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To report the indications and outcomes of penetrating keratoplasties with a graft diameter 8.5 mm in severe corneal diseases at the Department of Ophthalmology at Saarland University Medical Centre.Retrospective (6 years), descriptive, and observational.Thirty-five large-diameter penetrating keratoplasties (LDPKPs) in 27 patients (mean age, 62 ± 22 years) were performed from March 2010 to December 2016. The indication for surgery, number of previous corneal transplantations, best-corrected visual acuity (BCVA) before surgery, intraocular pressure, graft status, and BCVA at last follow-up were recorded.Infectious keratitis represented 83% of the indications (of those, 45% fungal). The mean corneal graft diameter was 10.8 ± 1.7 (min 8.75, max 15.0) mm. Twenty-three eyes (65% absolute) had at least one previous penetrating keratoplasty (mean graft size, 9.2 ± 1.6 mm). The mean pre-surgery BCVA was 1.96 ± 0.23 logMAR. With a mean follow-up period of 20.2 ± 13.4 months, the mean BCVA was 1.57 ± 0.57 logMAR at last follow-up. Overall, 12 grafts (35%) remained clear until the last follow-up, and in 23 grafts (65%), the primary disease recurred, or corneal decompensation developed. Up to the last follow-up, 6 eyes (17%) had to be enucleated.In complex cases of infectious keratitis requiring a LDPKP to remove the complete pathology and preserve eye integrity, the visual outcomes are generally expected to be poor, not only because of the well-known risks of LDPKP but also because of the consequences of the infectious disease itself. This knowledge is important for adequate counselling of the patient preoperatively.ZIEL: Bericht über Indikationen und Ergebnisse von perforierenden Keratoplastiken mit Transplantatdurchmesser 8,5 mm bei schweren Hornhauterkrankungen an der Klinik für Augenheilkunde des Universitätsklinikums des Saarlandes.Retrospektive (6 Jahre) und deskriptive Beobachtungsstudie.Von März 2010 bis Dezember 2016 wurden 35 „Large-Diameter perforierende Keratoplastiken“ (LDPKPs) bei 27 Patienten (mittleres Alter 62 ± 22 Jahre) durchgeführt. Erfasst wurden die Indikation zur Operation, die Anzahl der vorausgegangenen Hornhauttransplantationen, der bestkorrigierte Visus (BCVA) vor der Operation, der Augeninnendruck, der Transplantatstatus und der BCVA beim letzten Follow-up.Die infektiöse Keratitis machte 83% der Indikationen aus (davon 45% Pilzkeratitis). Der mittlere Durchmesser des Hornhauttransplantats betrug 10,8 ± 1,7 mm (mind. 8,75, max. 15,0 mm). 21 Augen (65% absolut) hatten mindestens eine vorangegangene perforierende Keratoplastik (mittlere Transplantatgröße 9,2 ± 1,6 mm). Der mittlere BCVA vor der Operation betrug 1,96 ± 0,23 logMAR. Bei einer mittleren Nachbeobachtungszeit von 20,2 ± 13,4 Monaten betrug der mittlere BCVA beim letzten Follow-up 1,57 ± 0,57 logMAR. Insgesamt blieben 12 Transplantate (35%) bis zur letzten Nachuntersuchung klar und bei 23 Transplantaten (65%) trat die primäre Erkrankung erneut auf oder es entwickelte sich eine Hornhautdekompensation. Bis zum Ende des Beobachtungszeitraums mussten 6 Augen (17%) enukleiert werden.Bei komplexen Fällen von infektiöser Keratitis, die eine LDPKP erfordern, um die gesamte Pathologie zu entfernen und die Integrität des Auges zu erhalten, sind die zu erwartenden Visusergebnisse im Allgemeinen eher ungünstig, nicht nur wegen der bekannten Risiken der LDPKP, sondern auch wegen der Folgen der Infektionskrankheit selbst. Dieses Wissen ist wichtig für eine adäquate Beratung und Aufklärung der Patienten präoperativ.

