The Assessment of Acute Chorioretinal Changes Due to Intensive Physical Exercise in Senior Elite Athletes.

Regular physical exercise is known to lower the incidence of age-related eye diseases. We aimed to assess the acute chorioretinal alterations in older adults following intense physical strain. Seventeen senior elite athletes were recruited who underwent an aerobic exercise on a cycle ergometer and macular scanning by optical coherence tomography. A significant thinning of the entire retina was observed 1 min after exercise, followed by a thickening at 5 min, after which the thickness returned to baseline. This trend was similar in almost every single retinal layer, although a significant change was observed only in the inner retina. Choroidal thickness changes were neither significant nor did they correlate with the thickness changes of intraretinal layers. The mechanism of how these immediate retinal changes chronically impact age-related sight-threatening pathologies that, in turn, result in a substantially reduced quality of life warrants further investigation on nontrained older adults as well.

The assessment of acute chorioretinal changes due to intensive physical exercise in young adults.

PURPOSE: There is abundant evidence on the benefits of physical activity on cardiovascular health. However, there are only few data on the acute effects of physical exercise on the retina and choroid. Our aim was the in vivo examination of chorioretinal alterations following short intense physical activity by spectral domain optical coherence tomography (SD-OCT). METHODS: Twenty-one eyes of 21 healthy, young subjects (mean age 22.5 ± 4.1 years, 15 males and 6 females) were recruited. Macular scanning with a SD-OCT was performed before and following a vita maxima-type physical strain exercise on a rowing ergometer until complete fatigue. Follow-up OCT scans were performed 1, 5, 15, 30 and 60 minutes following the exercise. The OCT images were exported and analyzed using our custom-built OCTRIMA 3D software and the thickness of 7 retinal layers was calculated, along with semi-automated measurement of the choroidal thickness. One-way ANOVA analysis was performed followed by Dunnett post hoc test for the thickness change compared to baseline and the correlation between performance and thickness change has also been calculated. The level of significance was set at 0.001. RESULTS: We observed a significant thinning of the total retina 1 minute post-exercise (-7.3 ± 0.6 µm, p < 0.001) which was followed by a significant thickening by 5 and 15 minutes (+3.6 ± 0.6 µm and +4.0 ± 0.6 µm, respectively, both p <0.001). Post-exercise retinal thickness returned to baseline by 30 minutes. This trend was present throughout the most layers of the retina, with significant changes in the ganglion cell-inner plexiform layer complex, (-1.3 ± 0.1 µm, +0.6 ± 0.1 µm and +0.7 ± 0.1 µm, respectively, p <0.001 for all), in the inner nuclear layer at 1 and 5 minutes (-0.8 ± 0.1 µm and +0.8 ± 0.1 µm, respectively, p <0.001 for both), in the outer nuclear layer-photoreceptor inner segment complex at 5 minute (+2.3 ± 0.4 µm, p <0.001 for all) and in the interdigitation zone-retinal pigment epithelium complex at 1 and 15 minutes (-3.3 ± 0.4 µm and +1.8 ± 0.4 µm, respectively, p <0.001 for both). There was no significant change in choroidal thickness; however, we could detect a tendency towards thinning at 1, 15, and 30 minutes following exercise. The observed changes in thickness change did not correlate with performance. Similar trends were observed in both professional and amateur sportsmen (n = 15 and n = 6, respectively). The absolute changes in choroidal thickness did not show any correlation with the thickness changes of the intraretinal layers. CONCLUSIONS: Our study implies that in young adults, intense physical exercise has an acute effect on the granular layers of the retina, resulting in thinning followed by rebound thickening before normalization. We could not identify any clear correlation with either choroidal changes or performance that might explain our observations, and hence the exact mechanism warrants further clarification. We believe that a combination of vascular and mechanic changes is behind the observed trends.

Factors influencing haze formation and corneal flattening, and the impact of haze on visual acuity after conventional collagen cross-linking: a 12-month retrospective study.

