[Morphologic Corneal Changes after Crosslinking for Keratoconus]. / Morphologische Hornhautveränderungen nach Crosslinking bei Keratokonus.

Keratoconus is a relatively common (1 : 2000) bilateral disease leading to a change in biochemical and biomechanical corneal structure as well as thinning and ectasia. For more than 10 years, crosslinking has been a therapeutic option in cases of progression. Using riboflavin and UVA-radiation, the anterior corneal stroma (300 µm) gets stiffened by crosslinking of collagen fibers. When protocols and limitations are adhered, the procedure is described to be effective and of low-risk. This review gives an overview about physiologic and pathologic changes in keratoconic corneas before and after crosslinking. Based on histopathologic examination, the current knowledge in published literature is reviewed and is complemented by our own investigations.

[Collision tumor]. / Kollisionstumor.

A 65-year-old woman presented with a painless, partially pigmented and partially hyperkeratotic tumorous lesion on the lower eye lid. Histopathologic findings of the wedge resection showed a collision tumor of a highly differentiated squamous cell carcinoma and a fibrosing basal cell carcinoma. Collision tumors involving these two components are rare, particularly in the periocular region.

[Rare presentation of a scleral nevus with progression in size]. / Seltene Präsentation eines skleralen Nävus mit Größenprogredienz.

A 52-year-old male caucasian patient presented with a limbal subconjunctival pigmentation of unknown origin with progressive enlargement over the past years. Differential diagnoses included a malignant melanocytic lesion; therefore, an excisional biopsy was performed. Prior investigations showed no ciliary body or anterior chamber angle involvement. Histological and immunohistochemical analysis revealed the rare diagnosis of a scleral nevus. The clinical, histological and immunohistochemical findings as well as the relevant differential diagnoses are discussed.

[Blepharitis - When to Perform Surgery?]. / Blepharitis - wann greifen wir zum Skalpell?

AIM: Meibomian gland dysfunction/blepharitis is usually a harmless inflammatory process of the lid margin. However, it can be the first sign of a malignant lesion. Patients/Results: Clinical and histological findings are illustrated for 8 patients with changes in the lid margin and with the differential diagnosis of blepharitis. CONCLUSION: Tumours of the lid margin can mimic blepharitis or induce meibomian gland dysfunction. Conversely, blepharitis can present in a nodular form, which is highly indicative of a neoplasm. In these cases, surgical excision with ophthalmopathological evaluation of the tissue is mandatory, in order to reach the correct diagnosis and to treat the patient appropriately.

[Recurrent keratoconjunctivitis]. / Rezidivierende Keratokonjunktivitis.

BACKGROUND: Molluscum contagiosum is a highly infectious viral disease of the skin and mucous membranes. These lesions are found particularly often in children and young adults and are generally self-limiting. Nevertheless, molluscum contagiosum lesions in close vicinity to the eyes should be actively removed if they cause conjunctival or corneal irritation. CASE REPORT: We report the case of a 14-year-old boy who was treated for approximately 9 months for recurrent chronic keratoconjunctivitis with corneal neovascularization. Careful inspection of the eyelids revealed molluscum contagiosum. After removal of the lesions on both sides, short-term anti-inflammatory therapy and long-term surface lubrication, a gradual improvement was observed so that an almost complete visual recovery was achieved. CONCLUSION: In long-standing keratoconjunctivitis refractory to treatment, special attention should be paid to the possible presence of molluscum contagiosum, particularly in children and the lesions should be promptly removed.

[Orbital metastasis of a previously unknown lung carcinoma mimicking posterior ischemic optic neuropathy]. / Orbitale Metastase eines bis dato unbekannten Lungenkarzinoms mit klinischem Aspekt einer posterioren ischämischen Optikusneuropathie.

A 65-year-old patient presented with increasing loss of vision in the right eye. A relative afferent pupillary defect as well as visual field perimetry deficits in an otherwise unremarkable eye led to the presumed diagnosis of ischemia of the optic nerve; however, further imaging revealed an extensive necrotic bronchial carcinoma in the left upper lobe metastasizing to the orbit with compression of the optic nerve. The clinical and histological features are discussed with respect to possible primary origins of orbital metastases.

[Routine investigation of foetal eyes--in what way and what for?]. / Routineuntersuchung fetaler Augen--wie und warum?

