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Background: If used properly, contact lenses (CLs) provide a safe and effective alternative to eyeglasses for refractive error correction. However, often due to patient noncompliance, CL-related complications may occur, such as discomfort, dry eye, as well as serious conditions like infectious keratitis. Our study aimed to assess the perceived knowledge and behavior of CL wearers in Switzerland regarding the handling of CLs and associated ocular health risks., Methods: This investigator-initiated, cross-sectional, qualitative, multicenter study was conducted in Switzerland from August 2023 to August 2024. After verbal consent, CL wearers were interviewed using a structured survey. The questionnaire explored participants' demographics, their perceived knowledge of the overall handling of CLs and associated health risks, as well as their behavior in two emergency scenarios involving monocular redness or pain. The descriptive statistical analysis was performed using Microsoft Excel (Microsoft Corp., Redmond, WA, USA). Figures were created with Prism version 10.2.3 (GraphPad Software, San Francisco, CA, USA)., Results: A total of 172 participants with a median (IQR [range]) age of 39 (27 to 54 [10 to 82]) years were interviewed, whereby 81 (47.1%) were female. Myopia (61.0%) and keratoconus (30.2%) were the most reported indications for CL use. In terms of overall CL handling, 91.3% of participants felt well or sufficiently informed, whereas this was the case of 66.3% regarding CL-related health risks. In the scenario involving eye redness during CL use, 135 of 175 (77.1%) responses did not mention seeking professional advice, while 25 (14.3%) indicated visiting an ophthalmologist within 1 day of symptom onset. In the event of monocular pain, 67 of 179 (37.4%) responses did not consider seeking professional care, whereas 86 (48.0%) included consulting an ophthalmologist., Conclusion: This study provides insight into the unmet educational need of CL wearers, especially regarding CL-related complications. Participants generally felt better informed about overall CL handling than about the potential health risks. This information discrepancy is reflected by their responses to scenarios involving monocular redness or pain, where a considerable number of participants failed to react adequately. Further studies are warranted to explore effective, practical strategies for improving patient awareness and behavior., Competing Interests: The authors declare that they have no conflict of interest., (Thieme. All rights reserved.)

Purpose: For specific samples, there are different methods and requirements for testing sterility. Blood and blood products are analyzed using automated blood culture methods, while pharmacopeial sterility is assessed using membrane filtration or direct inoculation according to the European Pharmacopoeia (Ph. Eur. 2.6.1.) to detect microbial growth. As autologous serum eye drops (ASEDs) may be viewed as both a blood product and a classical drug, the Swiss legislator has classified these as non-standardizable drugs, and thus, the pharmacopeial requirements apply. This study investigates ASED preparations with respect to the performance of a common automated blood culture system, BD BACTEC, in detecting aerobic and anaerobic bacteria and fungi in ASED preparations, with pharmacopeial sterility testing using agar plate cultures., Methods: Based on the European Pharmacopoeia, we inoculated sterile filtered blood serum with BioBalls of the six reference strains at a low concentration of three colony-forming units per milliliter (CFU/mL). A test battery of three different BD BACTEC culture media (hereafter referred to as Trio-BACTEC : BD BACTEC Plus Aerobic/F-Medium, BD BACTEC Lytic/10 Anaerobic/F-Medium, BD BACTEC Mycosis IC/F-Medium) and three agar plates [Tryptic Soy Agar (TSA), Chocolate Blood Agar, Sabouraud's Dextrose Agar] were inoculated per strain. We incubated the Trio- BACTEC in the BD BACTEC Blood Culture System at 35 °C for 5 days, the TSA and Chocolate plates at 35 °C for 5 days, and the Sabouraud plates at 25 °C for 7 days. We confirmed positive growth signals by microscopy or MALDI-ToF mass spectrometry and included negative controls., Results: We detected all reference strains using BACTEC and agar plates. No growth was observed in the negative controls. Overall, growth detection by BACTEC and agar plates was comparable, except for Aspergillus brasiliensis and Candida albicans , which was detected after 1 day on solid media and after 2 days on BACTEC., Conclusion: This study demonstrates the comparability of sensitivity and detection speed using the automated blood culture method and agar plates for sterility validation of ASED, even at low bacterial and fungal contamination levels., Competing Interests: The authors declare that they have no conflict of interest., (Thieme. All rights reserved.)

