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.

Clinical course of Acanthamoeba keratitis by genotypes T4 and T8 in Hungary.

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

Shielding effect of the smoke plume by the ablation of excimer lasers.

BACKGROUND: Shielding and scattering effect of the smoke plume column ejected from the laser ablated material is a well-known phenomenon. Debris evacuation system of the excimer laser equipment removes these particles, but insufficient air flow can result in undesired refractive outcomes of the treatment. The aim of this study was to reveal the effect of the air flow speed on the actual ablation depth. METHODS: SCWIND AMARIS 500E flying spot excimer laser was tested in this study. A 150 µm phototherapeutic keratectomy (PTK) profile with 8 mm diameter was applied to the surface of polymethyl methacrylate (PMMA) plates. The velocity of the air flow was changed with adjustable air aspiration system. Ablation depth was measured with highly-precise contact micrometer. RESULTS: The prediction model was statistically significant, F(1,8) = 552.85, p < 0.001, and accounted for approximately 98.7% of variance of ablation (R2 = 0.987, R2adj = 0.986). Lower air flow speed resulted in a weaker ablation capability of the excimer laser. CONCLUSION: Air flow generated by the aspiration equipment is a key factor for the predictable outcomes of refractive treatment. Therefore, manufacturer inbuilt debris removal system should be regularly checked and maintained to ensure proper clinical and predictable refractive results.

[Impact of crosslinking on corneal epithelial healing]. / Crosslinking kezelés hatása a szaruhártya hámosodására.

INTRODUCTION AND AIM: To analyse the effect of crosslinking (CXL) on corneal epithelial healing. PATIENTS AND METHOD: 39 keratoconus patients following CXL and 11 patients following PRK were enrolled in this study. 21, 45 and 69 hours after CXL and 16, 37 and 61 hours following PRK slitlamp photographs were taken using fluorescein staining and the size of the epithelial defect and the time of epithelial closure was determined. As the observation time-points differed in both groups, the size of the epithelial defect following PRK was calculated for the time points used for analysis of CXL patients. These data were compared using chi-quadrat test. RESULTS: Following crosslinking, epithelial closure occured within 3, following PRK within 4 days. In the area of epithelial erosion 45 and 69 hours after CXL or PRK treatment statistically significant difference (p = 0.005 and p<0.001) was verified. CONCLUSION: Our results show beneficial effect of crosslinking on corneal epithelial healing. Orv. Hetil., 2017, 158(10), 376-379.

[Relationship between corneal surface temperature and air flow conditions during refractive laser eye surgery using three different excimer lasers]. / A szaruhártya felszíni homérséklete és légáramlási viszonyainak alakulása refraktív célú lézeres beavatkozás közben három különbözo típusú és ismétlési frekvenciájú excimer lézerberendezésnél.

INTRODUCTION: Thermal conditions during photorefractive keratectomy might be an important issue related to the corneal wound healing and long-term outcomes. AIM: Authors tried to find out the importance of temperature conditions during the treatment. METHOD: One eye of 90 patients has been included into the study. Photorefractive keratoctomy was applied with Carl Zeiss MEL 70, MEL 80 and Wavelight Allegretto excimer lasers. EBRO TLC 730 infrared thermometer was used for the measurement of surface temperature of the cornea before epithelial removal, as well as before and after the treatment. Average age of the patients was 25.5 ± 3 yr. Average myopic correction was -3.2 ± 0.8 Dpt. RESULTS: Statistically significant difference was found in temperature change between MEL 80 and the other two types of excimer laser devices. CONCLUSIONS: Different air flow conditions of the smoke removal system might have an influence on changes of the corneal temperature during treatment, but the refractive results were not influenced by this issue. Orv. Hetil., 2016, 157(43), 1717-1721.

[Evaluation of free radical quantity in the anterior chamber following femtosecond laser-assisted capsulotomy]. / Szabadgyök-felszabadulás vizsgálata femtoszekundum lézerrel asszisztált capsulotomiát követoen.

INTRODUCTION: Femtosecond laser is a revolutionary, innovative treatment method used in cataract surgery. AIM: To evaluate free radical quantity in the anterior chamber of the eye, during femtosecond laser assisted capsulotomy, in a porcine eye model. METHOD: Seventy fresh porcine eyes were collected within 2 hours post mortem, were transported at 4 ºC and treated within 7 hours. Thirty-five eyes were used as control and 35 as femtosecond laser assisted capsulotomy group. A simple luminol-dependent chemiluminescence method was used to measure the total scavenger capacity in the aqueous humour, as an indicator of free radical production. The emitted photons were expressed in relative light unit %. RESULTS: The relative light unit % was lower in the control group (median 1%, interquartile range [0.4-3%]) than in the femtosecond laser assisted capsulotomy group (median 4.4%, interquartile range [1.5%-21%]) (p = 0.01). CONCLUSIONS: Femtosecond laser assisted capsulotomy decreases the antioxidant defense of the anterior chamber, which refers to a significant free radical production during femtosecond laser assisted capsulotomy. Orv. Hetil., 2016, 157(47), 1880-1883.