The investigation of foetal eyes not only allows for the observation of ocular development. It is supportive and sometimes even mandatory for the diagnosis of systemic and ocular syndromes. This review gives an overview about the investigation of foetal eyes, their assignment to developmental stages, challenges related to the investigation of foetal eyes, clinically relevant syndromes, and academic questions. The morphological development of the eye has been investigated since the 19th century and will not be covered in this article. The investigation of foetal eyes that have been collected during the routine paediatric autopsy, is complicated by artifacts. Artifacts are the result of autolysis, fixation, and mechanical manipulation. They have to be distinguished from genuine findings. Besides the search for findings such as coloboma or cataract, the morphological classification of the foetal eye is of importance. The anterior-posterior diameter allows for the diagnosis of microphthalmia. The case reports comprise Goldenhar's syndrome, MIDAS syndrome and others. In conclusion, the investigation of foetal eyes is often helpful and critical for paediatric diagnostics and should be performed with great care.

[Clinico-pathological correlations: posterior compartment of the eye and orbit]. / Klinisch-pathologische Korrelationen: Befunde des hinteren Augenabschnitts und der Orbita.

Diseases of the posterior compartment and the orbit are characterised by histological findings, most of which can be reproduced clinically. Examples are the examination of calcifications in retinoblastoma by ultrasonography. In the present review, histological findings of tumour and other diseases of the posterior ocular compartment and the orbit are presented and correlated with the clinical pictures and imaging techniques: uveal melanoma, choroidal nevus, choroidal metastases, choroidal hemangioma, retinoblastoma, Coat's disease, sympathetic ophthalmia, pleomorphic adenoma (benign mixed tumour) of the lacrimal gland, dacryoadenitis, lymphoma, rhabdomyosarcoma, Langerhans cell histiocytosis, orbital metastases, and phthisical eyes. Histopathology is usually the gold standard for a definitive diagnosis. It is very important for residents and those in training to become familiar with clinico-pathological correlations as these provide insight in pathophysiological processes. Regarding ophthalmic surgery, ophthalmic pathology offers the possibility to study wound healing and complications. A close collaboration between clinicians and ocular pathologists allows for an optimised processing of the submitted tissue and diagnosis. Thus, pre- and postoperative care can also be improved. This outstanding knowledge that ophthalmologists have gained over the last decades and beyond, should be preserved and passed on to the next generations in order to maintain a high standard in ophthalmological care.

[Breaking the line of defence]. / "Line of defence" durchbrochen.

Tarantulas have urticating hairs which may cause severe irritation of the skin, respiratory tract and eyes. Inflammation and granulomas (ophthalmia nodosa) can develop in the anterior and posterior segment of the eye presenting as keratoconjunctivitis or uveitis. We present a case of a female patient with an intracorneal tarantula hair and subsequent keratouveitis after contact with a pet tarantula. Because of the unsatisfactory effects of topical steroids surgical removal of the tarantula hair was performed which resulted in remission of the inflammatory signs and recovery of visual acuity.

[The situation of ophthalmic pathology in Germany: the current status]. / Zur Situation der Ophthalmopathologie in Deutschland: eine aktuelle Bestandsaufnahme.

BACKGROUND: Ophthalmic pathology with its 150 year-old tradition is a subspecialty which since its beginning has contributed substantially to progress in ophthalmology. Nevertheless, deactivation or even termination of ophthalmopathological laboratories has occurred in the past years mainly due to economic pressure. In order to evaluate the situation and future perspectives of the existing, active laboratories in Germany and to ask for the kind of support desired from the Section for Ophthalmic Pathology of the German Ophthalmological Society (DOG) a survey was carried out using a questionnaire. RESULTS: The main results were as follows. 1. Specialised ophthalmic pathology is performed in Germany almost exclusively in laboratories integrated in university eye clinics. 2. There is close cooperation with institutes for pathology and dermatopathology. 3. The main focus is placed on the cornea, tumours of the eye and its adnexae, and the conjunctiva. 4. The number of ophthalmopathological specimens investigated per year is generally below 1000 and often below 500. 5. The diagnostic spectrum and equipment of the laboratories is generally good. 6. There are some deficits concerning ophthalmopathological education and the status of ophthalmic pathology within the clinics. 7. A considerable number of scientific publications is generated by the members of the laboratories. 8. At present there is only minimal fear that the own laboratory will be eliminated in the near future. 9. Ophthalmic pathology is established as an integral component of ophthalmology in patient care and, even more, in ophthalmic research. 10. The DOG-Section "Ophthalmic pathology" is requested to initiate stays in foreign laboratories, to initiate scientific multicentre studies, and to support activities dedicated to preserve the ophthalmopathological laboratories. DISCUSSION: For the first time valid data concerning the situation of ophthalmopathological laboratories in Germany have been collected. The information gathered can and should be used as an argument for the preservation and, if possible, even expansion of the occupation with normal and pathologic eye morphology at eye hospitals in and beyond Germany.

