Intraocular neutralizing antibodies against aflibercept in patients with age related macular degeneration.

PURPOSE: To detect immunoglobulins in aqueous humour of AMD patients after repeated administration of intravitreal aflibercept. PATIENTS AND METHODS: Twenty-one patients (age: 77.85 ± 9.21 years) previously treated with intravitreal aflibercept due to wet type age-related macular degeneration (AMD group) and 18 age-matched control subjects (age: 69.75 ± 12.67 years) were included in this study. Patients in the AMD group received a mean of 5 intravitreal injections (min: 1 max: 17) prior to the cataract surgery. Samples of aqueous humour (50 µl) were obtained by anterior chamber paracentesis as the first step of routine cataract surgery. The IgG content of the samples was analysed by an in-house developed ELISA system. RESULTS: A significant increase in nonspecific IgG levels in the AMD group was detected compared to the control group (13.37 ± 6.65 vs. 9.44 ± 6.55 µg/ml; p = 0.03). In 11 patients, intraocular anti-aflibercept immunoglobulins could be detected (0.05 ± 0.01 µg/ml) which was significantly higher than the limit of detection for anti-aflibercept (0.04 µg/ml; p = 0.001). No correlation was found between the number of injections or the type of CNV and the aqueous level of anti-aflibercept (r = 0.02; p = 0.95). CONCLUSION: According to our results, penetration of non-specific systemic antibodies through the impaired blood-retinal barrier is higher in patients with neovascular AMD than in subjects with an intact structural barrier. Evaluation of neutralizing antibodies to anti-VEGF agents in the aqueous humour can lead us to understanding tachyphylaxis and changes in intraocular immune mechanisms due to AMD.

Seven-year outcomes following intensive anti-vascular endothelial growth factor therapy in patients with exudative age-related macular degeneration.

BACKGROUND: Anti-vascular endothelial growth factor (VEGF) therapy is currently the most effective therapy of exudative age-related macular degeneration (AMD). The aim of this study was to assess long-term benefits of intensive aflibercept and ranibizumab anti-VEGF therapy in patients with exudative AMD. METHODS: Two clinical trial sites recruited their original subjects for a re-evaluation 7 years after the baseline visit of the phase-3 Vascular Endothelial Growth Factor (VEGF) Trap-Eye: Investigation of Efficacy and Safety in Wet Age-Related Macular Degeneration (VIEW 2) trial. Forty-seven eyes of 47 patients with AMD originally treated with ranibizumab (14 eyes) or aflibercept (33 eyes) were included. RESULTS: Mean number of injections was 17.8 ± 3.0 during participation in the VIEW 2 trial. Fourteen of 47 (30%) eyes were given additional injections with a mean number of 5.7 ± 4.5 after the trial. At a mean follow-up time of 82 ± 5 months best corrected visual acuity (BCVA) remained stable or improved (≤ 10 letters lost) in 55% of patients in the entire study population, in 43% in the ranibizumab group and in 60% in the aflibercept group. In both groups combined mean BCVA was 54 ± 13 letters at baseline, 65 ± 17 letters at the end of the intensive phase and 45 ± 25 letters at the end of follow-up. There was no statistically significant difference in BCVA between the two groups at baseline (p = 0.88) and at the end of follow-up (p = 0.40). Macular atrophy was observed in 96% of eyes, average area was 7.22 ± 6.31 mm2 with no statistically significant difference between groups (p = 0.47). Correlation between BCVA at end-of-follow-up and the area of atrophy was significant (p < 0.001). At the end of follow-up, fluid was detected in 7 of 47 eyes (15%) indicating disease activity. CONCLUSION: Long-term efficacy of aflibercept and ranibizumab was largely consistent. Following a two-year intensive therapy with as-needed regimen, BCVA was maintained or improved in almost half of the patients and in the ranibizumab group and more than half of the patients in the aflibercept group with very few injections. In a remarkable proportion of eyes, BCVA declined severely which underlines the need for long-term follow-ups and may indicate a more prolonged intensive therapy. TRIAL REGISTRATIONS: VIEW 2 study: ClinicalTrials.gov ID: NCT00637377, date of registration: March 18, 2008. Long-term follow-up: IRB nr.: SE RKEB 168/2022, ClinicalTrials.gov ID: NCT05678517, date of registration: December 28, 2022, retrospectively registered.

