Aims To determine the prevalence and clinicopathological features of malignant melanocytic lesions in specimens clinically diagnosed as pterygia.Methods This retrospective study analysed all conjunctival specimens submitted with the clinical diagnosis 'pterygium' to the ophthalmic pathology laboratory of the Eye Center, University of Freiburg, Germany, between August 1999 and August 2024. Specimens that unexpectedly revealed a histopathological diagnosis of malignant melanocytic lesions were further reviewed for their clinical and pathological characteristics.Results Among 2298 clinically presumed pterygia, seven specimens (0.30%) harboured a malignant melanocytic lesion: four (0.17%) were invasive conjunctival melanomas and three (0.13%) were high-grade conjunctival melanocytic intraepithelial lesions (C-MIL). Three of four melanomas were amelanotic or hypomelanotic (75%) or exhibited atypical temporal localisation (75%).Conclusion Malignant melanocytic lesions, though rare, may arise within or mimic pterygia. Their often amelanotic presentation can complicate clinical recognition. Routine histopathological evaluation of all excised pterygia is therefore essential to detect unexpected malignancies as conjunctival melanoma C-MIL.

Abstract:BACKGROUND: Malignant eyelid tumors are the most frequent malignant tumors in ophthalmology. They threaten the patients' vision and, if not treated adequately, even the patients' life. Complete resection of the tumor is the standard of care, but poses unique surgical challenges, due to the anatomical and functional importance of the eyelid region. Abstract:MATERIAL AND METHODS: We retrospectively analyzed data of 1,443 consecutive patients with malignant eyelid tumors who were treated at the Eye Center, Medical Center - University of Freiburg between 2009 and 2019. Data were collected on tumor type, post-excisional size of the lid defect, frequency of re-excisions and reconstructive effort regarding surgical duration and complexity. Reconstructive duration was categorized by the time required for eyelid reconstruction and the complexity of the reconstructive procedures, as based on the operation and procedure codes (OPS). Abstract:RESULTS: The largest mean defect size (MDS) was seen in cases of malignant melanoma (MDS: 560 mm2 (95% CI: 290 - 992 mm2). Re-excisions were most common in SGC (71%), then SCC and LM (both 53%). Regarding reconstruction duration, most patients (74%) required 30 - 90 minutes, with a minority needing less than 30 minutes (21%) or more than 90 minutes (5%). Reconstructive complexity was predominantly intermediate (54%), with 22% requiring low and 24% high reconstructive complexity. Abstract:CONCLUSIONS: The majority of malignant eyelid tumor reconstructions can be managed with surgical procedures that typically last between 30 and 90 minutes and have intermediate complexity, but surgeons must maintain expertise in complex reconstruction techniques for challenging cases.

Ophthalmic pathology is essential for diagnosing ocular diseases, correlating clinical and histopathological findings, and advancing research. The Eye Center at the University of Freiburg, Germany, has archived histopathological specimens since 1945, offering a unique resource to analyse long-term diagnostic trends. This study examines 43,169 diagnoses from 39,256 specimens over 71 years (1945–2015), providing insights into the evolution of ophthalmic pathology at a major tertiary care centre. We performed a retrospective analysis of all archived ophthalmic pathology reports, categorising specimens by anatomical region and recording diagnoses, patient age and surgery dates. Data were analysed mostly in 10-year intervals, with annual sub-analyses for the four most frequent sites. Statistical parameters assessed changes in diagnostic frequency, patient demographics, and age-related trends. Results were compared with 38 international studies to contextualise findings. The eyelid was the most common site (50

