Issue
“Szemészet” (“Ophthalmology”) is the earliest, uninterruptedly published periodical of the medical disciplines in Hungary. The editorial ambitions have been the same from the very beginning: developing the Hungarian medical terminology, instituting its Hungarian counterparts within practical considerations, providing vocational training, and supporting the scholarship.
The article describes the vision rehabilitation tasks that ophthalmologists do. The most important duty of ophthalmologists is to detect their patients' need for vision rehabilitation and, in this case, provide them the choice of vision rehabilitation while also giving contact information. Visual rehabilitation is necessary for patients with a visual acuity of less than 0.5–0.32, visual field loss, diminished contrast sensitivity, or cerebral visual impairment, or if daily activities such as transportation, self-care, and reading become moderately difficult due to poor vision. Vision rehabilitation can assist patients in improving their independence, ability to work, psychological health, and social well-being.
In this review, the fundamental terms of biometry are presented, as well as the factors influence the precision of intraocular lens calculation, and available methods that improve its potential. Anatomical and pathophysiological features of the high myopic eye are characterised, which influence the precision of intraocular lens calculation fundamentally and limit the selection of intraocular lens. The development of biometry is demonstrated in high-myopic eyes, with suggestions for sophisticated determination to the appropriate intraocular lens power and type. The unconcealed purpose of the study is to encourage our surgeons for using cutting-edge intraocular lens calculation formulas during the biometry of high myopic eyes routinely and to proclaim against the old doctrine, of calculating every high myopic eye to –2.0 D for the prevention of hyperopic postoperative outcomes.
Aim: Presentation of the PreserFlo™ MicroShunt, a minimally invasive aqueous drainage implant, based on our clinical results and international literature data. Patients and methods: Open-angle glaucoma patients were selected from two clinical centres (Department of Ophthalmology, University of Pécs Clinical Centre (10 eyes) and Department of Ophthalmology of Vas County Markusovszky University Teaching Hospital (10 eyes)), for PreserFlo™ MicroShunt implantation, whose elevated intraocular pressure (IOP) could not be controlled with two or more topical antiglaucoma medications and was also associated with visual field progression. Patients with poor adherence or intolerance to topical medications with local and/or systemic side effects were also included (3 cases in the two centres). Results: The PreserFlo™ MicroShunt effectively reduced the intraocular pressure in our patients with known glaucoma, in accordance with the literature. Compared to traditional filtration surgery, the IOP-lowering effect of PreserFloTM did not show a significant difference in the short term. Nevertheless, the MicroShunt seems to have a better risk profile compared to the gold standard trabeculectomy; early postoperative management is simpler, less time-consuming, involves fewer follow-up examinations, and necessitates fewer secondary interventions. Experienced trabeculectomy surgeons show a fast learning curve. Conclusion: Based on our observations, PreserFlo™ shunt implantation can be recommended as a primary choice in well-selected cases of elevated intraocular pressure that cannot be controlled with 2 or more topical antiglaucoma drugs in order to prevent the progression of glaucoma. Further studies are required to confirm the current results.
Purpose: To present a successful outcome case of macular Candida infection with severe SARS-CoV-2 infection. Patient, methods: A 43-year-old, otherwise healthy male patient was intubated and ventilated due to advanced SARS-CoV-2 infection. After 15 days, as his condition improved, he was removed from the ventilator. He noticed a decrease in the vision of the left eye. A general ophthalmic and imaging study (fundus photo, blue autofluorescence and OCT) raised suspicion of a Candida infection located in the parafoveal area. Intensive general and antifungal treatment was applied. The course of the disease was detected with functional and multimodal morphological methods. Results: The general Candida infection spread fungal colonies embedded in the macular choroid and began to sprout. The tendency of this to penetrate into the vitreous through the retina was detected before the breakthrough. The immediate onset of antimycotic treatment confirmed the process diagnostically, and it resolved with minimal loss of macular function. Conclusion: In a SARS-CoV-2 infection with impaired immune status, there is an increased risk of developing a general fungal infection and consequent ophthalmic complications. Recognition of the process in the early phase of the clinical picture and the immediate initiation of antimycotic treatment may prevent the development of severe Candida endophthalmitis.
For the ophthalmologists of the 21st century the implantation of intraocular lenses as part of the surgical treatment of cataracts is an everyday routine. Today it’s hard to even entertain the view dominant in the first half of the past century – then the deliberate placement of an artificial object into the delicate organic structure of the human eye seemed a scandalous, insane idea. The English ophthalmologist Sir Nicholas Harold Lloyd Ridley, inventor of the IOL, took on this seemingly self-evident belief with a determination sustained through decades. His legacy speaks for itself. Today millions of artificial lenses are implanted annually all around the world, the vision of their wearers rectified in a quality hitherto unimaginable. The following essay is the story of the main architect of this reality.
