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Purpose: To compare anterior chamber parameters in normal eyes and eyes with mild to moderate keratoconus corneas using rotating Scheimpflug imaging and evaluate trends in corneal protrusion progression. Setting: Department of Ophthalmology, Semmelweis University, Budapest, Hungary. Methods: The anterior chamber depth (ACD) at the corneal center, thinnest point of the cornea, and 1.0 mm, 2.0 mm, and 3.0 mm paracentrally; central pachymetry; and posterior elevation were measured by Scheimpflug imaging (Pentacam) in eyes with keratoconus and eyes of refractive surgery candidates. A generalized estimating equation (GEE) was used to identify predictors of keratoconus. Correlations between posterior elevation and ACD at minimum pachymetry were analyzed by linear and piecewise linear regression. Results: The keratoconus group comprised 41 eyes (24 patients) and the control group, 70 eyes (41 patients). The ACD was significantly deeper in the keratoconus group than in the control group (P<.05) and was significantly correlated with posterior elevation. In the multivariable GEE model, posterior elevation (odds ratio [OR], 1.46; P<.001) and ACD at minimum pachymetry (OR, 7.54; 95% confidence interval, 1.35-42.05) were significant predictors of keratoconus. Segmented analysis of the correlation between posterior elevation and central ACD showed a better fit to data than linear regression and identified a 40 μm threshold level for posterior elevation. The GEE determined 450 μm as a similar threshold for central corneal thickness. Conclusion: There was a threshold level of posterior corneal elevation and corneal thickness values beyond which the level of corneal protrusion in keratoconus accelerated. Financial Disclosure: No author has a financial or proprietary interest in any material or method mentioned. [Copyright &y& Elsevier]

Purpose: to evaluate the results of intraocular lens (IOL) exchange in cases of severe negative dysphotopsia and to measure the distance between the iris and the IOL optic using ultrasound biomicroscopy (UBM). Setting: Szent Rókus Hospital and Eye Clinic, Semmelweis University, Budapest, Hungary. Methods: Data of patients with major negative dysphotopsia symptoms after phacoemulsification with IOL implantation were reviewed retrospectively. In cases in which IOL exchange was performed to diminish the symptoms, the distance between the iris and the anterior surface of the IOL optic was measured by UBM and compared with that in a group of nonsymptomatic pseudophakic patients (control group). Results: in 3806 cataract procedures, 5 eyes (4 patients) had severe negative dysphotopsia symptoms. Intraocular lens exchange was performed in 3 cases. In 1 case, the secondary IOL was implanted in the reopened capsular bag and the symptoms persisted. In 2 cases, the secondary IOL was implanted in the ciliary sulcus and the symptoms resolved. On UBM, the mean iris–optic distance was 0.45 mm ± 0.07 (SD) in the symptomatic group, 0.59 ± 0.29 mm in the control group (n = 21) (P = .353), and 0.00 mm in the sulcus-fixated group. Conclusions: The iris–optic distance was not statistically significantly different between eyes with severe negative dysphotopsia symptoms and nonsymptomatic eyes. However, when IOL exchange reduced the iris–IOL distance, the severe negative dysphotopsia symptoms resolved. Financial Disclosure: No author has a financial or proprietary interest in any material or method mentioned. [Copyright &y& Elsevier]

Red circles signify initially stereoblind patients, white dots in the center of datapoints mark acuity equal to or below 0.4 logMAR, while a light gray line indicates a linear fit for patients without limiting factors, which is copied to (e) as well. The negative exponential fit indicates improvement (solid line) during the therapy (thick black line) and the expected improvement rate (dotted line) had the therapy been continued. (e) The improvement of patients with only one of the limiting factors also lie along the same linear fit calculated for patients without either of the limiting factors, whereas patient affected by both factors showed no or very limited improvement. [Extracted from the article]

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'. [ABSTRACT FROM AUTHOR]

Aims/Purpose: Fixation stability may be a biomarker of strabismus and amblyopia recurrence after strabismus surgery and therapeutic interventions to improve visual acuity in amblyopic eyes, respectively. We have recently shown that it is possible to improve fixation stability in adult amblyopic eyes after strabismus surgery using microperimetric biofeedback fixation training (BFT). In this study we evaluated the effects of BFT on fixation stability influencing monocular and binocular visual functions in adult patients with amblyopia. Methods: Participants were 18 patients with monocular amblyopia (mean age = 35.2 ± 9.8 years; 6 females, 3 anisometropic, 5 strabismic and 10 mixed amblyopia). BFT has been applied monocularly to 13 amblyopic eyes either on the spontaneous preferential retinal locus (PRL) or to a fixation area close to the PRL. The other five subjects did not undergo BFT (control group). Best‐corrected visual acuity (BCVA near and distance), monocular (PRL) and dichoptic contrast sensitivity function (CSF) and fixation stability (BCEA 68%) were measured three times: baseline, after 10 and after 20 BFT sessions or twice within 6 months interval for the controls. Results: Baseline fixation stability correlated positively with monocular amblyopic BCVA and CSF, especially in the high frequency range, whereas it was positively associated with dichoptic amblyopic CSF only in the low frequency range, most likely reflecting binocular imbalance. Preliminary results showed that BFT applied to amblyopic eyes improved fixation stability and visual functions. However, some clinical conditions may be required to achieve significant changes. Conclusions: BFT applied to adult amblyopic eyes is a new potential approach to aid in the treatment of suppresive amblyopia in adult patients. Critical pre‐treatment fixational and/or sensorial criteria associated with satisfactory therapeutic effects of BFT on amblyopia remains to be investigated. [ABSTRACT FROM AUTHOR]

Purpose: To examine the effects of a biological treatment (adalimumab) on visual function in patients with ankylosing spondylitis and in uveitic patients without macular edema during one-year treatment with adalimumab.Methods: Sixteen eyes of eight consecutive Caucasian patients treated with adalimumab were followed up using microperimetry (MAIA; CenterVue, Padova, Italy). Five patients had ankylosing spondylitis without uveitis, three patients had panuveitis without macular edema. Macular sensitivity and macular integrity were recorded.Results: During six-month follow-up, the average threshold did not change significantly (p = .649). Macular integrity was stable (p = .225). The macular sensitivity point analysis showed no significant effects (examination F(3,56) = 0.494 and p = .688; point*examination F(108,2016) = 0.688 and p = .994) during the follow-up.Conclusions: During one-year follow-up, adalimumab did not affect macular function, unlike the well-established maculopathy induced by hydroxychloroquine. Microperimetry may be considered when following-up macular function in patients undertaking adalimumab. [ABSTRACT FROM AUTHOR]

Vernal keratoconjunctivitis (VKC) is a chronic, allergic, and potentially severe ocular disease affecting children and adolescents that can lead to impaired quality of life (QoL) and loss of vision. This study evaluated the efficacy and safety of an investigational therapy for severe VKC, cyclosporine A (CsA) cationic emulsion (CE), an oil-in-water emulsion with increased bioavailability versus conventional CsA formulations. The VErnal KeratoconjunctiviTIs Study (VEKTIS) is a phase 3, multicenter, double-masked, vehicle-controlled trial. Pediatric patients (4 to younger than 18 years) with active severe VKC (grade of 3 or 4 on the Bonini severity scale) and severe keratitis (corneal fluorescein staining [CFS] score of 4 or 5 on the modified Oxford scale). One hundred sixty-nine patients were randomized to CsA CE 0.1% (1 mg/ml) eye drops 4 times daily (high dose), CsA CE twice daily (low dose) plus vehicle twice daily, or vehicle 4 times daily for 4 months. The primary end point was a mean composite score that reflected CFS, rescue medication use (dexamethasone 0.1% 4 times daily), and corneal ulceration over the 4 months. Differences in least-squares means versus vehicle for the primary end point were statistically significant for both the high-dose (0.76; P = 0.007) and the low-dose (0.67; P = 0.010) groups, with treatment effect mainly driven by CFS score. Significant differences were found between both active treatment groups and vehicle for use of rescue medication. Vernal keratoconjunctivitis symptoms and patient QoL (assessed by visual analog scale and the Quality of Life in Children with Vernal Keratoconjunctivitis questionnaire) improved in all 3 groups, with significant improvements for high-dose CsA CE versus vehicle. The efficacy of high-dose CsA CE in improving keratitis, symptoms, and QoL for those with severe VKC was demonstrated in these study patients. In addition, in this study cohort, CsA CE was well tolerated. [ABSTRACT FROM AUTHOR]