BACKGROUND:To characterize different growth patterns of retinal hemangioblastomas (RHs) in patients with von Hippel-Lindau disease (VHLD) using swept-source optical coherence tomography angiography (SS-OCTA). METHODS:Single-center observational cross-sectional study. SS-OCTA B-scans were centered over primary treatment-naïve RHs to display the perfusion in the inner, middle, and outer areas (IA, MA, OA). Distinctive growth patterns were characterized using K-means cluster analysis of the flow signal. RESULTS:Annual screening of 201 patients with VHLD revealed 49 patients with 85 RHs (41 recurrent, 44 primary treatment-naïve RHs). High-quality SS-OCTA images were available for 24 primary RHs and were pooled with scans of the treatment-naïve form of 6 recurrent RHs, which were taken at a prior visit, for further analysis. Out of 30 primary RHs, 18 were located juxtapapillary (jRH) and 12 peripherally (pRH). K-means cluster analysis distinguished seven exophytic (23.3%, 2 jRH, 5 pRH), nine endophytic (30%, 6 jRH, 3 pRH), and fourteen sessile (46.7%, 10 jRH, 4 pRH) growth patterns. Fractions of the flow signal in the IA, MA, and OA were 7.3 ± 3.3%, 89.3 ± 5.0%, and 3.4 ± 3.5% for exophytic RHs, 22.2 ± 7.4%, 65.6 ± 7.3%, and 12.1 ± 8.2% for sessile RHs, and 65.4 ± 5.7%, 26.6 ± 4.9%, and 8.0 ± 6.1% for endophytic RH. CONCLUSION:OCTA contributes to further elucidating the morphology of RHs as a useful complementary diagnostic tool that can help to provide customized therapeutic approaches in the future and thus improve the effectiveness of RH treatment.

Background Ophthalmic pathology is essential for diagnosing ocular diseases, correlating clinical and histopathological findings, and advancing research. The Eye Center at the University of Freiburg, Germany, has archived histopathological specimens since 1945, offering a unique resource to analyse long-term diagnostic trends. This study examines 43,169 diagnoses from 39,256 specimens over 71 years (1945–2015), providing insights into the evolution of ophthalmic pathology at a major tertiary care centre. Methods We performed a retrospective analysis of all archived ophthalmic pathology reports, categorising specimens by anatomical region and recording diagnoses, patient age and surgery dates. Data were analysed mostly in 10-year intervals, with annual sub-analyses for the four most frequent sites. Statistical parameters assessed changes in diagnostic frequency, patient demographics, and age-related trends. Results were compared with 38 international studies to contextualise findings. Results The eyelid was the most common site (50%), with chalazion (18%), basal cell carcinoma (BCC) (16%), and papilloma (16%) as the leading diagnoses. The cornea (17%) was dominated by Fuchs’ dystrophy (19%), keratoconus (13%), and keratitis (11%), while pterygium (29%) and nevus (12%) prevailed in the conjunctiva (14%). In the orbit (1.2%), inflammation (12%) and lymphoma (9.5%) were most frequent. Key trends included a rise in chalazion, Fuchs’ dystrophy, and pterygium, linked to surgical advancements (e.g., microsurgery, DMEK) and increased UV exposure. The age range of patients widened for most diagnoses, reflecting an aging population and broader surgical indications. A decline in squamous cell carcinoma (SCC) and younger age at BCC diagnosis suggest improved UV protection and earlier detection. Regional comparisons revealed higher rates of chalazion and BCC in Freiburg than in Asian cohorts, likely due to genetic and environmental factors. Conclusions This 71-year analysis highlights dynamic shifts in ophthalmic pathology, shaped by historical events, clinical progress, demographics, and environmental influences. The study emphasises the vital role of ophthalmologists in pathology, ensuring integrated clinical-histopathological expertise for accurate diagnoses and optimal patient outcomes. Our study data offer valuable insights into the frequency and evolving trends of the most common diagnoses over an extended period. These findings support future research in molecular diagnostics and global comparative studies, reinforcing the importance of ophthalmologist-led ophthalmic pathology in specialised eye care.

Ophthalmic pathology at the Eye Center at Medical Center, University of Freiburg, Germany, looks back on a tradition of more than 150 years. Surgical specimens and associated histological diagnoses have been archived since 1945. This study is the first of its size to include 39,256 specimens examined in a single ophthalmic pathology laboratory over 71 years. We retrospectively studied ophthalmic pathology reports and clinical records of histological specimens archived between 1945 and 2015 and compared our results with 22 studies from the literature. Samples were grouped by localisation and histopathological diagnoses assigned to various categories. Both were coded and entered into a database together with the year of surgery, patient sex and age at excision. The patients’ age at surgery was documented in 38,845 cases (99

