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Absztrakt: A solaris retinopathia a fotoreceptorok és a retina pigmentepitheliumának ultraibolya (UV) fény okozta fotokémiai és termikus károsodása. A behatás következtében a leggyakoribb panaszok között a visuscsökkenés, a homályos látás és a pozitív scotomák szerepelnek. A diagnózis alkotásában az optikai koherencia tomográfia (OCT), a mikroperimetria és a fluoreszcein angiográfia (FLAG) nyújt segítséget. A szerzők egy 18 éves férfi esetét mutatják be, aki prolongált napfény-expozíció után jelentkezett a Semmelweis Egyetem Szemészeti Klinikáján, mindkét szemet érintő centralis scotoma miatt. Az OCT-felvételeken a retina egyes rétegeiben folytonossághiányt és reflexiófokozódást figyeltünk meg, míg mikroperimetriás vizsgálattal a laesióknak megfelelően érzékenységcsökkenés volt tapasztalható. A féléves követés során a jobb retina folytonossághiánya csökkent, míg a bal oldal teljes restitúciót mutatott. A mikroperimetriás lelet az OCT-n látottakkal korrelált. A beteg szubjektív panasza a jobb szemén minimálisra csökkent, mindennapi életét nem korlátozza, a bal szemére megszűnt. A solaris retinopathiának jelenleg specifikus terápiája nincs. A panaszok és az eltérések kedvező esetben 3–6 hónap alatt normalizálódnak, ez felhívja a figyelmet a megfelelő tájékoztatás és a prevenció szerepére. Orv Hetil. 2020; 161(16): 632–636.

Abstract: Retinal arterial occlusion causes acute, painless vision loss, and it requires immediate emergency care. There are two separate arterial systems (retinal and ciliary) in the retina, and in most cases only the central retinal artery and its branches supply blood to the inner retinal layers. Cilioretinal artery is an anatomical variant, which can also supply blood to the macula from the ciliary arterial system, and in the case of a retinal arterial occlusion, the cilioretinal artery could save central vision. We report a case of a 67-year-old woman who suffered a central retinal arterial occlusion while having a patent cilioretinal artery and she had a complete recovery of her central visual acuity. A series of fundus photography and optical coherence tomography images are presented that were taken during follow-up. The patient’s complaints started one week before she presented in our department therefore acute therapy was not given. However, during the course of the follow-up her status gradually improved, and she finally regained 1,0 (20/20) visual acuity. In the presence of a cilioretinal artery following a central retinal arterial occlusion, there is a chance of visual acuity preservation. Orv Hetil. 2019; 160(29): 1146–1152.

The aim of this study was to report the findings from enhanced depth imaging (EDI) and swept-source optical coherence tomography (OCT) in a choroidal osteoma. A case study of a patient with choroidal osteoma is presented and discussed. A 25-year-old woman presented with an asymptomatic peripapillary mass. Fundus examination revealed a yellow–orange, well-defined geographical lesion. B‑scan ultrasonography, corroborated by fundus autofluorescence (FAF) and OCT findings, pointed to the diagnosis of choroidal osteoma. Calcified areas of the tumor were iso-autofluorescent on FAF and hyporeflective on OCT, revealing the morphological patterns of cancellous bone, including a sponge-like pattern and lines indicating lamellae, Haversian canals, and cement lines. Decalcified patches of the tumor were hypofluorescent on FAF and hyperreflective on OCT and showed overlying retinal damage—most prominently depigmentation and retinal pigment epithelium disruptions. A central area of the tumor revealed unusual characteristics; hyperreflectivity on OCT indicating decalcification but isofluorescence on FAF and sharing the same color as the rest of the retina on fundus photography. The area also differed from the other decalcified areas with its cumulus cloud-like appearance. Compared with EDI-OCT, SS-OCT images showed some increased definition of the bony features of the tumor, especially in its deeper layers, as well as a mild reduction of the shadowing caused by overlying retinal vessels. The morphological features of a choroidal osteoma are demonstrated using EDI- and SS-OCT. Calcified and decalcified areas of the tumor were differentiated, as well as another area showing unexpected characteristics. In our case, SS-OCT imaging revealed very similar features to EDI-OCT.

