Search

"AIM: To estimate the prevalence of blindness and visual impairment resulting from cataract in the population aged ≥50y in Hungary, and to assess the cataract surgical services. METHODS: A rapid assessment of avoidable blindness (RAAB) was conducted. A total of 3523 eligible people were randomly selected and examined. Each participant underwent surgery for cataract was interviewed with regard to the year, place, and costs of the surgery. Participants with obvious cataract were asked why they had not yet undergone surgery (barriers to surgery). RESULTS: An estimated 12 514 people were bilaterally blind; the visual acuity (VA) in 19 293 people was

Purpose. Keratoconus (KC) has been defined as a “noninflammatory” corneal disease, but recent studies have noted a potential inflammatory origin. We analysed the Ocular Surface Disease Index (OSDI) and ocular surface temperature (OST) in KC patients compared to controls.Patients and Methods. A total of 179 eyes in 90 patients with KC (topographic keratoconus classification 0-1 to 4, age 36.1 ± 12.5 years, 65.9% males) and 82 eyes in 41 controls (age 36.4 ± 12.8 years, 47.6% males) were examined. The participants completed the OSDI questionnaire and underwent corneal topography, tomography, and thermography. Additional outcome measures were vision- and discomfort-related OSDI subscores and mean OST at the corneal centre during 10 seconds of sustained eye opening after blinking.Results. The OSDI score (31.4 ± 22.4 vs. 17.5 ± 17.9) and vision- (17.7 ± 14.6 vs. 10.5 ± 13.2) and discomfort-related (14.3 ± 10.7 vs. 9.4 ± 10.5) OSDI subscores were significantly higher in KC patients than in controls (p<0.001). We found no significant difference in the central corneal OST (34.2 ± 0.6°C vs. 34.2 ± 0.7°C;p=0.41) between the two groups (p≥0.22). The OSDI score and subscores poorly to fairly correlated with the surface asymmetry index (SAI) and surface regularity index (SRI;r > 0.174,p<0.005), but did not correlate with the central corneal OST (r r ≥ −0.086).Conclusion. KC patients had increased OSDI scores and vision- and discomfort-related OSDI subscores without an increase in the OST compared to a normal population. OSDI score/subscores weakly correlate with SAI and SRI but do not correlate with OST in KC patients or controls. Vision- and discomfort-related symptoms of KC have to be managed in parallel in ophthalmological practice, but the necessity of anti-inflammatory treatment cannot be verified through ocular thermography.

Cystinosis is a rare lysosomal storage disease affecting amino acid metabolism, characterized by the accumulation and crystallization of cystine in various tissues, primarily in the eye and kidney. The major ophthalmic symptom is photophobia, which is related to the corneal deposition of cystine crystals. The light sensitivity significantly impairs the quality of life of the affected patients, thus, effective ophthalmic treatment to reduce the crystal density is very importance. In the current case report, we present the characteristic ocular clinical appearance and treatment options of cystinosis by reviewing the literature. A simple aqueous solution of cysteamine, which aids in the dissolution of crystals, has been widely used in topical treatment in the past, however, its therapeutic efficacy is debatable. Recently, a new viscous formulation of cysteamine has been proposed for ophthalmic treatment. For the treatment of corneal cystine crystals in our patient, the new viscous format of cysteamine has been applied, and therapeutic effects were recorded for a year. Applying the viscous cysteamine formulation, a marked and gradual decrease in photophobia was observed in our patient in the first year of the treatment. Anterior-segment optical coherence tomography and in vivo confocal microscopy represented a continuous decrease in the density of corneal crystals even from the first month of the treatment period. The aim of our case report is to present the ophthalmic symptoms of cystinosis and the results of the first clinical application of viscous formulation of cysteamin eye drops in Hungary in a cystinosis patient. Orv Hetil. 2022; 163(21): 846-852.A cystinosis ritka, aminosav-anyagcserét érintő, lizoszomális tárolási megbetegedés, melyben jellegzetes eltérés a cisztin felszaporodása és kikristályosodása a különböző szervekben, szövetekben, elsősorban a szemben és a vesében. Szemészeti vonatkozásban kiemelkedő jelentőségű a cisztinnek a corneában való lerakódása, ami nagyfokú fényérzékenység kialakulásához vezet. A kifejezett fényérzékenység jelentősen rontja az érintett páciensek életminőségét, így a kristályok mennyiségének csökkentését célzó hatékony szemészeti kezelés kiemelt szereppel bír. Esettanulmányunk kapcsán a szakirodalom áttekintésével mutatjuk be a cystinosis jellegzetes szemészeti klinikai megjelenését és kezelési lehetőségeit. A lokális kezelésben korábban széles körben alkalmazták a kristályok feloldását elősegítő ciszteamin egyszerű vizes oldatát, e készítmény terápiás hatékonysága azonban vitatott. Újabban a ciszteamin új, viszkózus oldatának alkalmazására nyílt lehetőség. A 29 éves férfi betegünknél a cornealis cisztinkristályok kezelésére viszkózus formátumú, ciszteamintartalmú készítményt vezettünk be, és ezt alkalmaztuk 1 éven át. Páciensünknél az új lokális szemcsepp használata mellett a kezelés megkezdését követő egy évben a fényérzékenység jelentős, fokozatos csökkenését figyeltük meg. Elülső szegmens optikaikoherencia-tomográfiás és in vivo konfokális mikroszkópos vizsgálatainkkal kimutatható volt a cornealis kristályok mennyiségének folyamatos csökkenése már az 1. hónaptól kezdve. Jelen közleményünk célja, hogy felhívja a figyelmet a cystinosis szemészeti tüneteire, illetve a Magyarországon elsőként alkalmazott, viszkózus formátumú ciszteaminkezelés hatékonyságára. Orv Hetil. 2022; 163(21): 846–852.

The 3D scanning of existing structures has become easily available nowadays for practicing structural engineers. The number of specialised companies to perform this service is in a constant rise, while the financial burden of the service is considered to be good value for money. The current study aims to present different methods of using 3D scanning in structural design processes, showing the importance of integrating innovative and new technologies in the day-to-day life of structural engineers. The presented applications of 3D scanning in structural design include load evaluation of existing structures, in order to determine the real loading or load carrying capacity reserves; measuring the construction imperfection and execution errors; mapping the surroundings of new constructions, if these are connected to non-uniform surfaces of existing structures; damage evaluation of steel elements in the aftermath of a fire, in order to determine the elements that could be reused during the rehabilitation process of the structure. The authors present real life examples from their structural design practice, concerning evaluation of different existing structures and rehabilitation projects of historical monuments.

Age-related macular degeneration (AMD) is a progressive neurodegenerative disease affecting the central area (macula lutea) of the retina. Research on the pathogenic mechanism of AMD showed complex cellular contribution governed by such risk factors as aging, genetic predisposition, diet, and lifestyle. Recent studies suggested that microbiota is a transducer and a modifier of risk factors for neurodegenerative diseases, and mitochondria may be one of the intracellular targets of microbial signaling molecules. This review explores studies supporting a new concept on the contribution of microbiota—mitochondria disorders to AMD. We discuss metabolic, vascular, immune, and neuronal mechanism in AMD as well as key alterations of photoreceptor cells, retinal pigment epithelium (RPE), Bruch’s membrane, choriocapillaris endothelial, immune, and neuronal cells. Special attention was paid to alterations of mitochondria contact sites (MCSs), an organelle network of mitochondria, endoplasmic reticulum, lipid droplets (LDs), and peroxisomes being documented based on our own electron microscopic findings from surgically removed human eyes. Morphometry of Bruch’s membrane lipids and proteoglycans has also been performed in early AMD and aged controls. Microbial metabolites (short-chain fatty acids, polyphenols, and secondary bile acids) and microbial compounds (lipopolysaccharide, peptidoglycan, and bacterial DNA)—now called postbiotics—in addition to local effects on resident microbiota and mucous membrane, regulate systemic metabolic, vascular, immune, and neuronal mechanisms in normal conditions and in various common diseases. We also discuss their antioxidant, anti-inflammatory, and metabolic effects as well as experimental and clinical observations on regulating the main processes of photoreceptor renewal, mitophagy, and autophagy in early AMD. These findings support an emerging concept that microbiota-mitochondria disorders may be a crucial pathogenic mechanism of early AMD; and similarly, to other age-related neurodegenerative diseases, new treatment approaches should be targeted at these disorders.

