Purpose. Adult healthy human corneas bear a distinctive number of antigen-presenting cells (APCs) important for the fate of a graft. The purpose of this study was to differentiate between Langerhans cells (LCs) and other dendritic cells (DCs) and between mature and immature APCs in fresh and cultured human corneas using specific markers.

To compare the efficacy of a computer-assisted marker system for toric intraocular lenses (IOLs) (Callisto Eye System) with manual marking techniques. University Eye Hospital Munich, Ludwig-Maximilians-University, Munich, Germany. Prospective case series. This study included patients having cataract surgery with implantation of a toric IOL (Torbi 709 M). They were randomly assigned to 1 of 2 groups based on the marking system used, manual or digital. Patients were included if they had age-related cataract and a regular corneal astigmatism of 1.25 diopters (D) or higher. Visual and refractive outcomes as well as rotational stability were evaluated. Vector analysis was performed to evaluate total astigmatic changes. The study comprised 57 eyes of 29 patients; there were 28 eyes in the manual group and 29 eyes in the digital group. The mean toric IOL misalignment was significantly lower in the digital group than in the manual group (2.0 degrees ± 1.86 [SD] versus 3.4 ± 2.37 degrees; P = .026). The mean deviation from the target induced astigmatism was significantly lower in the digital group (0.10 ± 0.08 D versus 0.22 ± 0.14 D; P = .008). During surgery, the mean toric IOL alignment time was significantly shorter in the digital group (37.2 ± 11.9 seconds versus 59.4 ± 15.3 seconds; P = .003). The mean overall time required to perform the surgery was significantly shorter in the digital group (727.2 ± 198.4 seconds versus 1110.0 ± 382.2 seconds; P < .001). A digital tracking approach for toric IOL alignment was efficient and safe to improve refractive outcomes. Furthermore, image-guided surgery helped streamline the workflow in refractive cataract surgery.

Purpose: The purpose of this study was to determine the quantity and distribution of antigen presenting cells (APC) in various inflammatory and non-inflammatory corneal diseases, comparing in vivo confocal microscopy (IVCM) and immunohistochemistry. Material and methods: Corneae of 41 eyes, composed of group 1 (status post herpes-keratitis), group 2 (keratoconus) and group 3 (graft rejection after keratoplasty) were investigated. IVCM was used preoperatively to assess the distribution and density of dendritic cells in the corneal center versus the paracentral area. Afterwards, all patients underwent penetrating keratoplasty. The host corneas were analyzed by immunohistochemistry for antigen presenting cell distribution, density and characterization by using specific markers for CD207/Langerin, CD209/DC-SIGN and HLA-DR. The IVCM findings were compared with immunohistochemistry results in the corneal epithelium. Results: Cells with branching dendritic morphology were visualized by IVCM mainly in the basal epithelial layer and subepithelial nerve plexus of the central and paracentral cornea. The density of APC in IVCM decreased in all groups towards the central part of the cornea. The highest gradient was observed in group 2, followed by groups 1 and 3. The corneal paracenter showed similiar distribution of APC in group 1 and 2 (76.7 cells/mm² and 74.4 cells/mm²). The highest density of central APC was observed in group 1 (53.76 cells/mm²), followed by group 3 (27.0 cells/mm²) and group 2 (24.2 cells/mm²). In immunohistochemistry positive stained, APC were distributed similarly to IVCM but with a higher density (p < 0.05). Conclusion: Distribution, density and stage of maturation of corneal epithelial APCs can be evaluated on morphological basis by IVCM. However, the corneal APCs density was about three-fold lower compared to immunohistochemistry findings.

Purpose: To implant a small-aperture intraocular lens (IOL) (IC-8) in eyes with severe corneal irregularities to reduce higher-order aberrations and provide better central visual acuity. Setting: University Hospital, LMU Munich, Germany. Design: Prospective nonrandomized interventional case series. Methods: Eyes with severe corneal irregularities due to keratoconus, previous penetrating keratoplasty, status postradial keratotomy, or scarring after ocular trauma were enrolled. Exclusion criteria were progressive keratoconus, pseudoexfoliation, glaucoma, maculopathy, reduced endothelial cells (<1800 cells/mm²), and central corneal opacity. Conventional phacoemulsification with implantation of the small-aperture IOL was performed. The primary efficacy endpoint was corrected distance visual acuity (CDVA), uncorrected distance visual acuity (UDVA), uncorrected intermediate visual acuity (UIVA), and uncorrected near visual acuity (UNVA). Secondary endpoints were life quality assessment using the Visual Function Questionnaire-25 and determination of the refractive defocus curve. Results: Seventeen eyes of 17 patients were enrolled. In all 17 patients, CDVA improved from 0.37 ± 0.09 to 0.19 ± 0.06 logarithm of the minimum angle of resolution (logMAR) 3 months postoperatively (P < .0001). Similarly, postoperative UDVA, UIVA, and UNVA improved significantly in 100%, 88%, and 88%, respectively. The defocus curve showed best results at 0.17 logMAR with a defocus of −0.5 diopter. In addition, overall life quality analyses reported less difficulty with activities under reduced optical phenomena conditions. Conclusions: The small-aperture IOL was a useful option in eyes with severe corneal irregularities, had a high safety index and a high satisfaction rate, and can lead to better visual quality in these cases. Further studies are needed to improve power calculation of this IOL.

PURPOSE: To assess the wound healing, inflammation, and tissue ultrastructure in the human corneal stroma after small incision lenticule extraction (SMILE) and femtosecond laser–assisted LASIK (FS-LASIK). METHODS: Sixteen corneoscleral discs of 16 human donors unsuitable for corneal transplantation were obtained from an eye bank. Eight eyes underwent SMILE with −5.00 diopters (D) of myopic correction; in 3 of them the lenticule was not extracted. Further 5 donor corneas were subjected to FS-LASIK with −5.00 D ablation, and 3 eyes served as the control group without surgical intervention. Postoperatively, specimens were incubated in organ culture medium for 72 hours before being subjected to immunofluorescence staining for CD11b, Ki67, fibronectin, terminal deoxynucleotidyl transferase-mediated dUTP-digoxigenin nick-end labelling assay, and high-magnification scanning electron microscopy. RESULTS: Keratocyte apoptosis, keratocyte proliferation, and infiltration of immune cells were generally mild and comparable between FS-LASIK and SMILE (irrespective of surgical lenticule extraction). By staining for fibronectin, we observed a trend toward milder fibrotic response in the corneal stroma after SMILE than after FS-LASIK. On the contrary, scanning electron microscopy analysis revealed a smoother, more regular ultrastructural appearance of the residual corneal bed after FS-LASIK. CONCLUSIONS: Corneal stromal wound healing after SMILE and FS-LASIK was virtually identical with respect to keratocyte proliferation and apoptosis in the human donor eye model. Although reactive fibrosis adjacent to the laser application site appeared less marked after SMILE, the stromal bed after LASIK exhibited a smoother surface texture. [ J Refract Surg. 2018;34(6):393–399.]