Solar retinopathy is the photochemical and thermic injury of the retinal photoreceptors and the pigment epithelium caused by ultraviolet (UV) radiation. As a consequence, the most common symptoms are visual acuity deterioration, blurred vision and positive scotoma. Optical coherence tomography (OCT), microperimetry and fluorescein angiography (FLA) are helpful in determining the diagnosis. Authors present an 18-year-old male having central scotomas affecting both eyes who presented at the Department of Ophtalmology of Semmelweis University. OCT scans revealed a localised defect and hyperreflectivity of certain retinal layers and microperimetry examination detected decreased retinal sensitivity consistent with the lesions. After a follow-up of 6 months, the defect of the right eye became more subtle and the one on the left disappeared completely. Microperimetry results correlated with OCT findings. Subjective symptoms on the right eye decreased significantly and they do not affect his daily life anymore, symptoms on the left eye discontinued. Currently, no specific therapy exists for solar retinopathy. Symptoms and defects in favourable cases normalise in 3–6 months which highlights the importance of public health education and prevention. Orv Hetil. 2020; 161(16): 632–636.A solaris retinopathia a fotoreceptorok és a retina pigmentepitheliumának ultraibolya (UV) fény okozta fotokémiai és termikus károsodása. A behatás következtében a leggyakoribb panaszok között a visuscsökkenés, a homályos látás és a pozitív scotomák szerepelnek. A diagnózis alkotásában az optikai koherencia tomográfia (OCT), a mikroperimetria és a fluoreszcein angiográfia (FLAG) nyújt segítséget. A szerzők egy 18 éves férfi esetét mutatják be, aki prolongált napfény-expozíció után jelentkezett a Semmelweis Egyetem Szemészeti Klinikáján, mindkét szemet érintő centralis scotoma miatt. Az OCT-felvételeken a retina egyes rétegeiben folytonossághiányt és reflexiófokozódást figyeltünk meg, míg mikroperimetriás vizsgálattal a laesióknak megfelelően érzékenységcsökkenés volt tapasztalható. A féléves követés során a jobb retina folytonossághiánya csökkent, míg a bal oldal teljes restitúciót mutatott. A mikroperimetriás lelet az OCT-n látottakkal korrelált. A beteg szubjektív panasza a jobb szemén minimálisra csökkent, mindennapi életét nem korlátozza, a bal szemére megszűnt. A solaris retinopathiának jelenleg specifikus terápiája nincs. A panaszok és az eltérések kedvező esetben 3–6 hónap alatt normalizálódnak, ez felhívja a figyelmet a megfelelő tájékoztatás és a prevenció szerepére. Orv Hetil. 2020; 161(16): 632–636.

Introduction: Measurement of central critical flicker-fusion frequency is a common screening test for eye diseases and additionally it can serve as a useful diagnostic test in numerous neurological and internal diseases. The test might also be used for monitoring purposes. Aim: The aim of the authors was to evaluate a digital central critical flicker-fusion frequency measuring device (IMEA ADR III) in 30 young, healthy Hungarian subjects. Method: After a general ophthalmological screening examination, monocular central critical flicker-fusion frequency was measured with four colours. Measurements were carried out on two separate days in three sessions under standardized conditions. Intrasession, intersession and intervisit variabilities, differences in central critical flicker-fusion frequency using the four colours and the effect of certain other influencing factors were determined. Results: There were no statistically significant differences between sessions in the mean and standard deviation of the measurement sets. The central critical flicker-fusion frequency threshold for red colour was significantly lower than for other colours, and the threshold for blue colour was significantly lower than for green. There were no significant differences regarding sex, age, iris colour, and smoking indicating that these factors did not influence the central critical flicker-fusion frequency threshold in these subjects. Conclusions: Measurement results with the device are reliable and reproducible in healthy, young population in separate sessions. Orv. Hetil., 2016, 157(27), 1079–1086.