Cyclosporine A Decreases Dryness-Induced Hyperexcitability of Corneal Cold-Sensitive Nerve Terminals.

Cyclosporine A (CsA) is used for the treatment of dry eye (DE) with good clinical results, improving tear secretion and decreasing subjective symptoms. These effects are attributed to the improved tear film dynamics, but there are no data on the effect of CsA on the abnormal sensory nerve activity characteristic in DE. Our purpose was to evaluate the CsA effect on the enhanced activity of corneal cold thermoreceptors in a tear-deficient DE animal model using in vitro extracellular recording of cold thermoreceptors nerve terminal impulses (NTIs) before and in the presence of CsA. NTI shape was also analyzed. Blinking frequency and tearing rate were also measured in awake animals before and after topical CsA. CsA increased the tearing and blinking of treated animals. CsA significantly decreased the peak response to cold of cold thermoreceptors. Neither their spontaneous NTIs discharge rate nor their cooling threshold were modified. CsA also seemed to reverse some of the changes in NTI shape induced by tear deficiency. These data suggest that, at least in part, the beneficial clinical effects of CsA in DE can be attributed to a direct effect on sensory nerve endings, although the precise mechanisms underlying this effect need further studies to be fully clarified.

Sigma-1 Receptor Agonist Fluvoxamine Ameliorates Fibrotic Response of Trabecular Meshwork Cells.

Primary open-angle glaucoma remains a global issue, lacking a definitive treatment. Increased intraocular pressure (IOP) is considered the primary risk factor of the disease and it can be caused by fibrotic-like changes in the trabecular meshwork (TM) such as increased tissue stiffness and outflow resistance. Previously, we demonstrated that the sigma-1 receptor (S1R) agonist fluvoxamine (FLU) has anti-fibrotic properties in the kidney and lung. In this study, the localization of the S1R in TM cells was determined, and the anti-fibrotic efficacy of FLU was examined in both mouse and human TM cells. Treatment with FLU reduced the F-actin rearrangement, inhibited cell proliferation and migration induced by the platelet-derived growth factor and decreased the levels of fibrotic proteins. The protective role of the S1R in fibrosis was confirmed by a more pronounced increase in alpha smooth muscle actin and F-actin bundle and clump formation in primary mouse S1R knockout TM cells. Furthermore, FLU demonstrated its protective effects by increasing the production of nitric oxide and facilitating the degradation of the extracellular matrix through the elevation of cathepsin K. These findings suggest that the S1R could be a novel target for the development of anti-fibrotic drugs and offer a new therapeutic approach for glaucoma.

Depression and anxiety in different hypertension phenotypes: a cross-sectional study.

BACKGROUND: Hypertension is a major risk factor of cardiovascular mortality. Mood disorders represent a growing public health problem worldwide. A complex relationship is present between mood disorders and cardiovascular diseases. However, less data is available about the level of depression and anxiety in different hypertension phenotypes. The aim of our study was to evaluate psychometric parameters in healthy controls (Cont), in patients with white-coat hypertension (WhHT), with chronic, non-resistant hypertension (non-ResHT), and with chronic, treatment-resistant hypertension (ResHT). METHODS: In a cross-sectional study setup 363 patients were included with the following distribution: 82 Cont, 44 WhHT, 200 non-ResHT and 37 ResHT. The patients completed the Beck Depression Inventory (BDI) and the Hamilton Anxiety Scale (HAM-A). RESULTS: BDI points were higher in WhHT (7 (3-11)) and ResHT (6 (3-11.5)) compared with Cont (3 (1-6), p < 0.05). Similarly, HAM-A points were higher in WhHT (8 (5-15)) and ResHT (10.5 (5.25-18.75)) compared with Cont (4 (1-7), p < 0.05) and also compared with non-ResHT (5 (2-10), p < 0.05). ResHT was independently associated with HAM-A scale equal or above 3 points (Beta = 3.804, 95%CI 1.204-12.015). WhHT was independently associated with HAM-A scale equal or above 2 points (Beta = 7.701, 95%CI 1.165-18.973) and BDI scale equal or above 5 points (Beta = 2.888, 95%CI 1.170-7.126). CONCLUSIONS: Our results suggest psychopathological similarities between white-coat hypertension and resistant hypertension. As recently it was demonstrated that white-coat hypertension is not a benign condition, our findings can have relevance for future interventional purposes to improve the outcome of these patients.