BACKGROUND: Our aim was to determine associations of pachymetry, keratometry, and their changes with haze formation and corneal flattening after collagen cross-linking, and to analyse the relationship between postoperative haze and visual outcome. METHODS: Retrospective analysis was performed on 47 eyes of 47 patients with keratoconus using the Pentacam HR Scheimpflug camera before and 1, 3, 6 and 12 months after cross-linking. Corneal backscattered light values in grey scale unit were recorded in the anterior, center and posterior corneal layers and in four concentric rings. Surface area- and thickness-corrected grey scale unit values were assessed with an additional calculation. Friedman test with post hoc Wilcoxon signed-rank test was used to analyse changes in visual acuity, pachymetry, keratometry and densitometry. Spearman's rank correlation test was used to detect correlations of haze formation and corneal flattening with pachymetry, keratometry and their postoperative change. Generalized estimating equations analysis was used to investigate the influence of densitometry values on postoperative visual acuity after controlling for the effect of preoperative keratometry. RESULTS: One year after treatment, significant flattening was observed in maximum and mean keratometry readings (p < 0.001). Significantly increased densitometry values were observed in three central rings compared to baseline (post hoc p < 0.0125). According to receiver operating characteristic curve, densitometry value of the anterior layer of 0-2 mm ring was the most characteristic parameter of densitometry changes after cross-linking (area under the curve = 0.936). Changes in haze significantly correlated with preoperative maximum keratometry (R = 0.303, p = 0.038) and with the changes in maximum keratometry (R = -0.412, p = 0.004). Changes in maximum keratometry correlated with preoperative maximum keratometry (R = -0.302, p = 0.038). Postoperative haze had a significant impact on uncorrected and best corrected distance visual acuity (ß coefficient = 0.006, p = 0.041 and ß coefficient = 0.003, p = 0.039, respectively). CONCLUSIONS: Our findings indicate that in more advanced keratoconus more significant corneal flattening effect parallel with haze formation can be observed after cross-linking. Despite significant reduction of keratometry, postoperative corneal haze may limit final visual acuity.

Congenital ptosis repair using posterior approach levator plication / Veleszületett szemhéjcsüngés mutéti megoldása a szemhéjemelo izom kötohártya feloli redozésével.

Összefoglaló. Bevezetés: Szemhéjcsüngésnek (ptosis vagy blepharoptosis) nevezzük azt az állapotot, amikor a felso szemhéj abnormálisan alacsony pozícióban van. A szemhéjcsüngésnek lehetnek veleszületett és szerzett formái. Célkituzés: Célunk volt bemutatni a szemhéjemelo izom (levator) - veleszületett szemhéjcsüngés korrekciója céljából végzett - kötohártya feloli redozésének eredményeit retrospektív módszerrel. Módszer: 20 beteg 22 szemhéján végeztük el a mutétet (átlagéletkor: 19,4 ± 9,9 év, férfi: 12 [60%], no: 8 [40%]). Beválasztási kritérium volt a közepes (5-8 mm) vagy jó (9 mm felett) levatorfunkció. Kizártuk a korábban szemhéjkorrekciós mutéten átesett és a 3 hónapnál rövidebb követési idovel rendelkezo betegeket. A mutét elott megmértük a levatorfunkciót és a margó-reflex-távolságot. A mutét után megmértük a margó-reflex-távolságot, a szemhéjak magassága közti aszimmetria mértékét, és elemeztük a szemhéj posztoperatív kontúrját. Eredmények: A preoperatív levatorfunkció 10,6 ± 3,0 mm, a preoperatív margó-reflex-távolság 1,8 ± 0,8 mm volt. A 7,8 ± 7,2 hónap átlagos követési ido alatt a posztoperatív margó-reflex-távolság 3,2 ± 0,8 mm volt. A preoperatív és a posztoperatív margó-reflex-távolság különbsége nem tért el szignifikánsan a sikeres és a sikertelen mutétek között (p = 0,523). A szemhéjak magassága közti aszimmetria mértéke 3 betegnél haladta meg az 1 mm-t. A szemhéj posztoperatív kontúrja minden esetben megfelelo volt. A mutét összességében 86,4%-ban (19/22) volt sikeres. A helyi érzéstelenítésben és altatásban végzett mutétek közt nem találtunk szignifikáns különbséget a sikeresség tekintetében (p = 0,227). Következtetés: Tanulmányunk alapján az elvégzett mutéteink eredményessége a nemzetközi irodalomban közöltekhez hasonló volt. A veleszületett szemhéjcsüngés korrekciójára a kötohártya feloli levatorredozés megfelelo kezelési mód közepes vagy annál jobb levatorfunkció esetén. Orv Hetil. 2021; 162(18): 705-711. INTRODUCTION: Droopy eyelid (ptosis or blepharoptosis) is defined through abnormally low upper eyelid position. Ptosis can be classified as congenital or acquired. OBJECTIVE: Our purpose was to report the results of posterior approach levator plication for congenital ptosis in a retrospective review. METHOD: 22 eyelids of 20 patients were included in this study (age: 19.4 ± 9.9 years, male: 12 [60%], female: 8 [40%]). The inclusion criteria were moderate (5-8 mm) or good (more than 9 mm) levator function. Patients with postoperative follow-up time shorter than 3 months and those who underwent previous eyelid surgery were excluded. The data collected included preoperative levator function and margin reflex distance, postoperative margin reflex distance, inter-eyelid height asymmetry and postoperative eyelid contour. RESULTS: Preoperative levator function was 10.6 ± 3.0 mm, preoperative margin reflex distance was 1.8 ± 0.8 mm. During 7.8 ± 7.2 months postoperative follow-up, postoperative margin reflex distance was 3.2 ± 0.8 mm. The difference between preoperative and postoperative margin reflex distance was not significant (p = 0.523) in the group of successful operations compared with unsuccessful operations. Inter-eyelid height asymmetry was more than 1 mm in 3 cases. Satisfactory postoperative eyelid contour was achieved in all cases. Overall success rate was 86.4% (19/22). Surgical success did not differ significantly between surgeries in local or general anaesthesia (p = 0.227). CONCLUSION: Our study shows an overall success rate of the procedures comparable to those in international publications. Posterior approach levator plication for congenital ptosis with moderate or better levator function seems to be a suitable treatment method. Orv Hetil. 2021; 162(18): 705-711.