Despite the introduction of novel agents, multiple myeloma remains incurable for most patients, necessitating further therapeutic options. Venetoclax, a selective BCL-2 inhibitor, had shown promising results in patients with translocation t(11;14), but questions remain open about its optimal use. We have contacted all Hungarian haematology centers for their experience treating t(11;14) myeloma patients with venetoclax. 58 patients were reported. 37 received venetoclax in the relapsed/refractory setting with few or no other therapeutic options available. 21 patients started venetoclax as salvage after failing to achieve satisfactory response to first line therapy. In the relapsed/refractory setting objective response rate (ORR) was 94%, median progression-free survival (PFS) 10.0 months and median overall survival (OS) 14.6 months. In reinduction patients, ORR was 100%, median PFS and OS were not reached. Importantly, we found no adverse effect of high risk features such as deletion 17p or renal failure, in fact renal failure ameliorated in 42% of the cases, including three patients who became dialysis independent. Our study also reports the highest number of plasma cell leukemia cases successfully treated with venetoclax published in literature, with refractory plasma cell leukemia patients achieving a median PFS of 10.0 and a median OS of 12.2 months.

Introduction: Posterior segment diseases are the most common causes of blindness and visual impairment in devel-oped countries among people aged 50 years and older in Hungary. Objective: The purpose of this study was to estimate the prevalence of visual impairment and blindness caused by posterior segment diseases in the population aged 50 years and older in Hungary. Method: 105 census enumeration units were randomly selected with a probability proportional to size by the Hungar-ian Central Statistical Office. The standardised Rapid Assessment of Avoidable Blindness (RAAB) method was used. Participants underwent eye examination with a direct ophthalmoscope. Participants underwent visual acuity testing with a Snellen tumbling E-chart with or without a pinhole. Dilated fundus examination was performed in diabetic participants using an indirect binocular ophthalmoscope. Results: In total, 3523 (95.9%) out of 3675 eligible people were examined, of whom the prevalence of bilateral blind-ness and severe visual impairment was 0.7% and 0.2%, respectively. The most common causes of visual impairment caused by posterior segment diseases were age-related macular degeneration (1.419%), glaucoma (0.397%), diabetic retinopathy (0.341%) and rhegmatogenous retinal detachment (0.198%). The most common causes of blindness caused by posterior segment diseases were age-related macular degeneration (37.5%), glaucoma (16.7%), diabetic retinopathy (8.3%), high myopia (8.3%), rhegmatogenous retinal detachment (8.3%) and retinitis pigmentosa (8.3%). Conclusion: Prevalence of severe visual impairment and blindness caused by posterior segment diseases was lower compared to results of RAAB surveys in other countries. The frequency order of different posterior segment diseases was in line with developed countries. Availability of eye care should be improved and financing should be modernized due to the continuously increasing number of patients with age-related macular degeneration, glaucoma, diabetes and pathologic myopia.Összefoglaló. Bevezetés: A fejlett országok körében a hátsószegmens-betegségek számítanak a vakság és a gyengénlátás leggyakoribb okának az időskorú lakosság körében. Célkitűzés: Tanulmányunk célja a hátsószegmens-betegségek okozta látásromlás és vakság prevalenciájának meghatározása az 50 éves és annál idősebb korú lakosság körében Magyarországon. Módszer: A Központi Statisztikai Hivatal által kijelölt 105 lakókörzetben, az Elkerülhető Vakság Gyors Felmérése (Rapid Assessment of Avoidable Blindness; RAAB) metodika segítségével végeztük a vizsgálatokat. Minden résztvevőnél direkt szemtükörrel szemvizsgálatot végeztünk. A látóélességet egyszerűsített Snellen-tábla segítségével, stenop lyukkal, illetve a nélkül vizsgáltuk. A cukorbeteg résztvevőkön pupillatágítást és szemfenéki vizsgálatot végeztünk indirekt binokuláris oftalmoszkóppal. Eredmények: Összességében 3675 alkalmas résztvevőből 3523 (95,9%) személyt vizsgáltunk, akik között a hátsószegmens-betegségek következtében kialakult kétoldali vakság és súlyos látásromlás prevalenciája 0,7% és 0,2% volt. A hátsó szegmens betegségei miatt kialakult összes látásromlás leggyakoribb okai gyakorisági sorrendben (prevalenciaértékkel) a következők voltak: öregkori maculadegeneratio (1,419%), glaucoma (0,397%), diabeteses retinopathia (0,341%) és rhegmatogen ideghártya-leválás (0,198%). A hátsószegmens-betegség okozta vakság leggyakoribb okai az öregkori maculadegeneratio (37,5%), a glaucoma (16,7%), a diabeteses retinopathia (8,3%), a nagyfokú myopia (8,3%), a rhegmatogen retinaleválás (8,3%) és a retinitis pigmentosa (8,3%) voltak. Következtetés: Hazánkban a súlyos látásromláshoz és vaksághoz vezető hátsószegmens-betegségek előfordulási gyakorisága más, korábban RAAB-felmérést végzett országokéhoz képest alacsonyabb, az egyes kórképek gyakorisági sorrendje pedig a fejlett országokéhoz hasonló. Az öregkori maculadegeneratiós, glaucomás, cukorbeteg és patológiás myop páciensek folyamatosan növekvő száma miatt javítani kellene a szemészeti ellátás hozzáférhetőségén és modernizálni a finanszírozását. Orv Hetil. 2022; 163(16): 624–630.

Duchenne muscular dystrophy (DMD) is caused by X-linked inherited or de novo DMD gene mutations predominantly affecting males who develop early-onset muscle degeneration, severely affecting their quality of life and leading to reduced life expectancy. DMD patients may also develop proliferative retinopathy, cataract, ERG abnormalities, altered contrast sensitivity, color vision losses, and elevated flash detection thresholds during dark adaptation. Depending on the position of the genetic alteration in the large DMD gene, it is associated with a lack of the full-length dystrophin protein possibly with an additional loss of one or several other dystrophins, which are normally transcribed from internal promoters in retina and crystalline lens. During the last decades, the properties of the dystrophins have been characterized in patients with different genetic alterations and in genetic mouse models of DMD. The complex expression pattern of the dystrophins in photoreceptors, Müller glial cells and astrocytes, likely influences synaptic transmission, ionic balance and vascular integrity of the retina. However, the specific function of each retinal dystrophin remains largely unknown. This review describes the current knowledge on dystrophin expression, the putative molecular, structural, and physiological properties of retinal dystrophins, and the main clinical implications associated with the loss of dystrophins in DMD patients and mouse models. Current data and working hypotheses warrant future research on retinal dystrophins to increase our understanding of dystrophin function in the central nervous system in general and to unveil new retinal mechanisms and therapeutic avenues for retinal diseases.

Background Our aim was to determine associations of pachymetry, keratometry, and their changes with haze formation and corneal flattening after collagen cross-linking, and to analyse the relationship between postoperative haze and visual outcome. Methods Retrospective analysis was performed on 47 eyes of 47 patients with keratoconus using the Pentacam HR Scheimpflug camera before and 1, 3, 6 and 12 months after cross-linking. Corneal backscattered light values in grey scale unit were recorded in the anterior, center and posterior corneal layers and in four concentric rings. Surface area- and thickness-corrected grey scale unit values were assessed with an additional calculation. Friedman test with post hoc Wilcoxon signed-rank test was used to analyse changes in visual acuity, pachymetry, keratometry and densitometry. Spearman’s rank correlation test was used to detect correlations of haze formation and corneal flattening with pachymetry, keratometry and their postoperative change. Generalized estimating equations analysis was used to investigate the influence of densitometry values on postoperative visual acuity after controlling for the effect of preoperative keratometry. Results One year after treatment, significant flattening was observed in maximum and mean keratometry readings (p p R = 0.303, p = 0.038) and with the changes in maximum keratometry (R = -0.412, p = 0.004). Changes in maximum keratometry correlated with preoperative maximum keratometry (R = -0.302, p = 0.038). Postoperative haze had a significant impact on uncorrected and best corrected distance visual acuity (β coefficient = 0.006, p = 0.041 and β coefficient = 0.003, p = 0.039, respectively). Conclusions Our findings indicate that in more advanced keratoconus more significant corneal flattening effect parallel with haze formation can be observed after cross-linking. Despite significant reduction of keratometry, postoperative corneal haze may limit final visual acuity.