[Effects of COVID-19 on psychological well-being, lifestyle and attitudes towards the origins of the pandemic in psychiatric patients and mentally healthy subjects: fi rst Hungarian descriptive results from a large international online study]. / A COVID-19 pandémia hatása a pszichológiai jóllétre, az életmódra és a járvány eredetével kapcsolatos attitudökre pszichiátriai betegséggel élo és egészséges személyekben: egy nagy nemzetközi vizsgálat elso magyarországi adatai.

The COVID-2019 pandemic has presented a new situation affecting not only the somatic but the mental health of people worldwide and exposing the world including healthcare professionals to a challenge never experienced before. Therefore its effects on mental health, although can be estimated, but cannot be predicted, thus we are only halfways prepared for understanding as well as screening, preventing and treating the pandemic-related mental health problems. For this reason, the Mental Health Sector of the Scientific Researches Institute of the Pan-Hellenic Medical Association prepared a large, international online, general population study with participation from over 42 countries, assessing various aspects of general mental function, needs and behaviors that could occur during the COVID-19 outbreak, as a result of either the outbreak itself or the social measures adopted in order to control it. While the study is ongoing, here we present the first descriptive results from the Hungarian study sample including 738 adult participants collected during the first wave of COVID-19-associated lockdown, focusing on differences in the effect of COVID-19 on psychological and lifestyle measures, as well as attitudes towards the pandemic between mentally healthy participants and people with mental disorders.

DECREASED RETINAL CAPILLARY DENSITY IS ASSOCIATED WITH A HIGHER RISK OF DIABETIC RETINOPATHY IN PATIENTS WITH DIABETES.

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 <50% had an odds ratio of 4.55 (P = 0.003) for DR and an odds ratio of 3.22 (P = 0.03) for decreased visual acuity (<20/25) after controlling for systemic and ocular confounding factors. CONCLUSION: The risk of DR and vision loss is substantially higher in eyes with lower VD, suggesting that optical coherence tomography angiography metrics may serve as prognostic biomarkers for the prediction of early onset DR.

Effect of maternal depression and anxiety on mother's perception of child and the protective role of social support.

OBJECTIVE: The purpose of this study was to investigate the impact of postpartum depressive and anxiety symptoms on maternal perception of the infant and the protective role of social support. BACKGROUND: Adverse effects of perinatal depression on mother-child interaction are well documented; however, the role of maternal perception has not been examined. METHODS: We used the data of 431 women enrolled in a prospective study in a single maternity unit. Depressive and anxiety symptoms were measured using the Edinburgh Postnatal Depression Scale (EPDS), the State Trait Anxiety Inventory (STAI), and the mother's perception of infant with the Mother's Object Relation Scale (MORS). We used Multidimensional Scale of Perceived Social Support (MSPSS) in order to measure social support. RESULTS: Depressive and anxiety symptoms were positively associated to less positive emotions and a more dominant attitude of child as perceived by mothers. This association was even more significant in the case of trait anxiety. Perceived social support has been found to be a protective factor which was able to reduce this tendency. CONCLUSION: The findings have potential implications for our understanding of the impact of maternal depressive and anxiety symptoms on the developing mother-infant relationship.

[Blinding spontaneous suprachoroidal haemorrhage in anticoagulant taking wet-AMD patients]. / Spontán suprachorioidealis vérzés okozta vakság véralvadásgátló kezelésben részesült idoskori makuladegenerációs betegeken.

We present cases of blinding spontaneous suprachoroidal haemorrhage in anticoagulant taking wet-AMD patients. A retrospective study has been performed to present the clinical course, management and final outcome of spontaneous suprachoroidal haemorrhage in 7 eyes of six age-related macular degeneration patients seen in our clinic from January 2016 to April 2017. All patients were on chronic oral anticoagulant therapy because of cardiovascular disorder. In one patient, haematological disorder was also present modifying significantly the haemostasis. All eyes received prior anti-VEGF treatment for exsudative AMD. Acute angle closure glaucoma - with no response to topical and oral IOP lowering therapy - was the most frequent ocular complication in our cases. The final visual prognosis was usually very poor. The risk of spontaneous suprachoroidal haemorrhage is increased in wet-AMD patients who are on anticoagulant therapy. To prevent this blinding condition, a stronger communication between ophthalmologists and cardiologists would be beneficial, with an ophthalmological check-up in this group of patients before and during the use of anticoagulants. Orv Hetil. 2018, 159(24): 985-990.

