[Corneal deposits in monoclonal gammopathy of undetermined significance. Review of the literature and case report]. / Szaruhártya-lerakódások bizonytalan jelentoségu monoklonális gammopathiában. Irodalmi áttekintés és esetbemutatás.

To summarize ophthalmological signs of monoclonal gammopathy of undetermined significance (MGUS) and to present a case report. Summary of the literature data and presentation of the history of a 46-year-old female patient. In MGUS, pathological, but non-malignant plasma cells produce abnormal monoclonal immunoglobulin. Its prevalence is 0.15%, but it increases with age. As yearly 1-2% of MGUS patients develop multiple myeloma, frequent hematological follow-up is necessary. Corneal opacifications in MGUS have been described in a few dozens of patients in the literature. These may be nummular or crystal-like, or even present with white or grey line-forming depositions in the stroma. They may be centrally or peripherally localized. In our patient, bilateral, branching, geographical corneal opacifications were detected predescemetally, that were progressing and reaching the optical centre during follow-up. With 0.15 best corrected visual acuity, penetrating keratoplasty was performed (postoperative best spectacle-corrected visual acuity 0.6). Masson trichrom staining of the explanted cornea verified protein deposition, immunhistochemistry identified kappa light chain immunglobulin deposition in the posterior stroma, surrounded with inflammatory cells. Serum electrophoresis and bone marrow biopsy of our patient proved MGUS, therefore, hematological follow-up is going on. In the case of progressive, atypical corneal opacification, the hematological diagnosis of monoclonal gammopathy must be excluded - monoclonal gammopathy of ocular significance -, as delay in proper diagnosis and treatment of the systemic disease may have devastating consequences. Orv Hetil. 2018; 159(39): 1575-1583.

Indapamide-induced transient myopia with supraciliary effusion: case report.

BACKGROUND: Ingestion of sulphonamide-derived drugs has been reported to possibly have ocular side-effects. Authors aimed to present a rare case of indapamide-induced transient myopia with ciliary body edema and supraciliary effusion. CASE PRESENTATION: A 39 years old caucasian female patient presented at the Department of Neurology with headache and sudden bilateral loss of distant vision. Neurological assessment and cranial CT scans were unremarkable. For her hypertension, twice a day bisoprolol 2.5 mg and once a day indapamide 1.5 mg tablets were prescribed several days before. At her presenting, ophthalmic findings were as follows: visual acuity 0.08-7.25Dsph = 1.0 and 0.06-7.25Dsph = 1.0; IOP 25 mmHg and 24 mmHg, anterior chamber depth (ACD) 2.32 mm and 2.49 mm, lens thickness (L) 4.02 mm and 4.09 mm in the right and the left eye, respectively. By means of ultrasound biomicroscopy (UBM), thickened (720 / 700 micron) and detached ciliary body, its forward movement (ciliary body-cornea angle 108' / 114') and forward rotated ciliary processes were seen. Angle opening distance (AOD500) were 300 / 314 microns. By the following days, the myopia gradually diminished, and a week after her first symptoms, her uncorrected visual acuity was 1.0 in both eyes, IOP 13 mmHg and 17 mmHg, ACD 3.68 mm and 3.66 mm, L 3.78 mm and 3.81 mm in the right and the left eye, respectively. Ciliary body edema and detachment disappeared (ciliary body thickness 225 / 230 micron), both of the ciliary body-cornea angle 134' / 140' and the AOD500 (650 / 640 microns) increased. At this point, the patient admitted that she had stopped taking indapamide two days before. CONCLUSIONS: Our case report is the third one in the literature to present indapamide-induced transient myopia, and the first to employ UBM for describing the characteristics of this rare condition. According to the findings, authors suggest that both ciliary muscle contraction and ciliary body edema may play role in the pathomechanism. UBM seems to be a useful tool in the differential diagnosis of acute myopia. Further, authors wish to draw attention to one of the potential adverse effects of this drug which was not listed by its package insert.

[Ophthalmological results in the Hungarian comprehensive health care screening program, 2011-2022]. / Szemészeti eredmények Magyarország átfogó egészségvédelmi szuroprogramjában, 2011­2022.

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

Myopia management algorithm. Annexe to the article titled Update and guidance on management of myopia. European Society of Ophthalmology in cooperation with International Myopia Institute.

