Serous retinal detachments: diagnostic and therapeutic considerations

doi: 10.55342/szemhungarica.2023.160.1.2

Referential scientific paper


The aim of this publication is to present our knowledge about serous retinal detachments using case reports, literature reviews, and our own clinical experiences. Serous detachment of the neurosensory retina can occur in the course of several illnesses, such as central serous chorioretinopathy, drug-induced serous retinal detachments, autoimmune and inflammatory disorders, or developmental malformations. By presenting our instructive clinical cases, we summarise the new diagnostic modalities that aid diagnosis and the selection of the most effective available therapeutic tool.

ISSUE: Szemészet 160. évfolyam, 2023; 1. szám 2–12.
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A new era in the treatment of ocular surface inflammatory diseases: "soft" topical steroids in the anti-inflammatory therapeutic algorithm

doi: 10.55342/szemhungarica.2023.160.1.13



Many pathological factors can cause inflammatory diseases on the ocular surface. The most common and therefore the clinically most relevant ocular surface inflammatory disease is the dry eye disease, which is a growing health problem affecting an increasingly large population. The reduction of chronic ocular surface inflammation is a major therapeutic challenge, as prolonged topical application of the prompt-acting steroids is limited by a number of ocular side effects. The latest advances in the research of anti-inflammatory treatment options are the development of "soft" steroids. A "soft" drug is a biologically active compound that, after achieving a local therapeutic effect, inactivates predictably at the site of action to a non-toxic substance. The advent of the soft steroid drugs opens a new chapter in the topical ophthalmic anti-inflammatory treatment algorithm, as the well-known ophthalmic side effects of topical steroids (ocular hypertension and cataractogenic effects) are minimised with these agents. The aim of the present work is to summarize the clinico-pharmacological characteristics, clinical application, the efficacy and side-effect profile of the "soft" topical steroids.

ISSUE: Szemészet 160. évfolyam, 2023; 1. szám 13–18.
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Vitrectomy and lens surgery: in one sitting or sequentially? Literature summary

doi: 10.55342/szemhungarica.2023.160.1.19



Introduction: :In our vitrectomy practice, the removal of the lens is almost always an issue when planning surgery for a phakic eye. If this is indicated, we have to decide whether to perform phacoemulsification and implantation of an intraocular lens before or after the vitrectomy. The literature is not consistent.
Discussion: :After a lens-sparing vitrectomy, there is a high risk of developing a cataract or a significant progression of an existing cataract, and therefore, in many cases, a simultaneous lens surgery is recommended. Depending on the opacity of the lens, the age of the patient, the indication for vitrectomy, the planned amount of vitreous removal (core or complete vitrectomy), the type of tamponade, and perhaps the size of the wound, a combined operation may be considered. The aim of this review is to analyse the relevant literature, including the development and risk factors of cataract in the vitrectomized eye, the advantages and disadvantages of combined versus sequential surgery, the characteristics of the surgical solution, and the financing issues.
Conclusion: :In the light of the highly controversial literature, it is probably not yet possible to reach a consensus on the preoperative parameters under which phacoemulsification should be performed in conjunction with vitrectomy. Therefore, this will remain an individual decision in most cases, even with the trend in the literature that are apparent and are likely to become more pronounced in the future.

ISSUE: Szemészet 160. évfolyam, 2023; 1. szám 19–27.
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Toric lens calculation: the role of IOL tilt?