In keratoconus (KC), an increase of the corneal back surface area may result in endothelial cell density (ECD) decrease and an increase of the corneal front surface area in ocular surface temperature (OST) decrease due to increased heat dissipation. Along with these hypotheses, we aimed to analyse the correlation between ECD and central corneal OST in patients with KC and healthy controls.A total of 154 eyes with KC (mean age 36.1 ± 12.5 years) and 92 healthy eyes (mean age 36.4 ± 12.8 years) were examined. Corneal front and back surface area at the central 5 mm corneal diameter (FSA and BSA) were calculated based on Pentacam measurement data:FSA or BSA = 2×3.14×R(R-√RECD was significantly lower in KC (2498 ± 356/mmEndothelial cell density seems to have a mild impact on central ocular surface temperature in keratoconus and normal subjects. This effect is not correlated to the corneal front or back surface area.

PURPOSE To report the indications and outcomes of 8.5/8.6-mm excimer laser-assisted penetrating keratoplasties (PKPs) at a tertiary corneal subspecialty referral center. METHODS This retrospective, descriptive, observational study included 107 PKPs performed in 96 patients (mean age, 53 ± 12 years). The patients' indications for surgery, best-corrected visual acuity, surface regularity index, surface asymmetry index, topographic astigmatism, central endothelial cell density, central corneal thickness, and graft status were recorded preoperatively, 6 weeks postoperatively, and before (12 ± 2 months) and after (19 ± 4 months) the suture removal. RESULTS The surgeries included 48 primary PKPs and 59 repeat PKPs. The main indications were corneal ectatic disorders (50%), severe corneal keratitis (21%), and corneal scars (16%) in the primary PKP group and highly irregular astigmatism after PKP (51%) and previous graft decompensation (37%) in the repeat PKP group. From preoperative measurements to the last follow-up visit without sutures, we found significant improvements (P < 0.001 for all) in visual acuity (0.7 ± 0.3 LogMAR to 0.3 ± 0.2 LogMAR), surface regularity index (1.5-1.0), and surface asymmetry index (2.59-1.1). At the last follow-up, the mean outcome measurements did not significantly differ between the primary and repeat PKP groups. Overall, 89 grafts (83%) remained clear at the last follow-up. CONCLUSIONS In cases of ectatic disorders and highly irregular astigmatism after keratoplasty, 8.5/8.6-mm excimer laser-assisted PKP seems to be an excellent treatment option, achieving a significant improvement in visual acuity.

Purpose: To summarize actual literature data on clinical signs, differential diagnosis, and treatment of acanthamoeba keratitis. Methods: Review of literature. Results: Clinical signs of acanthamoeba keratitis are in early stages grey-dirty epithelium, pseudodendritiformic epitheliopathy, perineuritis, multifocal stromal infiltrates, ring infiltrate and in later stages scleritis, iris atrophy, anterior synechiae, secondary glaucoma, mature cataract, and chorioretinitis. As conservative treatment, we use up to one year triple-topical therapy (polyhexamethylene-biguanide, propamidine-isethionate, neomycin). In therapy resistant cases, surgical treatment options such as corneal cryotherapy, amniotic membrane transplantation, riboflavin-UVA cross-linking, and penetrating keratoplasty are applied. Conclusion: With early diagnosis and conservative or surgical treatment, acanthamoeba keratitis heals in most cases. Keywords: Acanthamoeba, Keratitis, Cornea, Contact lens

Background The purpose of this report was to describe a single case of recurrent interstitial keratitis in a young patient leading to keratoconus-like corneal changes. Results Over the 2 years follow-up, the patient developed clinical signs of keratoconus with Vogt’s striae, Fleischer Ring and paracentral stromal thinning in the affected eye only. The tomographic measurements revealed a rapid reduction of corneal thickness from 581 to 303 μm and an irregular steepening of the pathological cornea. True net corneal power increased from 42.8 to 48.8 dioptres (D) and maximal power of the anterior surface from 44.9 to 66.9 D. Best-corrected visual acuity (BCVA) decreased from 20/20 to 20/200. A penetrating excimer laser keratoplasty was performed to restore vision and corneal stability. Conclusion Keratoconus-like changes can occur in young patients with recurrent interstitial keratitis and request corneal transplantation.