Proliferative vitreoretinopathy

doi: 10.55342/szemhungarica.2022.159.2.51



Proliferative vitreoretinopathy (PVR) is a disease that can be a consequence of numerous vitreoretinal diseases, primarly retinal detachment. Despite the expanding knowledge of molecular biology and the pharmacological developments built on it, it is still primarily a surgical disease with many risk factors. In terms of its complexity, despite large-scale advances in surgical techniques and visualization, this vision-threatening condition has not been eliminated and remains a significant challenge for current and future vitreoretinal surgeons and general ophthalmologists alike. The purpose of this training paper is to present the latest results of the state of the art.

ISSUE: Szemészet 159. évfolyam, 2022; 2. szám 51–63.
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Accuracy of telemedicine evaluation of OCT findings in diabetics

doi: 10.55342/szemhungarica.2022.159.2.64

Original scientific paper


Objective: The goal of this study was to investigate the accuracy of telemedicine evaluation of optical coherence tomography (OCT) recordings in diagnosing abnormalities in the eyes.
Method: Macular OCT imaging of 716 eyes from 378 diabetics using the iVue 100 OCT. Each image was evaluated by two separate investigators in the normal/abnormal/non-classifiable categories, and the required control date (in the 1 month/3 month/1 year categories) was assigned.
Results: Overall, 94.8% of OCT admissions were evaluable, with investigators rating 26.1% as normal and 68.7% as abnormal. The evaluators agreed on the normal/abnormal/non-classifiable category in 88.1% of cases, with only 4.2% disagreeing. Only one ophthalmologist rated the recording, and the other did not evaluate it, in 7.7% of the cases. Regarding the control date, the two examiners indicated the same interval in 66.9%, the control date was judged differently in 25.6%, and only one examiner indicated a control date in 7.5%. Based on OCT images, the two most common diseases were diabetic macular edema (DME) (36.9%) and age-related macular degeneration (20.5%).
Conclusions: The findings support the notion that OCT is a useful technique for detecting DME. The evaluators' agreement was excellent in the normal/abnormal/non-classifiable category, and the frequency of substantial discrepancies in control time was low. At the same time, divergent viewpoints play a useful part in the intended teaching of artificial intelligence.

ISSUE: Szemészet 159. évfolyam, 2022; 2. szám 64–68.
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Corneal polymegathism and pigmentary retinopathy in MELAS syndrome – a case report

doi: 10.55342/szemhungarica.2022.159.2.69

Case report


Introduction: MELAS syndrome (mitochondrial encephalopathy, lactic acidosis, and stroke-like episodes) is the most common mitochondrial disease. As it is characteristic of mitochondrial diseases, the symptoms are very heterogeneous and ophthalmic involvement is common.
Case report: In this case report, we present the case of three female patients with MELAS syndrome - one mother and two daughters. Genetic testing confirmed the presence of the disease-specific mtDNA m.3243A>G mutation in all three of them. All patients had symptoms affecting multiple organ systems in addition to ocular manifestation. Mild ptosis, anisocoric and visual field defects could be seen in two patients, one patient had nystagmus. Polymegathism of the cornea endothelium and involvement of the retinal pigment epithelium were observed in all our patients.
Conclusion: The possibility of a mitochondrial disease should be considered in cases of ophthalmic patients with multi-organ complaints. A detailed description of the symptoms as well as a family history may help the diagnosis. Accurate diagnosis can be established by genetic testing. For patients with genetically confirmed MELAS syndrome, a thorough ophthalmic status assessment using specular microscopy and multimodal imaging is strongly recommended due to the anterior and posterior segment involvements.