Corneal dystrophies are inherited disorders that can lead to significant visual impairment and often require surgical intervention in advanced stages. Fuchs endothelial corneal dystrophy (FECD) is the most frequently diagnosed type in Western countries and remains a leading global indication for corneal transplantation. In contrast, non-Fuchs dystrophies represent a diverse group of less common entities, each with distinct clinical features, surgical considerations, and regional variations in incidence and management. Despite their relevance, long-term data on the full spectrum of corneal dystrophies remain scarce. This study aimed to evaluate the distribution and temporal trends in dystrophy types and associated surgical procedures over eight decades at a tertiary referral center in Germany. This retrospective analysis included 3 827 histopathologically confirmed corneal dystrophy specimens identified from an archive of 58 150 ophthalmic specimens collected between 1945 and 2024. Extracted data included dystrophy type, patient age at surgery, sex assigned at birth and associated surgical procedures. Distribution and temporal trends were analyzed descriptively. FECD accounted for 90.3

BACKGROUND:While the incidence of herpes zoster has been reported to exhibit seasonal patterns in different global regions, with some studies suggesting correlations with weather data, data specific to Germany has been lacking. We investigated the seasonality of herpes zoster incidence in Germany and compared weather data. PATIENTS AND METHODS:We conducted a single centre, interdisciplinary retrospective analysis of all herpes zoster cases at the Department of Dermatology and the Eye Centre from the Medical Centre, University of Freiburg from January 1st 2009 to December 31st 2022. 2,829 patients were identified using ICD-10 code B02.0 - 9. Monthly and cumulative daily incidences were calculated and plotted. Weather data were compared, including mean monthly temperature, sunshine duration, and UV-index. RESULTS:The analysis revealed two distinct incidence peaks: a summer peak correlating with weather factors, and an unexpected winter peak from late December through early January that did not correlate with the investigated weather parameters. CONCLUSIONS:Our findings suggest that weather factors, like temperature, and UV-index, influence the incidence of herpes zoster in Germany. The previously undescribed "new year spike" indicates that additional, non-meteorological factors may trigger herpes zoster reactivation. This study provides insights into herpes zoster epidemiology in Germany and highlights the need for further research into trigger factors.

Angle-closure glaucoma is a less common form of glaucoma in Europe than open-angle glaucoma. Nevertheless, the clinical picture should also be known here since it can lead to severe visual disturbances and even blindness within a short time. It is divided into primary and secondary forms and can be further categorized depending on the presence of a pupillary block. In all cases, therapy is initially based on resolving the cause of the angle-closure and treating any underlying disease that may be present. In addition, intraocular pressure reduction must be achieved. This can be effectuated conservatively or surgically. Depending on the specific subtype of angle-closure, different treatments are promising.

Background: The spectrum of conjunctival tumors in children and adolescents significantly differs from that of adults.Objective: The aim of this study was to show the distribution of histopathological diagnoses of pediatric conjunctival tumors.Material and methods: Retrospective case series including all conjunctival tumors of children and adolescents under 18 years of age examined histologically over a period of 25 years (1990-2015) at the Eye Center in Freiburg, Germany.Results: Among the 262 conjunctival specimens, the most common diagnoses were conjunctival nevi (148, [56%]), most often with junctional activity (106/148, [72%]), pyogenic granulomas (26, [10%]), and dermolipomas (18, [7%]). In one case a malignant tumor (conjunctival melanoma) was detected (1, < 1%).Conclusion: The results suggest that pediatric conjunctival tumors are benign in most cases. Most of them were of melanocytic origin, with a junctional conjunctival nevus being the most common diagnosis.

Angle-closure glaucoma is a less common form of glaucoma in Europe than open-angle glaucoma. Nevertheless, the clinical picture should also be known here since it can lead to severe visual disturbances and even blindness within a short time. It is divided into primary and secondary forms and can be further categorized depending on the presence of a pupillary block. In all cases, therapy is initially based on resolving the cause of the angle-closure and treating any underlying disease that may be present. In addition, intraocular pressure reduction must be achieved. This can be effectuated conservatively or surgically. Depending on the specific subtype of angle-closure, different treatments are promising.

