Cataract surgery in 2021 in Hungary – summary of the results of cataract register

doi: 10.55342/szemhungarica.2022.159.3.94

Original scientific paper


Purpose: To create a register with the data of the Hungarian cataract procedure for the year of 2021.
Methods: A questionnaire with 14+1 questions was sent to Hungarian institutions which are dealing with ophthalmic surgeries (cataract and refractive surgeries), from 79 institutions 63 answered.
Results: In Hungary the number of cataract procedures is between 80,000 and 90,000. The COVID-19 pandemic resulted in a significant decrease already in 2020, the number of cataract surgeries decreased under 60,000, in 2021 the number decreased under 50,000. Today, 90% of cataract procedures are performed in a one-day surgery basis both in hospitals and one-day ophthalmic surgery centers. The penetrance of the drop anesthesia is 100%, retrobulbar and peribulbar anesthesia is still used infrequently. The mode of incision is corneal in all institutions, in limited cases limbal incisions may be used if necessary. The average time within the hospital decreased to 4.8 hours. The nucleus removal was phacoemulsification on 99%, and in 0.2% extracapsular cataract surgery, in 0.8% suction (pediatric cataract surgery), in 0.9% femtolaser assisted pretreatment was performed. The cortex removal was performed in 7,6% with bimanual technique and in 92.4% with one-hand I/A handpiece. The ratio of toric lenses was 6.98%, multifocal lenses were implanted in 6.76% and multifocal-toric lenses were used in 0.61% in 2021. Intracameral cefuroxim is administered in all insitutes at the end of the surgery, subconjunctival antibiotics was applied in 1.4%, during the preoperative period topical antibiotics is used in 20 institutions, previously it was used in 30 institutions. Postoperatively in 85% only modern fluorokinolons, in 5% fluorokinolons/or aminoglycozides and in 10% only aminoglycosides were prescribed for 12 days on average. The surgical treatment of presbyopia is performed rather with multifocal lenses instead of other corneal procedures.
Conclusions: The COVID-19 pandemic decreased the number of cataract surgeries approximately by 30% in Hungary. In 2021 due to newer close-ups even caused more decrease in surgery. The suspension of surgery lasted on average 94 days (3 months). In 89% of the institutions the number of patients waiting for cataract surgeries increased, in 84% the waiting time increased also by a quarter of a year (3 months). The number of leaving personnel (nurses, scrub nurses, assistants) increased during the past 2 years. In order to keep the human resource, the achievement based financing should be introduced in the hospitals as well in order to motivate personal.

ISSUE: Szemészet 159. évfolyam, 2022; 3. szám 94–99.
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Calculation and surgical practice of the toric intraocular lens

doi: 10.55342/szemhungarica.2022.159.3.100



The aim of the present education article is to summarise the essential theoretical knowledge on astigmatism and to analyse the possibilities and important aspects of the astigmatism correction with a toric intraocular lens from a practical standpoint.
Astigmatism, as a low-order refractive error of the eye, can significantly affect the visual acuity of the patient. The average corneal astigmatism is around 1.0 D and is over 1.5 D in a significant proportion of the population, which can be corrected by surgical and non-surgical methods. Exceeding the effectivity of incision methods, toric intraocular lens implantation is a potent way to neutralize corneal astigmatism in the course of cataract surgery. After inaccurate surgical correction, residual astigmatism is one of the most common causes of patient dissatisfaction. In addition to the presence of regular corneal astigmatism, there are a number of less common indications for the implantation of a toric lens. The main contraindication is the uncertainty of the expected lens stability in the capsule. Nowadays, toric intraocular lens power calculation is recommended using modern optical and new generation calculation methods. Its implantation must take into account surgically induced astigmatism, cyclotorsion, and the marking of the post-operative axis by different methods before surgery is of particular importance. Even with the most precise surgical technique and planning, many sources of error can cause suboptimal results, in which case a well-planned artificial lens repositioning can be performed, typically.

ISSUE: Szemészet 159. évfolyam, 2022; 3. szám 100–111.
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Systemic side effects of topically applied ophthalmic compounds. Review article

doi: 10.55342/szemhungarica.2022.159.3.112



Many of the medications used to treat eye diseases are applied topically, as eye drops or ointments. The local side effects of these products are generally well known, and diagnosis is rarely a problem, as they occur at the site of application. Systemic side effects are much less common but are more difficult to detect since they occur in other organs or organ systems distant from the site of application, while the risk is much higher and can be life-threatening.
The present article reviews the most relevant knowledge on the pharmacokinetics of the topical route of administration, the patient populations that are particularly sensitive to the development of adverse reactions and summarizes some of the agents that have the potential to cause serious, potentially life-threatening systemic adverse reactions.