Biofeedback training has been used to improve fixation stability in subjects with central vision loss, but the psychophysiological mechanisms underlying the functional improvements resulted was not reported. The aim of this study was to investigate the effects of microperimetric biofeedback training on different visual functions and self-reported quality of vision in subjects with age-related macular degeneration. This case-control study included six subjects (72.0 ± 6.1 years of age) diagnosed with age-related macular degeneration (wet or dry) with low vision (best corrected visual acuity ranging from 0.5 to 0.1 in the study eye) and five healthy volunteers (64.2 ± 3.7 years of age). Ophthalmological and functional examinations were obtained from all subjects twice with an approximately 3-month interval. Subjects with central vision loss performed 12 sessions (10 min each) of biofeedback training between the two examinations. Functional evaluation included: microperimetry, spatial luminance contrast sensitivities, color vision thresholds, visual acuity, and reading speed. Visual performance during daily activities was also assessed using a standardized questionnaire. The ratio (2nd/1st examination) of the spatial luminance contrast sensitivity at lower spatial frequencies were much higher for the training subjects compared with the controls. In addition, self-reported quality of vision improved after the training. The significant improvement of the visual function such as spatial luminance contrast sensitivity may explain the better self-reported quality of vision. Possible structural and physiological mechanisms underlying this neuromodulation are discussed. [ABSTRACT FROM AUTHOR]

Abstract: Aim: The aim of this study was to estimate the prevalence and causes of blindness, severe visual impairment (SVI), moderate visual impairment (MVI), and early visual impairment (EVI) and its causes in an established market economy of Europe. Design: A cross‐sectional population‐based survey. Methods: A sample size of 3675 was calculated using the standard Rapid Assessment of Avoidable Blindness (RAAB) software in Hungary. A total of 105 clusters of 35 people aged 50 years or older were randomly selected with probability proportionate to size by the Hungarian Central Statistical Office. Households within the clusters were selected using compact segment sampling. Visual acuity (VA) was assessed with a Snellen tumbling E‐chart with or without a pinhole in the households. Results: The adjusted prevalences of bilateral blindness, SVI, MVI and EVI were 0.9% (95% CI: 0.6–1.2), 0.5% (95% CI: 0.2–0.7), 5.1% (95% CI: 4.3–5.9) and 6.9% (95% CI: 5.9–7.9), respectively. The major causes of blindness in Hungary were age‐related macular degeneration (AMD; 27.3%) and other posterior segment diseases (27.3%), cataract (21.2%) and glaucoma (12.1%). Cataract was the main cause of SVI, MVI and EVI. Cataract surgical coverage (CSC) was 90.7%. Of all bilateral blindness in Hungary, 45.5% was considered avoidable. Conclusion: This study proved that RAAB methodology can be successfully conducted in industrialized countries, which often lack reliable epidemiologic data. The prevalence of blindness was relatively low, with AMD and other posterior segment diseases being the leading causes, and cataract is still a significant cause of visual impairment. [ABSTRACT FROM AUTHOR]

Connexin36 (Cx36) constituent gap junctions (GJ) throughout the brain connect neurons into functional syncytia. In the retina they underlie the transmission, averaging and correlation of signals prior conveying visual information to the brain. This is the first study that describes retinal bipolar cell (BC) GJs in the human inner retina, whose function is enigmatic even in the examined animal models. Furthermore, a number of unique features (e.g. fovea, trichromacy, midget system) necessitate a reexamination of the animal model results in the human retina. Well-preserved postmortem human samples of this study are allowed to identify Cx36 expressing BCs neurochemically. Results reveal that both rod and cone pathway interneurons display strong Cx36 expression. Rod BC inputs to AII amacrine cells (AC) appear in juxtaposition to AII GJs, thus suggesting a strategic AII cell targeting by rod BCs. Cone BCs serving midget, parasol or koniocellular signaling pathways display a wealth of Cx36 expression to form homologously coupled arrays. In addition, they also establish heterologous GJ contacts to serve an exchange of information between parallel signaling streams. Interestingly, a prominent Cx36 expression was exhibited by midget system BCs that appear to maintain intimate contacts with bistratified BCs serving other pathways. These findings suggest that BC GJs in parallel signaling streams serve both an intra- and inter-pathway exchange of signals in the human retina. [ABSTRACT FROM AUTHOR]

Ca-buffer proteins (CaBPs) modulate the temporal and spatial characteristics of transient intracellular Ca-concentration changes in neurons in order to fine-tune the strength and duration of the output signal. CaBPs have been used as neurochemical markers to identify and trace neurons of several brain loci including the mammalian retina. The CaBP content of retinal neurons, however, varies between species and, thus, the results inferred from animal models cannot be utilised directly by clinical ophthalmologists. Moreover, the shortage of well-preserved human samples greatly impedes human retina studies at the cellular and network level. Our purpose has therefore been to examine the distribution of major CaBPs, including calretinin, calbindin-D28, parvalbumin and the recently discovered secretagogin in exceptionally well-preserved human retinal samples. Based on a combination of immunohistochemistry, Neurolucida tracing and Lucifer yellow injections, we have established a database in which the CaBP marker composition can be defined for morphologically identified cell types of the human retina. Hence, we describe the full CaBP make-up for a number of human retinal neurons, including HII horizontal cells, AII amacrine cells, type-1 tyrosine-hydroxylase-expressing amacrine cells and other lesser known neurons. We have also found a number of unidentified cells whose morphology remains to be characterised. We present several examples of the colocalisation of two or three CaBPs with slightly different subcellular distributions in the same cell strongly suggesting a compartment-specific division of labour of Ca-buffering by CaBPs. Our work thus provides a neurochemical framework for future ophthalmological studies and renders new information concerning the cellular and subcellular distribution of CaBPs for experimental neuroscience. [ABSTRACT FROM AUTHOR]

Retinal connexins (Cx) form gap junctions (GJ) in key circuits that transmit average or synchronize signals. Expression of Cx36, -45, -50 and -57 have been described in many species but there is still a disconcerting paucity of information regarding the Cx makeup of human retinal GJs. We used well-preserved human postmortem samples to characterize Cx36 GJ constituent circuits of the outer plexiform layer (OPL). Based on their location, morphometric characteristics and co-localizations with outer retinal neuronal markers, we distinguished four populations of Cx36 plaques in the human OPL. Three of these were comprised of loosely scattered Cx36 plaques; the distalmost population 1 formed cone-to-rod GJs, population 2 in the mid-OPL formed cone-to-cone GJs, whereas the proximalmost population 4 likely connected bipolar cell dendrites. The fourth population (population 3) of Cx36 plaques conglomerated beneath cone pedicles and connected dendritic tips of bipolar cells that shared a common presynaptic cone. Overall, we show that the human outer retina displays a diverse cohort of Cx36 GJ that follows the general mammalian scheme and display a great functional diversity. [ABSTRACT FROM AUTHOR]

Highlights: [•] The level of the complement activation products was elevated in the aqueous humor of Fuchs’ dystrophic patients. [•] The complement system was activated both through the classical and alternative pathways in the aqueous humor. [•] No correlation was found between the duration of the corneal oedema and the level of the complement activation products. [•] No difference was found as regards the level of the complement activation products between the patients with stage 2 or stage 3 disease. [Copyright &y& Elsevier]

