[The German keratomycosis registry : Initial results of a multicenter survey]. / Das Deutsche Pilz-Keratitis-Register : Erste Ergebnisse einer multizentrischen Erhebung.

BACKGROUND AND PURPOSE: Mycotic keratitis is a serious but relatively rare disease. No targeted data collection in Germany existed until the foundation of the German Pilz-Keratitis Register in 2015. PATIENTS AND METHODS: The inclusion of retrospective and prospective patients was carried out. INCLUSION CRITERIA: diagnosis confirmed by the polymerase chain reaction (PCR), culture, histology or confocal microscopy (IVCM). Collected parameters: date of symptom onset, date and method of diagnosis, risk factors, visual acuity and findings at admission and at follow-up, conservative and surgical treatment. RESULTS: By January 2018, a total of 102 eyes from the years 2000-2017 were reported from 16 centers (64.3% female, mean age 52 years, range 18-95 years). The initial diagnosis was made correctly in only 20.6% of cases. The mean time to correct diagnosis was 31.7 ±â€¯46.9 (0-296) days. The diagnosis was confirmed in cultures in 74.5%, histologically in 30.4%, by PCR in 38.2% and IVCM in 27.4%. Fungal species identified were: 36.7% Fusarium spp., 35.8% Candida spp., 6.4% Aspergillus spp. and 21.1% other. The most important risk factor was the use of contact lenses. The most commonly used antifungal agent was voriconazole (64.7%) followed by amphotericin B (37.2%). Penetrating keratoplasty was performed in 65.7% of the cases and 8.8% of the affected eyes had to be enucleated. The visual acuity of the entire study population increased from the initial 0.16 ±â€¯0.25 (0.001-1.0) decimal to 0.28 ±â€¯0.34 (0-1.0) decimal. CONCLUSION: The correct diagnosis of fungal keratitis is often significantly delayed. The treatment can be very difficult and keratoplasty is often necessary. In order to gain a better understanding of this disease, to recognize previously unknown risk factors and, if necessary, a change in the spectrum of pathogens and to identify approaches to treatment optimization, the fungal keratitis registry will be continued.

Cryofixation during live-imaging enables millisecond time-correlated light and electron microscopy.

Correlating live-cell imaging with electron microscopy is among the most promising approaches to relate dynamic functions of cells or small organisms to their underlying ultrastructure. The time correlation between light and electron micrographs, however, is limited by the sample handling and fixation required for electron microscopy. Current cryofixation methods require a sample transfer step from the light microscope to a dedicated instrument for cryofixation. This transfer step introduces a time lapse of one second or more between live imaging and the fixed state, which is studied by electron microscopy. In this work, we cryofix Caenorhabditis elegans directly within the light microscope field of view, enabling millisecond time-correlated live imaging and electron microscopy. With our approach, the time-correlation is limited only by the sample cooling rate. C. elegans was used as a model system to establish compatibility of in situ cryofixation and subsequent transmission electron microscopy (TEM). TEM images of in situ cryofixed C. elegans show that the ultrastructure of the sample was well preserved with this method. We expect that the ability to correlate live imaging and electron microscopy at the millisecond scale will enable new paradigms to study biological processes across length scales based on real-time selection and arrest of a desired state. LAY DESCRIPTION: Researchers seek to link cellular functions to their smallest structural components. Currently this requires correlation of two imaging techniques, live imaging and electron microscopy. Current correlative methods, however, have limited time resolution due to the sample preparation procedures for electron microscopy. Following live imaging, samples are transferred from the light microscope to a cryofixation, or ultra-fast freezing, instrument. The biological process progresses until the sample freezes, 1 second or more after the last live image. In this work, samples are cryofixed directly within the light microscope field of view. By eliminating the transfer step, time correlation between light and electron microscopy images of our samples is limited only by the freezing rate to the order of milliseconds rather than seconds.

[Candida infiltrations in the iris and lens during iritis and situation after sepsis]. / Candida-Infiltrat in Iris und Linse bei Iritis und Zustand nach Sepsis.

Intraocular Candida infections are overall rather rare; nevertheless they are often found as endogenous infections after Candida sepsis and can be sight-threatening. The most common manifestations are either a sole chorioretinitis or an endophthalmitis. Here we report the case of a 35-year-old man developing Candida infiltrations in the lens capsule and behind the iris after corticosteroid treatment of a presumed HLA-B27-positive iritis. The patient suffered from a life-threatening intensive care stay with positive Candida blood cultures earlier after intestinal perforation. With systemic intracameral and topical voriconazole, the infection was successfully treated. In patients with positive blood samples for Candida, topical and systemic corticosteroids should be given with care even months after the last positive blood cultures.

[Corneal cell therapy-an overview]. / Korneale Zelltherapie ­ Eine Übersicht.