The Predictive Role of Thyroid Hormone Levels for Early Diabetic Retinal Changes in Experimental Rat and Human Diabetes.

Purpose: In diabetic subjects, early visual functional alterations such as color vision deficiencies (CVDs) are known to precede clinically apparent diabetic retinopathy. Prominent photoreceptor outer segment degeneration and an increase in the number of retinal dual cones (co-expressing S- and M-opsins simultaneously) have been described in diabetic rat models, suggesting a connection with the development of CVDs. As cone opsin expression is controlled by thyroid hormones, we investigated the diabetic retina in association with thyroid hormone alterations. Methods: In rat models of type 1 and 2 diabetes, dual cones were labeled by immunohistochemistry, and their numbers were analyzed in relation to free triiodothyronine (fT3) and free thyroxine (fT4) levels. Quantification of dual cones was also performed in human postmortem retinas. Additionally, a cross-sectional case-control study was performed where thyroid hormone levels were measured and color vision was assessed with Lanthony desaturated D15 discs. Results: A higher number of dual cones was detectable in diabetic rats, correlating with fT4 levels. Dual cones were also present in postmortem human retinas, with higher numbers in the three diabetic retinas. As expected, age was strongly associated with CVDs in human patients, and the presence of diabetes also increased the risk. However, the current study failed to detect any effect of thyroid hormones on the development of CVDs. Conclusions: Our results point toward the involvement of thyroid homeostasis in the opsin expression changes in diabetic rats and human samples. The evaluation of the possible clinical consequences warrants further research.

Meibomian gland dysfunction and dry eye: Diagnosis and treatment / Meibom-mirigy-diszfunkció és a száraz szem: Diagnosztikai és kezelési lehetoségek

Összefoglaló. A szárazszem-panaszok hátterében gyakran áll Meibom-mirigy-diszfunkció, melynek felismerése kiemelten fontos a hatékony kezelés érdekében. A Meibom-mirigyek kóros muködése miatt a termelt lipid nem oszlik el megfeleloen a szemfelszínen, így a könnyfilm párolgása fokozódik. A könnytermelési zavar következtében szárazszem-panaszok alakulnak ki, melyek a hagyományos könnypótló kezelésre rendszerint csak átmenetileg javulnak. A Meibom-mirigy-diszfunkciót gyakran kíséri a szemhéjszél Demodex-atka-fertozése - az atka eradikálása szükséges a mirigyek muködésének helyreállításához és ezáltal a panaszok megszüntetéséhez. A Meibom-mirigy-diszfunkció a leggyakrabban enyhe formában jelentkezik; a terápia ilyenkor a beteg által is elvégezheto szemhéjtisztításból áll, míg a gyógyszeres kezelés csak az elorehaladottabb, kifejezett gyulladással járó formákban szükséges. Az összefoglaló áttekinti a Meibom-mirigy-diszfunkció klinikai jeleivel és kezelésével kapcsolatos legfontosabb tudnivalókat, különös tekintettel a Demodex-fertozés felismerésére és kezelésére vonatkozóan. Orv Hetil. 2021; 162(2): 43-51. Summary. The onset of dry eye complaints is often a result of Meibomian gland dysfunction and its diagnosis is essential for effective treatment. In the case of Meibomian gland dysfunction, there is an increased evaporation of the tear film due to the abnormal secretion of lipids that cannot spread on the ocular surface. The treatment of dry eye complaints associated with Meibomian gland dysfunction with tear supplementation is usually ineffective and only results in an intermittent relief of complaints. Meibomian gland dysfunction is often associated with Demodex infestation of the eyelids, and eradicating the mites is essential to re-establish normal meibum production and thus, decreasing ocular complaints. In most cases, Meibomian gland dysfunction is mild, and the treatment of these forms is based on ocular hygiene performed by the patient, while only more advanced forms with inflammatory processes require pharmacologic treatment. This review summarizes the most important knowledge on the clinical signs and treatment of Meibomian gland dysfunction with particular attention to the diagnosis and treatment of ocular Demodex infection. Orv Hetil. 2021; 162(2): 43-51.

