The purpose of this summary is to support professional work in Hungary in order to prevent the further spread of myopia and provide actionable guidelines for experts. It is important to discuss myopia and share knowledge about it because the number of myopic individuals has significantly increased in childhood, both globally and in Hungary. This increase raises concerns as myopia can become the leading cause of blindness, but there are now effective procedures available that can help prevent or at least delay the onset of myopia, as well as slow down its progression in those who have already developed it. Due to the urgency of the situation, the International Myopia Institute (IMI) and the European Society of Ophthalmology (SOE) have developed and published the latest knowledge and recommended treatment guidelines for myopia management. This Hungarian-language summary is based on these guidelines and numerous studies with proven results. The guidelines summarize the current international definition and classification of myopia, present the pathomechanism of nearsightedness, discuss epidemiological findings, identify risk factors, and highlight current procedures that can prevent or delay the onset of myopia and slow down its progression.
Original scientific paper
Purpose: To assess the visual performance and symptoms of dysphotopsia of patients underwent bilateral implantation of AcrySof Vivity IQ (Alcon) extended depth of focus (EDoF) intraocular lens.
Method: In this prospective multicentric study uncorrected (UDVA) and corrected distance visual acuity (CDVA) was measured preoperatively, 1 week, 1 month and 3 months postoperatively. Hereafter uncorrected intermediate visual acuity (UIVA), and uncorrected near visual acuity (UNVA) was tested from 66 cm and 40 cm, respectively, symptoms of positive and negative dysphotopsia was recorded 1 month and 3 months postoperatively. At the 1-month follow-up of the second eye, glasses were ordered on request. In addition to the above binocular UDVA, UIVA, UNVA and glass-wearing was tested at the 3-months-control.
Results: Ninety-six eyes of 48 patients were involved. Preoperative UDVA improved significantly from 0.35 (±0.25) to 0.87 (±0.19), and CDVA from 0.62 (±0.33) to 0.96 (±0.10) at 1 week (P<0.001), and then not significantly at 1- and 3 months. UIVA was around 0.7, while UNVA around 0.6 at 1 week, and did not change significantly after that. Binocular visual acuities exceeded slightly the monocular values in all distances. Spontaneous and forced positive and negative dysphotopsia symptoms decreased at 3 months and did not cause unbearable problems at any patients. For fare 85-, for intermediate 94-, and for reading distance 46% of the patients did not wear glasses at all since the surgery.
Conclusion: Our first experience is specifically good with the Vivity IQ refractive EDoF intraocular lens. This lens provided most patients with good distance, excellent intermediate, and functional near vision, with low reported dysphotopsia symptoms.
Original scientific paper
Introduction: Bardet–Biedl syndrome (BBS) is a rare multisystemic autosomal recessive disease that belongs to the group of ciliopathies. It presents ophthalmologically as syndromic retinitis pigmentosa. The aim is to describe the characteristics of the BBS10 subtype by presenting two cases.
Case report: At the University of Debrecen, Department of Ophthalmology, at the end of 2022, sixty patients with previously diagnosed retinitis pigmentosa had a detailed ophthalmological examination and genetic sampling for genotyping (Blueprint Genetics, Retinal Dystrophy Panel Plus, version 7). Biallelic mutations in the BBS10 gene were found in two male patients, confirming Bardet–Biedl syndrome. Polydactyly, renal failure, retinal dystrophy, and obesity were present in both patients. In addition, learning difficulties and hypogonadism were observed in one of them.
Conclusion: Based on the literature and our clinical findings, the BBS10 subtype typically presents with severe Bardet-Biedl syndrome features such as visual disturbances, renal impairment, and obesity.
Original scientific paper
Introduction: The uveitis masquerade syndrome includes inflammation-like systemic and ophthalmic pathologies appearing as infiltration of the eyeball but not based on infections or immune processes, secondarily. Two main groups are distinguished: neoplastic and non-neoplastic.
Objective and methods: To demonstrate the differential diagnosis of uveitis masquerade syndrome and the difficulties of therapy selection by reporting a primary intraocular lymphoma case.
Case report: A 65-year-old female patient presented in June 2019 with “floating blurs” in front of her amblyopic left eye, which were diagnosed as vitreous haemorrhage. The fundus could not be examined at that time; BCVA was 0.9/hm. Following the absorption of the vitreous haemorrhage, a chorioretinitis lesion became visible in the macula. Systemic investigation was started to clarify the aetiology of the uveitis, which ended with negative results. A vitreous sample was taken, from which no pathogen could be detected. As a result of the systemic antibiotic and steroid therapy, the process regressed. In January 2020, right eye panuveitis was diagnosed, and methotrexate treatment was initiated. Due to the progression in the left eye, repeated vitreous sampling was performed, and mature B-cell non-Hodgkin lymphoma was diagnosed by flow cytometry. The haematological examination was completed without any other abnormal results. In January 2021, a brain lesion was found, which proved to be DLBCL histologically and necessitated chemotherapy. She reached complete remission and became ophthalmologically asymptomatic by September 2021, with a BCVA of 1.0/nlp.
Conclusions: The diagnosis of uveitis masquerade syndromes is difficult. It can take longer than a year from the initial symptoms to determine the exact aetiology due to the chance of confusion with inflammatory pathologies. We emphasise that a uveitis masquerade syndrome should be considered when an inflammatory disease is refractory to therapy.
Introduction: Endogenous endophthalmitis is a severe form of intraocular inflammation, potentially leading to blindness, caused by the haematogenous spread of a pathogen.
Objective and methods: The aim of this study is to present a case of bilateral endogenous endophthalmitis of iatrogenic origin during the COVID-19 pandemic, overview diagnostic and therapeutic decision-making, and review the literature.
Case report: A 61-year-old male patient with secondary immunodeficiency after splenectomy presented to our outpatient clinic with visual impairment of the right eye. Due to his poor general condition and advanced ocular inflammation, he was admitted to the Infectology Department for endogenous endophthalmitis and sepsis based on clinical signs. Despite the empirical topical and systemic antimicrobial therapy, his condition deteriorated rapidly. Upon revealing that it was due to a bilateral gluteal abscess in the area of the intramuscularly administered non-steroidal anti-inflammatory injections, the abscesses were resected urgently. In the same session, the rapidly progressive inflammatory process necessitated the enucleation of the right eyeball, which developed phthisis. Treatment of the symptomatic left eye was also initiated. At the end of 1.5 years of follow-up, an uneventful status was found on the right side, suitable for wearing a prosthetic eye; the left eye healed with residual symptoms, and its best corrected visual acuity was 1.0.
Conclusion: Prompt diagnosis and initiation of local and systemic treatment of endophthalmitis of endogenous origin are crucial. In presenting this case, we would like to draw attention not only to the severity and rapid progression of the disease and the difficulties of therapy, but also to the importance of taking a thorough medical history.