Retinal cavernous hemangiomas are rare, benign, usually unilateral hamartomas. Retinal features have been extensively studied previously. The exact pathogenesis of this disease is still unknown, and there are no reports that suggest hormonal associations. We describe a case of retinal cavernous hemangioma of a young body-builder who had taken anabolic steroids. A 32-year-old healthy man was examined. In his previously active body-builder career, he had taken an unknown dose of anabolic steroids for an unknown duration. The patient presented with best-corrected visual acuity of 20/20 on both eyes. Fundus examination of the right eye revealed a 4–5 optic disc diameter-sized thickened and folded retina at the mid-periphery. The lesion exhibited dilated vessels, numerous saccular aneurisms, dot-shaped intraretinal hemorrhages, and fibrosis. Fluorescein angiography showed delayed arterial filling, capillary dropout, and aneurismal changes with hyperfluorescence of the upper portion of the saccules with blockage in the inferior portion from the sedimented blood cells. After summarizing the findings, the diagnosis of cavernous hemangioma was made. Steroid intake was the sole potential contributing factor to the disease in our patient’s medical history. Not excluding the possibility that this might be a coincidental finding, this potential link might need further investigations.

To evaluate the macular thickness, choroidal thickness, and visual acuity changes in eyes of patients with bilateral chronic central serous chorioretinopathy during eplerenone treatment.This prospective clinical trial was conducted on patients with bilateral chronic central serous chorioretinopathy, who had subretinal fluid (SRF) in 1 eye. Twenty-eight patients were treated with 50 mg/day of oral eplerenone for 3 months and were observed for another 3 months. Twenty-eight eyes with SRF were compared with the 28 fellow eyes with pachychoroid pigment epitheliopathy.The central macular and choroidal thickness showed a significant decrease (P0.005) at 3 months in all eyes, but change in choroidal thickness was smaller in nonexudative fellow eyes (P0.05 at 6 months). In the exudative eyes, the decrease in choroidal thickness showed a significant correlation with the resolution of SRF (P0.001). Visual acuity remained stable in all eyes, with significant improvement only in exudative eyes at 6 months (P0.005). Baseline choroidal thickness was a significant positive predictor for SRF decrease (P = 0.003).Patients with chronic central serous chorioretinopathy can safely be treated with eplerenone as it can reverse choroidal vasodilation with an accompanying resolution of the SRF and improvement in visual acuity. These beneficial therapeutic effects are more pronounced in the exudative eyes.

Measurement of central critical flicker-fusion frequency is a common screening test for eye diseases and additionally it can serve as a useful diagnostic test in numerous neurological and internal diseases. The test might also be used for monitoring purposes.The aim of the authors was to evaluate a digital central critical flicker-fusion frequency measuring device (IMEA ADR III) in 30 young, healthy Hungarian subjects.After a general ophthalmological screening examination, monocular central critical flicker-fusion frequency was measured with four colours. Measurements were carried out on two separate days in three sessions under standardized conditions. Intrasession, intersession and intervisit variabilities, differences in central critical flicker-fusion frequency using the four colours and the effect of certain other influencing factors were determined.There were no statistically significant differences between sessions in the mean and standard deviation of the measurement sets. The central critical flicker-fusion frequency threshold for red colour was significantly lower than for other colours, and the threshold for blue colour was significantly lower than for green. There were no significant differences regarding sex, age, iris colour, and smoking indicating that these factors did not influence the central critical flicker-fusion frequency threshold in these subjects.Measurement results with the device are reliable and reproducible in healthy, young population in separate sessions.