[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.

Retinal and choroidal thickness measurements using spectral domain optical coherence tomography in anterior and intermediate uveitis.

BACKGROUND: Macular edema is a common cause of visual loss at uveitic patients. The aim of our study was to investigate retinal and choroidal thickness at the macula in anterior (AU) and intermediate (IMU) uveitis and in healthy individuals using spectral domain optical coherence tomography (SD-OCT). METHODS: Case-control study of 21 patients with AU and 23 patients with IMU and 34 age-matched healthy controls was performed with Spectralis SD-OCT (Heidelberg Engineering, Germany). High resolution SD-OCT scans and macular mapping were applied for automated measurement of retinal thickness. Standardized, masked manual measurement of the choroidal thickness was performed in the center of the ETDRS fields on enhanced depth imaging (EDI) scans. Evaluation of central retinal subfield thickness, 3 mm and 6 mm perifoveal rings was performed in the corresponding ETDRS zones in patient groups. RESULTS: The mean central retinal subfield thickness was significantly higher in IMU (368.65 ± 115.88 µm, p = 0.0003), but not significantly different in AU (290.42 ± 26.37 µm p = 0.6617) compared to that of in controls (278.55 ± 18.31 µm). In both uveitis groups retina was significantly thicker in the 3 and 6 mm perifoveal rings than that of in controls (359 ± 15.24 µm in AU and 390.55 ± 70.90 µm in IMU vs 345,41 ± 15.28 µm in the control group, p = 0.0388 and p < 0.0001) in the 3 mm and (313.83 ± 16.63 µm in AU and 343.33 ± 57.29 µm in IMU vs 299 ± 13.82 µm in the control group, p = 0.0171 and p < 0.0001) in the 6 mm ring. Central choroidal thickness was 311.94 ± 60.48 µm in the control eyes, showed no significant difference in AU (312.61 ± 90.35 µm) and IMU (303.17 ± 93.66 µm) eyes, and was also similar at the perifoveal rings. CONCLUSION: Significant topographical changes could be detected in the macula of AU and IMU patients. Retinal thickness in the perifoveal rings was increased both in AU and IMU, but in the center only in IMU. Choroidal thickness seems to be unaffected by uveitis, even in the presence of macular edema, at least in the early stage of the inflammatory disease process.

Comparative Analysis of Clinical and Patient-Reported Outcomes of a New Enhanced Monofocal IOL and a Conventional Monofocal IOL.

Purpose: To compare the outcomes of the Tecnis Eyhance ICB00 IOL, designed to enhance intermediate vision, to a conventional Tecnis Monofocal ZCB00 IOL. Methods: This retrospective analysis compared two cohorts of patients undergoing lens replacement surgery with bilateral implantation of the Tecnis ICB00 or the Tecnis ZCB00 IOL (383 patients in each group). Monocular and binocular uncorrected distance (UDVA), intermediate (UIVA; 66cm), and near (UNVA; 40cm) visual acuities, refractive predictability, and patient-reported outcomes were compared. A sub-analysis of patients with the Eyhance IOL was performed to compare patients who achieved bilateral emmetropia to those with mini-monovision. One-month postoperative outcomes were analyzed. Results: Both groups had comparable UDVA outcomes. On average, both monocular and binocular UIVAs were approximately one Snellen line better in patients implanted with Eyhance IOL (monocular UIVA: ICB00 0.23 ± 0.18 logMAR, ZCB00 0.33 ± 0.19 logMAR; binocular UIVA: ICB00 0.18 ± 0.18 logMAR, ZCB00 0.26 ± 0.20 logMAR, p < 0.01). Likewise, the mean UNVA was also one Snellen line better with the ICB00 model (monocular UNVA: ICB00 0.51 ± 0.20 logMAR, ZCB00 0.61 ± 0.18 logMAR; binocular UNVA: ICB00 0.42 ± 0.19 logMAR, ZCB00 0.51 ± 0.22 logMAR, p < 0.01). There was no difference between the two groups in overall satisfaction or visual phenomena. A subgroup of patients who achieved mini-monovision with Eyhance IOL had, on average, one Snellen line better UIVA and UNVA compared to patients with bilateral emmetropia. Conclusion: Patients receiving the enhanced monofocal IOL had better intermediate and near vision compared to those receiving the conventional monofocal IOL, with similar levels of patient-reported photic phenomena in both groups.