In recent years, the cultivation and expansion of primary corneal cells has made significant progress. The transplantation of cultured limbal epithelial cells represents a successful and established treatment of the ocular surface. Cultivated corneal endothelial cells are undergoing a clinical trial in Japan. Stromal keratocytes can now be expanded in vitro. A wide range of stem cell sources is being tested in vitro and animal models for their possible application in corneal cell therapy. This article gives an overview of recent advancements and prevailing limitations for the use of different cell sources in the therapy of corneal disease.

Retrobulbar Hemodynamics and Visual Field Progression in Normal Tension Glaucoma: A Long-Term Follow-Up Study.

PURPOSE: Vascular risk factors are important factors in the pathogenesis of glaucoma. The purpose of this research was to investigate retrobulbar hemodynamics and visual field progression in patients with normal tension glaucoma (NTG). PATIENTS AND METHODS: 31 eyes of 16 patients with NTG were included in a retrospective long-term follow-up study. Colour Doppler imaging was performed at baseline to determine various CDI parameters in the different retrobulbar vessels. The rate of visual field progression was determined using the Visual Field Index (VFI) progression rate per year (in %). To be included in the analysis, patients had at least 4 visual field examinations with a follow-up of at least 2 years. RESULTS: Mean follow-up was 7.6 ± 4.1 years with an average of 10 ± 5 visual field tests. The mean MD (mean defect) at baseline was -7.61 ± 7.49 dB. The overall VFI progression was -1.14 ± 1.40% per year. A statistical significant correlation between VFI progression and the RI of the NPCA and PSV of the CRA was found. CONCLUSION: Long-term visual field progression may be linked to impaired retrobulbar hemodynamics in patients with NTG only to a limited degree. Interpretation of the data for an individual patient seems to be limited due to the variability of parameters.

[Sensitivity and Specificity of the Nerve Fibre Imaging Using Scanning Laser Ophthalmoscopy and of Optic Nerve Analysis Using Heidelberg Retina Tomography in Glaucoma]. / Sensitivität und Spezifität der Nervenfaserdarstellung mittels Scanning-Laser-Ophthalmoskop und der quantitativen Sehnervenanalyse bei Glaukom.

PURPOSE: Imaging of the optic nerve head and the nerve fibre layer are used in the diagnosis of glaucoma. We have investigated the diagnostic precision of nerve fibre layer imaging using a manually operated scanning laser ophthalmoscope and analysis of the optic nerve head using the Heidelberg Retina Tomograph II (HRT). PATIENTS AND METHODS: 42 patients with glaucoma, 16 patients with ocular hypertension (OHT) and 24 healthy control subjects were included in a clinical study. Nerve fibre layer imaging was performed using a scanning laser ophthalmoscope (SLO, Rodenstock Instr. argon laser 488 nm). Nerve fibre layer defects were analysed peripapillarily for every single degree (defect or no defect) at 1.7 mm (near) and at 3.4 mm (far) distance to the optic nerve head. Specificity and sensitivity of the HRT II were calculated using the Moorfields regression analysis (MRA). RESULTS: Patients with glaucoma were found to have 109 ± 92° (near) and 109 ± 92° (far) defects of the nerve fibre layer. Patients with OHT (8 ± 14° [far] and 6 ± 11° [near]) and control subjects (0 ± 0° [far] and 0 ± 1° [near]) showed significantly smaller defects (p < 0.0001). Sensitivity at > 90 % specificity for POAG and controls was 85.7 % (far) and 82.9 % (near). Sensitivity at > 90 % specifity for OHT and POAG was 85.7 % (far) und 82.9 % (near). Specificity of controls for the MRA was 83.3 % (borderline classified as normal). Specificity of OHT patients was 93.8 % (borderline classified normal). Sensitivity of the MRA for POAG was 80.9 % (borderline classified normal) and 90.5 % (borderline classified glaucoma). CONCLUSIONS: Nerve fiber layer imaging using a manually operated scanning laser ophthalmoscope was found to achieve a higher diagnostic precision as compared to optic disc evaluation using the HRT II.

[Retinal vasculitis as manifestation of multiple sclerosis]. / Retinale Vaskulitis als Erstmanifestation einer multiplen Sklerose.

Multiple sclerosis (MS) is the most common chronic disease of the central nervous system in Germany. In 80 % of patients early stages of the disease are characterized by a clinically isolated episodic course. Ocular manifestations are common and mostly affect the optic nerve or the uvea and in some cases the retinal vessels. Here we report on a bilateral retinal vasculitis as the first manifestation of MS in a 27-year-old patient. All symptoms resolved after high dose steroid treatment; however, intensive follow-up is crucial due to potential occlusive, ischemic complications.