Purpose: To establish a national consensus on assessing visual function for fitness to drive in Switzerland., Methods: The minimum medical requirements for visual function for fitness to drive are regulated by Swiss Federal Law, namely, by the Traffic Licensing Ordinance (TLO). The medical examination techniques relevant in this context and their assessment are not further specified therein, which leads to legal inequality among drivers and uncertainty among examiners. We established a study group of representatives of the Traffic Medicine Section of the Swiss Society of Forensic Medicine and the Traffic Commission of the Swiss Society of Ophthalmology to develop a national consensus on assessing visual function for fitness to drive in Switzerland. In structured meetings, the authors discussed medical examination techniques and available international and local recommendations on this topic, with respect to Swiss legislation. In the event of a contrary opinion, the topic was discussed again in a follow-up session until we reached an agreement. We defined consensus as complete agreement on the subject under discussion., Results: The study group held five in-person meetings between March 2019 and January 2023. The authors developed recommendations intended for all professional groups assessing driving fitness. We prepared an aid for daily practice on how to examine the minimum medical requirements for visual function listed in the TLO Annex 1, using standardized test procedures and considered how to interpret the findings obtained, accounting for aspects of traffic medicine and ophthalmology., Conclusions: A consensus on the assessment of visual function for fitness to drive in Switzerland is crucial to ensure legal equality for drivers and legal certainty for examiners. Regular review of the consensus is imperative if we are to consider future legal developments and new scientific evidence in assessing fitness to drive., Competing Interests: The authors declare that they have no conflict of interest., (The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).)

Competing Interests: Declaration of interests We declare no competing interests.

Importance: Randomized clinical trials are conducted to establish both drug safety and efficacy. However, evidence of adverse events associated with these drugs in the clinical practice setting can be of value at generating hypotheses regarding less common safety issues, even if causality cannot be determined., Objective: To present and analyze cases of intraocular inflammation associated with faricimab therapy in patients referred to a single European institution., Design, Setting, and Participants: This was a review starting in April of 2024 of an observational case series. Patients were from a single academic-based tertiary referral center in Switzerland. Included in the analysis were patients referred for intraocular inflammation soon after receiving a faricimab intravitreal injection between June 1, 2022, and March 5, 2024., Exposure: Faricimab, 6 mg (0.05 mL of a 120-mg/mL solution), administrated for neovascular age-related macular degeneration or diabetic macular edema., Main Outcomes and Measures: The systemic and ocular histories and imaging data available were reviewed. The following were evaluated: visual acuity measured with habitual correction using the Early Treatment of Diabetic Retinopathy Study charts before and after the event; intraocular pressure; patient symptoms; anterior, intermediate, or posterior location of the intraocular inflammation; and the presence of retinal vasculitis. Multimodal imaging including color fundus photographs, fluorescein angiograms, indocyanine green angiograms, and optical coherence tomography were reviewed., Results: A total of 12 eyes from 7 patients (mean [SD] age, 73.3 [16.7] years; 4 female [57.1%]) over 22 months were identified as having noninfectious intraocular inflammation after intravitreal faricimab injections. Among these cases, in 2 eyes, retinal vasculitis was present together with anterior and posterior inflammation. One of the 2 eyes had an occlusive form of vasculitis of the arteries and veins, leading to subsequent macular capillary nonperfusion and clinically relevant irreversible vision deterioration from 20/80 to 20/2000. The remaining eyes were characterized by moderate anterior segment inflammation without substantial vision changes. The intraocular inflammation event occurred after a median (IQR) of 3.5 (2.0-4.3) faricimab injections. The median (IQR) interval between the last faricimab injection and the diagnosis of inflammation was 28 (24-38) days. Increased intraocular pressure of 30 mm Hg or higher was found in 3 eyes., Conclusions and Relevance: This case series highlights the occurrence of rare, but potentially severe, intraocular inflammation associated with faricimab therapy. Although these findings do not prove causality and can only generate hypotheses for future investigations, these results suggest the importance of continuous surveillance and monitoring for patients undergoing faricimab therapy to promptly identify and manage potential adverse events.

