Purpose: The aim of this study was to compare the long-term outcome of Descemet membrane endothelial keratoplasty (DMEK) in patients with Fuchs endothelial corneal dystrophy (FECD) and pseudophakic bullous keratopathy (PBK). Methods: Records of consecutive DMEK surgeries performed between 2015 and 2016 at the Department of Ophthalmology, Cologne, Germany, were retrospectively reviewed from the prospective Cologne DMEK Database. Eyes with either PBK or FECD with a complete 3-year follow-up were enrolled. Main outcome parameters included central corneal thickness (CCT), peripheral corneal thickness (PCT), best spectacle-corrected visual acuity (BSCVA, logarithm of the Minimum Angle of Resolution), and endothelial cell count (ECC) before and after DMEK. Results: Four hundred two eyes from 402 patients were included (FECD n = 371, PBK n = 31). Preoperatively, CCT (FECD: 681.91 ± 146.78 μm; PBK: 932.25 ± 319.84 μm) and PCT (FECD: 732.26 ± 98.22 μm; PBK: 867.54 ± 88.72 μm) were significantly higher in the PBK group (P < 0.01). Three years after DMEK, CCT (FECD: 526.56 ± 27.94 μm; PBK 663.71 ± 132.36 μm) was significantly lower in both groups compared with the preoperative values (P < 0.01), whereas PCT showed no significant difference. PCT increased during the course in the PBK group from month 12 after DMEK (12 mo: 783.73 ± 127.73 μm; 24 mo: 837.50 ± 110.19 μm; 36 mo: 857.79 ± 140.76 μm). The increase in PCT correlated with an accelerated ECC loss starting 12 months after DMEK (P = 0.036). Before DMEK, BSCVA in FECD was significantly higher (P < 0.001) compared with that in PBK. After 3 years, BSCVA improved in FECD and PBK eyes without significant difference (P = 0.239). Conclusions: Visual acuity after DMEK in PBK and FECD seems to be comparable during the long-term follow-up. Peripheral and central corneal edema seems to recur faster in eyes with PBK than in those with FECD. Therefore, using a donor graft with higher ECC or possibly a larger graft could be a promising approach for PBK patients.

Soft nano‐ and microfiber‐based polymer scaffolds bear enormous potential for their use in cell culture and tissue engineering since they mimic natural collagen structures and may thus serve as biomimetic adhesive substrates. They have, however, so far been restricted to small‐scale production in research labs with high batch‐to‐batch variation. They are commonly produced via electrospinning or melt electrowriting and their delicate nature poses obstacles in detachment, storage, and transportation. This study focuses on overcoming challenges in the high throughput production and practical handling, introducing new methods to reproducibly prepare such scaffolds suitable for quantitative cell culture applications. Attention is given to the seamless handling and transfer of samples without compromising structural integrity. Challenges in detaching fibers without damage as well as storage, and transport are addressed. Cell culture studies demonstrate the methodological advantages, emphasizing the potential for standardized testing and biological readouts of these delicate fiber materials. The developed methods are applicable across various electrospinning and melt electrowriting approaches and can essentially contribute to their utilization in laboratory research and commercial applications.

Background Topical NGF eye drops (Cenegermin) were approved in 2015 as an orphan drug for the treatment of neurotrophic keratopathy (NK). The active substance Cenegermin is a recombinant form of human NGF (nerve growth factor). Objectives Presentation of efficacy and safety of Cenegermin for use in patients in an university real-life setting. Material and Methods Retrospective study at the Köln University Eye Hospital from 2017 to 2019 with n = 11 eyes. Average follow-up was 13.5 ± 7.1 months. Reasons for treatment were neurotrophic keratopathy stage II and III, clinically mostly in combination with corneal neovascularization. Results Seven eyes with a NK II and 4 eyes with a NK III with a median observation period of 13.6 months (range 1.2 – 20.3 months) from a total of 11 patients were included. The median patient age was 42.8 ± 23.6 years (range 18 – 75 years). Before the start of therapy, the median erosion area measured 3.1 ± 1.4 × 1.9 ± 1.1 mm and the median ulcer area had a size of 2.3 ± 1.1 × 2.1 ± 0.8 mm. After the start of therapy with Cenegermin (application 6×/day), the epithelial defect closed in all 11 study eyes (100%) within 4 – 12 weeks (mean: 49 d ± 9 d). In 9 out of 10 patients (90%) pre-existing corneal neovascularization regressed significantly (p < 0.001). Before the start of therapy, a value in the Luneau test of 2.9 ± 1.9 (minimum 1/6, maximum 4/6) was found and rose to a median value of 4.2 ± 1.7 (minimum 2/6, maximum 6/6) after 18 months (p = 0.015). Therapy with Cenegermin had no long-term effect on intraocular pressure: the pressure ranged between 13.2 ± 4.1 mmHg (minimum 8 mmHg, maximum 21 mmHg). Under therapy with NGF eye drops, 67% of the patients, after an initial decrease, showed a long-term improvement in visual acuity (BSCVA) from 0.72 ± 0.31 to 0.46 ± 0.29 logMAR after 18 months (p = 0.005). Relapses in form of a corneal erosion in the long-term follow-up were observed in only one eye. One patient had to stop therapy because of local pain, no other local and systemic side effects were observed. Conclusion This real-life series on the use of Cenegermin in a university context shows a good effectiveness of the substance for epithelial closure in various underlying diseases (100% within 12 weeks). There is a long-term improvement in vision and corneal sensitivity. Larger real-life cohorts with various underlying diseases should follow.

