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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.

To assess prevalence, clinical manifestations, required keratoplasties, follow-up, and outcome in patients with Herpes Simplex Virus Keratitis (HSK) attending a University Tertiary Referral Center.Retrospective (12 years), descriptive, observational study.A total of 817 eyes with clinical diagnosis of HSK from 779 patients were classified by the type of presentation. We gathered data on the visual acuity, refraction, IOP, and required surgical procedures.Stromal involvement including scars represented the most common diagnosis in our department and the main indication of penetrating keratoplasty (PKP). Epithelial keratitis (16%) presented with the best visual acuity at the first visit. Necrotizing keratitis represented 17% of the patients, 78% of whom required PKP; this group also had the worst visual acuity at first examination and was the main indication for emergency PKP. Among all eyes, 288 (35%) required PKP. A total of 230 (28%) PKPs were elective procedures and 58 (7%) PKPs were performed as emergency procedures. Two patients with quiet endothelial decompensations after recurrent HSV endotheliitis were treated with DMEK and had good visual outcomes without HSV recurrence at last follow-up.HSK is a prevalent disease with severe consequences when not treated appropriately and on time. Even when making an accurate diagnosis, the disease can be extremely aggressive, with all the implications it brings to the patients and health system. Elective PKP had better outcomes in terms of visual acuity and clear graft percentage compared to emergency PKP.Beurteilung der Prävalenz, der klinischen Manifestationen, der erforderlichen Keratoplastiken, der Nachsorge und der Ergebnisse bei Patienten mit Herpes-simplex-Virus-Keratitis (HSK), die ein tertiäres universitäres Referenzzentrum besuchen.Retrospektive (12 Jahre), deskriptive Beobachtungsstudie.Insgesamt wurden 817 Augen mit der klinischen Diagnose HSK von 779 Patienten nach der Art der Präsentation klassifiziert. Wir sammelten Daten zur Sehschärfe, Refraktion, IOD und den erforderlichen chirurgischen Eingriffen.Die stromale Beteiligung einschließlich Narben stellte die häufigste Diagnose in unserer Abteilung und die Hauptindikation für eine perforierende Keratoplastik (PKP) dar. Patienten mit epithelialer Keratitis (16%) stellten sich beim ersten Besuch mit der besten Sehschärfe vor. Die nekrotisierende Keratitis machte 17% der Patienten aus, von denen 78% eine PKP benötigten; diese Gruppe hatte auch die schlechteste Sehschärfe bei der Erstuntersuchung und war die Hauptindikation für eine PKP à chaud. Von allen Augen benötigten 288 (35%) eine PKP. Insgesamt 230 (28%) PKPs waren elektive Eingriffe und 58 (7%) PKPs wurden à chaud durchgeführt. Zwei Patienten mit ruhigen endothelialen Dekompensationen nach rezidivierender HSV-Endotheliitis wurden mit DMEK behandelt und hatten bei der letzten Nachbeobachtung einen guten Visus ohne HSV-Rezidiv.HSK ist eine weitverbreitete Erkrankung mit schwerwiegenden Folgen, wenn sie nicht angemessen und rechtzeitig behandelt wird. Selbst wenn die richtige Diagnose gestellt wird, kann die Krankheit extrem aggressiv sein, mit all ihren Auswirkungen auf die Patienten und das Gesundheitssystem. Die elektive PKP hatte im Vergleich zur PKP à chaud bessere Ergebnisse in Bezug auf die Sehschärfe und das Transplantatüberleben.

Purpose. Keratoconus (KC) has been defined as a “noninflammatory” corneal disease, but recent studies have noted a potential inflammatory origin. We analysed the Ocular Surface Disease Index (OSDI) and ocular surface temperature (OST) in KC patients compared to controls.Patients and Methods. A total of 179 eyes in 90 patients with KC (topographic keratoconus classification 0-1 to 4, age 36.1 ± 12.5 years, 65.9% males) and 82 eyes in 41 controls (age 36.4 ± 12.8 years, 47.6% males) were examined. The participants completed the OSDI questionnaire and underwent corneal topography, tomography, and thermography. Additional outcome measures were vision- and discomfort-related OSDI subscores and mean OST at the corneal centre during 10 seconds of sustained eye opening after blinking.Results. The OSDI score (31.4 ± 22.4 vs. 17.5 ± 17.9) and vision- (17.7 ± 14.6 vs. 10.5 ± 13.2) and discomfort-related (14.3 ± 10.7 vs. 9.4 ± 10.5) OSDI subscores were significantly higher in KC patients than in controls (p<0.001). We found no significant difference in the central corneal OST (34.2 ± 0.6°C vs. 34.2 ± 0.7°C;p=0.41) between the two groups (p≥0.22). The OSDI score and subscores poorly to fairly correlated with the surface asymmetry index (SAI) and surface regularity index (SRI;r > 0.174,p<0.005), but did not correlate with the central corneal OST (r r ≥ −0.086).Conclusion. KC patients had increased OSDI scores and vision- and discomfort-related OSDI subscores without an increase in the OST compared to a normal population. OSDI score/subscores weakly correlate with SAI and SRI but do not correlate with OST in KC patients or controls. Vision- and discomfort-related symptoms of KC have to be managed in parallel in ophthalmological practice, but the necessity of anti-inflammatory treatment cannot be verified through ocular thermography.

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.

In April, 2007, a 42-year-old woman was admitted to hospital with periorbital swelling, double vision, hyper osmia, and dizziness. Recent history included a gastro intest inal in fection (February, 2007), bilateral ear pain, and a sore throat. Systolic blood pressure was 150 mm Hg, heart rate was 80 beats per min, and temperature was 37∙4°C. Laboratory tests showed a low concentration of thyroidstimulating hormone (0∙04 mU/L, normal value 0∙27–4∙2 mU/L) and raised values of free T3 (12∙1 pmol/L; 3∙1–6∙8 pmol/L) and free T4 (36∙1 pmol/L; 12∙0–22∙0 pmol/L). TSH-receptor antibodies (1∙9 U/L; normal 15 000 U)— suggesting the presence of Miller-Fisher syndrome. Our patient continued treatment with carbimazole and prednisolone; her Miller-Fisher syndrome was managed supportively. 4 months later all her symptoms had disappeared. Carbimazole and prednisolone were gradually reduced and then stopped completely. Miller-Fisher syndrome is a rare variant of the GuillainBarre syndrome and is characterised by combined ophthalmoplegia, ataxia, and hyporefl exia. Antibodies to GQ1b, which are present in 85–90% of patients, are highly sensitive for this syndrome, indicating that peripheral nerve myelin is the target of an immune attack. The binding of anti bodies to oculomotor nerves causes ophthalmoplegia. The diff erential diagnosis encompasses Guillain-Barre syn drome, acute ophthalmoplegia without ataxia, and Bickerstaff ’s brainstem encephalitis, but not other neuropathic disorders. Molecular mimicry may have a signifi cant role in the onset of the Miller-Fisher syndrome, since the GQ1b epitope has been found in lipopoly sac charides of Campylobacter jejuni. Therapeutic regimens for the Miller-Fisher syndrome include treatment with intravenous immuno globulin and plasmapheresis to remove the anti bodies to GQ1b, although the rate of spon tan eous recovery is high. Our patient had a mild form of Graves’ disease—the thickened eye muscles visible on MRI were compatible with the presence of an endocrine ophthalmopathy, but the pattern of limited eye movement was atypical and is better explained by the coinciding presence of Miller-Fisher syndrome.