This study analyzes the dynamics of short-term treatment response to the first intravitreal faricimab injection in eyes with diabetic macular edema (DME). This retrospective, single-center, clinical trial was conducted at the Department of Ophthalmology, University Hospital Zurich. Patients with treatment-naïve and pretreated DME were included. Patient chart data and imaging were analyzed. Safety and efficacy (corrected visual acuity (CVA), central subfield thickness (CST), and signs of intraocular inflammation (IOI)) of the first faricimab intravitreal therapy (IVT) were evaluated weekly until 4 weeks after injection. Forty-three eyes (81% pretreated) of 31 patients were included. Four weeks after the first faricimab IVT, CVA remained stable and median CST (µm) decreased significantly ( p < 0.001) from 325.0 (293.5-399.0) at baseline to 304.0 (286.5-358.0). CVA at week 4 was only associated with baseline CVA ( p < 0.001). CST was the only predictive variable ( p = 0.002) between baseline and week 4 CST. Weekly safety assessments did not show any sign of clinically significant IOI. This study suggests faricimab is an effective treatment for (pretreated) DME, showing structural benefit 1 month following the first injection without short-term safety signals.

Fungal keratitis is a rare yet severe infection of the cornea. Fungal species distribution depends on the climate and socioeconomic status and can show regional variation. This retrospective single-center study was conducted at a tertiary eye care center and the collaborating Institute of Medical Microbiology in Switzerland. On investigating all fungal-positive corneal scrapings and contact lens assessments of patients with keratitis from January 2012 to December 2023, 206 patients were identified, of which 113 (54.9%) were female. The median age was 38 (IQR 29.8, [18-93]), and 154 (74.8%) applied contact lenses. The most commonly found pathogen was Candida spp., followed by Fusarium spp. Molds were 1.8 times more common than yeasts. Linear regression showed no significant increase or decrease in the infection rate over time ( p = 0.5). In addition, 10 patients (4.9%) were found to have coinfections with Acanthamoeba , 11 (5.3%) with HSV-1, none with HSV-2, and 4 (1.9%) with VZV. This study provides a long-term overview of fungal-positive corneal scrapings and contact lens specimens of patients with fungal keratitis. Based on our results, coinfections with Acanthamoeba , HSV, and VZV are frequent, especially in patients wearing contact lenses. Thus, wearing contact lenses may facilitate coinfection in fungal keratitis.

Ophthalmologists' diagnostic and treatment competence in Acanthamoeba keratitis varies widely. This investigator-initiated, retrospective, single-center chart review examined the electronic patient files regarding PCR-positive Acanthamoeba keratitis. We included corneal and contact lens assessments. We further reviewed the patient's medical history, corneal scraping results regarding viral or fungal co-infections, and the duration from symptom onset to final diagnosis. We identified 59 eyes of 52 patients from February 2010 to February 2023, with 31 of 52 (59.6%) being female patients. The median (IQR, range) patient age was 33 (25.3 to 45.5 [13 to 90]) years, and the mean (SD, range) time to diagnosis after symptom onset was 18 (10.5 to 35 [3 to 70]) days. Overall, 7 of 52 (7.7%) patients displayed a bilateral Acanthamoeba infection, and 48 (92.3%) used contact lenses at symptom onset. Regarding other microbiological co-infections, we found virologic PCR testing in 45 of 52 (86.5%) patients, with 3 (6.7%) positive corneal scrapings. Fungal cultures were performed in 49 of 52 (94.2%) patients, with 5 (10.2%) positive corneal scrapings. The medical treatment success rate was 45/46 (97.8%). This study raises awareness of patient education in contact lens handling and screens for further microbial co-infections in suspected Acanthamoeba cases.