To detect environmental factors, which may be possible risk factors in the disease course of Fuchs’ endothelial corneal dystrophy (FECD). Evaluation of patients with FECD registered in the FECD genetics database of the Center for Ophthalmology, University Hospital Cologne. For the evaluation, disease onset, central corneal thickness, best spectacle corrected visual acuity (BSCVA, logMAR), and modified Krachmer grading (grades 1–6) were correlated with the presence of diabetes mellitus (DM), body mass index (BMI), and smoking behavior. To put the age-related increase in Krachmer grading into perspective, a correction of grading were formed. Depending on the variables studied, differences between groups were examined by Mann–Whitney U test and chi-square test. The significance level was 5%. 403 patients with FECD were included in the analysis. The mean age of the patients was 70.0 ± 10.32 (range 28–96) years. The mean age at diagnosis of those patients was 63.1 ± 13.2 years. The female-to-male ratio was 1.46:1. Patients with a BMI > 30.0 kg/m² developed FECD significantly earlier than patients with a BMI < 30 kg/m², p = 0.001. Patients with DM showed significantly more often an Krachmer grade of 5, p = 0.015. Smoking had a negative effect on Krachmer grading (p = 0.024). Using the mediation analysis, the presence of DM correlated Krachmer Grade 5 (p = 0.015), and the presence of DM correlated with BMI > 30.0 kg/m² (p = 0.012). In addition to smoking and DM our study shows for the first time that obesity may have a negative impact on the development of FECD. Whether dietary interventions and hormones can influence the development or progression of the disease needs to be investigated in future studies.

Zusammenfassung: Hintergrund: Die COVID-19-Pandemie im Jahr 2020 und 2021 schränkt die Versorgung augenärztlicher Patienten vielfach ein. Teleophthalmologische Leistungen wie Videokonsultation oder medizinische Telefonberatungen könnten den Mangel an notwendigen Kontrollen bei chronischen Erkrankungen, zumindest teilweise, kompensieren. Teleophthalmologische Angebote sind jedoch in Deutschland aktuell noch deutlich unterrepräsentiert. Ziel der Arbeit: Um die Bereitschaft auf Patientenseite zur Telemedizin und virtuellen Klinik zu ermitteln, führten wir bei Patienten der Hochschulmedizin mit bekanntem Glaukom als chronische Erkrankung eine Umfrage mittels Fragebogen während der ersten Welle der COVID-19-Pandemie zum Thema Teleophthalmologie durch. Methoden: Es wurden 100 Patienten befragt. Der Fragenkatalog beinhaltete 22 Fragen mit Mehrfachwahl-Antwortmöglichkeiten. Als Einschlusskriterium galten das Vorhandensein eines Glaukoms als chronische Erkrankung, Alter über 18 Jahre sowie eine ausreichende sprachliche Verständigung zur Beantwortung der Fragen. Die Daten wurden anonymisiert erhoben, analysiert und ausgewertet. Ergebnisse: In der Patientenumfrage konnte aufgezeigt werden, dass eine hohe Bereitschaft zur Teleophthalmologie bei den Befragten im Bereich des Glaukoms als chronische Erkrankung vorhanden ist und diese in Anspruch genommen werden würde; 74,0 % der Befragten würden Telemedizin und virtuelle Kliniken akzeptieren; 54,0 % der Befragten ophthalmologischen Patienten gab an, dass ihr Arzt‑/Klinikbesuch aufgrund von SARS-CoV‑2 nicht stattfinden konnte; 17,0 % der Patienten gaben an, dass sich durch die SARS-CoV-2-Pandemie ihre Meinung gegenüber der Telemedizin geändert hat. Diskussion: Die Akzeptanz der Patienten für Telemedizin bei Patienten mit chronischem Offenwinkelglaukom scheint erstaunlich hoch. Diese ist durch die SARS-CoV-2-Pandemie noch weiter gesteigert worden. Diese Ergebnisse spiegeln eine generelle Bereitschaft bei Patienten mit chronischer Augenerkrankung wider, reflektieren jedoch nicht die Anwendbarkeit sowie die Akzeptanz aus ärztlicher Sicht. Diese Form der virtuellen Konsultation findet jedoch bei einem Großteil der Patienten mit Glaukom Akzeptanz und könnte überdacht werden.

Many diseases that threaten vision originate from imbalances in the production or signaling of vascular endothelial growth factor (VEGF) and nerve growth factor (NGF). While VEGF inhibitors can suppress pathological blood vessel growth and NGF therapies can promote tissue regeneration, treatments employing the growth factors are often invasive, inefficient, or not suitable for long‐term use. For example, the use of NGF‐containing eye drops requires high drug loads and frequent administration, thereby increasing the potential for side effects and high costs. Based on a critical overview of currently used experimental and clinical approaches for the delivery or inhibition of growth factors, we highlight aptamers as promising yet underexplored therapeutic tools. Aptamers combine high target specificity, tunable structure and affinity, stability, low immunogenicity, and scalable chemical synthesis. These properties allow aptamers to be readily incorporated into biomaterial carriers, such as hydrogels, implants, or contact lenses, to improve the controlled binding of growth factors for precise modulation of their levels in ocular tissues via release or sequestration strategies. Leveraging these advantages in future developments could facilitate the aptamer‐functionalized platforms to overcome the limitations of current therapies and advance more sustainable, targeted, and patient‐oriented treatment strategies in ophthalmology.