Monocanalicular silicone stent implantation in children with congenital nasolacrimal duct obstruction / Monocanalicularis szilikonsztent implantációja könnycsatorna-elzáródással született gyermekekben.

Összefoglaló. Bevezetés: Csecsemokorban a könnyezés gyakori oka a könnycsatorna veleszületett elzáródása, mely az esetek nagy részében 1 éves korra spontán oldódik. Célkituzés: Retrospektív tanulmányunk célja a monocanalicularis szilikonsztent (Masterka®) implantációjával kapcsolatos eredményeink bemutatása. Módszer: 2015. január 1. és 2020. január 30. között monocanalicularis szilikonsztent implantációján átesett gyermekek adatait dolgoztuk fel. Bevonási kritériumként szerepelt a legalább 6 hónapja fennálló, konzervatív kezelésre nem szuno könnyezés és emiatt elozetesen elvégzett szondázás, mely után a panaszok kiújultak. Kizárási kritérium volt a csontosan elzárt ductus nasolacrimalis és a hibás szemhéjállás. A mutét hatékonyságát a szilikonsztent eltávolítását követo legalább 2 hónap panaszmentességgel definiáltuk. Eredmények: 25 gyermek (10 lány [40%] és 15 fiú [60%]) összesen 30 szemén végeztünk szilikonsztent-beültetést. Az átlagéletkor 4,92 ± 3,03 év (1,5-12 év, n = 25) volt. Minden páciens a születése óta könnyezett. A mutét elott váladékképzodést 20 (66,67%, n = 30), krónikus szemhéj- és kötohártya-gyulladást 10 (33,33%, n = 30) esetben észleltünk. Tompalátást, jelentos astigmiát nem találtunk. A sztentet átlagosan 3,5 ± 1,0 (n = 30) hónap után távolítottuk el. A mutétet követoen 1 héttel 24 (80%, n = 30), 3 hónappal 28 (93,33%, n = 30) és 6 hónappal 24 (88,89%, n = 27) szem volt tünetmentes. Következtetés: A Masterka® implantációja egyszeruen kivitelezheto, kifejezetten hatékony módszer lehet az 1 évnél idosebb gyermekek veleszületett könnycsatorna-szukületének megoldására, különösen olyan esetekben, amikor a korábbi szondázás nem vezetett eredményre, valamint hosszabb szakaszon észlelünk szukületet. Ez utóbbi esetekben megfontolandó lenne a primer szilikonsztent-implantáció is. Orv Hetil. 2020; 161(48): 2037-2042. INTRODUCTION: Congenital nasolacrimal duct obstruction is a common cause of epiphora in infants. In most cases, spontaneous resolution occurs by 1 year of age. OBJECTIVE: Retrospective evaluation of clinical outcomes of monocanalicular lacrimal duct stent implantation (Masterka®). METHOD: Data of patients undergoing monocanalicular silicone stent implantation between 1st January 2015 and 30th January 2020 were evaluated. Inclusion criteria were resistant tearing to conservative therapy which had been persisting at least for 6 months, and previous probing did not resolve the symptoms. Exclusion criteria were associated bony obstruction or eyelid malposition. Treatment success was defined as complete resolution of epiphora at least two months after the procedure. RESULTS: Implantation was performed on 30 eyes of 25 children (10 females [40%] and 15 males [60%]). The mean age was 4.92 ± 3.03 years (1.5-12 years, n = 25). Epiphora was a persistent symptom in every patient since birth. Preoperatively, discharge was observed in 20 (66.6%, n = 30) patients, while chronic blepharitis and conjunctivitis occurred in 10 (33.33%, n = 30) children. Amblyopia or significant astigmatism was not observed in any case. Stent was removed after 3.5 ± 1.0 (n = 30) months. At one week postoperatively 24 (80%, n = 30), at 3 months 28 (93.33%, n = 30) and at 6 months 24 (88.89%, n = 27) eyes were asymptomatic. CONCLUSION: Implantation of monocanalicular silicone stent is effective and easy-to-perform. It can resolve congenital tear duct stenosis, especially where previous probing was not successful and where stenosis is longer or occurs in several localizations. In the latter cases, primary stent implantation should be considered. Orv Hetil. 2020; 161(48): 2037-2042.