doi: 10.55342/szemhungarica.2023.160.1.28

Original scientific paper


Introduction: This study is based on our previous experiences about the difference between total corneal astigmatic values and the Barrett Toric formula's results in WTR astigmatic eyes but the good agreement in cases of ATR astigmatic eyes. Our aim was to check this experience with the exclusion of a specific parameter or equipment dependence in the background.
Methods: We performed IOL calculations on 14 WTR (>0.5 D) eyes of 7 persons with Anterion (Ant) and IOLMaster700 (I700) biometers. We compared the astigmatic values (Ast) of total corneal power (Ant: TCP, I700: TK) and the results of the standard keratometry (Ant: SimK, I700: K) – based Barrett Toric (BT) and Abulafia-Koch (AK) formulas. The BT formula was used both in its posterior corneal curvature predicted (BTP) and measured (BTM) versions as well.
Results: AstSimK: 1.06±0.37 D, AstK: 1.05±0.38 D, AstTCP: 0.93±0.34 D, AstTK: 0.84±0.35 D, SimKBTP-KBTP: 0.03±0.07 D, SimKBTP-SimKAK: 0.01±0.05 D, SimKBTP-SimKBTM: –0.03±0.06 D, AstTCP-SimKBTP: 0.43±0.10 D, AstTCP-SimKBTM: 0.40±0.12 D, AstTK-KBTP: 0.36±0.09 D.
Discussion: The standard keratometric and total corneal power-related parameters of Ant and I700 showed no significant differences. The insignificant differences between SimKBTP and SimKAK show the similar characteristics of the regression formulas. The similar values of SimKBTP and SimKBTM exclude the causal role of corneal posterior surface data. Thus, in light of the statistically different results between the total corneal astigmatic values and the regression formulas, another source must be assumed.
Conclusion: Based on the literature data, the role of lens tilt in astigmatic aberration is probable. So, the determination and counting of lens tilt during toric calculation are worth considering.

ISSUE: Szemészet 160. évfolyam, 2023; 1. szám 28–31.
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Treatment difficulties of ocular toxoplasmosis in a case study during the Covid-19 pandemic

doi: 10.55342/szemhungarica.2023.160.1.32

Case report


Uveitis may be infectious or non-infectious, often with idiopathic etiology. One of the most common forms of infectious posterior uveitis is toxoplasmosis caused by the protozoa Toxoplasma gondii. After the primary infection the process becomes inactive, dormant, and may recur, especially in immuno compromised individuals. In this case report, we would like to present the case of an immunocompetent young male patient who has been diagnosed with left eye toxoplasmosis years ago at a school ophthalmic screening test. This was followed by a targeted antibiotic and corticosteroid therapy, the process became inactive and then resumed four years later. Serious side effects of general corticosteroid therapy has been observed, so we were able to apply antiinflammatory therapy only locally, however, the process was regressing. Months later, during the Covid-19 pandemic, the process recurred in association with Sars-Cov-2 infection, his condition has worsened. Our patient was treated according to the European Uveitis Recommendations proposed for the Covid-19 pandemic period. Although the visual acuity in the eye with infection seemed impossible to improve based on the clinical overview, his condition became much better, the best-corrected vision was almost 100% (0.9). In this case, we would like to draw attention to the difficulties in the management of patients diagnosed with toxoplasmosis.

ISSUE: Szemészet 160. évfolyam, 2023; 1. szám 32–37.
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Posterior reversible encephalopathy syndrome with acute loss of vision – a case report

doi: 10.55342/szemhungarica.2023.160.1.38

Case report


A case is presented here where posterior reversible encephalopathy syndrome (PRES) developed after a preeclamptic pregnancy. Considering severe preeclampsia, at the 30th gestational week, a caesarean section was performed on the patient. Afterwards, during the postoperative period, an ophthalmological examination was needed because of the sudden onset of painless bilateral loss of vision in the patient. Based on the bedside ophthalmological examination, which revealed normal eyeballs and a normal pupillary reflex pathway, a higher brain structure lesion was probable. The diagnosis of PRES was confirmed with an urgent axial MRI examination. The early recognition, and thus, early antihypertensive treatment resulted in a quick recovery of the neurological and ophthalmological symptoms, and 3 months later, the MRI also showed significant improvement. In the case presented, the ophthalmologist was a consultant. Ophthalmological symptoms suggested central nervous system involvement, which led to the diagnosis. PRES is known to be reversible only with early treatment, so knowledge of the pathology is essential for every practicing ophthalmologist.

ISSUE: Szemészet 160. évfolyam, 2023; 1. szám 38–42.
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