[Placoid chorioretinopathy in systemic infections]. / Placoid chorioretinopathiák szisztémás fertozésekben.

INTRODUCTION AND AIM: To present two cases of placoid chorioretinopathy (ocular syphilis and ocular tuberculosis) and underline the importance of differential diagnosis. METHOD: Two young female patients presented with unilateral loss of vision. Fundus examination showed yellowish placoid lesions in the posterior pole in both cases. RESULTS: Performing fluorescein angiography and laboratory investigations, ocular syphilis was diagnosed in our first case and intraocular tuberculosis was diagnosed in our second case. CONCLUSION: It is important to determine the etiology of the placoid choriaretinopathies due to the different prognosis and therapy and the exclusion of systemic diseases. A comprehensive evaluation of these patients is inevitable for the correct diagnosis and appropriate management. Orv Hetil. 2018; 159(22): 863-869.

[Evaluation of diabetic microangiopathy using optical coherence tomography angiography]. / Diabeteses kisér-károsodás vizsgálata optikai koherencia tomográfián alapuló angiográfiával.

INTRODUCTION: Optical coherence tomography angiography is a non-invasive imaging technique that is able to visualize the different retinal vascular layers using motion contrast to detect blood flow without intravenous dye injection. This method might help to assess microangiopathy in diabetic retinopathy during screening and follow-up. AIM: To quantify retinal microvasculature alterations in both eyes of diabetic patients in relation to systemic risk factors using optical coherence tomography angiography. METHOD: Both eyes of 36 diabetic patients and 45 individuals without diabetes were examined. Duration of diabetes, insulin therapy, blood pressure, HbA1c, dyslipidemia, axial length and the presence of diabetic retinopathy were recorded. Retinal vessel density was measured by optical coherence tomography angiography. The effect of risk factors on vessel density and between-eye asymmetry was assessed using multivariable regression analysis. RESULTS: Vessel density was significantly lower and between-eye difference was significantly higher in diabetic patients compared to controls (p<0.05). Both vessel density and between-eye asymmetry significantly correlated with diabetes duration (p<0.05) after controlling for the effect of risk factors. The between-eye asymmetry in vessel density was significantly higher in patients without clinically detectable diabetic retinopathy compared to control subjects (p<0.001). CONCLUSIONS: There is a decrease in retinal vessel density and an increase in between-eye asymmetry in patients with diabetes compared to healthy subjects. By using optical coherence tomography angiography, the detection of these microvascular alterations is possible before clinically detectable diabetic retinopathy and might serve as a useful tool in both screening and timing of treatment. Orv Hetil. 2018; 159(8): 320-326.

Correlation-based evaluation of visual performance to reduce the statistical error of visual acuity.

Ophthalmologists evaluate visual acuity tests by the number of correctly recognized optotypes (usually letters) in the different lines of an eye chart. This probability-based scoring results in significant statistical error that can only be decreased by the time-consuming analysis of a larger number of optotypes. In this paper, we present a new, more precise correlation-based scoring method that takes the degree of misidentification into consideration too, rather than the mere fact of it. According to our experimental results, this new method decreases the uncertainty error by 28% if using the same number of optotypes at a given letter size or requires half the optotype number to produce the same error as that of probability-based scoring.

MINERALOCORTICOID RECEPTOR ANTAGONIST TREATMENT IN BILATERAL CHRONIC CENTRAL SEROUS CHORIORETINOPATHY: A COMPARATIVE STUDY OF EXUDATIVE AND NONEXUDATIVE FELLOW EYES.

