Purpose: We present a challenging case of a 9-year-old patient with refractory neurotrophic keratopathy (NK) who was successfully treated with cenegermin eye drops. Methods: A 7-year-old boy developed an ocular infection after a visit to a public swimming pool. After having been unsuccessfully treated for 2 years with antibiotics, steroids, and artificial tears, the patient presented to our clinic with a therapy-refractory NK. We initiated treatment with autologous serum eye drops that showed only weak response. Therefore, treatment with cenegermin eye drops was started. Results: After cenegermin therapy, a complete restoration of the corneal surface and an increase in visual acuity were achieved. Conclusions: The use of cenegermin is effective in treating pediatric NK.

Purpose: To evaluate the effect of ultraviolet A radiation on retinal function and structure after the corneal collagen crosslinking procedure. Methods: In the present prospective, single-center cohort study 17 eyes of 17 patients who underwent collagen crosslinking (Dresden protocol) for the treatment of corneal ectasia were examined preoperatively and at 2 and 6 weeks postoperatively with multifocal electroretinogram and optical coherence tomography. The P1 amplitude density (P1-AD) of the central retinal response was documented in 5 concentric rings, with ring 1 (R1) representing the foveal response and rings 2 to 5 (R2–R5) corresponding to successive annuli of stimulation. Visual acuity, corneal densitometry at the 0 to 2 mm zone and at the 2 to 6 mm annulus, and macular thickness (MT; central, 1 mm, 3 mm, and 5 mm zones) were recorded. Results: The preoperative values of P1-AD were R1 = 109.96 ± 28.96, R2 = 49.8 ± 14.46, R3 = 29.85 ± 8.9, R4 = 19.33 ± 6.3, and R5 = 16.39 ± 5.48 nV/deg2. At 2 weeks, these values were R1 = 77.54 ± 24.47, R2 = 36.55 ± 12.53, R3 = 21.53 ± 7.71, R4 = 15.3 ± 6.13, and R5 = 13.32 ± 5.48, showing a significant reduction for R1-R4 (P ≤ 0.026). The 6-week P1-AD was R1 = 99.8 ± 31.23, R2 = 40.67 ± 16.39, R3 = 24.98 ± 7.13, R4 = 16.35 ± 4.84, and R5 = 13.76 ± 3.98, showing no significant differences compared with preoperative values (P ≥ 0.054). Corneal densitometry increased significantly at 2 weeks (P < 0.001) and remained increased at 6 weeks (P < 0.001), showing statistically insignificant correlations with 2-week P1-AD (P ≥ 0.553). The central MT increased (P = 0.787), whereas MT at 1 mm (P = 0.444), 3 mm (P = 0.039), and 5 mm (P < 0.001) zones decreased. Conclusions: The return of P1-AD to preoperative (physiologic) values at 6 weeks confirms the safety standards of the duration and intensity of ultraviolet A radiation, as proposed by the Dresden protocol. However, temporary postoperative retinal dysfunction cannot be excluded.

In children, ONH of highly hyperopic eyes are smaller than those of emmetropic eyes. RNFL thickness and neural rim volume are similar to emmetropic eyes. They can therefore appear more crowded.

An 8 years old male presented to our clinic with dry eye symptomes. Different therapiy attemps were made in the last few months and did not lead to any improvement. Examining this patient revealed multiple signs of vitamin A deficiency, which could confirmed by laboratory examination. The initial substitution of vitamin A led to a fast rehabilitation and a following nutrition consulting kept the patient symptom-free over 6 month follow up. Vitamin A deficiency -although rare in the developed countries- is an importent differential diagnosis of the dry eye especially in children. Vitamin A deficiency not only causes ocular manifistaion, but also general symptoms. Dietary change and initial subtitution is the key element for a fast and sustaining improvement.