From post-war reconstruction to the 21st century – Ophthalmic pathology in Freiburg 1945-2015. Part 2: Review of 43,169 histological diagnoses from 39,256 specimens collected over 71 years at a large German tertiary eye care centre

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.