ISSUE: Szemészet 159. évfolyam, 2022; 2. szám 69–75.
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Refractive index – dependent and independent – axial length measurement in optical biometry for IOL calculation

doi: 10.55342/szemhungarica.2022.159.2.76

Original scientific paper


Our publication is focused on the potential cost and benefit of using either a refractive index-dependent or an -independent distance measurements in optical biometry for IOL calculation.
Similar to acoustic biometry, where real distances are calculated as a division of the measured length by the respective sound propagation speed, in optical biometry, the denominator is the refractive index of the given medium. Due to simplifying calculation, acoustic biometry uses an averaged propagation speed for the entire bulb. Optical biometry follows this practice dominantly, as distances are corrected with an estimated, cumulative refractive index independently from the respective media. IOL calculation formulas are optimized for such data, supposedly. The question emerged whether the application of distances, calculated with their dedicated refraction indices in formulas are optimized for refraction index-independent data may corrupt results.
Based on the literature, we are going to compare IOL prediction data obtained from these different distance measurement methods.

ISSUE: Szemészet 159. évfolyam, 2022; 2. szám 76–79.
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Ocular surface graft versus host disease – diagnostics and therapy in our practice

doi: 10.55342/szemhungarica.2022.159.2.80

Original scientific paper


Purpose: Ocular graft versus host disease is a chronic ocular surface inflammation developing after allogenic haematopoetic stem cell transplantation. In this retrospective study, we analysed the data of patients, who were treated for ocular surface graft versus host disease in our ocular surface disease clinic between 2013, and February 2022.
Methods: After collecting anamnestic data, dry eye symptoms, signs of blepharitis, the measure of hyperaemia, scarring of conjunctiva, and the severity of corneal damage were recorded. We gathered therapeutic methods and observed patients’ status during the follow-up period.
Results: Eight patients suffering from ocular surface graft versus host disease were treated in the examined period (2 females, 6 males, age: 33.3±11.6 years). Ocular surface graft versus host disease developed 5-36 months after the transplantation. Systemic graft versus host disease preceded ocular involvement in every patient. The main complaints were dry eye and photosensitivity of 5 and 3 patients, respectively. Subconjunctival scarring was observed in 3 patients, symblepharon in one case. In four cases, corneal surfaces were damaged moderately, but they were involved in 3 patients severely. In addition to the tear substitution, autologous serum drops, fluorometholone drops, lacrimal punctal plug, therapeutic contact lens and cyclosporine eye drops were applied as treatment. During the follow-up periods (ranging from half-year to 7 years), the state of the ocular surfaces improved or stabilized at various severity stages. In one case, total limbal stem cell deficiency developed as a consequence of a bacterial ulcer.
Conclusions: If ocular graft versus host disease is recognized early and treated properly, the comfort of the patient and the state of the ocular surface can be improved significantly. In late-diagnosed-cases, irreversible damage can be developed, thus impairing life quality significantly.

ISSUE: Szemészet 159. évfolyam, 2022; 2. szám 80–85.
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Intraoperative complications during cataract surgery performed by residents and staff surgeons

doi: 10.55342/szemhungarica.2022.159.2.86

Original scientific paper


Introduction: Cataract surgery is the most commonly performed intraocular surgery worldwide.
Aim: Our study aimed to compare the incidence of intraoperative complications during phacoemulsification surgery performed by residents and ophthalmic specialists.
Method: This retrospective study included all cases of phacoemulsification cataract surgery, which were performed in the half year period between the 1 of January and the 30 of June, 2019 at the Department of Ophthalmology of Semmelweis University, Budapest, Hungary. For each patient, demographics, clinical history and operative details were reviewed. There were no exclusion criteria.
Results: A total of 1818 cases were included, among which 6.1% of cases were performed by residents (n=110). The overall complication rate was 5.6% (n=102). The intraoperative complication rate was significantly higher (p=0.0035) in cases of residents (n=13; 11.8%) than in cases of specialists (n=89; 5.2%). The most frequent complications were posterior capsule tear (n=50; 2.8%), zonular fiber loss (n=25; 1.4%) and anterior capsule tear (n=22; 1.2%).
Conclusion: Intraoperative complication rates were higher amongst residents than specialists.

ISSUE: Szemészet 159. évfolyam, 2022; 2. szám 86–90.
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