AimsTo determine the accuracy of diagnosing microbial keratitis by masked medical and non-medical observers using the Heidelberg Retina Tomograph II / Rostock Cornea Module in vivo confocal microscope. MethodsConfocal images were selected for 62 eyes with culture or biopsy proven infections. ResultsThe highest sensitivity and specificity values were 55.8% and 84.2%, and the lowest sensitivity and specificity values were 27.9% and 42.1%. The highest positive and negative likelihood ratios were 2.94 and 0.59, respectively. Agreement values were:fair to moderate (κ, 0.22-0.44) for reference standard versus observer diagnosis, moderate to good in intra-observer variability (repeatability, κ 0.56-0.88), and poor to moderate in inter-observer variability (reproducibility, κ , 0.15-0.47). The correct 4 diagnosis was associated with duration of disease for Acanthamoeba keratitis (r s = 0.60, p = 0.001). Conclusions

A diagnostic delay of less than 18 days between onset of symptoms and start of anti-amoebic treatment results in a better final VA after medical treatment and obviates the need for urgent and elective penetrating keratoplasty.

FOXC1 and PITX2 genetic defects explain 40% of our large ASD cohort. The current spectrum of intragenic FOXC1 and PITX2 mutations was extended considerably, the identified copy number changes were fine mapped, the smallest FOXC1 and PITX2 deletions reported so far were identified, and the need for dedicated copy number screening of the FOXC1 and PITX2 genomic landscape was emphasized. This study is unique in that sequence and copy number changes were screened simultaneously in both genes.

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Most of the tissue used for penetrating keratoplasty is issued through eye banks that store the corneoscleral button either in hypothermic storage at 2-68C or in organ culture at 31-378C.These two preservation techniques differ in technical aspects, tissue evaluation possibilities, storage time and microbiological safety. Hypothermic storage is simple and requires little expensive equipment. In general a pre-storage evaluation of the endothelium is performed by specular microscopy and storage time is usually around 7-10 days. Organ culture is a relatively complicated technique requiring more expertise and well-equipped facilities. Evaluation of the endothelium is not only performed before storage, but is routinely performed after storage through the use of light microscopy. With organ culture the allowed storage period is longer, up to four weeks. The vulnerability of organ culture to microbial contamination can be turned into an advantage because it allows the detection of residual micro-organisms on the cornea before surgery. Both preservation techniques seem to result in similar graft survival.The method of choice for preservation of the donor cornea is dictated by a number of factors mentioned in this review and this helps to explain the geographical differences in the use of the different techniques.

Corneal allograft rejection does not necessarily cause a higher than expected endothelial cell loss; almost half of the patients in this study showed a decline in ECD that is comparable to the decline in patients who undergo PKP and have an uneventful follow-up. The most important variable influencing the extent of endothelial cells loss is a delay in diagnosis and treatment.

Graft failure through endothelial cell loss is a constant threat throughout the lifetime of a corneal graft. It can occur at various time points after transplantation. Primary graft failure has nowadays become increasingly rare owing to meticulous eye banking methods and improved surgical techniques. Corneal graft rejection is always held responsible for endothelial cell loss. However a rejection episode that is promptly and adequately treated does not necessarily lead to a higher than expected cell loss. A more smouldering danger to ultimate graft survival is late endothelial failure. This gradual graft decompensation is secondary to a decrease in cell density below that necessary to maintain corneal deturgesence. The process of transplantation itself seems to set off a series of events (possibly immunological) that greatly exacerbates the endothelial cell loss compared to virgin corneas. This accelerated cell loss persists for at least 10-15 years after transplantation, after which a more-stable situation is reached and cell attrition returns to normal rates. This provides a strong rationale for setting high donor standards of minimal cell density. Newer transplantation techniques such as deep anterior lamellar keratoplasty and deep lamellar endothelial keratoplasty could provide possible solutions to prevent this late endothelial failure. However they still have to prove themselves in the long run.

Infantile haemangiomas (IH) are benign vascular tumours characterised by their very rapid growth. Although usually innocuous, periocular IH can cause serious visual loss through induction of strabismic, deprivational or anisometropic astigmatism. Common treatment modalities for these IH include intralesional and systemic oral steroids; however, both treatments are associated with potentially severe side effects. A report was published recently demonstrating the impressive effect of propranolol in the treatment of IH. This exciting finding has provoked a paradigm shift in the management of this condition. So far little has been reported in the specific ophthalmologic literature, although case reports are emerging. This review gives an overview of the recent findings and includes the authors' experience with 10 patients treated with propranol.