[Conjunctival Degeneration and Neoplasia]. / Bindehautdegenerationen und -neoplasien.

Conjunctival tumors result from gain of tissue, which can be either degenerative or neoplastic, but also inflammatory. In this article, degenerative (pterygium and pinguecula) as well as benign and malignant neoplastic conjunctival changes (epithelial, melanocytic and vascular tumors, choristomas as well as metastases) are discussed with regard to pathogenesis, symptoms, diagnostics and current status of treatment.

New posterior chamber phakic intraocular lens for high myopia: three-year results.

PURPOSE: To present the 3-year results regarding the safety and efficacy of the Epi.Lens N, a new posterior chamber phakic intraocular lens (PC pIOL). SETTING: Eye Center, University Hospital Freiburg, Freiburg, Germany. DESIGN: Prospective clinical study. METHODS: A PC pIOL was implanted in highly myopic eyes of consecutive patients. Standardized follow-up examinations including uncorrected (UDVA) and corrected (CDVA) distance visual acuities and refractions were performed 1, 3, and 6 months and 1, 2, and 3 years postoperatively. RESULTS: The patient cohort consisted of 30 eyes of 16 patients. The study eyes had a mean manifest refraction spherical equivalent of -10.1 diopters (D) ± 3.4 (SD), which decreased to -0.3 ± 0.8 D postoperatively. After 3 years, all eyes achieved (47%) or exceeded (53%) their preoperative CDVA, thus improving the mean CDVA from 20/21 (0.94) preoperatively to 20/18 (1.14) postoperatively. The mean postoperative UDVA (20/20 [0.98]) resembled the preoperative CDVA (20/21 [0.94]). When analyzing all eyes with good visual potential (preoperative CDVA 20/20 or better; n = 18), 94% achieved a postoperative UDVA of 20/20 or better. One small-diameter PC pIOL contacted the crystalline lens, which led to slight anterior subcapsular lens opacification. Despite this, the patient achieved a CDVA of 20/20. CONCLUSION: The 3-year results of this pilot study of a new PC pIOL showed good efficacy and safety. FINANCIAL DISCLOSURE: No author has a financial or proprietary interest in any material or method mentioned.

Comparison of corneal endothelial cell measurements by two non-contact specular microscopes.

BACKGROUND: Measurement of corneal endothelial cell density is important both for clinical diagnosis as well as clinical studies. Since endothelial cell loss is considered irreversible in humans, even small changes in endothelial cell density are relevant. Therefore it is important to know whether different instruments for endothelial cell density measurements give the same results and can thus be used interchangeably. In this study we compare corneal endothelial cell density and morphometry measurements from two widely used non-contact specular microscopes, the Topcon SP3000P and Konan Noncon Robo SP8000. METHODS: Endothelial cell measurements were performed with both the Topcon SP3000P and Konan Noncon Robo SP8000 on 34 eyes of 18 consecutive patients of our cornea clinics with poor image quality being the only exclusion criterion. Images were obtained using the auto-focussing method and manual cell selection. Endothelial cell density (ECD), hexagonal cell ratio (HEX) and coefficient of value (CV) of the endothelial cell layer were calculated by the instruments' built-in software. RESULTS: ECD values calculated by the Konan were systematically higher than Topcon values: in 94 % of eyes Konan gave a higher value than Topcon, leading to a mean difference in ECD between the instruments of 187 cells/mm(2) (P < 0.001 in paired Wilcoxon test). HEX showed a broad range of values and differed greatly with only weak correlation between the two instruments. CV values for Konan mostly exceeded Topcon values, and only showed a weak correlation between the two instruments as well. CONCLUSIONS: Values for ECD between the Konan and the Topcon do correlate well, but the ECDs calculated by the Konan are systematically higher than Topcon values. Both HEX and CV vary greatly and do not correlate sufficiently. Thus we recommend not to use the Konan and the Topcon instrument interchangeably.

Long-term tracking of the central corneal endothelial mosaic.

PURPOSE: When comparing follow-up endothelial cell (EC) density measurements it is only possible to demonstrate cell loss in large cohorts or in pronounced cases due to the standard deviation of measurements. However, especially in clinical studies or refractive surgery patients, EC stability is an important factor. Thus we developed a computer program to achieve cell-by-cell alignment of conventional specular non-contact EC photographs. This is a pilot study to evaluate whether this new diagnostic technique is applicable in postoperative patients. METHODS: Digitized endothelial cell photos of 30 eyes following implantation of a phakic posterior chamber intraocular lens for correction of high myopia were analyzed. All EC centroids were dotted on each image, and early and late follow-up pictures were automatically aligned on the basis of these centroids. The tracking results were confirmed via alternating image presentation of the corresponding image areas, and were reviewed for loss of individual cells. In addition, conventional EC density measurements were performed. RESULTS: Mean time interval between first and second postoperative EC image was 1.4 years (range 3 months-2.2 years), with early images taken at a median of 5.5 months after IOL implantation (lower/upper quartile 1.2-12.3 months). Extrapolated central EC density was 2812±500/mm2 at the first time point, and 2797±524/mm2 at the second time point. In 26 out of 30 image pairs, the EC mosaic was successfully retraced; cell loss in this area was excluded via photo flickering. Only in 4 image pairs, the EC mosaic could not be matched. CONCLUSIONS: We demonstrate that the corneal EC mosaic of clinical routine non-contact microscope pictures can be superimposed and compared on single cell level over time with our new computer based program. This new method is valuable to judge on EC stability even in small cohorts since it does not require mean values and standard deviations.