[Comparison of thickness values in nine macular subfields using time-domain and spectral-domain optical coherence tomography]. / Vastagságértékek összehasonlítása kilenc macularis mezoben time-domain és spectral-domain optikai koherencia tomográfiával.

AIM: To compare macular thickness measurements with spectral-domain (Cirrus HD-OCT) and time-domain (StratusOCT) optical coherence tomography. METHOD: Macular thickness was measured in nine ETDRS subfields in the same eye of 20 healthy subjects using both instruments. Using Cirrus HD-OCT both the Macular Cube 512×128 and Macular Cube 200×200 protocol, using StratusOCT the Fast Macular Thickness Map protocol was performed. Reproducibility of all three measurement series was assessed and the average of the measurement series was compared on each field. RESULTS: Measurement values obtained by StratusOCT were significantly lower than those obtained by Cirrus HD-OCT (p<0.001) in all subfields. Correlation coefficient between the results obtained by the two protocols of Cirrus HD-OCT was 0.977. CONCLUSIONS: By using Cirrus HD-OCT we could observe better repeatability than with StratusOCT. Using Cirrus HD-OCT significantly higher measurement values could be obtained in all subfields than those measured with Stratus. Using different OCT instruments we get significantly different values, therefore care needs to be taken when comparing data.

[Long-term treatment with intravitreal ranibizumab for exudative age-related macular degeneration]. / Hosszú távú intravitrealis ranibizumabkezelés exsudativ idoskori maculadegenerációban.

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.

Assessment of Visual Quality Improvement as a Result of Spectacle Personalization.

Personalized spectacles customized according to an individual's facial anatomy were developed to provide enhanced visual performance and overall comfort when compared to standard spectacles. In this comparative crossover trial, each subject was randomly assigned to wear either personalized spectacles or standard spectacles for two weeks and then tried the second pair for another two weeks. Visual acuity and reading speed were measured, and visual quality and comfort were assessed using specific questionnaires. The correlation of the wearing parameters with the subjects' satisfaction was calculated. According to our results, the subjects wearing personalized glasses reported significantly less experience of swaying and significantly higher overall satisfaction compared to those wearing the control spectacles. At the end of the study, 62% of subjects preferred the personalized spectacles, and visual quality was the primary reason for their spectacle preference followed by wearing comfort. The difference from the ideal cornea-vertex distance was significantly lower when wearing the personalized spectacles compared to the control frames. In addition, the absolute value of the difference from the ideal cornea-vertex distance was significantly correlated with patient satisfaction. These results suggest that personalized spectacles, customized according to an individual's facial anatomy for the ideal wearing parameters, result in both visual and comfort advantages for wearers.

Comparison of the 1st Generation and 3rd Generation Wavefront-Guided LASIK for the Treatment of Myopia and Myopic Astigmatism.

Purpose: To compare refractive, visual, and patient-reported outcomes associated with a 1st generation wavefront-guided (WFG) treatment with those associated with a 3rd generation WFG treatment. Patients and Methods: This retrospective study included patients who underwent femtosecond laser-assisted in situ keratomileusis (LASIK) for myopia/myopic astigmatism. Two random stratified samples of patients who underwent either 1stgeneration (WaveScan, Johnson & Johnson Vision, Santa Ana, CA) or 3rd generation (iDesign 2.0, Johnson & Johnson Vision, Santa Ana, CA) treatment matched on preoperative refraction were compared (4290 eyes of 2145 patients in each group). One-month postoperative visual, refractive, and patient-reported outcomes were analyzed. Refractive and monocular visual acuity analyses were performed using one random eye of each patient. Results: The percentage of eyes achieving 20/20 or better uncorrected vision was 91.3% (1958/2145) in the 1st generation group and 95.9% (2056/2145) in the 3rd generation group (p<0.01). Binocularly, the percentage of patients with 20/20 or better UDVA was 97.0% (2080/2145) and 99.2% (2127/2145) in the 1st and 3rd generation groups, respectively (p<0.01). The mean postoperative MSE was -0.01 ± 0.33 D in the 1st generation group and +0.19 ± 0.33 D in the 3rd generation group (p<0.01). Postoperative refractive astigmatism had a mean value of -0.20 ± 0.26 D and -0.18 ± 0.24 D in the 1st and 3rd generation groups, respectively (p<0.01). The mean correction index of refractive astigmatism was 1.09 ± 0.53 in the 1st generation group and 1.02 ± 0.38 in the 3rd generation group, p<0.01. The overall percentage of patients satisfied with vision was 92.8% (1991/2145 patients) in the 1st generation group and 97.3% (2087/2145 patients) in the 3rd generation group (p<0.01). Conclusion: For the majority of postoperative variables, there were significant differences between 1st and 3rd generation treatments. The 3rd generation treatments had better visual acuity outcomes and higher patient satisfaction.