The aim of this study is to determine the efficacy of a potent and specific vascular adhesive protein-1/semicarbazide-sensitive amine oxidase (VAP-1/SSAO) inhibitor, LJP 1207, as a potential antiangiogenic and anti-inflammatory agent in the therapy of corneal neovascularization. Corneal neovascularization was induced with intrastromal suturing in rabbits ( n = 20). Topical treatment with VAP-1/SSAO inhibitor LJP 1207 ( n = 5, 4 times a day), bevacizumab ( n = 5, daily), their combination ( n = 5) and vehicle only ( n = 5, 4 times a day) were applied postoperatively for 2 weeks. The development and extent of corneal neovascularization were evaluated by digital image analysis. At the end of the observation period, the level of corneal and serum VAP-1/SSAO activity was measured fluorometrically and radiochemically. The corneal VAP-1/SSAO activity was significantly elevated in the suture-challenged vehicle-treated group (3,075 ± 1,009 pmol/mg/h) as compared to unoperated controls (464.2 ± 135 pmol/mg/h, p < 0.001). Treatment with LJP 1207 resulted in slower early phase neovascularization compared to vehicle-treated animals (not significant). At days 7-14, there was no significant difference in the extent of corneal neovascularization between inhibitor- and vehicle-treated corneas, even though inhibitor treatment caused a normalization of corneal VAP-1/SSAO activity (885 ± 452 pmol/mg/h). Our results demonstrate that the significant elevation of VAP-1/SSAO activity due to corneal injury can be prevented with VAP-1/SSAO inhibitor LJP 1207 treatment. However, normalization of VAP-1/SSAO activity in this model does not prevent the development of corneal neovascularization. [ABSTRACT FROM AUTHOR]

Vascular adhesion protein-1 (VAP-1) controls the adhesion of lymphocytes to endothelial cells and is upregulated at sites of inflammation. Moreover, it expresses amine oxidase activity, due to the sequence identity with semicarbazide-sensitive amine oxidase. Recent studies indicate a significant role for VAP-1 in neovascularization, besides its contribution to inflammation. Pathological blood vessel development in severe ocular diseases (such as diabetes, age-related macula degeneration, trauma and infections) might lead to decreased visual acuity and finally to blindness, yet there is no clear consensus as to its appropriate treatment. In the present case study, the effects of two VAP-1 inhibitors on experimentally induced corneal neovascularization in rabbits were compared with the effects of a known inhibitor of angiogenesis, bevacizumab, an anti-vascular endothelial growth factor antibody. In accordance with recent literature data, the results of the preliminary study reported here indicate that the administration of VAP-1 inhibitors is a potentially valuable therapeutic option in the treatment of corneal neovascularization. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate ocular wavefront aberrations in keratoconus and describe their effect on visual quality. Setting: Department of Ophthalmology Semmelweis University, Budapest, Hungary. Design: Case-control study. Methods: Ocular aberrations over a 4.5 mm pupil were measured with a Hartmann-Shack sensor in eyes with keratoconus or subclinical keratoconus or of refractive surgery candidates with normal corneas. Visual quality metrics were calculated using an optical design program. The correlation between Zernike polynomials was evaluated using correlation analysis. Predictors of subclinical keratoconus and keratoconus among ocular aberrations were evaluated. Visual quality (point-spread function, retinal spot radius, Strehl ratio) between groups was compared. Results: Horizontal and vertical coma were significant predictors of subclinical keratoconus (P<.05, r 2 = 0.85) and oblique astigmatism and vertical coma of keratoconus (P<.05, r 2 = 0.64). Spot radius (P<.05, r 2 = 0.66) and the Strehl ratio (P<.05, r 2 = 0.64) were significant discriminators in all groups. On correlation analysis, interactions of ocular aberrations were different in keratoconus eyes than in control eyes. In keratoconus eyes, there was a negative correlation between defocus and spherical aberration (r = −0.41) and between astigmatism and secondary astigmatism (r = −0.68). In contrast, spherical aberration correlated positively with tetrafoil (r = 0.47) and the positive correlation between vertical coma and vertical tilt decreased (r = 0.67 versus r = 0.34). Conclusion: Image quality in keratoconus was significantly decreased at equal levels of total root mean square error. A combination of ocular aberrations in eyes with keratoconus decreased image quality. Financial Disclosure: No author has a financial or proprietary interest in any material or method mentioned. [Copyright &y& Elsevier]

To explore the effects of corneal astigmatism and asphericity on posterior elevation values calculated by different reference bodies and to compare their predictive accuracy in the diagnosis of keratoconus. In this prospective observational case series, 44 eyes of 24 patients with keratoconus and 70 eyes of 41 refractive surgery candidates as a control group were measured by the Pentacam Scheimpflug camera. Discriminating ability and predictors of posterior elevation measurements obtained by best fit toric ellipsoid (BFTE) and best fit sphere (BFS) reference surfaces were compared by receiver operator characteristic curves (ROC) and generalized estimating equation (GEE) models. Bland-Altman plots were used to determine the agreement between different reference surfaces. Receiver operator characteristic curve analysis showed that posterior elevation measured by a BFTE auto had a significantly higher area under ROC curves (0.99) value than BFTE 8-mm or BFS reference surfaces. ROC analysis identified cut-off values for BFTE auto (9.5-μm), for BFTE 8-mm (10.5-μm), for BFS auto (16.5-μm) and for BFS 8-mm (15.5-μm) reference surfaces. According to GEE models, corneal cylinder and posterior asphericity had the least effect in toric ellipsoid models. Bland-Altman plots showed a systematic bias at higher values of average posterior elevation measured BFS reference surfaces. Posterior corneal elevation value measured by the Pentacam camera can effectively discriminate keratoconus from normal corneas although measured values and cut-off points depend on the selection of reference body and corneal asphericity. Toric ellipsoid reference surface seems to be the most sensitive method to differentiate keratoconus. [ABSTRACT FROM AUTHOR]

Purpose: To investigate the post-blink changes of the topographical regularity indices, the corneal wavefront aberrations and the tear lipid layer's interference pattern, and analyze the relationship between these parameters' changes. Methods: Sequential topographical measurements were recorded on 23 normal participants. The surface regularity index (SRI), surface asymmetry index (SAI), corneal total higher order aberrations (HOA) root mean square (RMS), Coma RMS and Spherical RMS were calculated from the topographical measurement. The incidence of the type 1 (with an initial decrease after blink) alteration trend, and the times to the initial minimum were determined in every parameter. The movement of the tear lipid layer's interference pattern was recorded, and the spreading time of the lipid layer was measured subjectively by three independent observers. Results: The incidence of the type 1 SRI trend (82%) was the most common among those measured. The average time to the type 1 SRI trends' minimum was 4.05 ± 1.46 s. There was no correlation between the time to the minimum of type 1 trends of the topographical indices, the HOA, Coma and Spherical RMS. The mean lipid layer spreading time was 5.09 ± 1.90 s. We found weak but significant correlation between the times to the minimum of type 1 SRI trends and the lipid spreading time ( r = 0.540, p = 0.021).The minimum of the SRI index occurred before the stoppage of superficial lipid layer's motion. Conclusion: Relatively long lipid layer spreading time was observed suggesting that the tear film build-up process did not finish completely at the end of the initial rapid tear film alteration phase. The detected initial decrease of the SRI after blink related to the post-blink tear film motion. This initial pattern is characteristic of the majority of the normal population in spite of the post-blink alteration pattern of the topographical SAI or corneal aberrations. The SRI seems to be the most useful indirect topographical parameter of the tear film dynamics. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate ocular wavefront aberrations owing to keratoconus compared with normal controls and to describe the changes in the axis of line of sight (LoS) among keratoconic patients. Design: Prospective case-control study. Participants: Fifty-five eyes of 30 patients with keratoconus and 100 eyes of 50 refractive surgery candidates with normal corneas. Methods: Ocular aberrations over a 4.5 mm (undilatated) pupil were measured with a Hartmann-Shack sensor. Corneal topographic measurement was performed with a Tomey corneal topographer. The axis of the displacement of LoS was calculated by vector analysis. Main Outcome Measures: Root mean square (RMS) and higher order RMS values, ocular aberrations up to the 6th Zernike order and the distance of the LoS from the pupillary center (x and y offset values) in keratoconic and normal eyes were measured with aberrometry. The steepest and average keratometric values and the axis of the steepest meridian were measured in keratoconic eyes with topography. Correlations were made between the size and the direction of the shift in the LoS and ocular aberrations. Results: The following parameters were significantly higher in the keratoconus group compared to the control group: higher order RMS (P<0.001), Z3 −1 (P<0.001), Z3 −3 (P<0.002), Z3 3 (P = 0.001), Z4 −2 (P<0.001), Z4 2 (P<0.001), Z4 4 (P = 0.016), Z5 −5 (P = 0.03), Z5 −1 (P = 0.04), Z5 3 (P = 0.01), and y offset value (P<0.001). In keratoconic patients there was a significant correlation between the axis of the shift in the LoS and the steepest keratometric axis on topography (r = 0.59; P<0.001), the distance of the LoS from pupil center and vertical coma (r = −0.39; P = 0.004), and spherical aberration (SA; r = 0.29; P<0.04). There was also a significant correlation between the average keratometry value measured by topography and SA (r = −0.49; P<0.001). A factorial regression model testing the interactive effects of vertical coma and SA on the shift of LoS had a good fit on our data (r 2 = 0.69; P<0.001). Conclusions: A significant displacement of the LoS is observed in keratoconus and relates to the position of the cone on topography and the induced vertical coma measured by aberrometry. Financial Disclosure(s): The authors have no proprietary or commercial interest in any of the materials discussed in this article. [Copyright &y& Elsevier]