Objectives : This study entailed a weekly analysis of real-world data (RWD) on the safety and efficacy of intravitreal (IVT) faricimab in neovascular age-related macular degeneration (nAMD). Methods : A retrospective, single-centre clinical trial was conducted at the Department of Ophthalmology, University Hospital Zurich, University of Zurich, Switzerland, approved by the Cantonal Ethics Committee of Zurich, Switzerland. Patients with nAMD were included. Data from patient charts and imaging were analysed. The safety and efficacy of the first faricimab injection were evaluated weekly until 4 weeks after injection. Results : Sixty-three eyes with a complete 4-week follow-up were enrolled. Six eyes were treatment-naïve; fifty-seven eyes were switched to faricimab from another treatment. Neither group showed signs of retinal vasculitis during the 4 weeks after injection. Central subfield thickness (CST) and volume (CSV) showed a statistically significant decrease compared to the baseline in the switched group (CST: p = 0.00383; CSV: p = 0.00702) after 4 weeks. The corrected visual acuity returned to the baseline level in both groups. The macular neovascularization area decreased in both groups, but this was not statistically significant. A complete resolution of sub- and intraretinal fluid after 4 weeks was found in 40% (switched) and 75% (naïve) of the treated patients. Conclusions : The weekly follow-ups reflect the structure-function relationship beginning with a fast functional improvement within two weeks after injection followed by a return to near-baseline levels after week 3. The first faricimab injection in our cohort showed a high safety profile and a statistically significant reduction in macular oedema in switched nAMD patients.

Competing Interests: The authors declare that they have no conflict of interest.

Purpose: Proof of concept of ex vivo retinal vessel diameter measurements in human postmortem eyes., Methods: En face near-infrared (IR) images and optical coherence tomography (OCT) of the optic nerve head (ONH) were captured ex vivo with a Heidelberg Engineering Spectralis (Spectralis, version 7.0.4, Image Capture Module, version 1.2.4, Heidelberg Heidelberg, Germany) device, using a custom-made eye chamber holding and positioning the eyes during the image process. Thirty-two formaldehyde-fixated eyes of 16 patients were imaged. In the IR images, two independent graders measured retinal vessel diameters at the intersection of a drawn circle centered on the ONH with diameters of 2.0 mm and 3.4 mm, respectively. The anatomically corresponding measurements between both graders were statistically analyzed using a Wilcoxon signed-rank test., Results: A total of 246 matched measurements of both graders were analyzed across all 32 imaged eyes. Statistically significant differences between the graders were found for arterioles at 2 mm from the ONH. The other measurements did not show statistically significant intergrader differences. The mean values for arteriole diameters were 72.2 µm at 2.0 mm and 61.5 µm at 3.4 mm for grader 1, and 66.4 µm at 2.0 mm and 63.2 µm at 3.4 mm for grader 2. The mean diameter for venules were 75.5 µm at 2.0 mm and 79.3 µm at 3.4 mm for grader 1, and 67.4 µm at 2 mm and 79.1 µm at 3.4 mm for grader 2., Conclusion: To the best of our knowledge, this is the first study to present IR image-based retinal vessel diameters in ex vivo postmortem eyes. Retinal IR/OCT imaging is possible, and measurements are reproducible in formaldehyde-fixated human eyes. Fixation artefacts result in lower image quality, and this can impose challenges in correctly detecting, classifying, and measuring retinal vessels., Competing Interests: The authors declare that they have no conflict of interest., (Thieme. All rights reserved.)

Competing Interests: Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht.

Competing Interests: D. B. is a consultant and speaker for Novartis and Bayer, and a consultant for Alcon. D. R. M. is a speaker for Bayer and Roche. S. S., R. S., K. F., S. A. Z., and F. B. declare no conflict of interest related to the topic.

Competing Interests: The authors declare that they have no conflict of interest.