Myopia is becoming increasingly common in young generations all over the world, and it is predicted to become the most common cause of blindness and visual impairment in later life in the near future. Because myopia can cause serious complications and vision loss, it is critical to create and prescribe effective myopia treatment solutions that can help prevent or delay the onset and progression of myopia. The scientific understanding of myopia's causes, genetic background, environmental conditions, and various management techniques, including therapies to prevent or postpone its development and slow its progression, is rapidly expanding. However, some significant information gaps exist on this subject, making it difficult to develop an effective intervention plan. As with the creation of this present algorithm, a compromise is to work on best practices and reach consensus among a wide number of specialists. The quick rise in information regarding myopia management may be difficult for the busy eye care provider, but it necessitates a continuing need to evaluate new research and implement it into daily practice. To assist eye care providers in developing these strategies, an algorithm has been proposed that covers all aspects of myopia mitigation and management. The algorithm aims to provide practical assistance in choosing and developing an effective myopia management strategy tailored to the individual child. It incorporates the latest research findings and covers a wide range of modalities, from primary, secondary, and tertiary myopia prevention to interventions that reduce the progression of myopia.

The impact of the pandemic highlights the urgent need for myopia guidelines: The clinicians' role.

Myopia is already one of the leading causes of permanent vision impairment, including blindness, and the COVID-19 pandemic has exacerbated the global myopia-related burden among children owing to home confinement, increased screen time (e-learning), and decreased outside activities. To reverse the rising trend of myopia and myopia-related blindness, collaborative efforts are required. There is a wealth of evidence-based medicine (EBM) data on the epidemiology of myopia and effective interventions, but very little has been published on the clinicians' roles and responsibilities. However, this aspect is critical because preventing the onset and progression of myopia necessitates extensive health promotion and advocacy efforts among decision-makers. Only broad medical expert collaboration can bring about the necessary changes in children's lifestyle and education. This article discusses clinicians' critical roles in preventing the onset and progression of myopia.

OCT Imaging of lid-parallel conjunctival folds in soft contact lens wearers.

PURPOSE: To visualize, using Fourier-domain optical coherence tomography (FD-OCT), the alterations in lid-parallel conjunctival fold (LIPCOF) morphology in eyes with contact lenses and after their removal. METHODS: One randomly selected eye of each of 24 volunteers with normal ocular surface status was examined using FD-OCT. The study group included 18 female and 6 male subjects, with a mean age of 28.9 years (range, 18-50 years). The presence, height, and number of conjunctival folds and the tear meniscus area were evaluated by FD-OCT, and the difference between "before and after lens removal" were analyzed by the Wilcoxon signed-rank test. To determine the coverage of the folds, the OCT-LIPCOF grading system was applied. Visualization of the folds was compared on linear and raster scans. The Spearman rank test was applied for correlations (SPSS 16.0; SPSS Inc., Chicago, MI). RESULTS: OCT scans were able to visualize and objectively describe the LIPCOF and its relation to the tear film in contact lens wearers. Raster scanning provided more information about the folds, but the measurements were easier to carry out on the single line scans. After removal of the contact lens, the height of the conjunctival folds significantly decreased (p < 0.001), and the tear meniscus area significantly increased (p = 0.017). The number of LIPCOF did not change (p = 0.971), but LIPCOF coverage by the tear film increased after lens' removal and resulted in changes in the OCT-LIPCOF grading (p < 0.001). CONCLUSIONS: FD-OCT could be a quick, non-invasive, quantitative method for the imaging of LIPCOF in contact lens patients. When grading LIPCOF, the mechanical forces of the lens and the tear meniscus changes caused by the lens should be taken into account as these factors influence results. Follow-up of the patients using the same methods is suggested with or without contact lenses.

Update and guidance on management of myopia. European Society of Ophthalmology in cooperation with International Myopia Institute.

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

[Evaluation of color Doppler imaging of ophthalmic tumors based on histopathologic findings]. / Szemészeti daganatok színkódolt ultrahangvizsgálatának értékelése a szövettani eredmény tükrében.