Our topography system is an enhancement of a standard TMS-1 corneal topograph instrument (Computed Anatomy Inc., New York, NY, USA). Topographic images are captured at a rate of 4 s−1, allowing the recording of a series of 120 images in 30 s after a complete blink. In this prospective preliminary study 15 healthy volunteers were examined. The main outcome measures were the time profile of changes in surface regularity index (SRI), surface asymmetry index (SAI) and simulated keratometry values ( K1, K2). After a blink there was a tendency for improvement in ocular surface regularity. Later trends were less clear. Our topography system makes possible the detailed evaluation of tear-film dynamics in the post-blink period. The new technique may play an important role in the diagnosis of various tear-film abnormalities; the results may also have significant implications in the planning of refractive surgeries. [ABSTRACT FROM AUTHOR]

Hypoxic-ischemic encephalopathy (HIE) is still a major cause of neonatal death and disability as therapeutic hypothermia (TH) alone cannot afford sufficient neuroprotection. The present study investigated whether ventilation with molecular hydrogen (2.1% H2) or graded restoration of normocapnia with CO2 for 4 h after asphyxia would augment the neuroprotective effect of TH in a subacute (48 h) HIE piglet model. Piglets were randomized to untreated naïve, control-normothermia, asphyxia-normothermia (20-min 4%O2–20%CO2 ventilation; Tcore = 38.5 °C), asphyxia-hypothermia (A-HT, Tcore = 33.5 °C, 2–36 h post-asphyxia), A-HT + H2, or A-HT + CO2 treatment groups. Asphyxia elicited severe hypoxia (pO2 = 19 ± 5 mmHg) and mixed acidosis (pH = 6.79 ± 0.10). HIE development was confirmed by altered cerebral electrical activity and neuropathology. TH was significantly neuroprotective in the caudate nucleus but demonstrated virtually no such effect in the hippocampus. The mRNA levels of apoptosis-inducing factor and caspase-3 showed a ~10-fold increase in the A-HT group compared to naïve animals in the hippocampus but not in the caudate nucleus coinciding with the region-specific neuroprotective effect of TH. H2 or CO2 did not augment TH-induced neuroprotection in any brain areas; rather, CO2 even abolished the neuroprotective effect of TH in the caudate nucleus. In conclusion, the present findings do not support the use of these medical gases to supplement TH in HIE management. [ABSTRACT FROM AUTHOR]

Uveal melanoma (UM) is the most common primary malignant ocular tumour in adults, although its epidemiology in Central and Eastern Europe is unclear. This study aimed to analyse the incidence and all-cause mortality of UM in Hungary. This nationwide, retrospective, longitudinal study used data from the National Health Insurance Fund and included patients aged ≥18 years who were newly diagnosed with UM (ICD-10 C69.3 or C69.4) between 1 January 2012 and 31 December 2021. Age-standardised incidence and all-cause mortality rates were calculated using European Standard Population data from 2013. We identified 88 and 70 new patients with UM in 2012 and 2021, respectively, showing an almost stable trend. Age-standardised incidence rates varied between 6.40 and 10.96/1,000,000 person-years (PYs) during the analysed period. The highest age-standardised incidence was detected among men (13.38/1,000,000 PYs) in 2015. All-cause mortality decreased from 4.72/1,000,000 PYs to 0.79/1,000,000 PYs between 2012 and 2021. In conclusion, the UM incidence rate in Hungary is comparable to European incidence rates. The incidence did not markedly change, whereas all-cause mortality decreased during the study period, but this decline could not be attributed to improved treatment modalities for primary tumours and metastatic UM.

Background/objectives: Cyclosporine A cationic ophthalmic emulsion (CsA CE) was evaluated in paediatric and adolescent patients with vernal keratoconjunctivitis (VKC) in the NOVATIVE (NCT00328653) and VEKTIS (NCT01751126) trials. The similarity of these studies permitted pooled assessment of the effect of CsA CE on corneal damage as well as safety and tolerability., Subjects/methods: Pooled outcomes were assessed for the first 28 days of treatment. In NOVATIVE, 118 patients were randomised to 4 times daily (QID) CsA CE 0.05%, 0.1%, or vehicle eye drops. In VEKTIS, 169 patients were randomised to CsA CE 0.1% QID or twice daily (BID) or vehicle. For these analyses, treatment groups comprised: (1) pooled CsA CE 0.1% QID arms (high-dose; n = 96); (2) pooled CsA CE 0.05% QID arm from NOVATIVE and CsA CE 0.1% BID data from VEKTIS (low-dose; n = 93); and (3) pooled vehicle QID arms (vehicle; n = 98)., Results: Changes from baseline to day 28 (mean ± standard deviation) in corneal fluorescein staining (CFS) scores for CsA CE high-dose, low-dose, and vehicle groups were -1.6 ± 1.47 (95% CI: -0.9, -0.1; p = 0.0124 vs vehicle), -1.7 ± 1.39 (95% CI: -1.1, -0.3; p = 0.0015 vs vehicle), and -1.0 ± 1.55, respectively. Adverse events (AEs) of any type were reported in 37.5%, 34.4%, and 37.8% of the high-dose, low-dose, and vehicle groups, respectively. Most were mild or moderate in severity., Conclusions: CsA CE significantly decreased corneal damage and was safe and well tolerated in patients with VKC. These data support CSA CE as a treatment option for the management of VKC., (© 2022. The Author(s).)

Aim: To review existing data for the prevalence of corrected, uncorrected, and inadequately corrected refractive errors and spectacle wear in Hungary., Methods: Data from two nationwide cross-sectional studies were analysed. The Rapid Assessment of Avoidable Blindness study collected population-based representative national data on the prevalence of visual impairment due to uncorrected refractive errors and spectacle coverage in 3523 people aged ≥50y (Group I). The Comprehensive Health Test Program of Hungary provided data on the use of spectacles in 80 290 people aged ≥18y (Group II)., Results: In Group I, almost half of the survey population showed refractive errors for distant vision, about 10% of which were uncorrected (3.2% of all male participants and 5.0% of females). The distance spectacle coverage was 90.7% (91.9% in males; 90.2% in females). The proportion of inadequate distance spectacles was found to be 33.1%. Uncorrected presbyopia was found in 15.7% of participants. In all age groups (Group II), 65.4% of females and 56.0% of males used distance spectacles, and approximately 28.9% of these spectacles were found to be inappropriate for dioptric power (with 0.5 dioptres or more). The prevalence of inaccurate distance spectacles was significantly higher in older age groups (71y and above) in both sexes., Conclusion: According to this population-based data, uncorrected refractive errors are not rare in Hungary. Despite recent national initiatives, further steps are required to reduce uncorrected refractive errors and associated negative effects on vision, such as avoidable visual impairment., (International Journal of Ophthalmology Press.)