[Vascular lesion of the conjunctiva]. / Vaskuläre Läsion der Bindehaut.

A 44-year-old male patient first noticed a pain-free light red swelling of the right eye in 1983. Based on the results of the early indocyanine green angiography, MRI and sonography, a racemose hemangioma of the conjunctiva was diagnosed. Although a racemose hemangioma already exists at birth, it remains clinically silent for a long time and symptoms often first appear in early adulthood. In this patient external surgical excision was terminated due to substantial bleeding. A symptomatic treatment in the sense of surface care is considered to be the best option.

[Pilomatrixoma of the ocular adnexae: clinical and histologic analysis (13 cases)]. / Pilomatrixom der okulären Adnexe: Klinische und histologische Aufarbeitung von 13 Fällen.

BACKGROUND: Pilomatrixoma (calcifying epithelioma of Malherbe) is a rare benign tumour originating from the matrix of the hair root. In this study, we evaluated the clinical and histopathological characteristics of all the respective tumour specimens submitted to our laboratory since 1997. PATIENTS/MATERIALS AND METHODS: We reviewed the clinical and histologic findings of 13 pilomatrixomas localised to the ocular adnexae. Paraffin sections were stained with H&E and PAS and, in addition, immunohistochemistry was performed using markers for macrophages (CD68), for proliferative activity (Ki67), and for proliferation/apoptosis (CAS/CSE1L). RESULTS: All 13 pilomatrixomas were of reddish-livid colour and localised on the upper eyelid and/or near the eyebrow. The patients ages ranged from 4 to 84 years without preference for either gender. In 3 cases the correct diagnosis was made intraoperatively, while no pilomatrixoma was diagnosed prior to surgery. The most frequent false diagnoses were retention cyst (n = 3), atheroma (n = 2), and abscess (n = 2). There was no tumour recurrence in any of the cases within the time period presented. All 13 pilomatrixomas demonstrated the characteristic histology with areas of basophilic islands, shadow cells, calcification and a chronic granulomatous inflammation with foreign body giant cells in varying amounts. Immunhistochemical staining with anti-Ki67 and anti-CAS/CSE1L indicated a regular cellular maturation of the basophilic cells. No correlation was found between any of the histological or immunohistochemical markers and clinical parameters such as size, age and gender of the patient and duration of tumour presence prior to surgery. CONCLUSIONS: This case series represents one of the largest published so far, and underscores that pilomatrixoma can appear at any age. While it is usually not recognised clinically, it should be considered in the differential diagnosis especially for tumours of the upper eyelid. Our immunohistochemical findings support the basically benign nature of a pilomatrixoma but also point to the chronic inflammatory stimulus that can lead to complications after incomplete removal.

[Recurrent corneal tumour in a child]. / Rezidivierender Hornhauttumor bei einem Kind.

We present the clinical and histopathological findings in the unusual case of a recurrent corneal tumour in a child. Light and ultrastructural observations as well as immunohistochemistry indicate a benign reactive process. However, the prognosis regarding visual function is poor due to the infiltrative nature of the lesion and its tendency to recur. A possible diagnosis of nodular fasciitis is discussed.

[Neovascular glaucoma: aetiology, pathogenesis and treatment]. / Neovaskularisationsglaukom: Atiologie, Pathogenese und Therapie.

Neovascular glaucoma, as a typical secondary glaucoma, is due to ocular or (earlier) systemic diseases. The formation of a fibrovascular membrane on the anterior surface of the iris (rubeosis iridis) and extending into the chamber angle leads to irreversible obliteration of the outflow system, with a corresponding rise in intraocular pressure. The most frequent cause is retinal ischaemia resulting either from vascular occlusion or from diabetic alterations. The differential diagnosis must include acute angle-closure glaucoma and uncontrolled open-angle glaucoma. Treatment is aimed at eliminating the actual cause or at least reducing the risk factors (e.g. by retinal laser coagulation), or consists in cyclodestructive procedures. Medicamentous therapy comprises anti-inflammatory agents (steroids, cycloplegic agents) and substances that reduce the production of aqueous humour (carbonic anhydrase antagonists, beta blockers). In the near future, antiangiogenic medication might be another effective option. For end-stage neovascular glaucoma, the implantation of drainage devices is also discussed.