The study aimed at a quantitative evaluation of macular vasculature after primary repair of rhegmatogenous retinal detachment (RRD) in correlation with the elapsed postoperative time. Optical coherence tomography angiography (OCT-A) was performed in 66 eyes of 33 patients in a retrospective case-control study: superficial and deep retinal vessel density (VD) of the whole image, fovea, parafovea, non-flow area, and foveal avascular zone (FAZ) were measured. Data of eyes with RRD were compared to the healthy fellow eyes in 3 groups according to the elapsed time after surgery: RD1: 6–12 months (n = 10), RD2: 1–2 years (n = 10), and RD3: 2–10 years (n = 13). In RD1 VD was significantly lower in the superficial parafoveal, deep parafoveal, and deep whole area compared to the fellow eyes. In RD3 VD was significantly lower in the superficial fovea, parafovea, whole image, and deep fovea, the non-flow area was significantly enlarged. OCT-A demonstrated a significant reduction in the superficial and deep regions of the macular vasculature after the repair of RRD. The deep area is more affected in the early postoperative period and the superficial region and the extent of the non-flow area are more involved after a longer postoperative time.

Purpose There is abundant evidence on the benefits of physical activity on cardiovascular health. However, there are only few data on the acute effects of physical exercise on the retina and choroid. Our aim was the in vivo examination of chorioretinal alterations following short intense physical activity by spectral domain optical coherence tomography (SD-OCT). Methods Twenty-one eyes of 21 healthy, young subjects (mean age 22.5 ± 4.1 years, 15 males and 6 females) were recruited. Macular scanning with a SD-OCT was performed before and following a vita maxima-type physical strain exercise on a rowing ergometer until complete fatigue. Follow-up OCT scans were performed 1, 5, 15, 30 and 60 minutes following the exercise. The OCT images were exported and analyzed using our custom-built OCTRIMA 3D software and the thickness of 7 retinal layers was calculated, along with semi-automated measurement of the choroidal thickness. One-way ANOVA analysis was performed followed by Dunnett post hoc test for the thickness change compared to baseline and the correlation between performance and thickness change has also been calculated. The level of significance was set at 0.001. Results We observed a significant thinning of the total retina 1 minute post-exercise (-7.3 ± 0.6 μm, p < 0.001) which was followed by a significant thickening by 5 and 15 minutes (+3.6 ± 0.6 μm and +4.0 ± 0.6 μm, respectively, both p p p p p Conclusions Our study implies that in young adults, intense physical exercise has an acute effect on the granular layers of the retina, resulting in thinning followed by rebound thickening before normalization. We could not identify any clear correlation with either choroidal changes or performance that might explain our observations, and hence the exact mechanism warrants further clarification. We believe that a combination of vascular and mechanic changes is behind the observed trends.

Tafasitamab; B-cell lymphoma Tafasitamab; Linfoma de células B Tafasitamab; Limfoma de cèl·lules B Tafasitamab (MOR208), an Fc-modified, humanized, anti-CD19 monoclonal antibody, combined with the immunomodulatory drug lenalidomide was clinically active with a good tolerability profile in the open-label, single-arm, phase II L-MIND study of patients with relapsed/refractory diffuse large B-cell lymphoma (DLBCL) ineligible for autologous stem-cell transplantation. To assess long-term outcomes, we report an updated analysis with ≥35 months’ follow-up. Patients were aged >18 years, had received one to three prior systemic therapies (including ≥1 CD20-targeting regimen) and Eastern Cooperative Oncology Group performance status 0-2. Patients received 28-day cycles of tafasitamab (12 mg/kg intravenously), once weekly during cycles 1-3, then every 2 weeks during cycles 4-12. Lenalidomide (25 mg orally) was administered on days 1-21 of cycles 1-12. After cycle 12, progression-free patients received tafasitamab every 2 weeks until disease progression. The primary endpoint was best objective response rate. After ≥35 months’ follow-up (data cut-off: October 30, 2020), the objective response rate was 57.5% (n=46/80), including a complete response in 40.0% of patients (n=32/80) and a partial response in 17.5% of patients (n=14/80). The median duration of response was 43.9 months (95% confidence interval [95% CI]: 26.1-not reached), the median overall survival was 33.5 months (95% CI: 18.3-not reached) and the median progression-free survival was 11.6 months (95% CI: 6.3-45.7). There were no unexpected toxicities. Subgroup analyses revealed consistent long-term efficacy results across most subgroups of patients. This extended follow-up of L-MIND confirms the long duration of response, meaningful overall survival, and well-defined safety profile of tafasitamab plus lenalidomide followed by tafasitamab monotherapy in patients with relapsed/refractory diffuse large B-cell lymphoma ineligible for autologous stem cell transplantation. ClinicalTrials.gov identifier: NCT02399085.

BackgroundVisual fixation may be affected in amblyopic patients and, moreover, its stability may be associated with the effects of amblyopic treatments on visual performance in patients with strabismus. Therefore, fixation stability is a relevant biomarker that might predict the recurrence of amblyopia after a therapeutic intervention. Microperimetric biofeedback fixation training (BFT) can stabilize visual fixation in adult patients with central vision loss. It was the purpose of the present study to evaluate the effects of BFT on fixation stability in adult amblyopic patients after surgical intervention to treat strabismus.MethodsParticipants were 12 patients with strabismus (mean age = 29.6 ± 8.5 years; 6 females) and 12 healthy volunteers (mean age = 23.8 ± 1.5 years; 9 females). The protocol included ophthalmological and microperimetric follow-ups to measure fixation stability and macular sensitivity. BFT was applied monocularly to four amblyopic eyes either on the spontaneous preferential retinal locus or to a fixation area closer to the anatomical fovea after surgical treatment of strabismus.ResultsBaseline measurements showed significantly altered microperimetric average threshold in amblyopic eyes compared to fellow eyes (p = 0.024) and compared to control eyes (p p = 0.805). BFT applied to operated eyes resulted in a more stable fixation with improvements of about 50% after three months of training.ConclusionsFixation stability improvements following BFT highlight its potential use in adult amblyopic eyes after the surgical alignment of the strabismus. Future investigations may also consider applying this method in combination with standard treatments to improve vision in amblyopic patients.

Carotid artery stenosis (CAS) is among the leading causes of mortality and permanent disabilities in the Western world. CAS is a consequence of systemic atherosclerotic disease affecting the majority of the aging population. Optical coherence tomography angiography (OCTA) is a novel imaging technique for visualizing retinal blood flow. It is a noninvasive, fast method for qualitative and quantitative assessment of the microcirculation. Cerebral and retinal circulation share similar anatomy, physiology, and embryology; thus, retinal microvasculature provides a unique opportunity to study the pathogenesis of cerebral small vessel disease in vivo. In this study, we aimed to analyze the effect of systemic risk factors on retinal blood flow in the eyes of patients with significant carotid artery stenosis using OCT angiography. A total of 112 eyes of 56 patients with significant carotid stenosis were included in the study. We found that several systemic factors, such as decreased estimated glomerular filtration rate (eGFR), hypertension, and carotid occlusion have a significant negative effect on retinal blood flow, while statin use and carotid surgery substantially improve ocular microcirculation. Neither diabetes, clopidogrel or acetylsalicylic acid use, BMI, serum lipid level, nor thrombocyte count showed a significant effect on ocular blood flow. Our results demonstrate that a systematic connection does exist between certain systemic risk factors and retinal blood flow in this patient population. OCTA could help in the assessment of cerebral circulation of patients with CAS due to its ability to detect subtle changes in retinal microcirculation that is considered to represent changes in intracranial blood flow.