PURPOSE: To examine retrospectively the diagnostic and differential diagnostic value of color Doppler imaging (CDI) in cases of suspected intraocular and orbital tumors. PATIENTS AND METHODS: Color Doppler examination (using Acuson 128, Philips-ATL UM-9, HDI 3000, 5000, Siemens Elegra, GE Logiq9) was performed in a total of 194 patients (177 intraocular, 17 orbital tumors). The results were compared to the clinical findings (routine examination, conventional ultrasound examination) and the results of angiography (FLAG, ICG). Furthermore, in 73 cases histopathology records were obtained for comparison. RESULTS: Signs of blood flow could be detected in 137 cases (71%); the Doppler spectrum was low resistance in the large majority (130) of these cases. In cases where histopathology records were available, 60 of the 73 (82%) showed good concordance between the CDI diagnosis and the pathological results. CDI gave false positive results in 3, and false negative findings in 10 cases; the latter occurred mainly in small iris or ciliary body tumors. CONCLUSIONS: Using CDI, blood flow is demonstrable in the majority of intraocular and orbital tumors, especially if the tumor diameter is larger than 3 mm. CDI flow detection, however, is less reliable for iris or ciliary body tumors.

Imaging lid-parallel conjunctival folds with OCT and comparing its grading with the slit lamp classification in dry eye patients and normal subjects.

PURPOSE: To visualize and describe the morphologic appearance of lid-parallel conjunctival folds (LIPCOFs) by using optical coherence tomography (OCT) and to relate it to dry eye signs and symptoms. METHODS: The LIPCOF grade, noninvasive tear film breakup time (NIBUT), lipid layer interference pattern, and dry eye symptoms were recorded in 17 normal subjects and 33 patients with dry eye. LIPCOFs were evaluated with a slit lamp and visualized by OCT. Three different algorithms for OCT were developed to grade LIPCOFs according to tear meniscus height or the covering tear film on the folds. RESULTS: The three OCT methods showed significant correlation with the slit lamp method (r = 0.470-0.473, P < 0.01). The OCT LIPCOF imaging methods were independent of NIBUT. The Dry Eye Questionnaire (DEQ) scores correlated with the height of the folds and the absence of tear film coverage of the folds (r = 0.574, P < 0.001 and r = -0.527, P < 0.001, respectively). The OCT LIPCOF grades correlated with the DEQ scores (r = 0.494, P < 0.001 and r = 0.310, P = 0.029, respectively). The slit lamp grade did not correlate with the DEQ scores in the whole population, but did in the normal group (r = 0.458, P = 0.024). The OCT LIPCOF grades showed inverse correlation with lipid pattern in the normal group (r = -0.422-0.481, P = 0.05); however, this association disappeared in the dry eye group. CONCLUSIONS: OCT enabled a noninvasive, high-resolution method of imaging, evaluating, and classifying LIPCOFs. These new classifications correlated well with the slit lamp grade and the DEQ scores, promising a new, more objective evaluation of dry eye.

Different autoregulation response to dynamic exercise in ophthalmic and central retinal arteries: a color Doppler study in healthy subjects.

PURPOSE: Prospective examination of the influence of changes in heart rate, arterial blood pressure and intraocular pressure induced by short dynamic exercise on orbital blood-flow velocities, and comparison of the autoregulation response in the ophthalmic artery and the central retinal artery. METHODS: Twelve young healthy volunteers were involved in the ophthalmic artery study and 12 others in the central retinal artery study. Blood-flow velocities were measured using color Doppler imaging before and after exercise. RESULTS: After exercise systolic blood pressure and heart rate were higher ( P<0.004) and intraocular pressure was lower ( P<0.006). However, in the central retinal artery the mean flow velocity, end-diastolic velocity and resistive indices remained stable, while in the ophthalmic artery these velocities actually decreased, and resistive indices increased significantly ( P<0.005). In the central retinal vein the velocities showed no significant change. CONCLUSION: Our results confirm the presence of an effective compensatory autoregulation for the retinal circulation, in connection with an increase in the ocular perfusion pressure induced by exercise. However, we found that in the ophthalmic artery some over-compensation occurs (significant decrease in some velocity parameters), whereas in the central retinal artery important flow parameters (mean velocity, end-diastolic velocity and resistive indices) appear to be successfully stabilized. Exercise history, heart rate, blood pressure and intraocular pressure all have to be monitored in orbital blood flow studies, as these variables are strongly affected by the changes in the autonomic nervous system and in turn significantly influence the measured flow velocity and resistivity values.