We herein compare topical interferon alpha 2b (IFN-α2b) to topical mitomycin C (MMC) in the adjuvant management after excision of primary acquired melanosis with atypia (PAM) and melanoma of the conjunctiva/cornea (CM). We included 25 tumors from 25 patients (six with PAM and 19 with CM). After surgical excision, four patients started with adjuvant IFN-α2b (two in combination with radiotherapy), 19 with MMC, and two with radiotherapy alone. Five patients were switched from initial MMC/radiotherapy to IFN-α2b during follow-up. Efficacy was assessed via time to tumor recurrence and initial therapy response. With initial IFN-α2b, three patients (3/4, two with additional radiotherapy) showed complete remission (follow-up: 1478–1750 days) and one recurrence (1/4) was noted after 492 days. With initial MMC, no recurrence was recorded in 15 of the 19 patients (follow-up: 99–4732 days). Five patients were switched from MMC or radiotherapy to IFN-α2b: two patients showed complete remission (2/5), while another two (2/5) experienced recurrences and remained without recurrence after repeated courses of IFN-α2b (follow-up: 1798 and 1973 days). Only one patient showed incomplete response. Adverse effects were recorded in five patients, all received MMC. Topical IFN-α2b (arguably together with radiotherapy) may be a viable alternative to MMC in PAM and CM. We observed fewer side effects at similar response rates. However, when response to MMC was poor, IFN-α2b may also be of limited utility.

Background The symptoms of acute angle closure, an emergency event that can lead to irreversible blindness without timely treatment, are diverse. Initially, these can be interpreted as internal or neurological diseases if headaches, pupil rigidity or nausea are in the foreground. The aim of our study was to assess the rate of harming and invasive diagnostics after primary presentation of patients with acute primary angle closure to nonophthalmologists. Methods Retrospective single center study of patients with acute primary angle closure. To analyze these patients, all patients who were treated by surgical iridectomy (5-133.0) or iridotomy by laser (5-136.1) in the period 2014-2018 at the Eye Center at Medical Center, University of Freiburg (Germany), were identified. Subsequently, data analysis was carried out through file inspection to check the inclusion and exclusion criteria and the course of the disease. Results In total, 91 patients with acute primary angle closure were included. Of these, 28% (n = 25) initially presented to nonophthalmological disciplines. In this patient group 56% (n = 11) received nontargeted diagnostics, with cranial imaging in 32% (n = 8) and lumbar puncture in 8% (n = 2). Conclusion Acute primary angle closure is associated with a high rate of nontargeted diagnostics by nonophthalmologists. Therefore, the clinical picture of acute angle closure should be in mind across all disciplines. With unspecific symptoms such as headaches, nausea and vomiting as well as pupil rigidity, the possibility of an acute increase in intraocular pressure caused by acute angle closure must be considered and early consultation with an ophthalmologist is recommended.

BACKGROUND/AIMS:Retinal haemangioblastomas (RH) remain a major cause of visual impairment in patients with von Hippel-Lindau (VHL) disease. Identification of genotype-phenotype correlation is an important prerequisite for better management, treatment and prognosis.METHODS:Retrospective, single-centre cohort study of 200 VHL patients. Genetic data and date of onset of RH, central nervous system haemangioblastomas (CNSH), pheochromocytoma/paraganglioma (PPGL), clear cell renal cell carcinoma (ccRCC) and pancreatic neuroendocrine neoplasm (PNEN) were collected. The number and locations of RH were recorded.RESULTS:The first clinical finding occurred at an age of 26 ± 14 years (y) [mean ± SD]. In 91 ± 3% (95% CI 88-94) of the patients, at least one RH occur until the age of 60y. A total of 42 different rare VHL gene variants in 166 patients were detected. A higher age-related incidence of RH, CNSH, ccRCC and PNEN was detected in patients with a truncating variant (TV) compared to patients with a single amino-acid substitution/deletion (AASD) (all p < 0.01), while it is reverse for PPGL (p < 0.01). Patients with a TV showed 0.10 ± 0.15 RH per y during their lifetime compared to 0.05 ± 0.07 in patients with AASD (p < 0.02). The median enucleation/phthisis-free survival time in patients with a TV was 56y (95% CI 50-62) compared to 78y (95% CI 75-81) in patients with AASD (p < 0.02).CONCLUSION:Compared to patients with AASD, patients with a TV develop RH, CNSH, ccRCC and PNEN earlier. They experience a higher number of RH and bear a higher risk of enucleation/phthisis. Thus, patients with a TV might be considered for a more intensive ophthalmological monitoring.