Purpose: Macular structure is poorly evaluated in early-treated phenylketonuria (ETPKU). To evaluate potential changes, we aimed to examine retinas of PKU patients using optical coherence tomography (OCT) with additional OCT angiography (OCTA) and compare the results to healthy controls. Methods: A total of 100 adults were recruited in this monocentric, case-control study: 50 patients with ETPKU (mean age: 30.66 ± 8.00 years) and 50 healthy controls (mean age: 30.45 ± 7.18 years). Macular thickness, vessel density and flow area of the right eye was assessed with spectral domain OCT angiography SD-OCT(A). Macular microstructural data between the ETPKU and control group was compared. In the ETPKU group, the relationship between visual functional parameters (best corrected visual acuity [VA], spherical equivalent [SE], contrast sensitivity [CS] and near stereoacuity) and microstructural alterations was examined. The dependency of OCT(A) values on serum phenylalanine (Phe) level was analysed. Results: There was significant average parafoveal and perifoveal total retinal layer thinning in ETPKU patients compared to healthy controls (p

Introduction Patients with relapsed/refractory (R/R) diffuse large B-cell lymphoma (DLBCL) who are not eligible for autologous stem cell transplant (ASCT) have a poor prognosis. Tafasitamab (MOR208) is an Fc-enhanced, humanized, monoclonal antibody that targets CD19, which is broadly expressed across B-cell malignancies, including DLBCL. The immunomodulatory drug lenalidomide (LEN) has antiproliferative and antiangiogenic effects. L-MIND (NCT02399085) is an ongoing, open-label, single-arm, Phase II study of tafasitamab + LEN in patients with R/R DLBCL who are ineligible for ASCT. L-MIND results from prespecified patient subgroup analyses were presented previously (primary analysis: data cut-off Nov 30, 2018). Here, we report long-term clinical efficacy from the L-MIND study after a median follow-up of 31.8 months for overall survival (OS) (data cut-off: Nov 30, 2019). Methods Patients enrolled were aged ≥18 years with R/R DLBCL (1-3 prior systemic therapies, including ≥1 CD20-targeting regimen), ASCT-ineligible and with an Eastern Cooperative Oncology Group performance status of 0-2. Patients received 28-day cycles of tafasitamab (12 mg/kg intravenously), once weekly during Cycles 1-3 with a loading dose on Cycle 1 Day 4, then every 2 weeks during Cycles 4-12. LEN (25 mg orally) was administered on Days 1-21 of Cycles 1-12. After Cycle 12, progression-free patients received tafasitamab every 2 weeks until disease progression. The primary endpoint is objective response rate (ORR; partial response [PR] + complete response [CR]), assessed centrally by an independent review committee. Secondary endpoints include duration of response (DOR), progression-free survival (PFS), OS and safety analyses. Results Of 81 patients enrolled, 80 patients received tafasitamab + LEN and were included in the full analysis set (FAS) for efficacy. Median follow-up was 22.7 months. In the FAS, ORR was 57.5% (95% confidence interval [CI]: 45.9-68.5) (Figure 1A). The CR rate was 40.0% (n=32/80), of which 90.6% (n=29/32) were PET-confirmed. Median time to response (PR or CR) was 2.0 months and median time to CR was 6.1 months. Median DOR was 34.6 months (95% CI: 26.1-34.6); median PFS was 12.1 months (95% CI: 6.3-not reached [NR]); and median OS was 31.6 months (95% CI: 18.3-NR). The 24-month DOR and OS rates were 71.3% (95% CI: 52.8-83.7) (Figure 1B) and 57.2% (95% CI: 45.1-67.5) (Figure 1C), respectively. In the subgroup analysis, patients with CR as best objective response had better outcomes than those with PR: median DOR, NR (95% CI: 26.1-NR) vs 5.6 months (95% CI: 2.2-34.6); 24-month DOR rate, 86.4% (95% CI: 61.3-95.7) vs 38.5% (95% CI: 14.1-62.8); and 24-month OS rate, 90.6% vs 42.7%. Patients with 1 prior line of therapy had a trend for better outcomes than those with ≥2 prior lines: ORR, 67.5% vs 47.5%; 24-month OS rate, 67.9% vs 46.3%. The 24-month DOR rate was similar by the number of prior lines (1 prior line: 67.9% [95% CI: 42.5-84.0] vs ≥2 prior lines: 77.8% [95% CI: 51.1-91.0]). ORR was similar by primary refractory vs non-primary refractory status (53.3% vs 58.5%); however, primary refractory status impacted 24-month DOR (50.0% vs 74.8%, respectively). Patients refractory to their last line of therapy achieved similar ORRs to those who were not (60.0% vs 55.6%). The 24-month DOR was similar regardless of refractory status to last therapy (Figure 1B), and 24-month OS rates were higher in non-refractory patients (Figure 1C). As expected, patients with a low/low-intermediate International Prognostic Index score had better outcomes than those with an intermediate-high/high score: ORR, 67.5% vs 47.5%; 24-month DOR rate, 92.1% vs 44.3%; and 24-month OS rate, 76.5% vs 36.5%. Based on the Hans algorithm, outcomes were encouraging independent of germinal center B-cell (GCB) DLBCL (n=38) or non-GCB DLBCL (n=22) disease: ORR, 47.4% vs 68.2%; median DOR, 34.6 vs 26.1 months; 24-month DOR rate, 66.7% vs 62.9%; and 24-month OS rate, 51.3% vs 65.0%. Conclusions Long-term L-MIND subgroup data show that encouraging activity observed at primary analysis remains durable after ≥2 years of follow-up; patients with CR continue to experience long DOR and high OS. Although the influence of poor prognosis risk factors is still evident, the clinical activity of tafasitamab in combination with LEN followed by tafasitamab monotherapy continues to show promise in difficult-to-treat ASCT-ineligible patients with R/R DLBCL. Disclosures Maddocks: Pharmacyclics: Consultancy, Honoraria; Seattle Genetics: Consultancy, Honoraria; Karyopharm: Consultancy; ADC Therapeutics, AstraZeneca: Consultancy; BMS: Consultancy, Research Funding; Morphosys: Consultancy, Honoraria; Celgene: Consultancy, Honoraria. Duell:Morphosys: Research Funding. González-Barca:Sandoz: Consultancy; Gilead: Consultancy; Janssen: Consultancy, Honoraria; Abbvie: Honoraria; Takeda: Honoraria; Roche: Honoraria; MorphoSys: Other; Celtrion: Consultancy; Kiowa: Consultancy; Celgene: Consultancy. Jurczak:Janssen, MeiPharma, Merck, Pharmacyclics, Roche, Tekeda, TG Therapeutics: Research Funding; Jagiellonian University: Ended employment in the past 24 months, Research Funding; Maria Sklodowska-Curie National Research Institute of Oncology: Consultancy, Current Employment. Liberati:Novartis: Research Funding; GSK: Research Funding; Incyte: Honoraria; Janssen: Honoraria, Research Funding; Oncopeptides: Research Funding; Morphosys: Research Funding; Karyopharm: Research Funding; Pfizer: Research Funding; Takeda: Research Funding; Roche: Membership on an entity's Board of Directors or advisory committees, Research Funding; Abbvie: Honoraria, Research Funding; Onconova: Research Funding; Verastem: Research Funding. de Vos:Bayer: Consultancy; Verastem: Consultancy. Nagy:MorphoSys AG: Patents & Royalties. Obr:Roche: Honoraria. Gaidano:Sunesys: Membership on an entity's Board of Directors or advisory committees; Abbvie: Membership on an entity's Board of Directors or advisory committees, Speakers Bureau; Janssen: Membership on an entity's Board of Directors or advisory committees, Speakers Bureau; Astrazeneca: Membership on an entity's Board of Directors or advisory committees. Abrisqueta:Roche: Consultancy, Honoraria, Speakers Bureau; Celgene: Consultancy, Honoraria; Janssen: Consultancy, Honoraria, Speakers Bureau; AbbVie: Consultancy, Honoraria, Speakers Bureau. André:Celgene: Other, Research Funding; Johnson & Johnson: Research Funding; Amgen: Other: TRAVEL, ACCOMMODATIONS, EXPENSES (paid by any for-profit health care company), Research Funding; Roche: Other: TRAVEL, ACCOMMODATIONS, EXPENSES (paid by any for-profit health care company), Research Funding; Abbvie: Consultancy; Seattle Genetics: Consultancy; Novartis: Consultancy, Research Funding; Gilead: Consultancy, Other: TRAVEL, ACCOMMODATIONS, EXPENSES (paid by any for-profit health care company); Bristol-Myers-Squibb: Consultancy, Other: TRAVEL, ACCOMMODATIONS, EXPENSES (paid by any for-profit health care company); Karyopharm: Consultancy; Takeda: Consultancy; CHU UCL Namur, site Godinne, Yvoir, Belgium: Current Employment. Dreyling:Celgene: Consultancy, Research Funding, Speakers Bureau; Roche: Consultancy, Research Funding, Speakers Bureau; Novartis: Consultancy; Janssen: Consultancy, Research Funding, Speakers Bureau; Abbvie: Research Funding; Astra Zeneca: Consultancy; Beigene: Consultancy; Gilead: Consultancy, Research Funding, Speakers Bureau; Bayer: Consultancy, Speakers Bureau. Menne:Amgen: Honoraria, Membership on an entity's Board of Directors or advisory committees; Kite/Gilead: Honoraria, Speakers Bureau; Novartis: Honoraria, Other: Travel costs, Speakers Bureau; Pfizer: Honoraria, Other: Travel costs, Speakers Bureau; Celgene: Honoraria, Other: Travel grants; Roche: Speakers Bureau; Janssen: Honoraria, Research Funding, Speakers Bureau; Astra Zeneca: Research Funding; Takeda: Honoraria, Speakers Bureau. Dirnberger-Hertweck:MorphoSys AG: Current Employment. Weirather:MorphoSys AG: Current Employment. Ambarkhane:MorphoSys AG: Current Employment. Salles:Takeda: Honoraria; BMS/Celgene: Honoraria, Other: consultancy or advisory role; Autolos: Other: consultancy or advisory role; Abbvie: Other: consultancy or advisory role; Roche: Honoraria, Other: consultancy or advisory role; Novartis: Honoraria, Other: consultancy or advisory role; MorphoSys: Honoraria, Other: consultancy or advisory role; Janssen: Honoraria, Other: consultancy or advisory role; Epizyme: Honoraria, Other: consultancy or advisory role; Kite, a Gilead Company: Honoraria, Other: consultancy or advisory role ; Debiopharm: Consultancy, Honoraria, Other: consultancy or advisory role; Genmab: Honoraria, Other; Karyopharm: Honoraria.