Purpose To introduce the first Hungarian patients with genetically defined Leber congenital amaurosis (LCA) and to report 2 novel mutations. Methods Seven otherwise healthy patients (4-29 years, 5 male and 2 female) who had an onset of severe visual impairment before age 2 years were investigated. The diagnosis was established in all individuals by medical history, funduscopy, and full-field electroretinogram (ERG). Ocular examination included visual acuity testing, digital fundus photography, and in 6 patients retinal imaging with optical coherence tomography (OCT). Arrayed primer extension microarray screening was performed in all probands. In 2 patients, further Sanger sequencing and targeted next-generation sequencing revealed the second disease allele. Results A cone-rod type LCA was revealed in 4 patients and a rod-cone type disease in 3 patients. Five patients presented with maculopathy. Optical coherence tomography (OCT) imaging showed diffuse retinal thickening in 3 probands with severe macular atrophy in one. Full-field ERGs were undetectable or residual in all patients. Genetic screening revealed AIPL1, CRB1, and CEP290 gene-related pathology in 6 patients; in 1 proband, no mutation was found. Three homozygous and 3 compound heterozygous mutations were identified. Two novel variants were detected: c.2536G>T (p.G846X) in the CRB1 gene and c.4929delA (p.Lys1643fsX2) in the CEP290 gene. Conclusions Genetic subtypes identified are among the most common ones in LCA; the phenotypes are consistent with those reported previously. Both novel mutations are predicted to result in a premature translation termination. The phenotype related to the novel CRB1 mutation results in severe atrophic maculopathy.

Choroidal folds present as parallel bright and dark lines, which may be detected with funduscopy. Optical coherence tomography, red free fundus photography, autofluorescence and fluorescein angiography may be also helpful to establish the diagnosis. The authors present the case of a 70-year-old male who was evaluated because of a 1-month history of blurred vision on his right eye. Dilated fundus examination revealed choroidal folds in both eyes, which failed to affect visual acuity. No neurological pathologies were found. There was no change in the patient condition during a follow-up period of 6 months. The authors note that choroidal folds are often not recognized because they are usually asymptomatic. There are several possible causes which should be considered. The diagnosis of idiopathic choroidal folds is based on the exclusion of other pathologies. Observation of the patient's visual acuity and monitoring for fundus changes are needed.A choroidearedők a szemfenéki vizsgálat során világos és sötét vonalakként megjelenő párhuzamos csíkokként ismerhetők fel. A diagnózis megállapítását az optikai koherencia tomográfia, a vörösmentes szemfenéki fotó, az autofluoreszcencia, valamint a fluoreszcein-angiográfia segítheti. A szerzők 70 éves férfi betegük esetét ismertetik, akit 1 hónapja fennálló jobb oldali látáspanasz miatt vizsgáltak. Pupillatágítást követő fundusvizsgálaton mindkét oldalon choroidearedőket észleltek. A choroidearedők a beteg látóélességét nem befolyásolták. Neurológiai kivizsgálás során nem találtak kóros neurológiai eltérést. A beteget 6 hónapig követték, ez idő alatt változás nem következett be. A szerzők kiemelik, hogy a choroidearedők gyakran nem kerülnek felfedezése, mert legtöbbször tünetmentesek. Etiológiájában számos ok felmerülhet, ezért az idiopathiás choroidearedő diagnózisa egyéb patológiás eltérések kizárásán alapul. A követés során a látóélesség és a szemfenéki kép ellenőrzése szükséges. Orv. Hetil., 2014, 155(27), 1083–1086.

To report ocular symptoms and optical coherence tomography (OCT) features of polyneuropathy, organomegaly, endocrinopathy, monoclonal gammopathy, and skin changes (POEMS) syndrome.Case report of two Caucasian patients with POEMS, one of whom also had multicentric Castleman disease.Both patients presented with edema on both optic disks, bilateral macular edema was seen in case 1, and peripapillary choroidal neovascularization was seen on the right side in case 2. OCT confirmed papilledema involving all retinal layers, with additional bilateral peripapillary serous retinal detachment involving the macula in both cases, and peripapillary CNV in case 2. Changes in retinal nerve fiber layer thickness, total peripapillary retinal thickness, and macular detachment were followed with OCT over the course of the disease and after administration of systemic therapy.OCT examination of the optic nerve head and the macula has an important additional role in the diagnosis and follow-up of POEMS syndrome and Castleman disease.