The founding year of the Hungarian Ophthalmological Association is 1904, however it was 1905, when the first statues were accepted and the Executive Committee was elected. The basis to the wording of the statutes was the rules of the Heidelberg Society established by Graefe. The official journal of the Association became the Szemészet. The first elected President of the Association was Professor Emil Grosz. The Secretary was Professor Laszlo Blaskovics. In 1922 the Hungarian Ophthalmological Association was renamed as Hungarian Ophthalmological Society, which was changed during the political course following the WWII. The previous name was give back again in 1967. The annual meetings were organized during the past 65 years without any breaks. Even the COVID-19 pandemia in 2020 was not able to disturb the meetings, a Webinarium was organised solving the problem. The official journal of the Hungarian Ophthalmological Society is the Szemészet, since 2022 it can be reached on-line as well with English abstracts and as an open access journal.
Geographic atrophy (GA) is one of the dry forms of age-related macular degeneration that causes severe visual impairment, which increases social challenges, but is also the subject of intensive research. The purpose of this continuing education review is to present up-to-date results of the state of science in relation to GA. With the development and wider access to multimodal imaging, both early diagnosis and progression monitoring have become possible. Certain microstructural abnormalities of the retina serve as biomarkers in establishing a prognosis. In addition to the traditional visual examination methods, other visual functional tests are also justified in the case of GA to accurately follow the patient's complaints. Effective drugs have already appeared in the therapeutic arsenal of GA, which was untreatable previously, and their continuous expansion is expected.
Introduction: Since 2016, only adalimumab has gotten approval among the tumour necrosis factor inhibitors for treating non-infectious, non-anterior uveitis. Adalimumab is the only biologic agent that can be given for the indication of uveitis. We introduce our experiences with adalimumab in the therapy of non-infectious non-anterior uveitis in adulthood in the southern Great Plain. Patients and methods: Retrospective investigation in the Department of Ophthalmology, University of Szeged, between 2017 and 2021. Results: We examined 18 (12 females and 6 males) patients. Their average age was 51 years old at the beginning of the therapy. Seven (39%) patients had intermedier, 3 (17%) patients had posterior, 8 (44%) patients had panuveitis. The causes of uveitis were systemic autoimmune disease in 4 cases, 1 patient had serpiginous chorioretinopathy, and 13 patients had idiopathic uveitis. During adalimumab therapy, the rate of additional local and systemic therapy decreased. The activity of the inflammation, the rate of cystoid macular edema, and glaucoma decreased. There was no progression or worsening in visual acuity. Conclusion: When DMARD therapy doesn’t work, biologic therapy can provide a resolution. Among our patients, the demographic data, the localization of the inflammation, the cause of the inflammation, the effect of adalimumab, and the complications of adalimumab therapy meet the data from the literature.
Aim: Selective laser trabeculoplasty is a proven, effective laser treatment for glaucoma. In addition to the initial recommendations, more and more clinical experience is being gathered in other indications. Methods: As a result of several mechanisms, the selective laser increases the permeability of the trabecular meshwork, thus reducing the intraocular pressure. The method is efficient and repeatable, as it does not cause permanent damage to the other parts of the trabecular network. Based on published and personally researched data, the laser is efficient in approximately 60-75% of the treated patients, and an approximately 20-25% decrease in intraocular pressure can be achieved by its application. Results: Since May 2016, we have performed 834 selective laser trabeculoplasty on 433 glaucoma patients at the Ophthalmology Department of the University of Pécs. In 72% of our patients, we achieved an effective 20% decrease in intraocular pressure. In 67% of the patients, the purpose of the laser treatment was complementary to the existing therapy, due to disease progression. Treatment change due to eyedrop intolerance or side effects was the indication in 15% of patients. In certain cases, we can use selective laser trabeculoplasty safely and effectively to reach patients eyedrop-free. Conclusion: Following the results of the LiGHT (Laser in Glaucoma and Ocular Hypertension) study, selective laser trabeculoplasty has taken its rightful place among antiglaucoma treatments. As a complementary treatment, its effectiveness is a 26% decrease in intraocular pressure. We consider selective laser treatment to be suitable as a replacement for monotherapy, because the intraocular pressure did not rise even after stopping the eye drops for the treated patients. Selective laser use is a cost-effective and reliable method as of primary and even independent therapy and can provide a good quality of life as an alternative to eyedrop treatments. Based on the treatment results so far, our aim is to have selective laser trabeculoplasty be used in as a high proportion as possible in the future, and to have it move forward from the “last chance” category.