Abstract: We present herewith cases of non-infectious uveitis with biological treatment where the ocular complaints were the initial symptoms indicating a multi-organ autoimmune disease. The first case was a patient with panuveitis and Vogt–Koyanagi–Harada disease, the second case was also a panuveitic patient with sarcoidosis and the third case was a patient with intermediate uveitis and inflammatory bowel disease. In all cases, emerging new, biological therapy (adalimumab) was necessary to achieve permanent inactive period of uveitis and the autoimmune disease. Introducing systemic biological treatment (adalimumab) in ophthalmology is crucial in the therapy of immune-mediated, non-infectious uveitis in order to preserve visual acuity. Orv Hetil. 2019; 160(44): 1744–1750.

Background This study aimed to determine the relationship between image quality and measurement repeatability of optical coherence tomography angiography (OCTA) parameters in patients with non-proliferative diabetic retinopathy. Methods A total of 100 eyes of 50 patients were included in the study. Three OCTA images were obtained consecutively during one session of imaging in all patients using the RTVue AngioVue OCTA device. We applied the signal strength index (SSI) provided by the RTVue system to define scan quality. Superficial vessel density (VD) in the central 3 × 3 mm macular and in the perifoveal region, as well as foveal avascular zone (FAZ) area were evaluated by the AngioAnalytics software for each scan from three consecutive measurements, whereby measurement repeatability of the OCTA parameters were calculated. The effect of SSI value on OCTA parameters, as well as on measurement errors was assessed. Results Values of SSI ranged from 30 to 85 with an overall mean of 61.79 ± 10.38. Mean SSI values showed significant positive correlation with the mean retinal capillary vessel density values, but not with non-flow area. Repeatability of OCTA parameters was generally improved with higher SSI values. We calculated a mean correction factor of 0.22% (95% CI 0.20–0.24 µm; p 2 (95% CI − 0.001 to 0.002; p = 0.001) for the non-flow area for each unit increase in SSI for the comparison of images with different SSI values. Conclusions The influence of image quality on OCTA metrics should be considered for image comparisons during follow-up to avoid misinterpretation of small changes in OCTA parameters in patients with diabetes.

Purpose To assess the validity of wide-field digital imaging (WFDI) and telemedicine-based screening compared with examination by binocular indirect ophthalmoscopy (BIO) and to present some of the results from the first five years of telemedicine-based screening in the Premature Eye Rescue Program in Hungary. Methods We performed a retrospective analysis in two periods that aimed to assess (a) the validity of retinal digital imaging and (b) routine bedside screening. The validity was assessed in two neonatal intensive care units (NICUs), one in the First Department of Paediatrics and the other in the Second Department of Obstetrics and Gynaecology, Semmelweis University. The telemedicine-based WFDI (WFDI-TM) screening program was introduced in two phases. In the first phase (from 30 November 2009 to 8 August 2010), BIO and WFDI were performed by the same paediatric ophthalmologist (Group A). In the second phase (from 9 August 2010 to 29 March 2011), BIO was performed by the paediatric ophthalmologist, while retinal images were captured by a trained neonatal transport nurse practitioner (Group B). BIO screening was the reference method as a gold standard in both phases. Results During the validity assessment period 634 examinations were performed in 153 preterm infants. Overall, 76 babies were screened in Group A and 80 were screened in Group B. We found lower sensitivity and specificity in cases of any ROP (sensitivity 86%, specificity 99%) compared with those of treatment-requiring retinopathy of prematurity (TR-ROP) (both sensitivity and specificity 100%). In the Premature Eye Rescue Program between 1April 2011 and 31 March 2016, we used WFDI in 3035 infants (4589 procedures). Over this five-year period, 100 (9.6%) infants were treated by laser, and no child who received care in any of the Semmelweis University NICUs became blind from ROP. Conclusions (a) WFDI-TM ROP screening is a useful and efficient approach, although it cannot completely replace BIO; (b) no ROP-related blindness developed among the screened preterm babies; and (c) WFDI-TM ROP screening can be implemented in the logistics of a neonatal emergency and ambulance team infrastructure with neonatal transport nurse practitioners as ‘photographers’.

Background Despite the significant impact of retinal diseases such as wet age-related macular degeneration (wAMD) and diabetic macular edema (DME), there is a limited understanding of how these conditions are managed in Central and Eastern Europe (CEE). Objectives To provide a comprehensive overview of the clinical and economic burden of wAMD and DME in CEE and the status quo associated with their management. Methods A narrative literature review was undertaken to identify existing data on wAMD and DME, including epidemiology, economic burden, clinical guidelines, and available and reimbursed treatments. Data were collected from relevant sources such as PubMed, ophthalmology associations, national statistical offices, and government agency websites; practical viewpoints were provided by local ophthalmologists and healthcare economics experts in CEE. Results Epidemiological data on wAMD and DME are limited in CEE, and intercountry comparison is difficult because of differences in data collection methodologies. There are effective treatment options for wAMD and DME, and international guidelines advocate the use of intravitreal anti-vascular endothelial growth factor injections as first-line therapy. Local expert organizations broadly support these recommendations; nevertheless, no clinical practice guidelines exist on the treatment of wAMD and DME in CEE. Access to and reimbursement of anti-vascular endothelial growth factor agents vary significantly in the region and, as a result, many patients remain untreated or inadequately treated. Conclusions There is an urgent need for the creation of a wAMD/DME treatment program in CEE to ensure that patients have timely access to the most appropriate treatments.