Purpose: To establish a national consensus on contraindications for corneal donation for transplantation in Switzerland., Methods: Swisstransplant (SWT), the Swiss national foundation coordinating tissue and organ donations, convened a working group consisting of six national corneal surgeons and eye bankers and donation experts to create a contraindication list for corneal donation. The group reviewed available national and international guidelines and recommendations, while adhering to Swiss law and transplant regulations. In cases of opposing opinions, the group held follow-up meetings until a consensus was reached. A consensus was defined as agreement among all parties present., Results: From March 2021 to November 2021, the study group held six meetings and created a standardized minimal contraindication list for corneal donation in Switzerland. Thanks to this list, SWT has created a mandatory working and documentation file for donor coordinators to use when evaluating multiorgan donors for corneal harvesting. The authors agreed that while the national consensus list provides standardized minimal contraindication criteria, local eye banks may choose to introduce additional, more rigorous criteria., Conclusion: Given that corneal transplantation is the most commonly performed transplantation, establishing a consensus on contraindications is crucial for recipient safety. The creation of a consensus on contraindications for corneal donation in Switzerland is an essential contribution to fulfil the legal requirements concerning quality assurance and provides sufficient high-quality donor tissue within the country. Therefore, periodic review and revision of the consensus is considered critical., Competing Interests: F. B., F. I., N. K., N. F., C. T., C. R., H. M., B. F., C. K., and I. M. were part of the corneal expert group that created the national consensus discussed in this manuscript. The authors, except F. I., N. K., N. F., C. R., and S. S., received honoraria from Swisstransplant for their contribution. F. I., N. K., N. F., and S. S. declare no conflict of interest related to the topic., (Thieme. All rights reserved.)

Competing Interests: D. B. is a consultant and speaker for Novartis and Bayer, and a consultant for Alcon. D. R. M. is a consultant for Bayer and Roche. B. L. is outside of the submitted work member of the steering committee of HOS, a post-marketing registry for Hunterʼs disease and received honoraria and travel grants by Shire, Takeda, Genzyme-Sanofi, and Alexion for various presentations. None of the declarations represent a conflict of interest related to the presented study. S. S., J. M. G., J. V. M. H., K. F., F. B., and S. A. Z. declare no conflict of interest related to the topic.

Purpose: To introduce a novel technique of the aseptic manufacture of autologous serum eye drops (ASEDs) with a prefiltered closed system and to analyze the sterility of the produced ophtioles between 2018 and 2022., Methods: This is a prospective single-center study conducted at the Department of Ophthalmology at a Swiss University Hospital between 2018 and 2022. For regulatory reasons, closed systems for manufacturing ASEDs are strongly recommended. We attached an upstream sterile filter (Sterivex PES0.22 µm Burlington, USA) to a commercially available closed system (COL System Modena, Italy) for manufacturing ASEDs. The goal of this novel approach was to reduce the microbiological contamination of the donated autologous blood. Using the presented manufacturing method, we are able to produce, on average, 56 ophtioles per batch, containing either 1.45 mL or 2.5 mL of autologous serum per ophtiole. For each batch of ASEDs, we performed a microbiological analysis by automated blood culture testing (BACTEC). This system examines the presence of bacteria and fungi., Results: We analyzed all manufactured batches between 2018 and 2022. None of the 2297 batches and the resulting 129 060 ophtioles showed bacterial or mycotic contamination. During the analyzed period, two batches were discarded: one due to fibrin-lipid aggregations, further microbiological and histological work-up excluded any contamination; another due to false-positive HIV in serological testing. Overall, the contamination rate was 0%, and the batch discharge rate was 0.09%., Conclusions: The combination of upstream sterile filtration with a commercial closed system for manufacturing ASEDs proved to be effective in ensuring sterility without any contamination over the past 4 years. This is becoming crucial, as the demand for autologous blood products for treating ocular surface disorders, such as refractory dry eyes or nonhealing defects of the corneal epithelium, is on the rise., Competing Interests: D. B. is a consultant and speaker for Novartis and Bayer, and a consultant for Alcon, without conflicts of interest regarding this study. D. R. M. is a speaker for Bayer and Roche, without conflicts of interest regarding this study. F. B., I. M., D. M. P., S. S., D. R. M., S. A. Z., and A. B. declare that they have no conflict of interest related to the topic., (Thieme. All rights reserved.)