Histologisch zeigte sich ein papillomatöser Tumor, welcher überwiegend aus basaloiden Zellen in der Epidermis bestand. Zudem lagen viele intrazellulären Melaningranula sowie eine Hyperund Parakeratose vor (. Abb. 1b). Dies sind die typischen histopathologischenMerkmale der klinischen Verdachtsdiagnose einer seborrhoischen Keratose. Überraschenderweise stellten sich jedoch innerhalb der seborrhoischen Keratose meh-

BACKGROUND:Acute closed-angle glaucoma has an incidence of 2.2-4.1 cases per 100 000 persons per year in Europe. It is an ophthalmological emergency in which markedly elevated intraocular pressure can damage vision permanently. Because the acute symptoms are not always clearly referable to the eyes, patients often present to physicians who are not ophthalmologists.METHODS:This review is based on pertinent articles retrieved by a selective search in PubMed.RESULTS:The diverse symptoms of acute closed-angle glaucoma include eye redness, worsening of vision and other visual disturbances, headache, and nausea. Acute closed-angle glaucoma has multiple causes. Not all predisposing factors have been definitively identified; above all, there are certain anatomical configurations of the eye that make it more likely to arise. The goals of treatment are to reduce the elevated intraocular pressure rapidly, which usually leads to marked symptom relief, as well as to eliminate the situation that led to closed-angle glaucoma. For proper treatment, the patient should be seen by an ophthalmologist without delay, on the day of symptom onset if possible.CONCLUSION:Primary prevention of acute closed-angle glaucoma is not always possible. Even physicians who are not ophthalmologists can diagnose markedly elevated intraocular pressure by palpation of the globe. Proper, specific treatment can help patients rapidly and lastingly.

Zusammenfassung Hintergrund Die Symptome des akuten Winkelblocks, ein Notfallereignis, das ohne rechtzeitige Therapie zur irreversiblen Erblindung führen kann, sind vielfältig. Diese können initial als internistische oder neurologische Erkrankungen gedeutet werden, wenn Kopfschmerzen, Pupillenstarre oder Übelkeit im Vordergrund stehen. Ziel unserer Studie war es, die Rate belastender und invasiver Diagnostik durch primäre Vorstellung bei Nichtophthalmologen bei akutem primären Winkelblock zu erfassen. Methode Retrospektive Single-Center-Studie von Patienten mit akutem primärem Winkelblock. Zur Identifizierung dieser wurden alle Patienten erfasst, bei denen im Universitätsklinikum Freiburg, Klinik für Augenheilkunde im Zeitraum 2014–2018 eine chirurgische Iridektomie (5-133.0) oder Iridotomie durch Laser (5-136.1) durchgeführt wurde. Anschließend erfolgte durch Akteneinsicht die Datenanalyse zur Prüfung der Ein- und Ausschlusskriterien sowie des Krankheitsverlaufs. Ergebnisse Eingeschlossen wurden 91 Patienten mit akutem primären Winkelblock. Davon stellten sich 28 % (n = 25) initial bei nichtophthalmologischen Fachdisziplinen vor. In dieser Patientengruppe erhielten 56 % (n = 11) eine nichtzielführende Diagnostik, wobei bei 32 % (n = 8) eine kraniale Bildgebung und bei 8 % (n = 2) eine Lumbalpunktion durchgeführt wurde. Schlussfolgerung Bei akutem primären Winkelblock zeigt sich eine hohe Rate an nicht wegweisender Diagnostik durch Nichtophthalmologen, weshalb dieses Krankheitsbild fächerübergreifend präsent sein sollte. Bei unspezifischen Symptomen, wie Kopfschmerzen, Übelkeit und Erbrechen sowie Pupillenstarre, muss an die Möglichkeit eines akuten Augeninnendruckanstiegs durch einen akuten Winkelblock gedacht und das frühzeitige Hinzuziehen eines Ophthalmologen erwogen werden.