PURPOSE To quantify retinal microvascular alterations using optical coherence tomography angiography in diabetic patients, and to evaluate the accuracy of decreased vessel density (VD) in predicting early diabetic retinopathy (DR). METHODS One hundred and two eyes of 51 diabetic patients and 92 eyes of 46 individuals without diabetes were examined. Duration of diabetes, insulin therapy, blood pressure, HbA1C, dyslipidemia, axial length, and the presence of DR were recorded. Retinal VD was measured using optical coherence tomography angiography. The effect of risk factors on VD and on DR was assessed using multivariable regression analyzes. RESULTS Compared with controls, VD was lower in diabetic patients (P < 0.05) and correlated with diabetes duration (P = 0.02). Decreased VD was associated with a higher risk of DR (odds ratio: 1.24, P = 0.009) after controlling for systemic and ocular confounding variables. Eyes with a VD of

Purpose Remote screening for retinopathy of prematurity by wide-field digital imaging and network telemedicine is increasingly used to prevent blindness without the unnecessary transport of infants. Our purpose was to train and license dedicated neonatal transport nurses to do this in Hungary. Materials and methods We developed a complex, four-step curriculum in mobile retinotelemetry. Using a robust selection process, we invited eight transport nurses (NtNP/RtN) to receive training during the 2008–2017 project. The curriculum started with the basics of ophthalmology. Using an artificial eye, it continued with the theory and practice of ophthalmologic exams. Then, supervised by an ophthalmologist, each nurse performed 50 video recordings of anaesthetized and non-anaesthetized infants. Results After demonstrating their competence, five of the eight candidate nurses received a license for retinotelemetry. During their subsequent practice, they had to undergo case reviews half-yearly by a specialist and renew their license every 2–3 years. During the 2008–2016 period, we analysed 7,177 remote screenings from a training perspective. During January 1–August 31 in 2017 period, we analysed extra data from 795 remote screenings of 332 infants from specific prevention perspectives. Conclusions With the cooperation of preexisting neonatal transport service and the ophthalmological reading centre of a university hospital, a mobile telemedicine screening network was successfully developed in Hungary. Our results demonstrate how retinotelemetry can support different levels of prevention medicine. The network should work effectively and efficiently with continuous professional development.

The present questionnaire-based study combines and expands technology acceptance and behavioural (risk and loss aversion) variables in explaining the demand for life insurance products. Loss aversi...

Summary Background To examine the rural–urban differences in the prevalence of diabetes mellitus (DM) and diabetic retinopathy (DR) in the population aged 50 years and older in Hungary. Methods 105 clusters of 35 people aged 50 years or older were randomly selected. Standardized rapid assessment of avoidable blindness (RAAB) with the diabetic retinopathy module was performed. Participants were classified as diabetic if they had a previous diagnosis of DM or a random blood glucose level ≥200 mg/dl. Each individual with DM who agreed underwent dilated fundus examination and DR grading. Results The prevalence of DM was higher in rural (21.8%) than in urban (18.6%) areas (p = 0.016). The prevalence of DR did not differ significantly between rural and urban areas in DM cases. Blindness (0.9% vs. 0.1%; p = 0.048) and blindness due to DM (0.3% vs. 0.0%; p = 0.021) in diabetic participants was significantly more common in rural than in urban areas. Diabetic eye screening coverage was significantly lower in rural than in urban areas (p ≤ 0,007). Conclusion Based on our results and the high rate of blindness and blindness due to DR in rural areas, primary eye care should be improved and a telemedical eye screening program should be undertaken, especially concentrating on rural areas.

Abstract: Introduction: Idiopathic strabismus sursoadductorius is characterized by an overaction of the inferior oblique (IO) muscle, with elevation of the eye in adduction. This can result in chronic headache, eye pain, diplopia and abnormal head posture. Aim: Presentation of clinical results after graded recession of inferior oblique overaction (IOOA) in strabismus sursoadductorius. Method: During a period of 6 years (2012–2017) we performed a dosed transposition of IO muscle in 53 patients in the Department of Ophthalmology of the Semmelweis University and analyzed the clinical results retrospectively. The mean age was 12.8, min–max: 2–51 years. The transposition of the muscle (8 mm, 10 mm or maximal) was performed because of IOOA and was planned depending on the vertical deviation (VD) in maximal adduction. In case of maximal transposition, the insertion of IO was placed under the lateral part of the lower rectus muscle. We evaluated the squint angle in five positions of gaze preoperatively and postoperative 1 week, 1 month and 3–6 months. We examined best corrected visual acuity, binocular vision and complications after surgery. Results: Postoperatively 25 patients had acceptable stereopsis (Titmus 5). Visual acuity remained stable after surgery in all cases. The VD measured in maximal adduction changed with a decrease of 7.5° when 8 mm transposition was performed, and changed with a decrease to 12°, when maximal recession was performed. The mean reduction of VD was 17.8 prism dioptres (PD) after 1 week (p

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.

Absztrakt: Az akut myeloid leukemia (AML) osztalyozasanak es rizikobecslesenek alapjaul a citogenetikai elteresek szolgalnak, azonban az elmult evekben az uj generacios szekvenalasnak (NGS) koszonh...

Abstract: Angioid streaks are defined as the special morphological alteration of the fundus; the most common clinical manifestations are irregular, reddish brownish stripes around the optic nerve head or on the posterior pole. On the basis of histological examination, the cause of this phenomenon is the breaks and continuity deficiencies in the thin layer of Bruch membrane caused by the degeneration of elastic fibers. The aim of this study is to present the ocular complication of this rare entity through the description of three cases, and to draw attention to systemic diseases in the background. In our first and third cases, pseudoxanthoma elasticum (Grönblad–Strandberg syndrome) was in the background, while in our second case, hematological disease was confirmed. In our first and second cases, the ocular complication was the choroidal neovascularization, which we treated with intravitreal anti-VEGF injection. In our third case, the choroidal rupture was the ocular complication, caused by trauma. Angioid streaks on the fundus may be sub-phenomena of systemic diseases, the detection, differential diagnosis and treatment require interdisciplinary collaboration between associate physicians. Orv Hetil. 2019; 160(25): 994–1000.

Radiosynoviorthesis (RSO) is used for the treatment of inflammatory joint diseases. However, there are no long-term results published comparing it to conservative therapy. Therefore, the aim of this prospective observational study was to evaluate response rates after radionuclide therapy in patients suffering from knee osteoarthritis over a time period of 10 years. Radionuclide therapy with intra-articular administration of colloidal 90Yttrium citrate was performed in osteoarthritic patients [Kellgren–Lawrence grades I/II (n = 69) and Kellgren–Lawrence grade III (n = 72)]. In patients with early-stage disease, an excellent/good response with respect to pain, joint mobility, and function was observed in 82.5% for 1 year and in 73.7% for 8 years after therapy. Responses declined to 50% at 10 years post treatment. In grade III patients, an excellent/good response was observed in 45.9%; a decline to 41.2% was observed in the first 8 years. In this group, the number of patients available for follow-up after 9 and 10 years dropped significantly from 51 patients after 8 years to only 30 patients after 9 years, and to nine patients after 10 years. As a result, these response rates were not appraisable. Long-term results of radiosynoviorthesis in knee osteoarthritis are excellent/good in many patients. The response rate depends on Kellgren–Lawrence stages, and early-stage radionuclide therapy for osteoarthritis is suggested.