Introduction: The World Health Organisation's VISION 2020 and World report on vision programs prioritize blindness prevention and vision rehabilitation development. The ophthalmology program, which is part of Hungary's comprehensive health care screening program, plays an important role in the national implementation of these., Objective: Summary of the results of Hungary's comprehensive health care screening program's ophthalmology program, which has been going on for 12 years., Method: The ophthalmological data of 168 522 people aged between 12 and 99 years who participated in the national screening program were analyzed in nine categories: the presence of eye disease, the use of glasses, the refractive power of the glasses, refractive errors (myopia, anisometropia), the functional vision questionnaire, dry eye, colour vision, educational and communication activities., Results: 18.1% of the participants reported having an eye disease, which was much more common in women and the elderly. The proportion of people who wore glasses reached 66%, with roughly one-third of them lacking appropriate glass strength. Myopia was the most common (58.7%) in people aged 18 to 35. Anisometropia was found in 6.5% of people. Women were more likely than men to have dry eyes (26.1%). Men had a higher rate of colour vision deficiency (5.7%) than women (0.7%)., Discussion: As blindness is 80% preventable, national screening tests and comprehensive educational activities that contribute to the early detection and treatment of eye diseases are important. It is critical to call attention to the significant growth in the prevalence of myopia in young people as well as the urgent need for the effective implementation of preventive measures. The importance of proper glasses must also be brought to the attention of the general population because incorrect glasses cause visual problems., Conclusion: The national ophthalmology screening and educational activity should be continued in the future, with the goal of reducing the incidence of eye diseases associated with visual impairment and increasing the proportion of people who wear appropriate glasses. To stop the spread of myopia, a national preventive and treatment program should be launched. Orv Hetil. 2023; 164(7): 253-259.

Aim: To examine the prevalence and composition of refractive errors in Hungary., Methods: Nationwide cross-sectional data collected between 2014 and 2019 were analysed from the Comprehensive Health Screening Program of Hungary, which provided spectacle dioptric power and autorefractometry data for 68 227 people (35 850 women and 32 377 men). Their age distribution, 18-99y, was similar to the national demographic distributions., Results: Of the total population, 16.50% of the refractive errors exhibited hyperopia, 40.05% emmetropia, and 43.45% myopia. Myopia was 3 times more frequent (58.7%) in younger ages (18-35y of age) compared to older age groups (19.4% of those 56-70y of age; P <0.001). High myopia showed a low prevalence (0.21%), and an increase parallel with ageing ( r =0.716; P =0.009)., Conclusion: Myopia is the most frequent refractive error in Hungary. The prevalence of myopia is especially increased, up to 2-3 times, in the younger age groups. Nationwide actions need to be taken to reduce the onset of myopia and its associated consequences., (International Journal of Ophthalmology Press.)

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.

Background and Purpose: We aimed to investigate the association between fluoxetine use and the survival of hospitalised coronavirus disease (COVID-19) pneumonia patients., Methods: This retrospective case-control study used data extracted from the medical records of adult patients hospitalised with moderate or severe COVID-19 pneumonia at the Uzsoki Teaching Hospital of the Semmelweis University in Budapest, Hungary between 17 March and 22 April 2021. As a part of standard medical treatment, patients received anti-COVID-19 therapies as favipiravir, remdesivir, baricitinib or a combination of these drugs; and 110 of them received 20 mg fluoxetine capsules once daily as an adjuvant medication. Multivariable logistic regression was used to evaluate the association between fluoxetine use and mortality. For excluding a fluoxetine-selection bias potentially influencing our results, we compared baseline prognostic markers in the two groups treated versus not treated with fluoxetine., Results: Out of the 269 participants, 205 (76.2%) survived and 64 (23.8%) died between days 2 and 28 after hospitalisation. Greater age (OR [95% CI] 1.08 [1.05-1.11], p<0.001), radiographic severity based on chest X-ray (OR [95% CI] 2.03 [1.27-3.25], p=0.003) and higher score of shortened National Early Warning Score (sNEWS) (OR [95% CI] 1.20 [1.01-1.43], p=0.04) were associated with higher mortality. Fluoxetine use was associated with an important (70%) decrease of mortality (OR [95% CI] 0.33 [0.16-0.68], p=0.002) compared to the non-fluoxetine group. Age, gender, LDH, CRP, and D-dimer levels, sNEWS, Chest X-ray score did not show statistical difference between the fluoxetine and non-fluoxetine groups supporting the reliability of our finding., Conclusion: Provisional to confirmation in randomised controlled studies, fluoxetine may be a potent treatment increasing the survival for COVID-19 pneumonia.

Background/aims: The purpose of this study was to estimate the total healthcare cost associated with diabetic retinopathy (DR) in the population aged 18 years and older in Hungary, and its projection for the year 2045., Methods: A cost model was developed based on the standardised rapid assessment of avoidable blindness with the diabetic retinopathy module (RAAB+DRM) methodology and recently reported prevalent-based cost of illness model. Projection for 2045 was made based on the estimation for increasing diabetes mellitus (DM) prevalence of the International Diabetes Federation. Costs were analysed from the perspective of the healthcare system and the patients. Our DR cost model was constructed according to the Scottish DR grading scale and based on the DR severity stadium., Results: The total DR-associated healthcare cost was US$145.8 million in 2016 and will increase to US$169.0 million by 2045. The two major cost drivers were intravitreal antivascular endothelial growth factor injections and vitrectomies in this study (US$126.4 million in 2016 and US$146.5 million in 2045); they amounted to 86.7% of the total treatment cost of DR. The DR-related cost per patient was US$180.5 in Hungary., Conclusions: The cost per patient for treating DR was lower in Hungary than in other countries. Due to the increasing socioeconomic burden of proliferative DR and diabetes-related blindness, it would be important to invest in DR screening, prevention and early treatment. Our new RAAB-based cost of DR model may facilitate comparisons of DR treatment costs across countries., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2021. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: Visual 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., Methods: Participants 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., Results: Baseline measurements showed significantly altered microperimetric average threshold in amblyopic eyes compared to fellow eyes (p = 0.024) and compared to control eyes (p < 0.001). Fixation was unstable in amblyopic eyes compared to control eyes (p < 0.001). Fixation stability did not significantly change after surgical alignment of strabismus (p = 0.805). BFT applied to operated eyes resulted in a more stable fixation with improvements of about 50% after three months of training., Conclusions: Fixation 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.