Ageing as a price of cooperation and complexity: self-organization of complex systems causes the gradual deterioration of constituent networks.

The network concept is increasingly used for the description of complex systems. Here, we summarize key aspects of the evolvability and robustness of the hierarchical network set of macromolecules, cells, organisms and ecosystems. Listing the costs and benefits of cooperation as a necessary behaviour to build this network hierarchy, we outline the major hypothesis of the paper: the emergence of hierarchical complexity needs cooperation leading to the ageing (i.e. gradual deterioration) of the constituent networks. A stable environment develops cooperation leading to over-optimization, and forming an 'always-old' network, which accumulates damage, and dies in an apoptosis-like process. A rapidly changing environment develops competition forming a 'forever-young' network, which may suffer an occasional over-perturbation exhausting system resources, and causing death in a necrosis-like process. Giving a number of examples we demonstrate how cooperation evokes the gradual accumulation of damage typical to ageing. Finally, we show how various forms of cooperation and consequent ageing emerge as key elements in all major steps of evolution from the formation of protocells to the establishment of the globalized, modern human society.

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.

Graft survival using cadaver and multiorgan donors between 2008 and 2017 in our department / Cadaverbol és multiorgan donorból származó szaruhártyák túlélése 2008 és 2017 között klinikánkon.

Összefoglaló. Bevezetés: Az elso szaruhártya-bank 1944-es alapítása óta jelentos változásokon ment át. A szaruhártya túlélését számos tényezo befolyásolja, így a tárolási mód, melynek a szövet lejárati ideje szerint rövid, közép és hosszú távú módszereit fejlesztették ki. Célkituzés: Retrospektív vizsgálatunk célja a 2008. január 1. és 2017. december 31. között perforáló és lamelláris keratoplasztika során felhasznált cadaverbol és multiorgan donorból származó szaruhártyák túlélésének vizsgálata volt a Semmelweis Egyetem Szemészeti Klinikáján. Módszer: Feljegyeztük a recipiens nemét, életkorát, a mutétet indikáló klinikai diagnózist, a mutét idopontját, a szövettani vizsgálat eredményét, valamint, hogy a beültetett szaruhártya cadaverbol vagy multiorgan donorból származott. Meghatároztuk, hogy a recipiens életkora korrelált-e a rekeratoplasztikáig eltelt idovel. Eredmények: 1451 szaruhártya-átültetés történt 1088 beteg (44,6% férfi) 1159 szemén (életkor 62,8 ± 18,5 év), melyek között 938 (64,6%) cadaver és 262 (18,0%) multiorgan donor került felhasználásra, 251 esetben (17,2%) nem állt rendelkezésre adat. A leggyakoribb primer diagnózis a szaruhártya-dekompenzáció volt (325 eset, 28%). A primer keratoplasztikák során felhasznált szaruhártyák 740 esetben (63,8%) cadaverbol, 212 esetben (18,2%) multiorgan donorból származtak, 207 esetben (17,8%) nem állt rendelkezésre adat. Elso rekeratoplasztika a primer keratoplasztikák közül 217 esetben (18,7%) történt. A leggyakoribb szövettani diagnózis az endothelsejt-degeneráció volt (130 esetben, 60,4%). 146 esetben (67,2%) korábban cadaver, 31 esetben (14,2%) multiorgan donor esetén került sor ismételt mutétre, 40 esetben (18,4%) nem állt rendelkezésre adat. Következtetés: Klinikánkon elsosorban cadaverbol származó donorok biztosítják a szaruhártya átültetésekhez szükséges szövetet. Cadaverbol vagy multiorgan donorból származó szaruhártyák esetén nem kerül gyakrabban sor rekeratoplasztikára. A szaruhártya-banki tevékenység további fejlesztésével növelheto a donorok túlélése hazánkban. Orv Hetil. 2021; 162(13): 488-496. INTRODUCTION: Corneal banking methods have been changing since the foundation of the first corneal bank in 1944. Corneal graft survival may be affected by several factors, among others the storage method, which may be short-, middle- and long-term storage. OBJECTIVE: To investigate corneal graft survival at the Department of Ophthalmology, Semmelweis University between 1 January 2008 and 31 December 2017, using cadaver and multiorgan donors for penetrating and lamellar keratoplasty, retrospectively. METHOD: Recipient sex, age, clinical diagnosis, date of surgery, histological examination results and origin of donors (cadaver or multiorgan donor) were recorded. Correlation between recipient age and time to repeat keratoplasty was also analyzed. RESULTS: There were 1451 keratoplasties in 1159 eyes (age 62.8 ± 18.5 years) of 1088 patients (44.6% male) using 938 (64.6%) cadaver and 262 (18.0%) multiorgan donors, data was not available in 251 (17.2%) cases. There was repeat keratoplasty in 217 patients (18.7% of first keratoplasties). The most common histological diagnosis was endothelial decompensation (130 cases, 60.4%) in these cases. In patients with a first repeat keratoplasty, in 146 cases (67.2%) the first donor originated from cadavers, in 31 cases (14.2%) from multiorgan donors and in 40 cases (18.4%) data were not available. CONCLUSION: Corneal donors mainly originate from cadavers at our Department. The necessity of repeat keratoplasties does not differ using cadaver or multiorgan donors. With further development of corneal banking, donor survival may be increased in Hungary. Orv Hetil. 2021; 162(13): 488-496.

