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), 55 answered.
Results: Cataract operations were performed by 300 specialist and 30 residents in 2023. During this period 71,895 cataract surgeries were reported. Today 90% of cataract procedures are performed in a one-day surgery basis both in hospitals and one-day ophthalmic surgery centers. In 2023 the number of surgeries were above 3,000, in 5 other institutions it was between 2,500–3,000 and in 10 cases between 100-500 and in 2, it was below 100. The penetrance of the drop anesthesia is 93.59%, retrobulbar (4.09%) and peribulbar anesthesia (1.3%) is still used unfrequently. The mode of incision is corneal wound in all institutions, in limited cases limbal incisions (0.42%) may be used if necessary. The mode of nucleus removal was phacoemulsification in 99.8%, in 0.2% it was extracapsular cataract extraction (ECCE) and suction. The cortex was removed in 4.0% by bimanual technique and in most of the cases with one-handed I/A device. In 1.4% femtolaser assisted cataract procedure (FLACS) were performed. In 99.41% of the cases, surgeons used foldable intraocular lenses and in 0.59% PMMA lenses. Silicon lenses were not reported at all. In 35.3% of the lens material was hyrdophilic and in 64.7% hydrophobic. In 9.3% toric intraocular lenses were implanted, in 2.4% multifocal lenses were used and in 0.7% multifocal-toric lenses were chosen. In 2.3% EDOF lenses were preferred in 2022. Intracameral cefuroxim were administered in all insitutes at the end of the surgery, subconjunctival antibiotics was applied in 1.0%, during the preoperative period topical antibiotics is used in 15 institutions. Postoperatively in 90.0% only modern fluorokinolons, in 6.0% fluorokinolons/or aminoglykozids and in 4.0% only aminoglycosids were prescribed for 12 days on average. The surgical treatment of presbyopia is performed rather with multifocal lenses instead of other corneal procedures. The average hospital stay decreased to 3.8 hours, the average waiting time was 77 days and in 23 institutions there was a possibility for paying cataract procedures. According to the data in 3.7% the patients (2,671 cataract procedures) covered the expenses of the cataract operations. At the end of 2023, waiting list comprised of 9,481 patients, which means 214 patients on average in each institutions. The number of refractive procedures showed a significant increase compared to 2022, and 2 types of refractive procedures were performed, namely surface (PRK) and incisional (femto-LASIK). SMILE method became also available in Hungary in 2023. LASEK, epi-LASIK were not performed at all in 2023. In case of surface refractive procedures in 94.0% of the cases Mitomycin-C was applied, and in 95.0% of the cases wavefront technology was used during treatment planning. The number of phototherapeutic keratectomies (PTK) is similar during the past years, the number of crosslinking (CXL) slightly increased.
Conclusions: The COVID-19 pandemia decreased the number of cataract surgeries approximately by 30% in Hungary between 2020–2022. In 2023 surgical numbers increased, on the other hand the yearly number is still lower than in 2019. The implantation of multifocal lenses decreased, however the implantation of EDOF lenses increased. In order to keep the human resource, the achievement based financing should be introduced in the hospitals in order to motivate personnel.

More than a third of orbital diseases are of inflammatory origin. Some of them are infectious inflammations, which are associated with severe, acute, local, and general symptoms. There are well-defined rules for their diagnosis and treatment. Non-infectious inflammations form a heterogeneous group. Some of them are specific, i.e., their causes are known; most of them are non-specific, idiopathic, i.e., the cause is unknown; this is orbital pseudotumor. Specific orbital inflammations are local manifestations of multisystem, mostly autoimmune diseases. Countless rheumatoid diseases, necrotising vasculitides, different forms of xanthogranulomatous, and spectrum diseases such as IgG4-associated disease are included here, among many other rare diseases. All of these diseases can appear in the orbit independently, or they can be part of a multi-organ disease at the same time. They can be called autoimmune-associated diseases of the orbit. The specific group also includes the well-known phenomenon when malignant tumors, lymphomas, and lymphoid hyperplasia cause inflammatory symptoms. Therapy means treating the underlying disease. The non-specific (NSOI), idiopathic (IOI) orbital inflammation, so-called orbital pseudotumor, which makes up the largest part of orbital inflammations, is not inadvertently the focus of professional interest. Not only is its cause unknown, but its diagnostic and therapeutic professional principles are also impossible to determine and follow in every case. The course of the disease and the reaction to treatment cannot be predicted. The purpose of this publication is to shed light on some diagnostic and therapeutic cornerstones.

A dural arteriovenous fistula is characterised by abnormal communication between the arteries supplying the dura and the cerebral venous sinus. Dural arteriovenous fistulas are rare and may cause delay in diagnosis because of their non-specific symptoms and complications. Here, we report a 78-year-old female who presented chemosis and exophthalmos. Digital subtraction angiography is the gold standard method for diagnosing a dural arteriovenous fistula. In our case, digital subtraction angiography showed a Cognard Type II/Borden Type II left cavernous sinus dural arteriovenous fistula. Treatment modalities include conservative management, endovascular intervention, microsurgery, and stereotactic radiosurgery. Following endovascular intervention, our patient had dramatic improvement in visual acuity, chemosis, and exophthalmos.

Introduction: In the following, we present a case in which a central nervous system tumour was found during the examination of a patient treated for polypoidal choroidal vasculopathy (PCV).
Case report: The 49-year-old male patient was referred to our clinic due to subretinal bleeding in his right eye. He underwent intravitreal aflibercept treatment, and later vitreous haemorrhage was found. After vitrectomy, characteristic patterns of polypoidal choroidal vasculopathy were found involving the macular centre on the right side and peripapillary region on the left side based on fundus fluorescein angiography examination. However, the patient's loss of light perception in the right eye could not be explained based on the fundus image alone. As an additional examination, cranial MRI angiography was performed, revealing a tumour in the area of the pituitary gland, which compressed the optic chiasm and caused sectoral visual field loss in the left eye as well. The condition required neurosurgical intervention. Histopathological results confirmed Rathke's cleft cyst.
Conclusion: According to our current scientific knowledge, we do not know if there is a connection between the two conditions, but without performing cranial imaging, the central nervous system tumour would not have been discovered, allowing neurosurgical treatment in the patient's case in time.