PURPOSE: To evaluate the macular thickness, choroidal thickness, and visual acuity changes in eyes of patients with bilateral chronic central serous chorioretinopathy during eplerenone treatment. METHODS: This prospective clinical trial was conducted on patients with bilateral chronic central serous chorioretinopathy, who had subretinal fluid (SRF) in 1 eye. Twenty-eight patients were treated with 50 mg/day of oral eplerenone for 3 months and were observed for another 3 months. Twenty-eight eyes with SRF were compared with the 28 fellow eyes with pachychoroid pigment epitheliopathy. RESULTS: The central macular and choroidal thickness showed a significant decrease (P < 0.005) at 3 months in all eyes, but change in choroidal thickness was smaller in nonexudative fellow eyes (P > 0.05 at 6 months). In the exudative eyes, the decrease in choroidal thickness showed a significant correlation with the resolution of SRF (P < 0.001). Visual acuity remained stable in all eyes, with significant improvement only in exudative eyes at 6 months (P < 0.005). Baseline choroidal thickness was a significant positive predictor for SRF decrease (P = 0.003). CONCLUSION: Patients with chronic central serous chorioretinopathy can safely be treated with eplerenone as it can reverse choroidal vasodilation with an accompanying resolution of the SRF and improvement in visual acuity. These beneficial therapeutic effects are more pronounced in the exudative eyes.

Age and diabetes related changes of the retinal capillaries: An ultrastructural and immunohistochemical study.

Normal human aging and diabetes are associated with a gradual decrease of cerebral flow in the brain with changes in vascular architecture. Thickening of the capillary basement membrane and microvascular fibrosis are evident in the central nervous system of elderly and diabetic patients. Current findings assign a primary role to endothelial dysfunction as a cause of basement membrane (BM) thickening, while retinal alterations are considered to be a secondary cause of either ischemia or exudation. The aim of this study was to reveal any initial retinal alterations and variations in the BM of retinal capillaries during diabetes and aging as compared to healthy controls. Moreover, we investigated the potential role of vascular endothelial growth factor (VEGF) and pro-inflammatory cytokines in diabetic retina.Transmission electron microscopy (TEM) was performed on 46 enucleated human eyes with particular attention to alterations of the retinal capillary wall and Müller glial cells. Inflammatory cytokines expression in the retina was investigated by immunohistochemistry.Our electron microscopy findings demonstrated that thickening of the BM begins primarily at the level of the glial side of the retina during aging and diabetes. The Müller cells showed numerous cytoplasmic endosomes and highly electron-dense lysosomes which surrounded the retinal capillaries. Our study is the first to present morphological evidence that Müller cells start to deposit excessive BM material in retinal capillaries during aging and diabetes. Our results confirm the induction of pro-inflammatory cytokines TNF-α and IL-1ß within the retina as a result of diabetes.These observations strongly suggest that inflammatory cytokines and changes in the metabolism of Müller glial cells rather than changes in of endothelial cells may play a primary role in the alteration of retinal capillaries BM during aging and diabetes.

OCULAR WAVEFRONT ABERRATIONS AND OPTICAL QUALITY IN DIABETIC MACULAR EDEMA.

PURPOSE: To evaluate optical quality and internal aberrations in patients with diabetic macular edema. METHODS: In this prospective study, 33 eyes of patients with diabetic macular edema were scanned with a ray-tracing wavefront device. As a control group, wavefront aberrometry was performed in 31 patients. Ocular and internal aberrations and visual quality metrics were evaluated separately to determine whether the source of aberrations was ocular or internal. Main outcome measures included corrected visual acuities, ocular and internal aberrations, Strehl ratio, and modulation transfer function. RESULTS: There was a statistically significant difference between the groups in internal higher order (HO) root mean square (0.34 ± 0.24 vs. 0.16 ± 0.05), HO Strehl ratio (0.08 ± 0.05 vs. 0.18 ± 0.09), and modulation transfer function (0.29 ± 0.1 vs. 0.4 ± 0.1). There was no statistically significant difference in Strehl ratio and HO root mean square between phakic and pseudophakic patients. Height of cystoid spaces was a significant predictor (P < 0.001) of Strehl ratio. Besides inner and outer segment integrity, HO Strehl ratio significantly determined best-corrected visual acuity. CONCLUSION: In eyes with macular edema, internal HO wavefront aberrations were greater than in control eyes. This increase in HO wavefront error seems visually relevant. This study results suggest increased intraretinal edema as the source of HO aberrations.