To compare macular thickness measurements with spectral-domain (Cirrus HD-OCT) and time-domain (StratusOCT) optical coherence tomography.Macular thickness was measured in nine ETDRS subfields in the same eye of 20 healthy subjects using both instruments. Using Cirrus HD-OCT both the Macular Cube 512×128 and Macular Cube 200×200 protocol, using StratusOCT the Fast Macular Thickness Map protocol was performed. Reproducibility of all three measurement series was assessed and the average of the measurement series was compared on each field.Measurement values obtained by StratusOCT were significantly lower than those obtained by Cirrus HD-OCT (p0.001) in all subfields. Correlation coefficient between the results obtained by the two protocols of Cirrus HD-OCT was 0.977.By using Cirrus HD-OCT we could observe better repeatability than with StratusOCT. Using Cirrus HD-OCT significantly higher measurement values could be obtained in all subfields than those measured with Stratus. Using different OCT instruments we get significantly different values, therefore care needs to be taken when comparing data.Célkitűzés: Retinavastagság-értékek összehasonlítása spectral-domain (Cirrus HD-OCT) és time-domain (Stratus OCT) optikai koherencia tomográfiás készülékkel. Módszer: Retinavastagság-mérések történtek a kilenc ETDRS macularis almezőben 20 egészséges személy azonos oldali szemén mindkét készülékkel. A Cirrus HD-OCT esetében a Macular Cube 512×128 és a Macular Cube 200×200 protokollt, a Stratus OCT készülékkel a Fast Macular Thickness Map protokollt használtuk. Vizsgáltuk mindhárom mérési sorozat reprodukálhatóságát, és a mérések átlagértékeit minden almezőben összehasonlítottuk egymással. Eredmények: A Stratus OCT-vel végzett mérési eredmények minden almezőben szignifikánsan alacsonyabbak voltak, mint a Cirrus esetében (p0,001). A Cirrus HD-OCT két különböző protokolljával végzett mérések eredményei között a korrelációs együttható 0,977 volt. Következtetések: A Cirrus HD-OCT használatával lényegesen jobb reprodukálhatóságot figyeltünk meg, mint a Stratus OCT esetében. A Cirrus HD-OCT használatával a mérési értékek szignifikánsan magasabbak minden almezőben, mint a Stratus OCT esetében. Különböző OCT-készülékek használatával jelentősen különböző mérési eredményekhez juthatunk, ezért az adatok összehasonlításakor óvatosság szükséges. Orv. Hetil., 154(52), 2059–2064.

BACKGROUND AND OBJECTIVE: To study the incidence of boundary detection errors produced by optical coherence tomography measurements in patients with diabetic retinopathy. PATIENTS AND METHODS: One hundred sixteen eyes with diabetic retinopathy of 64 consecutive patients with diabetes mellitus were included in this retrospective study. The StratusOCT instrument (Carl Zeiss Meditec, Dublin, CA) with the macular thickness map protocol was used for the examinations. After data acquisition, each scan was analyzed using the retinal thickness (single eye) protocol to evaluate whether there was any misdetection of the retinal boundaries. RESULTS: Boundary detection errors were found in 35.3% of eyes. The majority of artifacts were those caused by hard exudates (41.5%), followed by cystoid macular edema (31.7%) and proliferation (17.0%). CONCLUSION: Occurrence of artifacts with optical coherence tomography measurements in cases of diabetic retinopathy is not a rare phenomenon and verification of quantitative measurements is strongly recommended. [Ophthalmic Surg Lasers Imaging 2010;41:54–59.]