Purpose To compare clinical outcomes between two trifocal intraocular lenses (IOLs): the new FineVision POD F GF trifocal IOL made of hydrophobic acrylic glistening-free material, and the FineVision POD F IOL made of hydrophilic acrylic material with 26% water uptake in patients undergoing routine cataract surgery using standard phacoemulsification. Setting Semmelweis University, Department of Ophthalmology, Budapest, Hungary. Design Prospective controlled randomized single-center single-surgeon study. Methods Each patient had the hydrophilic POD F IOL implanted in one eye and the hydrophobic POD F GF IOL in the contralateral eye, according to a randomization table. Clinical outcomes included distance (4 m), intermediate (70 cm), and near (35 cm) visual acuities, contrast sensitivity measured under photopic and mesopic conditions, and defocus curves under photopic conditions. The follow-up was 6 months. Results The study comprised 25 patients. Under photopic conditions, there was no statistically significant difference between POD F GF and POD F IOLs for uncorrected distance (UDVA) (P = .607), uncorrected intermediate (UIVA) (P = .491), and uncorrected near (UNVA) (P = .414) visual acuities. Under mesopic conditions, there was no statistically significant differences between the 2 IOLs for UDVA (P = 1.00), UIVA (P = .149), and UNVA (P = .551). No statistically significant differences in contrast sensitivity were found between the groups under photopic (P = .4347) and mesopic (P = .425) conditions. No safety issues were reported. Conclusion The study demonstrated equally good visual and refractive outcomes for the POD F GF IOL and the POD F IOL, giving the surgeon the option to choose the preferred material for the individual patient without compromising clinical outcomes.

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.

Genus Acanthamoeba is an opportunistic protozoan that is widely distributed in the environment. Within this genus, numerous species are recognized as human pathogens, potentially causing Acanthamoeba keratitis (AK). AK is a corneal disease, associated predominantly with contact lens (CL) wear; its epidemiology is related to the specific Acanthamoeba genotypes. This study reports seven CL wearer, Acanthamoeba PCR-positive patients with AK, diagnosed between January 2015 and 2018. Patients had the diagnosis of AK 1.36 months after first symptoms. Genotyping allowed the identification of six isolates of the T4 and one of the T8 genotypes. At first presentation, pseudendritiformic epithelopathy/dirty epithelium (four eyes, 57.1%), multifocal stromal infiltrates (five eyes, 71.4%), ring infiltrate (three eyes, 42.8%), and perineuritis (one eye, 14.3%) were observed. AK was healed without later recurrence in two eyes (28.5%) using triple-topical therapy, in three eyes (42.8%) following additional penetrating keratoplasty. In one patient (14.3%), AK recurred following successful application of triple-therapy and was treated successfully with repeated triple-topical therapy and in one patient (14.3%), no follow-up data were available after diagnosis. We could not observe correlation of genotype and clinical course or the necessity of corneal transplantation in our case series.

Abstract: Inrtoduction: Caveolae are flask shaped with 50–100 nm size, non-clathrin associated invaginations of the plasmamembrane. The main membrane protein of the structures is caveolin-1. Caveolae play an important role in numerous cellular functions including vesicular transport and cell-cycle regulation, and create platforms for classical and alternative signaling pathways. According to international studies, caveolae may influence the physiology and pathology of lens epithelial cells. Aim: The aim of the study was to examine and compare the morphology of caveolae and the immunohistochemical difference of caveolin-1 in control (myopic and hyperopic) lens epithelial cells and human lens epithelial cells affected by cataract. Authors investigated whether caveolae might have a role in cataractogenesis. Method: Anterior lens capsules were obtained by capsulorhexis during surgery of senile cataract and refractive surgery of the clear lens. Ultra-fine sections have been studied by transmission electron microscopy, and semi-fine samples were labelled for immunohistochemistry with polyclonal caveolin-1 and cavin-1 antibodies. Results: By immunohistochemistry, in the control group, significant caveolin-1 label with low cavin-1 signal were measured in the lens epithelial cells. In the cataract group high cavin-1 and caveolin-1 expression was detected. In the control group, caveolae were not observed, but in the lens epithelial cells with cataract, increased number of caveolae have been detected by electron microscopy. Conclusions: For the development and maintenance of the specific caveolae shape, caveolin-1 is needed to be accompanied by cavin-1. Therefore, it is presumable that the increased expression of cavin-1 could explain the higher number of caveolae in the cataract group. These results might suggest that caveolae might play a role in cataractogenesis. Orv Hetil. 2019; 160(8): 300–308.

Abstract: Since 2017, the nomenclature of Fusarium, Acremonium and Sarocladium species have changed, as these morphologically homogeneous, but phylogenetically heterogeneous species and species complexes may be differentiated using MALDI–TOF MS examination, analyzing nucleotic sequences. This resulted in taxonomical changes. We summarize the clinical course, diagnostic and therapeutic options of keratitis caused by Fusarium and Sarocladium. The challenge of Fusarium and Sarocladium keratitis management for an ophthalmologist lies in delayed diagnosis and therapy, fulminant progression and penetration of the Descemet’s membrane, restricted availability, poor penetration of antifungal agents and therapy resistance. The diagnosis is based on the clinical history of corneal trauma or contact lens wear, PCR and MALDI–TOF MS, confocal microscopic examination, microbiological culture and light-microscopic analysis of corneal scrapings. As primary conservative treatment, 5% natamycin eye drops have to be used and with results of an antimycogram, topical 1% voriconazole or 0.15–0.25% amphotericin B, in some cases 0.02% polyhexamethylene-biguanide (PHMB) may be applied. Fusarium keratitis may benefit from additional 2 × 200 mg oral voriconazole treatment, daily. In therapy resistant cases, early, large diameter penetrating keratoplasty (PKP) has to be performed, with complete removal of the infected area. With late diagnosis, delayed specific treatment and surgery, mycotic hyphae may penetrate the Descemet’s membrane, leading to the loss of vision and enucleation in about every fourth patient. In our paper, we also present the heterogeneous clinical history of five Fusarium and Sarocladium keratitis cases. Orv Hetil. 2019; 160(1): 2–11.

TPS7075 Background: A novel genomically defined subset of higher-risk MDS (HR-MDS) patients with an actionable target characterized by overexpression of RARA has been identified (McKeown 2017). Approximately 30% of HR-MDS patients are RARA-positive (RARA+) by a blood-based biomarker test (Vigil, 2017). Biologically targeted therapy with tamibarotene, an oral selective RARα agonist, has potential to provide clinical benefit for RARA+ HR-MDS patients, irrespective of mutation or cytogenetic risk. Initial clinical data in RARA+ R/R HR-MDS patients treated with tamibarotene showed myeloid differentiation, improved blood counts, and reduced bone marrow blasts, including one patient who achieved marrow complete remission with hematologic improvement (Jurcic 2017). Tamibarotene in combination with azacitidine (aza) showed high complete response rates (CR) with rapid onset of response in RARA+ newly diagnosed (ND) unfit AML patients, including those with low blast count (≤ 30%) AML, and a majority of patients achieved or maintained transfusion independence (de Botton 2020). Tamibarotene/aza was generally well tolerated with no increase in myelosuppression compared to aza alone (de Botton 2020). Historical precedent demonstrating similar clinical outcomes in HR-MDS and AML, particularly low blast count AML (Estey 2021), supports further development of tamibarotene/aza in HR-MDS to improve clinical outcomes of standard of care treatment with hypomethylating agents (HMAs). Methods: This Phase 3, multi-center, randomized, double-blind, placebo-controlled study will compare activity of tamibarotene/aza to placebo/aza in RARA+ patients with ND HR-MDS. The primary objective is to characterize and compare the CR rate of tamibarotene/aza vs placebo/aza, with secondary objectives to characterize ORR, EFS, OS, transfusion independence rate, time to and duration of initial and complete responses, and safety. Approximately 190 patients will be randomized 2:1, providing 90% power to detect the difference in CR rates between the experimental and control arms, with a one-sided alpha of 0.025. Patients must be RARA+ based on the investigational biomarker test, ND with HR-MDS by WHO classification (Arber 2016), classified by IPSS-R risk category as very high, high, or intermediate risk with a blast count > 5% at study entry. Patients suitable for transplant at screening, or with prior treatment for MDS with any HMA, chemotherapy or transplant are excluded. Aza will be administered at 75 mg/m2 IV/SC daily on days 1-7 (or 1-5, 8-9) followed by tamibarotene/placebo at 6 mg BID orally days 8-28 of each 28-day cycle. Response will be assessed per modified IWG MDS criteria (Cheson 2006). The SELECT-MDS-1 trial opened in February 2021, recruitment is ongoing, with sites located in North America, Israel, and Europe. Clinical trial information: NCT04797780.