[Results of femtosecond laser-assisted cataract surgery using the new 2.16 software and the SoftFit® Patient Interface]. / A femtoszekundumlézer-asszisztált szürkehályog-mutét eredményei az új 2.16-os szoftverrel és a módosított SoftFit® páciensi felszínnel.

INTRODUCTION: Femtosecond laser-assisted cataract surgery improved the results of cataract surgeries. AIM: Outcome analysis of femtosecond laser-assisted cataract surgery using the novel 2.16 software and the SoftFit(®) Patient Interface. METHOD: The novel software and the newly developed Patient Interface were used in 100 eyes of 100 patients. RESULTS: Length of femtosecond laser pretreatment decreased to 45-60 seconds. The smaller size of the new patient interface resulted in easier docking even on pediatric eyes. Suction force used for docking decreased from 40-50 mmHg to 16-20 mmHg. Incidence rate of subconjunctival suffusion decreased from 40% to 15-20% and its clinical severity was reduced, too. No corneal microfolds evolved, thus the incidence rate of the free-floating capsulotomies increased from 30% to 97%. The total energy of femtosecond laser pretreatment was decreased by almost 50%. Corneal wounds had the desired structure, and they were easy to open and closed precisely. CONCLUSIONS: The SoftFit(®) patient interface and the novel software widened the possible uses of the femtosecond laser-assisted cataract surgery, e.g. in pediatric ophthalmology. Innovations improved the safety and the predictability of the method.

Changes of corneal topography indices after CXL in progressive keratoconus assessed by Scheimpflug camera.

PURPOSE: To evaluate the accuracy of Scheimpflug camera topography indices in detecting the therapeutic effect of corneal collagen cross-linking (CXL) on progressive keratoconus in the long term. METHODS: Fifty eyes of 25 patients with keratoconus were enrolled. CXL was performed in 25 eyes with progressive keratoconus (CXL group) and 25 fellow eyes with nonprogressive keratoconus served as controls. Thinnest corneal thickness, anterior keratometry (flat, steep), and keratoconus indices were measured with Scheimpflug camera before and 12 to 25 months after CXL. Regression analysis was used to evaluate the influence of corneal thickness and follow-up time on flattening effect of CXL. RESULTS: At baseline, steep keratometric values were significantly higher and thinnest corneal thickness values were lower in the CXL group (P = .027, .034), parallel with increased values of keratoconus indices: index of surface variance (P = .013), index of vertical asymmetry (P = .038), keratoconus index (P = .019), center keratoconus index (P = .039), index of height asymmetry (P = .037), index of height decentration (P = .0016), and radius minimum (P = .008). After adjustment for thinnest corneal thickness and follow-up time, CXL showed significant flattening effect expressed by changes in radius minimum (P < .001), index of surface variance (P = .03), keratoconus index (P = .006), center keratoconus index (P = .03), and index of height asymmetry (P = .026). Thinnest corneal thickness had significant influence on changes of index of surface variance (P = .049), index of vertical asymmetry (P = .01), and center keratoconus index (P = .03). Follow-up time showed no significant influence in any models (P > .05). CONCLUSIONS: Topographic indices indicate corneal flattening after CXL in the long term. Monitoring keratoconus index and index of height asymmetry should be the preferred choice in daily clinical practice because changes in values of these indices are independent from initial corneal thickness.

The effect of femtosecond laser capsulotomy on the development of posterior capsule opacification.

