathien in Deutschland sowie weltweit exponentiell angestiegen. Wir berichten über den Herpesnachweis als Ursache eines rezidivierenden DMEK-Versagens. Methoden: Ein[zum vollständigen Text gelangen Sie über die oben angegebene URL], 92. Versammlung des Vereins Rhein-Mainischer Augenärzte

Background Explanted corneae are highly needed for the surgical management of patients with severe corneal diseases. The aim of this study was to determine whether the body donors from the Institute of Anatomy are a suitable source of donor corneae. Methods At the Institute of Anatomy at Saarland University Medical Center in Homburg, corneae are prelevated from body donors who had consented to the removal of tissues for transplantation purposes during their lifetime. Following the report of death, the LIONS Eye Bank is informed and the contraindications of corneal explantation are clarified. Obtaining a blood sample within 24 h postmortem is mandatory. Results The Institute of Anatomy had 150 body donors in the time period from January 2018 to June 2019. Out of these, 68 (45.3%) were reported to the Eye Bank. The age of the donors (median 82 years (range: 57–96)) is not critical since the quality of the corneae depends on the number of endothelial cells (mean: 2109 ± 67 cells/mm2 (range: 511–2944 cells/mm2)). Contraindications were present in 19 (12.6%) cases. The corneae were extracted from 49 (32.7%) body donors. Out of these 98 corneae, 46 (46.9%) were successfully transplanted. Of all non-transplanted corneae, 6 (6.1%) were microbiologically contaminated, 10 (10.2%) had a positive serology, 22 (22.5%) had an endothelial cell count