Purpose: To report a case of Cogan’s syndrome and Takayasu’s arteritis presented on the same patient.
Summary: A 33-year-old woman was referred to our clinic for recurrent, bilateral uveitis. For a year she had several inflammatory episodes on both eyes in the forms of anterior uveitis, episcleritis, conjunctivitis, interstitial keratitis, and scleritis. Medical history included vertigo and tinnitus of unknown origin for 2 years and hearing loss eventually requiring cochlear implants in both ears. Serological tests showed the signs of Bartonella henselae infection; despite the proper antimicrobial therapy, ocular inflammations have recurred, however. All other laboratory tests, including immunoserology, were within the normal limits. We made a clinical diagnosis of Cogan’s syndrome. Over time, the patient developed symptoms of vascular occlusion affecting several organs. Her immunological examination established the diagnosis of Takayasu's arteritis.
Discussion: Cogan's syndrome associated with large vessel vasculitis is a known but rare case in the literature. In our patient, tocilizumab, already recommended by others, proved to be an effective therapy.

Purpose: To report a case of Cogan’s syndrome and Takayasu’s arteritis presented on the same patient.
Summary: A 33-year-old woman was referred to our clinic for recurrent, bilateral uveitis. For a year she had several inflammatory episodes on both eyes in the forms of anterior uveitis, episcleritis, conjunctivitis, interstitial keratitis, and scleritis. Medical history included vertigo and tinnitus of unknown origin for 2 years and hearing loss eventually requiring cochlear implants in both ears. Serological tests showed the signs of Bartonella henselae infection; despite the proper antimicrobial therapy, ocular inflammations have recurred, however. All other laboratory tests, including immunoserology, were within the normal limits. We made a clinical diagnosis of Cogan’s syndrome. Over time, the patient developed symptoms of vascular occlusion affecting several organs. Her immunological examination established the diagnosis of Takayasu's arteritis.
Discussion: Cogan's syndrome associated with large vessel vasculitis is a known but rare case in the literature. In our patient, tocilizumab, already recommended by others, proved to be an effective therapy.

Introduction: Retinal capillary haemangiomatosis (RCH) is a histologically capillary haemangioma mass located in retinal tissue. It occurs alone or in several foci, on the periphery of the retina, or around the optic nerve head; its exudative appearance can make it similar to Coats disease. The lesion may be accompanied by vitreoretinal trakción, vitreous haemorrhage, epiretinal membrane, and retinal detachment; progressive in nature.
Case report: The male patient, 43 years old at first appearance is under our control since 2002, i.e. for 22 years. RCH foci were detected in both eyes; one in preclinical form peripapillary on the right side, and several more developed forms in the left eye, located on the central retinal periphery. As a result of the exudation in the right eye, vitreous clouding, subretinal mass production, and incipient tractional retinal detachment began. Irradiation brachytherapy and then pars plana vitrectomy surgery were performed, adding cryotherapy to the foci and supplementing with laser coagulation. The eye later transformed into a painless hypotonic atrophic state. The slowly progressing lesion in the right eye was treated with various intravitreal anti-VEGF injections, predominantly bevacizumab; following this, beyond the 135th intervention, the functional state of the eye was preserved (VA=0.8 – 0.6).
Conclusion: In our case, the treatment of RCH with intravitreal anti-VEGF therapy gave favorable results in the long term, and we did not experience any significant side effects.

Introduction: Perfluorocarbon liquids (PFCL), which have been widely used in vitreoretinal surgeries, can be retained subretinally, especially in cases of managing large retinal tears, dialysis, injuries, or retinal detachments complicated by proliferative vitreoretinopathy (PVR) with unsolved or partly solved tractions. Publications regarding PFCL’s ocular toxicity are heterogeneous, and if surgical removal is suggested depending on its location and size, it may be challenging even for an experienced vitreoretinal surgeon.
Materials and Methods: To report a case presenting the preferred method of surgical removal of subretinal PFCL and its spontaneous resolution documented by optical coherence tomography (OCT) and review the publications regarding PFCL’s ocular toxicity.
Case report: Due to a macula-off retinal detachment that complicated with PVR in his right eye, a 56-year-old male patient underwent pars plana vitrectomy (PPV) along with internal limiting membrane (ILM) peeling. Later, he showed up with retinal redetachment and we performed re-PPV with silicone oil implantation. The OCT image, made on his control, displayed a subfoveal perfluorodecaline bubble with a diameter of 700 microns, which we removed with direct transretinal aspiration, conducted on a repeated operation.
Discussion: Regarding subretinal PFCL’s toxicity, the relating literature is somewhat controversial. In the management of subretinal PFCL, observation without intervention is acceptable in cases of extrafoveal retention. For smaller subfoveal PFCL, follow-up may also be allowed due to the possibility of spontaneous resolution. This scenario can occur, especially in eyes implanted with silicone oil and having previously undergone ILM peeling. In the case of larger subfoveal PFCL, which may act as a physical barrier in the nutrition of the outer retinal layers, surgical removal is advocated. Some of the publications recommend the removal of subfoveal PFCL through extrafoveal retinotomy after its displacement towards the periphery, while others, including the authors of this article, prefer direct transretinal aspiration, which requires prior ILM-peeling.