Cataract blindness in Hungary.

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.

The Effect of Physical Exercise on the Retina and Choroid.

There is only limited information available on the effects of physical exercise on the posterior pole. Retinal circulation is autoregulated similarly to the brain vasculature in order to provide constant flow and thus constant nutrition of the inner retinal structures while the choroid is mostly controlled by the sympathetic nervous system. The available data show that physical exercise may indeed have a positive effect on the retina and visual function. The assessment of retinal structure could serve as a marker in sports medicine, whereas physical activity could exert a positive protective effect against diseases such as diabetic retinopathy or age-related macular degeneration. According to our theory, similar to the term "trained heart" used in cardiology and sports medicine, the term "trained eye" could also be coined. This latter term would help to further emphasize the beneficial effects of physical exercise that works protectively not only for the cardiovascular but for the visual system as well, and thus could further help in the fight against avoidable blindness worldwide.

Feasibility of the rapid assessment of avoidable blindness with diabetic retinopathy module (RAAB+DR) in industrialised countries: challenges and lessons learned in Hungary.

PURPOSE: To present experiences gained during the planning, implementation, and practical performance of the rapid assessment of avoidable blindness with diabetic retinopathy module (RAAB+DR) in an established market economy. METHODS: A total of 3523 people aged 50 years or older were examined at their homes in 105 randomly selected clusters in Hungary. During the 4-month-long field work, five teams visited the clusters. Each team was composed of a senior ophthalmic resident or eye specialist, a nurse, an assistant, a driver, and a local guide. The local guides were found through local mayors of the towns or villages or other local leaders. RESULTS: Of all 105 clusters, 41% were completed in 1 day and 59% required a longer stay. The shortest daily examination time was 3.5 hours and the longest was 10 hours. Altogether, 7.6% of the enumeration areas needed revisit, mainly due to insufficient preparatory work and absence of the subjects. The best local guides were the local government workers, health visitors, and general practitioner (GP) nurses. Refusal of pupillary dilatation was relatively high and varied greatly among the study groups (7.7-43.8%). CONCLUSION: The performance of a RAAB+DR study in a well-industrialised country is difficult, but may be successful. The most critical factor for success is an excellent local guide who is able to achieve participation of the people. The results of the RAAB are a solid basis for the development of a national programme for universal eye health and to prepare active media campaigns.

Visual impairment and blindness in Hungary.

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.

[Regional disparities in the prevalence of diabetes and diabetic retinopathy in Hungary in people aged 50 years and older]. / Cukorbetegség és retinopathia diabetica regionális egyenlotlenségei Magyarországon az 50 éves és idosebb korú lakosság körében.

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.

Diabetes and diabetic retinopathy in people aged 50†years and older in Hungary.

BACKGROUND/AIMS: The purpose of this study was to estimate the prevalence of diabetes mellitus (DM) and diabetic retinopathy (DR) in the population aged 50 years and older in Hungary, and to assess the coverage of diabetic eye care services. METHODS: In total, 105 clusters of 35 people aged 50 years or older were randomly selected. The standardised rapid assessment of avoidable blindness (RAAB) with the diabetic retinopathy module (DRM) was used. Participants were classified as having DM if they were known to have DM or if their random blood glucose level was ≥200 mg/dL. Dilated fundus examination and Scottish DR grading were performed. RESULTS: In total, 3523 (95.9%) out of 3675 eligible subjects were examined. And 705 (20.0%) out of 3523 had known (661) or newly diagnosed DM (44). Twenty per cent of participants with known DM had a blood glucose level ≥200 mg/dL, and 27.4% had never had an ophthalmological examination for DR. Prevalence of DR and/or maculopathy was 20.7% and prevalence of sight-threatening DR (STDR) was 4.3% in one or both eyes among participants with DM. CONCLUSIONS: Prevalence of DM was in line with findings of other RAAB+DRM surveys and slightly lower than the unpublished earlier age-matched Hungarian estimate. Prevalence of DR was slightly lower than expected. The prevalence of STDR was low in people aged 50 years and older in Hungary compared with the results of other RAAB with DRM surveys. DR screening coverage was low. To prevent severe complications of DM and possible concomitant visual loss, the coverage of ophthalmic examinations in patients with DM should be increased.