The herbarium of Gyula Erazmus Nyárády has been assessed to contain around 90.000 sheets. During the past thirty years, the legacy of the famed botanist still found in public institutions and private collection across Romania and Hungary has been studied and processed by Kálmán Váczy, Sándor Bartha and especially Katalin Bartók. However, nothing is known about the sheets that had ended up outside Hungary or Romania. This study proposes to fill this gap to some extent: firstly, it draws attention to sheets from Nyárády’s herbarium found in the inventory of the world’s biggest botanical gardens, museums and universities of natural science; secondly, it goes into details about the circumstances of collecting the prepared taxa, and the conclusions that can be drawn from this; it presents the reasons why some sheets got abroad; and it adds more data to reconstruct Nyárády’s social network. It also indicates that the heritage, now known to consist of around 90.000 sheets, can be completed with the sheets found abroad.

Purpose This study aimed to examine the effectiveness of CO2 laser-assisted sclerectomy surgery (CLASS) in eyes with primary open-angle glaucoma (POAG) showing progression in spite of maximal local antiglaucomatous therapy. Materials and methods Patients with progressive POAG received CLASS treatment. We performed CLASS on 15 eyes (eight males and seven females). The primary endpoint was the change in the intraocular pressure (IOP), and additionally best spectacle-corrected visual acuity (BSCVA), C/D ratio (cup-to-disc), as well as use of antiglaucomatous drops were also investigated. Following the preoperative assessment, measurements were performed at 6-month follow-up. Results The average preoperative IOP was 26.13 ± 6.79 mmHg that dropped to 9.57 ± 4.09 mmHg at 1 day. IOP was stable at 1 month, 3 months, and 6 months. The BSCVA decreased to the 1-day and 1-week follow-up but returned to its original value to the 1-month check-up. Preoperatively, all patients were on maximal antiglaucoma drop therapy, after CLASS none of the patients needed antiglaucomatous treatment at 1 month. However, at 3 months, one of them needed antiglaucoma drops. C/D ratio showed non-significant changes. Conclusions CLASS procedure was found to be effective in decreasing IOP in POAG patients whose IOP was not compensated with maximal antiglaucomatous local therapy; patients needed significantly less local therapy following the CO2 laser surgery.

Összefoglaló. Bevezetés: A colorectalis eredetű májáttétek (CRCLM-ek) kuratív célú kezelésében elsődleges a sebészi reszekció. A műtét előtt különböző képalkotó vizsgálatok végezhetők, az egyik ilyen speciális vizsgálat a májsejtspecifikus kontrasztanyaggal végzett MR-vizsgálat. Célkitűzés: Tanulmányunkban a májsejtspecifikus kontrasztanyaggal végzett MR-vizsgálat helyét és szerepét vizsgáltuk a májsebészeti gyakorlatban colorectalis áttétes betegek esetében. Módszer: Az Uzsoki Utcai Kórház Sebészeti-Onkosebészeti Osztályán 2017. 01. 01. és 2019. 12. 31. között CRCLM miatt májreszekcióra kerülő betegek adatait elemeztük. Retrospektív módon vizsgáltuk a betegek általános sebészeti és onkosebészeti paramétereit, a képalkotó diagnosztikai eredményeket, a műtéti adatokat és a patológiai leleteket. Eredmények: 132, CRCLM miatt operált betegből 73 szoliter áttét (55%), míg 59 beteg (45%) többszörös áttét miatt került műtétre. 94 betegnél (71%) történt májsejtspecifikus MR-vizsgálat. Szoliter áttét esetén 60%-ban, multiplex áttétek esetén 85%-ban történt májsejtspecifikus MR-vizsgálat (p = 0,02). A szoliter áttétes betegek 8%-ában, míg a multiplex áttétes betegek 39%-ában mutatott további áttétet a májspecifikus kontrasztanyaggal végzett MR-vizsgálat (p = 0,001). A betegek 5%-ában igazolódott fals pozitivitás és 6%-ában fals negativitás a májsejtspecifikus MR-vizsgálat során. 264 góc vizsgálata alapján a májspecifikus kontrasztanyaggal végzett MR-vizsgálat szenzitivitása CRCLM esetén 95%-os, míg pozitív prediktív értéke 93%-os volt vizsgálatunkban. Következtetés: A májsejtspecifikus kontrasztanyaggal végzett MR-vizsgálat hasznos diagnosztikai módszer a CRCLM-ek sebészi reszekciója előtt. Leginkább többszörös áttétek esetén, preoperatív szisztémás onkológiai kezelést követően, illetve más képalkotó vizsgálaton igazolt eltűnt áttét esetén javasolható az alkalmazása. Orv Hetil. 2021; 162(50): 2010-2016.Liver resection is the only curtive treatment option of colorectal cancer liver metastases (CRCLMs). While different diagnostic modalities are available before surgery, a specific diagnostic tool is the liver-specific contrast-enhanced MRI.The purpose of this study was to evaluate the role of liver-specific contrast-enhanced MRI before resection of colorectal liver metastases.Patients with CRCLM, resected at the Department of Surgical Oncology, Uzsoki Teaching Hospital, between 01. 01. 2017 and 31. 12. 2019 were enrolled in our study. Clinical data, diagnostic, intraoperative and pathological findings were analyzed in a retrospective setting.132 CRCLM patients were resected in this period, 73 patients had solitary (55%), and 59 patients (45%) had multiple metastases. Liver-specific contrast-enhanced MRI was performed in 94 patients (71%). 60% of the patients with solitary and 85% of the patients with multiple CRCLM had liver-specific contrast-enhanced MRI (p = 0.02). Compared to other modalities, liver-specific contrast-enhanced MRI showed additional metastases in 8% of the patients with solitary, and in 39% of the patients with multiple metastases (p = 0.001). Liver-specific contrast-enhanced MRI had a 5% false-positivity and a 6% false-negativity rate. 264 leasions were analyzed, and the sensitivity of the liver-specific contrast-enhanced MRI was 95% with a predictive positive value of 93%.Liver-specific contrast-enhanced MRI is a useful diagnostic tool in CRCLM patients before liver resection. It is highly recommended in the case of multiple metastases, after preoperative chemotherapy and in the case of disappearing metastases. Orv Hetil. 2021; 162(50): 2010-2016.

Összefoglaló. A terhesség során a szervezet hormonrendszerében jelentős változások mennek végbe, melyek a magzat optimális anatómiai és élettani fejlődését, valamint a várandósság terminusig történő kihordását biztosítják. Ezen hatások sokszor a reproduktív szervrendszeren kívül más szerveket is érinthetnek, így a szemet és a szem függelékeit. A szemészeti változások élettani és kóros eltérésekben nyilvánulhatnak meg, melyek a legtöbbször átmenetiek és ártalmatlanok, bizonyos esetben azonban terápiás beavatkozást igényelhetnek, vagy súlyos háttérbetegség kórjelzői lehetnek. Közleményünkben áttekintjük a terhességhez kapcsolódó leggyakoribb fiziológiás szemészeti változásokat és egyéb patológiás szemészeti kórképeket, melyek a várandósság alatti megváltozott hormonális, immunológiai és metabolikus hatásokra kialakulhatnak, progrediálhatnak vagy fellángolhatnak. Ezenkívül ismertetjük a szülésvezetés módjának szemészeti indikációból történő eldöntésének vonatkozásait és a szülés kapcsán előforduló szemészeti szövődményeket. Orv Hetil. 2021; 162(52): 2089-2099. Summary. During pregnancy, significant changes occur in the endocrine system that ensure the appropriate anatomical and physiological development of the foetus as well as smooth delivery at term. Apart from the reproductive system, these effects can affect other organs such as the eye and ocular adnexa. Ophthalmic changes can manifest in physiological and pathological abnormalities, most of which are transient and harmless; however, some cases may require therapeutic intervention or may be indicative of severe underlying disease. Our review focuses on the most common physiological ophthalmic changes associated with pregnancy and other pathological ophthalmic diseases that may develop, progress or exacerbate due to altered hormonal, immunological and metabolic effects during gestation. Furthermore, aspects of deciding the delivery mode from an ophthalmic indication, along with ocular complications related to childbirth, are described. Orv Hetil. 2021; 162(52): 2089-2099.