Background: To report ophthalmological outcomes and treatment regimen in patients with Susac syndrome., Methods: This is a retrospective analysis of patients with Susac syndrome treated between November 2015 and March 2023. Multimodal imaging findings, ophthalmic examination data, information on neurological and sensorineural involvement, and therapeutic regimen were reviewed. Visual acuity was recorded as the logarithm of the minimum angle of resolution (logMAR). Ophthalmological manifestations and disease severity were assessed using the previously described clinical activity score (CAS)., Results: Ten patients with Susac syndrome m : f = 5 : 5 were identified. The mean follow-up time was 31.2 ± 23.3 months (range 1 to 78 months). The mean age was 41.4 ± 13.8 years (range 21 to 59 years). At baseline, corrected distance visual acuity (CDVA) was 0.03 ± 0.08 logMAR. At the last follow-up, CDVA improved to 0.00 ± 0.03 logMAR (p = 0.029). Three of 20 eyes showed an improvement of 5 letters, while no loss of visual acuity was recorded during the follow-up time. Baseline CAS was 10.65 ± 12.69, and CAS at the last follow-up was 5.15 ± 5.49 (p = 0.068). Except for one patient, all were initially treated with intravenous (i. v.) steroids and subsequent oral tapering. Depending on the treatment response, cyclophosphamide (n = 4), i. v. immunoglobulins (IVIGs) (n = 4), anti-CD20 antibodies (n = 3), or plasmapheresis (n = 1) were applied. All patients under treatment for more than 1 month (n = 9) showed improvement in CAS and CDVA., Conclusion: Susac syndrome is a rare autoimmune vascular endotheliopathy. Treatment of Susac syndrome appears to result in improving CAS and CDVA. The majority of patients, in addition to the systemic steroids, required systemic immunosuppressive agents. Interdisciplinary communication is crucial to reduce the time to diagnosis and initiation of therapy in patients with Susac syndrome., Competing Interests: The authors declare that they have no conflict of interest., (Thieme. All rights reserved.)

Purpose: To evaluate the increase in retinal thickness as a marker in predicting the onset of central retinal artery occlusions., Methods: Retrospective clinical study conducted at one Swiss hospital. Electronic records were filtered for patients with artery occlusions. Optical coherence tomography data, including time between the imaging and ischemic event, were reviewed. Increase in relative retinal thickness was measured, defined as an increase in retinal thickness compared to the unaffected partner eye. This was correlated with the time from symptom onset. A cutoff value of relative increase of < 24.5% was applied, as suggested in previous studies. The results were compared to the time gathered from the electronic records, and sensitivity, specificity, positive predictive value as well as negative predictive value were calculated for predicting an ischemia time of < 4.5 h., Results: Forty-two eyes from 41 patients with central artery occlusions were identified. Fourteen were female. Mean age was 66.4 ± 15.8 years. Initial corrected visual acuity was 2.41 ± 0.68 logMAR, and 2.13 ± 0.87 logMAR at the last follow-up (p > 0.05). Of eyes with a visual acuity of counting fingers (n = 38) or worse, 89.5% showed no improvement during follow-up, while eyes with logMAR 1 or better (n = 4) improved. Thirteen eyes (13 patients) presented within 4.5 h of the ischemic event. Four patients received i. v. thrombolysis, with visual recovery in one. In 12 eyes with an ischemia time of < 4.5 h, relative increase was below 24.5%. In the remaining 29 eyes with > 4.5 h, relative increase was below 24.5% in 4 eyes and above 24.5% in 25 eyes. This yielded a sensitivity of 92.3%, a specificity of 86.2%, with a positive predictive value of 75.0% and a negative predictive value of 96.2%., Conclusion: Central retinal artery occlusion is associated with severe vision loss. There is no current established therapy. Parameters that objectify the presence of a therapeutic window for thrombolysis are gaining in importance as patient history is often imprecise. Relative retinal thickness increase proved a noninvasive imaging parameter demonstrating adequate performance in detecting patients within the therapeutic window of thrombolysis. Further investigation of this parameter in central retinal occlusion is warranted., Competing Interests: The authors declare that they have no conflict of interest., (Thieme. All rights reserved.)