Contrast independence of dynamic random dot correlogram evoked VEP amplitude.

Dynamic random dot correlograms (DRDCs) are binocular stimuli that evoke a percept and a visual evoked potential (VEP) only in case of a mature and functional binocular system. DRDC-VEP is a method extensively used to study cortical binocularity in human infants and nonverbal children. Although the DRDC-VEP was invented 3 decades ago, neither the fundamental parameters, including contrast, of the stimulation nor the cerebral processing mechanisms have been clarified. The objective of the present study was to investigate the variability and detectability of adults' VEPs to DRDC under different stimulus contrast conditions. DRDCs were presented on the red and green channels of a computer monitor and were viewed with red-green goggles. The steady state DRDC-VEPs were recorded in healthy adult volunteers, and response reliability was assessed by the T(circ)(2) statistic. DRDC-VEP amplitude was independent of contrast, while VEP phases showed a weak correlation with contrast. Contrast invariance of DRDC-VEP amplitude suggests a very high contrast gain and dominant magnocellular input to the binocular correlation processing system.

Comparison of visual and refractive outcomes between hydrophilic and hydrophobic trifocal intraocular lenses sharing the same optical design.

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

Corneal-PAMPA: A novel, non-cell-based assay for prediction of corneal drug permeability.

The present study was aimed to develop an in vitro non-cell-based method, for the measurement of corneal permeability. To this avail, the parallel artificial membrane permeability assay (PAMPA) was used for studying the effects of composition of the artificial lipid membrane, the DMSO cosolvent content of the donor phase as well as different buffer solutions in the model. Based on experimental corneal permeability values of 25 active pharmaceutical ingredients (APIs), a final model with good predictive ability (R2 = 0.880) was developed and validated. The optimized conditions for the Corneal-PAMPA were the following: iso-pH conditions using phosphate buffer saline (PBS pH 7.4) without cosolvent, phosphatidylcholine (10.7 w/v %; without cholesterol) dissolved in a mixture of hexane:dodecane:chloroform = 70:25:5 (v/v) as an artificial membrane, 4 h incubation of the PAMPA plates at 35 °C. The model's applicability in the case of diluted solutions of eye drops was also demonstrated.

First report of Acanthamoeba genotype T8 human keratitis.

Acanthamoeba has a worldwide distribution in the environment and it is capable of causing a painful sight-threatening disease of the cornea designated as Acanthamoeba keratitis (AK). Nowadays, the cases of AK have surged all over the world along with its disease burden due to increasing use of contact lenses used not only for optical correction but also for cosmetic purposes. In our present work, epithelial abrasion of a 27-year-old female soft contact lens wearer with keratitis was examined. Genotype identification was carried out with a real-time fluorescence resonance energy transfer polymerase chain reaction (PCR) assay based on sequence analysis of the 18S rRNA gene. Genotyping allowed the identification of a T8 group isolate. The analysis confirmed the importance of a complete diagnostic protocol, including a PCR assay, for the clinical diagnosis of AK from human samples. Acanthamoeba T8 should be considered as potential causative organism in keratitis in human.