PURPOSE: To evaluate and compare the effects of femtosecond laser-assisted anterior capsulotomy and manual anterior capsulorhexis on posterior capsule opacification (PCO) development. METHODS: Femtosecond laser-assisted anterior capsulotomy was performed in 40 eyes of 40 patients (FS group) and manual anterior capsulorhexis was performed in 39 eyes of 39 patients (CCC group). An AcrySof one-piece hydrophobic acrylic intraocular lens (Alcon Laboratories, Inc., Fort Worth, TX) was implanted in all eyes. The PCO level was measured using Open-Access Systematic Capsule Assessment (OSCA) software 18 to 26 months after surgery. Postoperative intraocular lens position (ie, tilt and decentration) was measured using Scheimpflug images (Pentacam; Oculus Optikgeräte GmbH, Wetzlar, Germany). RESULTS: There was no statistically significant difference in age, axial length, and follow-up time between the two groups (P > .05). Vertical tilt, horizontal and total decentration of intraocular lenses, and PCO proved to be significantly higher in the CCC group (P = .03, .04, .03, and .01, respectively). After adjusting for axial length and follow-up time, manual anterior capsulorhexis was found to be a significant predictor of higher PCO scores in the multivariable regression model (ß: 0.33; 95% CI: 0.01 to 0.65; P = .04). Vertical tilt affected PCO scores after adjusting for axial length and follow-up time (ß: 0.07; 95% CI: 0.01 to 0.12; P = .02). No capsulotomies were performed during follow-up in either group. CONCLUSIONS: Femtosecond laser-assisted anterior capsulotomy proved to be a safe procedure for postoperative PCO rates. Due to better intraocular lens position, femtosecond laser-assisted anterior capsulotomy resulted in slightly decreased PCO scores; however, evaluating its clinical significance requires further studies.

[Correlation of the microbiota and intestinal mucosa in the pathophysiology and treatment of irritable bowel, irritable eye, and irritable mind syndrome]. / A mikroflóra és a bélnyálkahártya kölcsönhatása az irritábilis bél, irritábilis szem és irritábilis elme szindróma kórtanában és kezelésében.

Accumulating clinical evidence supports co-morbidity of irritable bowel, irritable eye and irritable mind symptoms. Furthermore, perturbation of the microbiota-host symbiosis (dysbiosis) is considered a common pathogenic mechanism connecting gastrointestinal, ocular and neuropsychiatric symptoms. Consequently, maintaining or restoring microbiota-host symbiosis represents a new approach to treat these symptoms or to prevent their relapses. Current treatment approach assigned a primary role to live probiotics alone or in combination with prebiotics to enhance colonization of beneficial bacteria and to strengthen the symbiosis. However, several papers showed major benefits of heat-killed probiotics as compared to their live counterparts on both intestinal and systemic symptoms. Recently, in addition to killing probiotics, in a proof of concept study lysates (fragments) of probiotics in combination with vitamins A, B, D and omega 3 fatty acids were successfully tested. These findings suggested a conceptual change in the approach addressed to both the microbiota and host as targets for intervention.

Atherosclerotic burden and cerebral small vessel disease: exploring the link through microvascular aging and cerebral microhemorrhages.

Cerebral microhemorrhages (CMHs, also known as cerebral microbleeds) are a critical but frequently underestimated aspect of cerebral small vessel disease (CSVD), bearing substantial clinical consequences. Detectable through sensitive neuroimaging techniques, CMHs reveal an extensive pathological landscape. They are prevalent in the aging population, with multiple CMHs often being observed in a given individual. CMHs are closely associated with accelerated cognitive decline and are increasingly recognized as key contributors to the pathogenesis of vascular cognitive impairment and dementia (VCID) and Alzheimer's disease (AD). This review paper delves into the hypothesis that atherosclerosis, a prevalent age-related large vessel disease, extends its pathological influence into the cerebral microcirculation, thereby contributing to the development and progression of CSVD, with a specific focus on CMHs. We explore the concept of vascular aging as a continuum, bridging macrovascular pathologies like atherosclerosis with microvascular abnormalities characteristic of CSVD. We posit that the same risk factors precipitating accelerated aging in large vessels (i.e., atherogenesis), primarily through oxidative stress and inflammatory pathways, similarly instigate accelerated microvascular aging. Accelerated microvascular aging leads to increased microvascular fragility, which in turn predisposes to the formation of CMHs. The presence of hypertension and amyloid pathology further intensifies this process. We comprehensively overview the current body of evidence supporting this interconnected vascular hypothesis. Our review includes an examination of epidemiological data, which provides insights into the prevalence and impact of CMHs in the context of atherosclerosis and CSVD. Furthermore, we explore the shared mechanisms between large vessel aging, atherogenesis, microvascular aging, and CSVD, particularly focusing on how these intertwined processes contribute to the genesis of CMHs. By highlighting the role of vascular aging in the pathophysiology of CMHs, this review seeks to enhance the understanding of CSVD and its links to systemic vascular disorders. Our aim is to provide insights that could inform future therapeutic approaches and research directions in the realm of neurovascular health.