Background: To estimate the impact of the COVID-19 pandemic on emergency inpatient volume in a tertiary eye care center in Germany with corneal main subspecialization., Material and Methods: A retrospective review of ocular emergency patients who attended the inpatient unit of the Department of Ophthalmology of Saarland University, Homburg/Saar, Germany during the COVID-19 pandemic, between 1 March and 30 April 2020, in comparison to the same time period in 2019. For each subject, clinical history and surgical reports were reviewed. After 24 March 2020, PCR examinations for SARS-CoV-2 were performed from throat swab specimens in all patients using real-time RT-PCR., Results: Totally, 135 patients were admitted in 2019 and 115 patients in 2020 as emergency cases. The patient age at the time of admission did not differ significantly between the two time periods (63.6 ± 17.9 years vs. 62.5 ± 19.6 years) (p = 0.792), but the average length of hospital stays increased significantly for 2020 (4.0 ± 3.6 vs. 4.4 ± 2.7 days, p = 0.043). The percentage of admissions due to acute corneal hydrops (0% vs. 3.5%) increased significantly from 2019 to 2020 (χ 2  = 4.772, p = 0.028), however, there was not a significant difference between the two years for any other diagnosis (χ 2  ≤ 3.564, p ≥ 0.059). From 2019 to 2020, the percentage of acute intravitreal anti-VEGF injections decreased significantly (7.9% vs. 1.3%, χ 2  = 3.985, p = 0.045), but the proportion of other emergency surgeries did not differ between the two years (χ 2  ≤ 3.617, p ≥ 0.057). COVID-19 PCR examination was performed in 66 (57.4%) cases in 2020 and all samples (100%) were negative., Conclusions: The COVID pandemic did not change emergency inpatient volume in our department, but duration of hospital stay was extended on average by 8 hours, mainly due to additional COVID-19-PCR examinations. The proportion of the most frequently performed surgeries did not change remarkably between 2019 and 2020, but with the introduction of Muraine's sutures in 2019, the percentage of admissions with acute corneal hydrops (with or without subsequent surgery) increased for 2020. No urgent surgery had to be postponed due to the COVID-19 pandemic at our department; all operations were performed successfully., Competing Interests: Dr. Tóth reported grants from EFOP-3.6.3-VEKOP-16-2017-00009. The work of Dr. Szentmáry at the Dr. Rolf M. Schwiete Center was supported by the Dr. Rolf M. Schwiete Foundation. No conflicting relationship exists for remaining authors., (Thieme. All rights reserved.)

The prevalence of myopia is increasing extensively worldwide. The number of people with myopia in 2020 is predicted to be 2.6 billion globally, which is expected to rise up to 4.9 billion by 2050, unless preventive actions and interventions are taken. The number of individuals with high myopia is also increasing substantially and pathological myopia is predicted to become the most common cause of irreversible vision impairment and blindness worldwide and also in Europe. These prevalence estimates indicate the importance of reducing the burden of myopia by means of myopia control interventions to prevent myopia onset and to slow down myopia progression. Due to the urgency of the situation, the European Society of Ophthalmology decided to publish this update of the current information and guidance on management of myopia. The pathogenesis and genetics of myopia are also summarized and epidemiology, risk factors, preventive and treatment options are discussed in details.

Összefoglaló. Bevezetés: A diabeteses retinopathia minden harmadik cukorbeteget érinti a világban, és a dolgozó korú lakosság körében a vakság vezető oka. Célkitűzés: Tanulmányunk célja a diabeteses retinopathia prevalenciaalapú költségterhének meghatározása 2018-ban a 18 évnél idősebb korú lakosság körében Magyarországon. Módszer: Standardizált 'rapid assessment of avoidable blindness' (RAAB) + diabeteses retinopathia modul alapú metodikán alapuló modellel analizáltuk a diabeteses retinopathia költségterhét. A diabeteses retinopathia okozta gazdasági terhet a Nemzeti Egészségbiztosítási Alapkezelő és a páciensek oldaláról felmerülő költségeket analizálva vizsgáltuk. A prevalenciaalapú diabeteses retinopathia költségmodellt a skót diabeteses retinopathia klasszifikációnak és a diabeteses retinopathia súlyossági stádiumának megfelelően állítottuk össze. Eredmények: A diabeteses retinopathia költségterhe 43,66 milliárd Ft volt 2018-ban. A két fő költségviselő az anti-VEGF-injekciók (28,91 milliárd Ft) és a vitrectomiák (8,09 milliárd Ft) voltak. Ez a két kezelési mód volt felelős a diabeteses retinopathiával kapcsolatban felmerülő összes költség 84,7%-áért. Az egy páciensre jutó átlagos költségteher 54 691 Ft volt hazánkban. Következtetés: A cukorbetegek szemészeti járó- és fekvőbeteg-ellátása alulfinanszírozott hazánkban. A proliferatív diabeteses retinopathia és a diabeteses maculaoedema növekvő társadalmi-gazdasági terhe miatt érdemes volna javítani a megelőzés, a szűrés és a korai kezelés jelenlegi helyzetén. Orv Hetil. 2021; 162(8): 298-305., Introduction: Diabetic retinopathy affects every third people with diabetes mellitus in the world and is the leading cause of blindness in adults of working age., Objective: The aim of this study was to analyse the economic burden associated with diabetic retinopathy in people aged 18 years and older in Hungary., Method: Rapid assessment of avoidable blindness (RAAB) with the diabetic retinopathy module (DRM) based diabetic retinopathy cost model study was conducted in Hungary in 2018. Economic burden of diabetic retinopathy was analysed from the perspective of the National Health Insurance Fund system and the patients. Our prevalence-based diabetic retinopathy cost model was performed according to the Scottish diabetic retinopathy grading scale and based on the diabetic retinopathy severity stadium., Results: The total diabetic retinopathy-associated economic burden was 43.66 billion HUF in 2018. The two major cost drivers were anti-VEGF injections (28.91 billion HUF) and vitrectomies (8.09 billion HUF) in Hungary; they covered to 84.7% of the total cost among people with diabetes mellitus. The diabetic retinopathy-related cost per patient was 54 691 HUF in Hungary., Conclusion: Outpatient and inpatient eye care of people with diabetes mellitus are underfinanced in Hungary. Due to the increasing socio-economic burden of proliferative diabetic retinopathy and diabetic macular oedema, it would be important to invest in proliferative diabetic retinopathy and macular oedema prevention, screening and early treatment. Orv Hetil. 2021; 162(8): 298-305.

Purpose: To study binocular balance by comparing dichoptic and standard monocular contrast sensitivity function (CSF) in stereonormal and stereoanomalous/stereoblind amblyopic subjects., Methods: Sixteen amblyopes and 17 controls participated. Using the capability of the passive three-dimensional display, we measured their CSF both monocularly and dichoptically at spatial frequencies 0.5, 1, 2, 4, and 8 cpds using achromatic Gabor patches on a luminance noise background. During monocular stimulation, the untested eye was covered, while for the dichoptic stimulation the untested eye viewed background noise. Dichoptic CSF of both eyes was acquired within one block., Results: In patients with central fixation, dichoptic viewing had a large negative impact on the CSF of the amblyopic eye, although it hardly affected that of the dominant eye. In contrast, dichoptic viewing had a small but significant effect on both eyes for controls. In addition, all participants lay along a continuum in terms of how much their two eyes were affected by dichoptic stimulation: by using two predefined contrast sensitivity ratios, namely, amblyopic sensitivity decrement and dichoptic sensitivity decrement, not only did we find a significant correlation between these variables among all participants, but also the two groups were identified with minimum error using a cluster analysis., Conclusions: Dichoptic CSF may be considered to measure visual performance in patients with altered binocular vision, because it better reflects the visual capacity of the amblyopic eye than the standard monocular examinations. It may also be a more reliable parameter to assess the efficacy of modern approaches to treat amblyopia.

Brain interstitial pH (pHbrain) alterations play an important role in the mechanisms of neuronal injury in neonatal hypoxic-ischemic encephalopathy (HIE) induced by perinatal asphyxia. The newborn pig is an established large animal model to study HIE, however, only limited information on pHbrain alterations is available in this species and it is restricted to experimental perinatal asphyxia (PA) and the immediate reventilation. Therefore, we sought to determine pHbrain over the first 24h of HIE development in piglets. Anaesthetized, ventilated newborn pigs (n = 16) were instrumented to control major physiological parameters. pHbrain was determined in the parietal cortex using a pH-selective microelectrode. PA was induced by ventilation with a gas mixture containing 6%O2-20%CO2 for 20 min, followed by reventilation with air for 24h, then the brains were processed for histopathology assessment. The core temperature was maintained unchanged during PA (38.4±0.1 vs 38.3±0.1°C, at baseline versus the end of PA, respectively; mean±SEM). In the arterial blood, PA resulted in severe hypoxia (PaO2: 65±4 vs 23±1*mmHg, *p<0.05) as well as acidosis (pHa: 7.53±0.03 vs 6.79±0.02*) that is consistent with the observed hypercapnia (PaCO2: 37±3 vs 160±6*mmHg) and lactacidemia (1.6±0.3 vs 10.3±0.7*mmol/L). Meanwhile, pHbrain decreased progressively from 7.21±0.03 to 5.94±0.11*. Reventilation restored pHa, blood gases and metabolites within 4 hours except for PaCO2 that remained slightly elevated. pHbrain returned to 7.0 in 29.4±5.5 min and then recovered to its baseline level without showing secondary alterations during the 24 h observation period. Neuropathological assessment also confirmed neuronal injury. In conclusion, in spite of the severe acidosis and alterations in blood gases during experimental PA, pHbrain recovered rapidly and notably, there was no post-asphyxia hypocapnia that is commonly observed in many HIE babies. Thus, the neuronal injury in our piglet model is not associated with abnormal pHbrain or low PaCO2 over the first 24 h after PA., Competing Interests: The authors have declared that no competing interests exist.

