Analysis of the Association between Retinal Artery Occlusion and Acute Ischaemic Stroke/ST-Elevation Myocardial Infarction and Risk Factors in Hungarian Patients.

Background and Objectives: We aimed to analyse data on retinal artery occlusion (RAO) patients to explore correlations with acute ischaemic stroke (AIS), ST-elevation myocardial infarction (STEMI), and cardio/cerebrovascular comorbidities. Patients and Methods: Our retrospective cohort study included 169 RAO and 169 age- and gender-matched control patients. We examined the association of AIS, STEMI, and related comorbidities such as hypertension (HT), type 1 and type 2 diabetes (T1DM and T2DM, respectively), hyperlipidaemia, and ischaemic heart disease (IHD) with RAO. We also recorded atrial fibrillation in our RAO patients. Results: Our results demonstrated that RAO patients developed both AIS and STEMI at a significantly higher rate compared to controls (p < 0.001 for both). We also found that RAO patients had a significantly higher prevalence of HT and hyperlipidaemia (p1 = 0.005, p2 < 0.001) compared to controls. Multiple risk factors together significantly increased the odds of developing AIS and STEMI. Conclusions: Our results suggest that through identifying and treating the risk factors for RAO patients, we can reduce the risk of AIS, STEMI, and RAO of the fellow eye. Considering that ophthalmologists are often the first detectors of these cardiovascularly burdened patients, collaboration with colleagues from internal medicine, cardiology, and neurology is essential to achieve secondary prevention.

[Autologous neurosensory retinal transplantation.] / Autológ neuroszenzoros retinatranszplantáció.

Macular hole is a full-thickness neuroretinal defect in the fovea. The surgical solution is the removal of the internal limiting membrane (ILM) during vitrectomy with gas filling. Several surgical techniques have been described for the closure of refractory macular holes (about 5%), that reappear after successful surgery or do not close despite surgery. This article presents the first autologous neurosensory retina transplantation performed in Hungary for a large, refractory, full-thickness macular hole, with a brief overview of macular hole surgery. In September 2022, we performed a combined phacovitrectomy with ERM/ILM peeling and SF6 gas filling due to cataract, epiretinal membrane (ERM), and large macular hole due to the deterioration of vision in our patient's left eye for months, with a visual acuity of 6%. We drew the patient's attention to the importance of postoperative head positioning, which she ignored. With a visual acuity of 4%, due to a refractive macular hole (at the base: 983 µm, at the smallest diameter: 609 µm), on December 14, 2022, autologous neurosensory retina transplantation was performed using intraoperative OCT (Zeiss ARTEVO 800). At the end of the surgery, decalin was left in the eye to keep the graft in place, and the patient spent 5 days in a supine position. The decalin was removed with another operation, followed by C3F8 gas filling. 8 weeks after surgery, we documented a closed macular hole with 20% visual acuity, which was stable during the 6-month follow-up. Among the options considered for the resolution of refractory macular holes, autologous neurosensory retinal transplantation, which results in a visual improvement of our patient, is an intervention worth considering. Intraoperative OCT was a great help in performing the surgery. Although the decalin left temporarily in the eye helps to keep the transplant in place, it requires a continuous supine position and another operation is essential to remove it. Further experience is needed to establish the exact indication for autologous neurosensory retinal transplantation. Orv Hetil. 2023; 164(38): 1511-1517.