Infections with Scedosporium spp. are emerging in the past two decades and are associated with a high mortality rate. Microbiological detection can be associated with either colonization or infection. Evolution from colonization into infection is difficult to predict and clinical management upon microbiological detection is complex. Microbiological samples from 2015 to 2021 were retrospectively analyzed in a single tertiary care center. Classification into colonization or infection was performed upon first microbiological detection. Clinical evolution was observed until July 2023. Further diagnostic procedures after initial detection were analyzed. Among 38 patients with microbiological detection of Scedosporium spp., 10 were diagnosed with an infection at the initial detection and two progressed from colonization to infection during the observation time. The main sites of infection were lung (5/12; 41.6%) followed by ocular sites (4/12; 33.3%). Imaging, bronchoscopy or biopsies upon detection were performed in a minority of patients. Overall mortality rate was similar in both groups initially classified as colonization or infection [30.7% and 33.3%, respectively (P = 1.0)]. In all patients where surgical debridement of site of infection was performed (5/12; 42%); no death was observed. Although death occurred more often in the group without eradication (3/4; 75%) compared with the group with successful eradication (1/8; 12.5%), statistical significance could not be reached (P = 0.053). As therapeutic management directly impacts patients' outcome, a multidisciplinary approach upon microbiological detection of Scedosporium spp. should be encouraged. Data from larger cohorts are warranted in order to analyze contributing factors favoring the evolution from colonization into infection., (© The Author(s) 2024. Published by Oxford University Press on behalf of The International Society for Human and Animal Mycology.)

Competing Interests: D. B. is a consultant and speaker for Novartis and Bayer, and a consultant for Alcon. S. S., D. R. M., T. H., A. B., M. R. J. W., S. A. Z., and F. B. declare no conflicts of interest related to the topic.

Purpose: To assess optic nerve head (ONH) and macular blood flow in young healthy volunteers using laser speckle flowgraphy (LSFG)., Methods: This is a prospective single-center study conducted at the Department of Ophthalmology, University Hospital Zurich from May to November 2021. Young, healthy men aged ≥ 18 years without ocular or systemic diseases were included. A corrected visual acuity (VA) of 0.0 logMAR or better in both eyes and an intraocular pressure (IOP) of 21 mmHg or lower were required for inclusion. Subjects exceeding a spherical equivalent (SE) of ± 6 diopters (dpt) were excluded. Blood flow in the macula and the ONH was recorded using the Nidek LSFG RetFlow device (Nidek Company, Ltd., Hirioshi-cho, Japan). Laser power was set to 0.5 Millivolts (mV). Mean blur rate (MBR) was recorded as a parameter for blood flow. MBR is a calculated parameter that represents relative blood flow velocity correlated with the real anatomical blood flow rate. Colored heat maps of the recorded retinal area were generated automatically by the RetFlow device., Results: Final analyses included 83 eyes of 43 male volunteers. Mean age was 21.9 years (SD ± 1.5, range: 20 to 29). Mean corrected VA was - 0.1 logMAR (SD ± 0.05, range: - 0.2 to 0.0), mean IOP was 15.4 mmHg (SD ± 2.5, range: 8.5 to 18.5), and mean SE was - 0.3 dpt (SD ± 1.2, range: - 5.0 to 1.2). Mean ONH MBR was 37.44 (SD ± 7.9, range: 22.5 to 53.5) and mean macular MBR was 27.8 (SD ± 9.7, range: 6.4 to 57.7). Pearson's Test showed a strong correlation between macular and papillary blood flow (p < 0.05, coefficient: 0.647)., Conclusion: This study provides both ONH and macular blood flow data in a healthy young male population, showing a strong correlation between ONH and macular blood flow in the examined eyes. Further investigations are required to assess the validity of MBR as a parameter for the combined evaluation of retinal blood flow at the macula and ONH in healthy volunteers and patients with various diseases., Competing Interests: The authors declare that they have no conflict of interest., (Thieme. All rights reserved.)