Aim: To examine the coexistence of diabetes mellitus (DM) and cataract in Hungary. The effects of DM on the cataract surgical results were also in the focus of analysis., Methods: Statistical data analysis of the results of the Rapid Assessment of Avoidable Blindness with Diabetic Retinopathy (RAAB+DR) module conducted in Hungary in 2015. This cross-sectional, population-based, national survey included 3523 people aged 50 years and over. Participants of the survey were examined on-site. Visual acuity, main cause for visual impairment (using direct and indirect ophthalmoscopes), in case of best corrected visual acuity (BCVA) ≤0.5 and blood glucose level (random test with glucometer) were examined., Results: The prevalence of cataract was 23.4%, and DM was 20.0%. The occurrence of cataract steadily increased with age. Among the examined participants with DM, the prevalence of cataract was significantly ( P =0.012) higher (+35%) than that in non-diabetic subjects (29.5% vs 21.8%). Following aging (OR=15.2%, P <0.001), DM proved to be the most independent influencing risk factor (OR=49.9%, P <0.001). The presence of DM was neither an influencing factor for complications of cataract surgery, nor for postoperative visual acuity., Conclusion: DM appears to be one of the main risk factors for developing cataract. Other risk factors, such as age, sex and environment also play an influencing role. Diabetes does not seem to affect the occurrence of cataract surgical complications., (International Journal of Ophthalmology Press.)

Purpose: To assess the safety and efficacy of cyclosporine A cationic emulsion (CsA CE) 0.1% eye drops in pediatric patients with severe active vernal keratoconjunctivitis (VKC)., Design: Multicenter, double-masked, randomized controlled trial 8-month safety analysis., Methods: Of 169 patients (age range, 4-17 years) initially randomized in the 4-month VErnal KeratoconjunctiviTIs Study (VEKTIS), 142 entered the 8-month follow-up period during which CsA CE patients remained on their original regimen (CsA CE 4 times daily [QID, high-dose] or CsA CE twice daily [BID, low-dose] + vehicle BID) and vehicle patients were allocated to one of these 2 active regimens. Main outcome measures were safety, including treatment-emergent adverse events, and efficacy, including corneal fluorescein staining (CFS) score., Results: Improvements in CFS score, rescue medication use, key VKC symptoms (photophobia, tearing, itching, and mucous discharge), and quality of life (QoL) assessed by QUICK questionnaire observed with CsA CE compared with vehicle during the 4-month evaluation period remained stable during the 8-month follow-up period, with the high-dose regimen continuing to provide greater benefits in most efficacy measures. CsA CE was well tolerated. Treatment-related treatment-emergent adverse events during the 12-month study were reported in 15 (20.8%) and 11 (15.7%) of the CsA CE high-dose and low-dose patients, respectively, most commonly instillation site pain (13.9% and 7.1%, respectively). Laboratory data, vital signs, slit lamp examination, best-corrected distance visual acuity, and intraocular pressure raised no safety concerns., Conclusions: Improvements in keratitis, symptoms, and QoL achieved after CsA CE treatment for 4 months remained stable over the 8-month follow-up period. CsA continued to maintain a favorable safety profile., (Copyright © 2019 The Authors. Published by Elsevier Inc. All rights reserved.)

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 <6/60, and the VA in 73 962 people was <6/18 in the better eye due to cataract. An estimated 77 933 eyes are blind; 98 067 eyes had a VA of <6/60, and an estimated 277 493 eyes had a VA of <6/18 due to cataract. Almost all cataract surgeries were conducted in government hospitals. The age- and sex-adjusted cataract surgical coverage with VA<3/60 in eyes was 90.0%. The rate of good visual outcome after surgery was 79.5%. Ocular comorbidity was the main cause of poor outcome (78.1%), followed by late complications (such as posterior capsule opacification) (17.2%), inadequate optical correction (3.1%), and surgical complications (1.6%). The main barrier to surgery in people with bilateral cataract and VA of <6/60 was 'need not felt'., Conclusion: The prevalence of visual impairment resulting from cataract is slightly higher than expected. The quality of the cataract surgical service seems adequate in Hungary. However, the number of cataract operations per year should continue to increase due to the increasing patient demands and the aging population., (International Journal of Ophthalmology Press.)

Cortical spreading depolarization (SD) involves activation of NMDA receptors and elicit neurovascular unit dysfunction. NMDA cannot trigger SD in newborns, thus its effect on neurovascular function is not confounded by other aspects of SD. The present study investigated if NMDA affected hypercapnia-induced microvascular and electrophysiological responses in the cerebral cortex of newborn pigs. Anesthetized piglets were fitted with cranial windows over the parietal cortex to study hemodynamic and electrophysiological responses to graded hypercapnia before/after topically applied NMDA assessed with laser-speckle contrast imaging and recording of local field potentials (LFP)/neuronal firing, respectively. NMDA increased cortical blood flow (CoBF), suppressed LFP power in most frequency bands but evoked a 2.5 Hz δ oscillation. The CoBF response to hypercapnia was abolished after NMDA and the hypercapnia-induced biphasic changes in δ and θ LFP power were also altered. MK-801 prevented NMDA-induced increases in CoBF and the attenuation of microvascular reactivity to hypercapnia. The neuronal nitric oxide synthase (nNOS) inhibitor (N-(4 S)-4-amino-5-[aminoethyl]aminopentyl-N'-nitroguanidin) also significantly preserved the CoBF response to hypercapnia after NMDA, although it didn't reduce NMDA-induced increases in CoBF. In conclusion, excess activation of NMDA receptors alone can elicit SD-like neurovascular unit dysfunction involving nNOS activity.

Cyclooxygenase-2 (COX-2) has an established role in the pathogenesis of hypoxic-ischemic encephalopathy (HIE). In this study we sought to determine whether COX-2 was induced by asphyxia in newborn pigs, and whether neuronal COX-2 levels were affected by H 2 treatment. Piglets were subjected to either 8 min of asphyxia or a more severe 20 min of asphyxia followed by H 2 treatment (inhaling room air containing 2.1% H 2 for 4 h). COX-2 immunohistochemistry was performed on brain samples from surviving piglets 24 h after asphyxia. The percentages of COX-2-immunopositive neurons were determined in cortical and subcortical areas. Only in piglets with more severe HIE, we observed significant, region-specific increases in neuronal COX-2 expression within the parietal and occipital cortices and in the CA3 hippocampal subfield. H 2 treatment essentially prevented the increases in COX-2-immunopositive neurons. In the parietal cortex, the attenuation of COX-2 induction was associated with reduced 8'-hydroxy-2'-deoxyguanozine immunoreactivity and retained microglial ramifcation index, which are markers of oxidative stress and neuroinfiammation, respectively. This study demonstrates for the first time that asphyxia elevates neuronal COX-2 expression in a piglet HIE model. Neuronal COX-2 induction may play region-specific roles in brain lesion progression during HIE development, and inhibition of this response may contribute to the antioxidant/anti-infiammatory neuroprotective effects of H 2 treatment.