Purpose To clarify the origin of the coexisting fluid in an optic disc pit case by using optical coherence tomography (OCT). Methods High resolution OCT (Cirrus™ prototype, Carl Zeiss Meditec) was used for image acquisition; three dimensional segmentation was performed using Food and Drug Administration–approved imaging software (3D-Doctor V4.0, Able software Corp., Lexington, MA) to demonstrate the structural changes of the optic nerve head and the retina. Results Using high resolution OCT, the authors demonstrated that this case of optic pit had a possible connection between the subretinal and the intraretinal space. Conclusions The authors assume that the intraretinal space is progressively filled with subarachnoidal fluid, leading to a tearing force within the outer neurosensory layers. A connection between the outer nuclear layer and the subretinal space may lead to a serous retinal detachment as a secondary event. Vision loss could consecutively be induced by a serous retinal detachment. High resolution OCT technology is able to visualize discrete changes of the microarchitecture of the optic nerve as well as the retina when combined with appropriate imaging software.

PurposeTo compare central corneal thickness measurements made using two different methods, optical coherence tomography (OCT) and ultrasound pachymetry, applied both in normal eyes and in eyes on which photorefractive keratectomy (PRK) had been performed. A second objective was to assess the intrasession variability of OCT measurements.MethodsIn this prospective study, central corneal thickness was measured in 20 normal subjects (normal group) and in 20 PRK patients using the StratusOCT instrument model 3000 (Carl Zeiss Meditec), and also with an ultrasound pachymeter. Five OCT measurements were performed using the Fast Macular Thickness protocol. Corneal thickness data were obtained with the Scan Profile analysis protocol. The OCT measurement results were compared with the mean value of three ultrasound pachymetry measurements for the same eye.ResultsThe pachymetry–OCT correlation coefficients were 0.96 and 0.97 in the normal and PRK groups, respectively (p=0.14). Neither linear regression nor Bland-Altmann analysis revealed any significant systematic measurement error. Intrasession standard deviations in the normal and PRK groups were 4.9 μm and 3.8 μm, respectively.ConclusionsNoncontact central corneal thickness measurements made using the StratusOCT instrument are accurate and reproducible, both in normal subjects and in post-PRK patients. The instrument system does not need any modifications to correctly detect and measure the center of the cornea.

Purpose To correlate leakage patterns in fluorescein angiography (FA) images and retinal morphologic features in high-definition optical coherence tomography (HD OCT) images in diabetic macular edema. Design Prospective pilot study and case series. Participants Nine consecutive patients (10 eyes) with diabetic macular edema. Methods All patients were examined using FA (HRA 2; Heidelberg Engineering) and HD OCT (Carl Zeiss Meditec; resolution, 512×128 pixels, 5.8×5.8 mm, and high-resolution scans consisting of 4096 A scans) on the same day. Using Adobe Photoshop (CS2 Version 9.0; Adobe Systems Incorporated, San Jose, CA) a grid containing 15×7 fields was superimposed on the HD OCT en face image and a late-phase FA image according to retinal landmarks. In each patient, a standardized analysis of 105 subfields was performed to provide a characterization of the type of vascular leakage in FA and the associated retinal morphologic changes in corresponding locations. Main Outcome Measures Angiographic leakage type and structural alteration in retinal morphologic features in OCT. Results There was a high consistency between FA and OCT in the petaloid pattern of hyperfluorescence that correlated with the presence of large cystic spaces in the outer nuclear layer (ONL) and the outer plexiform layer (OPL) with or without subretinal fluid in 30.4% and 69.6% of graded fields, respectively. A honeycomblike pattern of hyperfluorescence was associated with swelling and cystic spaces in ONL, OPL, the inner nuclear, and the inner plexiform layer in 71.4% of graded fields. Diffuse patterns of hyperfluorescence did not correlate with characteristic retinal changes in HD OCT, but rather showed diversity in the type of morphologic alteration. The presence of central fluid pooling, such as subretinal fluid, could be identified only by HD OCT and not by FA. Conclusions In the examined patients, a petaloid pattern and a honeycomb pattern of hyperfluorescence observed in FA were found to correlate to characteristic changes in HD OCT, whereas a diffuse leakage pattern was associated with nonuniform changes in retinal morphologic features. Financial Disclosure(s) The author(s) have no proprietary or commercial interest in any materials discussed in this article.