Spectral domain optical coherence tomography in patients after successful management of postoperative endophthalmitis following cataract surgery by pars plana vitrectomy.

BACKGROUND: Acute severe postoperative endophthalmitis may lead to severe vision loss. The aim of this study was the analysis of macular microstructure imaged by spectral domain optical coherence tomography in patients after pars plana vitrectomy due to postcataract endophthalmitis. METHODS: A cross sectional study was carried out in 17 patients who had cataract surgery in both eyes and underwent unilateral pars plana vitrectomy due to postcataract endophthalmitis. Postoperative best corrected visual acuity was determined in both eyes. Evaluation of macular thickness, macular volume, peripapillary retinal nerve fiber layer thickness and choroidal thickness using enhanced depth imaging technique was performed by spectral domain optical coherence tomography. The measurements obtained in the operated eye were compared to the fellow eye by Wilcoxon matched pair test. Correlation test was performed by Spearman rank order. RESULTS: A mean postoperative best corrected visual acuity of 63 ± 30 ETDRS letters versus 75 ± 21 letters was achieved in the study and fellow eyes, respectively, after a mean of 5.3 ± 4.5 months (p = 0.1). The mean macular thickness was 320.6 ± 28.8 µm SD in the study eyes compared to 318.4 ± 18.8 µm in the fellow eyes (p = 0.767). No differences were noted in macular volume (p = 0.97) and in peripapillary retinal nerve fiber layer thickness (p = 0.31). Choroidal thickness was significantly lower in the study eyes compared to the fellow eyes (p = 0.018). Epiretinal membrane was found in 7 eyes after endophthalmitis, while in the fellow eyes only in 3 cases (p = 0.13, Fisher's exact test). CONCLUSION: Choroidal thickness decreased significantly after endophthalmitis, but there was no functional correlation with the changes in choroidal microstructure. The development of epiretinal membranes may be associated with either vitrectomy or endophthalmitis in the history. Absence of other significant structural and morphological findings shows that successful treatment may guarantee good clinical results even in long term after this severe postoperative complication.

Periosteal microcirculatory action of chronic estrogen supplementation in osteoporotic rats challenged with tourniquet ischemia.

AIMS: Transient ischemia of osteoporotic bones during elective orthopedic surgery or fracture repair carries risks for serious complications, and estrogen loss or replacement has a potential to influence ischemia-reperfusion-induced inflammatory activation. To clarify this, we investigated the periosteal inflammatory changes in a clinically relevant time frame in ovariectomized rats, an experimental model of postmenopausal bone loss. Furthermore, the effects of chronic estrogen supplementation on the postischemic local and systemic inflammatory reactions were assessed. MAIN METHODS: Bilateral ovariectomy or sham operation was performed in 3-month-old female Sprague-Dawley rats. Five months later, estrogen replacement therapy with 17ß-estradiol (20 µg(-1) kg(-1) day(-1)) or vehicle treatment was initiated. The microcirculatory inflammatory consequences of 60-min total hindlimb ischemia followed by 180-min reperfusion were examined 11 months after ovariectomy and were compared with those in 3-month-old animals. KEY FINDINGS: The osteoporosis that developed 5 months after ovariectomy was significantly ameliorated by estrogen replacement therapy. Both in ovariectomized and in non-ovariectomized animals, ischemia-reperfusion elevated the neutrophil adherence ~3-fold in the postcapillary venules of the periosteum (intravital microscopy), with an ~50-60% increase in intravascular neutrophil activation (CD11b; FACS analysis), an enhanced TNF-α release (ELISA) and periosteal expression of ICAM-1 (the endothelial ligand of CD11b; immunohistochemistry). Exogenous 17ß-estradiol considerably reduced TNF-α release and the number of neutrophil-endothelial interactions in the periosteum, without affecting the CD11b and ICAM-1 expression changes. SIGNIFICANCE: Osteoporosis itself does not increase the magnitude of the limb ischemia-reperfusion-associated periosteal inflammatory reaction. Chronic estrogen supplementation, however, reverses osteoporosis and significantly ameliorates the microcirculatory consequences of transient ischemia.