Introduction: Diabetes mellitus (DM) is one of the main causes of blindness among persons aged 50 years and older., Aim: The purpose of our survey was to estimate the prevalence of DM and diabetic retinopathy (DR), as well as to assess the coverage of diabetic eye care services in different regions of Hungary., Method: In 105 clusters, 3675 people aged 50 years and older were included in the survey. The standardized rapid assessment of avoidable blindness (RAAB) with the diabetic retinopathy module (DRM) was used to examine the participants. Thereafter, differences between West-, Middle- and East-Hungary were analysed., Results: Prevalence of DM was higher in East-Hungary (20.9%), than in West- (19.5%) and in Middle-Hungary (19.5%). Prevalence od DR was higher in West-Hungary (24.1%), than in Middle- (17.8%) and in East-Hungary (19.6%). Proportion of participants who never had a fundus examination for DR was the lowest in Middle-Hungary (19.1%)., Conclusions: Primary care should be strenghten mainly in country settlements or telemedical eye screening program should be started to decrease the prevalence of diabetic eye complications. Orv. Hetil., 2017, 158(10), 362-367.

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&gt;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.

The literature indicates that in diabetes retinal dysfunctions related to neural retinal alterations exist prior to clinically detectable vasculopathy. In a previous report, a detailed description about the alteration of the outer retina was given, where diabetic degeneration preceded apoptotic loss of cells (Enzsöly et al., 2014). Here, we investigated the histopathology of the inner retina in early diabetes using the same specimens. We examined rat retinas with immunohistochemistry and Western blotting, 12 weeks after streptozotocin induction of diabetes. Glial reactivity was observed in all diabetic retinal specimens; however, it was not detectable all over the retina, but appeared in randomly arranged patches, with little or no glia activation in between. Similarly, immunoreactivity of parvalbumin (staining mostly AII amacrine cells) was also decreased only in some regions. We propose that these focal changes appear prior to affecting the whole retina and overt loss of cells. In contrast to these, most other markers used (calretinin, recoverin, tyrosin hydroxylase anti-Brn-3a and also calbindin in the optic part of the retina) did not show any major alterations in the intensity of immunoreactivity or in the number of stained elements. Interestingly, under diabetic conditions, the labeling pattern of PKC-α and calbindin in the ciliary retina showed a clear resemblance to the pattern described during development. This observation is in line with our previous study, reporting an increase in the number of dual cones, coexpressing two photopigments, which is another common feature with developing retinas. These data may indicate a previously uninvestigated regenerative capacity in diabetic retina.

The recently developed confocal cornea microscopy offers the opportunity to examine pathologies of the cornea and to gain insight into the activity of innate immunity. We aimed to investigate the corneal epithelial and Langerhans cell (LC) densities along with dry eye parameters in primary open-angle glaucoma (POAG) subjects, treated with either of two commercially available travoprost 0.004 % topical medications containing different preservatives. (1: benzalkonium chloride 0.015 % (TravBAK) and 2: polyquaternium-1 (PQ) 0.001 % (TravPQ). Consecutive case series of nineteen POAG patients on TravBAK (mean age: 64.8 ± 13.6 years), nineteen POAG patients on TravPQ (mean age: 66.8 ± 11.3 years) and nineteen age-matched healthy control subjects (63.8 ± 8.2 years). Ocular surface disease index (OSDI), lid parallel conjunctival folds (LIPCOF), Schirmer test (ST) and tear break up time (TBUT) were assessed, and then corneal epithelial and LC densities were investigated with confocal microscopy. Tear production was significantly reduced in both glaucoma patient groups compared to healthy individuals (p < 0.05). TBUT was significantly reduced and epithelial cell densities were significantly greater in patients treated with TravBAK compared to healthy individuals (p < 0.05 for all). LC densities were greater in both glaucoma groups compared to control subjects (p < 0.05 for all). Travoprost therapy may compromise ocular surface. The limited alertness of the corneal immune system found in patients with TravPQ can be considered as indicators of a less disturbed ocular surface and better controlled corneal homeostasis.

Hypertension affects a significant proportion of the population, however, it is often diagnosed with a delay. The aim of this article is to review the well known and less known eye abnormalities related to hypertension, and place them in the context of population based studies. Hypertension affects various parts of the eye. The originally classified hypertensive retinopathy (retinal microvascular changes) is still relevant, but new features are visible in cases of controlled hypertension. Signs of mild hypertensive retinopathy are more common than expected occurring in nearly 10-15% of the adult non-diabetic population. Hypertensive retinopathy can be an indicator of other hypertensive complications such as neurologic and cardiac complications. Microvascular changes are reversible in well controlled hypertension. Proper treatment of hypertension can reduce the development and progression of diabetic retinopathy and, thus, visual loss due to severe retinal diseases such as retinal vascular occlusion (artery and vein), retinal arteriolar emboli, macroaneurysm, ischemic optic neuropathy and age-related macular degeneration.

Introduction: The results of intravitreal ranibizumab treatment for exsudative age-related macular degeneration have been favourable until this time., Aim: To evaluate the two-year functional and anatomic results of intravitreal ranibizumab treatment., Method: 46 patients (age: 75 ± 9.1 years) were included in a prospective single center study. Treatment regimen was the following: monthly 0.5 mg ranibizumab was administered in the first 3 months, and later as required (pro re nata). The change of best corrected visual acuity and central retinal thickness was followed., Results: The visus change at the end of the follow-up time was not statistically significant compared to baseline (p = 0.760) and the at the end of the first year (p = 0.154). Central retinal thickness decreased significantly compared to baseline (p = 0.000001), but the change was not statistically significant compared to the end of the first year (p = 0.875)., Conclusions: Patients with neovascular macular degeneration treated with intravitreal ranibizumab using pro re nata regimen have stable visus for long term, and the exsudation could be reduced efficiently.

Behavioral research revealed that object vision is impaired in amblyopia. Nevertheless, neurophysiological research in humans has focused on the amblyopic effects at the earliest stage of visual cortical processing, leaving the question of later, object-specific neural processing deficits unexplored. By measuring event-related potentials (ERPs) to foveal face stimuli we characterized the amblyopic effects on the N170 component, reflecting higher-level structural face processing. Single trial analysis revealed that latencies of the ERP components increased and were more variable in the amblyopic eye compared to the fellow eye both in strabismic and anisometropic patent groups. Moreover, there was an additional delay of N170 relative to the early P1 component over the right hemisphere, which was absent in the fellow eye, suggesting a slower evolution of face specific cortical responses in amblyopia. On the other hand, distribution of single trial N170 peak amplitudes differed between the amblyopic and fellow eye only in the strabismic but not in the anisometropic patients. Furthermore, the amblyopic N170 latency increment but not the amplitude reduction correlated with the interocular differences in visual acuity and fixation stability. We found no difference in the anticipatory neural oscillations between stimulation of the amblyopic and the fellow eye implying that impairment of the neural processes underlying generation of stimulus-driven visual cortical responses might be the primary reason behind the observed amblyopic effects. These findings provide evidence that amblyopic disruption of early visual experience leads to deficits in the strength and timing of higher-level, face specific visual cortical responses, reflected in the N170 component., (Copyright © 2012 Elsevier Ltd. All rights reserved.)

Behcet's disease is a multisystem autoimmune disease with variable clinial manifestations. The diagnosis may pose a difficult challenge for the clinician, who has to be familiar with the wide spectrum and combination of the symptoms of Behcet's disease. It is considered a rare disease in Hungary, and there are only few reports on Behcet's disease in the Hungarian literature. However, the past history of Hungary, the worldwide growing incidence of the disease, and the authors' experience raise the possibility that the occurrence of the disease is higher than previously thought. In this review the authors present and discuss literature data on the pathogenesis and pathomechanism, as well as their own experience concerning the symptomatology of Behcet's disease in order to promote diagnosis and offer adequate therapy for the patients. The authors presume that the importance of the disease is underestimated in Hungary due to a considerable number of unrecognized cases and they propose to establish a national registry for Behcets disease.