Purpose: To present a case series of rare and severe complications after corneal collagen cross-linking (CXL) of keratoconus patients., Methods: Single-center descriptive case series covering the period of 2012 to 2022 at the Department of Ophthalmology at the University Hospital, Zurich, Switzerland., Results: We present four eyes of four patients that showed severe unusual complications within the first month after CXL. Three patients had been treated with the classical epithelium-off "Dresden" protocol. One patient had been treated with the accelerated epithelium-off protocol. One patient presented with extensive corneal edema due to rubbing the eye after treatment. Two patients showed a bacterial infectious keratitis: one due to Streptococcus pneumoniae and the other due to Staphylococcus hominis, Micrococcus luteus , and Streptococcus epidermidis . The latter of the two patients exhibited extensive infectious crystalline keratopathy. The fourth patient showed a severe ulcerative lesion where no infectious cause could be found. Therefore, an autoimmune keratolytic process had to be suspected. Apart from the corneal edema, which resolved ad integrum , the other complications resulted in permanent corneal scarring and thinning. One patient needed an emergency amniotic transplant., Conclusion: Severe complications after CXL remain rare. Most common causes are complications that are not directly associated with the treatment as such. Those indirect complications occur after the treatment during the healing course of the epithelium. Associations with bandage contact lenses, topical steroids, atopic disease, and inappropriate patient behavior are often suspected. Correctly performed corneal scrapings with repeated microbiological analysis and a detailed patient history are essential for establishing the correct diagnosis, especially in complicated cases that do not respond to a standard therapeutic regimen. This case series supports the efforts that are currently taken to improve the CXL technique in a way that postoperative complications are further reduced. A more efficient epithelium-on technique might be a step in that direction., Competing Interests: The authors declare that they have no conflict of interest., (The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).)

Competing Interests: D. B. is a consultant and speaker for Novartis and Bayer, and a consultant for Alcon. S. S., D. R. M., S. A. Z., and F. B. declare that they have no conflict of interest.

Background: Solar and laser-associated retinopathies are rare occurrences. The two retinopathies are both photo-induced but differ in the involved intensity and duration of exposure. The purpose of this study was to evaluate the clinical features and natural course of these two entities, with a focus on the changes in the outer retina over time., Patients and Methods: This retrospective analysis assessed patients with solar or laser maculopathy seen at the Department of Ophthalmology of the University Hospital Zurich in Switzerland over the last 10 years. Visual acuity (VA; Snellen) and optical coherence tomography (OCT) findings were reviewed and analyzed at baseline and last follow-up visit. Areas of damaged outer retina, identified on en face OCT images as hyporeflective areas, were tagged and compared between visits. Descriptive analysis was performed by calculating mean values ± standard deviation (SD). Statistical evaluation was done using the Wilcoxon signed rank test. A p value < 0.05 was considered statistically significant., Results: Five patients with solar retinopathy and six patients with laser-associated retinopathy were identified. In the solar retinopathy group, mean VA at baseline was 0.80 (SD ± 0.37) and improved to 0.90 (SD ± 0.36). This was not statistically significant (p = 0.066). In the laser-associated retinopathy group, mean VA at baseline was 0.89 (SD ± 0.18) and improved to 1.03 (SD ± 0.09), which was not statistically significant either (p = 0.063). At baseline, in OCT cross-sections, initial changes were observed in the interdigitation, myoid, and ellipsoid zone, as well as the outer nuclear layer and the Henle fiber layer. At follow-up, most cases presented an alteration in the residual ellipsoid zone, with the degree of the aforementioned alterations depending on the size of the initial defect. A decrease of the hyporeflective alterations measured in en face OCT scans was observed in both groups but was only statistically significant in the laser-associated retinopathy group (p = 0.018 versus p = 0.172)., Conclusions: OCT can help to detect and monitor solar and laser-associated retinal injuries. Most injuries are minor, with good functional restitution. Minor changes in the ellipsoid zone often persist, even in cases with full visual recovery., Competing Interests: The authors declare that they have no conflict of interest., (Thieme. All rights reserved.)

Competing Interests: Disclosure The authors report no conflicts of interest in this work.