ISSUE: Szemészet 159. évfolyam, 2022; 3. szám 112–118.
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Special forms of preretinal haemorrhages – case series

doi: 10.55342/szemhungarica.2022.159.3.119

Case report


The aetiology of preretinal haemorrhage is varied, and the majority of cases show spontaneous absorption. In this case series, we present the cases of our three female patients. We review the possible aetiologies of preretinal haemorrhage, the course of the disease, and the treatment options.
In the first case, we report a sub-internal limiting membrane (sub-ILM) haemorrhage as a complication of uncontrolled hypertension. In the second case, we present bilateral peripapillary and premacular haemorrhages as ophthalmic complications due to the underlying haematological disease (acute myeloid leukemia). In our third presentation, we describe a case of the rare Terson syndrome.

ISSUE: Szemészet 159. évfolyam, 2022; 3. szám 119–124.
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Endophthalmitis after Ahmed valve implantation in pediatric cases. Causes, treatment challenges and ways of prevention

doi: 10.55342/szemhungarica.2022.159.3.125

Original article


Aim: Prevention and reduction of postoperative pediatric endophthalmitis following Ahmed valve implantation.
Methods: Among the 106 Ahmed valve implantations performed between January 1, 2014, and December 31, 2021, 20 eyes of 19 patients were pediatric cases, with the mean age as 10.5 years (range: 2–17 years). The follow-up periods extended from 6 months to 7 years. Samples from the aqueous humor and the vitreous body were sent for microbiological examination in two cases.
Results:Following two interventions of the 20 pediatric cases, postoperative endophthalmitis developed. One of them was acute (two days following the surgery), while the other was a late-type (three months after the implantation). In the first case, light perception and shrinking eyeball remained, in the latter one, enucleation was necessary. Summary: The importance of preoperative screening tests, dental and otolaryngological examination, and treatment of the underlying diseases are emphasized in this publication. The responsibilities of parents/caregivers are listed. The significance of personal and oral hygiene is also highlighted.

ISSUE: Szemészet 159. évfolyam, 2022; 3. szám 125–129.
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Genotype-phenotype correlations in USH2A gene mutation-related RP presented with our genotyped cases

doi: 10.55342/szemhungarica.2022.159.3.130

Original article


Introduction: Usher syndrome is an autosomal recessive hereditary disease that ophthalmologically manifests itself in symptomatic retinitis pigmentosa. Usher syndrome has three major types. Along with sight loss, hearing loss is a typical symptom that appears during infancy in type I of the disease and during school age in type II. In type III, besides sight and hearing loss, balance disorder is also characteristic. In type II, the significant narrowing of the visual field develops in the third decade, followed by the damage of colour vision and central sight. In the background of its pathogenesis, biallelic mutations of ADGRV1, USH2A and WHRN genes have been reported. Our aim is to precisely assess patients with hearing loss and retinitis pigmentosa, as well as to perform their genotyping.
Materials and methods: 2 male and 2 female patients were examined at the Department of Ophthalmology of Semmelweis University with standard methods and multimodal imaging. Genotyping of patients with characteristic symptoms was performed with new generation sequencing (NGS, Illumina NextSeq, Usher Targeted Panel). The validation of the variants was done with Sanger sequencing.
Results: We identified four patients with type II Usher syndrome who all had the biallelic mutation of USH2A gene.
Conclusion: With detailed clinical, imaging and electrophysiological examinations as well as with genotyping, we documented both the phenotype and the genotype of our patients. We have observed that the severe phenotype is caused by mutations involving changes in DNA sequence length.

ISSUE: Szemészet 159. évfolyam, 2022; 3. szám 130–135.
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The role of Adolf Szily (1948–1920) and Aurel Szily (1880–1945) in the Hungarian ophthalmology

doi: 10.55342/szemhungarica.2022.159.3.136



Both the father named Adolf Szily and the son Aurel Szily had a significant role within the Hungarian and international ophthalmology. Both were interested in anatomy, organogenesis, developmental anomalies of the eye. Both had an active role in publishing especially in German language. Both were able to perform drawing, playing music and operating eyes on an artistic level.

ISSUE: Szemészet 159. évfolyam, 2022; 3. szám 136–138.
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