Current Issue

2024. 3. szám

 

Ophthalmological aspects of pseudotumor cerebri

doi: 10.55342/szemhungarica.2024.161.3.107

Ophthalmological aspects of pseudotumor cerebri

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Summary

Pseudotumor cerebri (PC), also known as idiopathic intracranial hypertension (IIH), is an intracranial hypertension of unknown etiology, typically affecting young, overweight women. The leading ophthalmoscopic finding is papilledema, which without treatment leads to progressive atrophy of the optic nerve, resulting in blindness. The incidence of the disease varies among countries, but it follows the incidence of obesity in a given country. Although pseudotumor cerebri mostly affects young females, males and children can also develop the disease. PC is a diagnosis of exclusion, necessitating the systematic exclusion of other causes of intracranial hypertension. Diuretics are the first-line treatment. In cases of progressive optic nerve axon loss, surgical intervention should be considered. in order to treat PC, neurointerventional procedures are being performed in an increasing number in Hungary as well.

ISSUE: Szemészet 2024; 161. évfolyam, 3. szám, 107–116.
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Biofeedback fixation training

doi: 10.55342/szemhungarica.2024.161.3.117

Original scientific paper

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Summary

Biofeedback fixation training is a relatively new technology that provides an additional therapy-rehabilitation option for people with low vision. The purpose of this review is to describe the theoretical foundations, history, and current areas of application of biofeedback fixation vision training. This method may be applied to two major illness categories. This training is most frequently used in cases of permanent macula impairment (such as macular degeneration or macular hole), when the fovea's visual function has been lost, and the procedure can aid in finding and teaching of a new effective fixation location. Another potential new area of use is when the macula is not physically injured but the fixation is extrafoveal (for example, in the case of amblyopia), in which case the training objective is to increase fixation stability and restore fixation to the fovea. The technique was also applied to improve the fixation stability of healthy eyes. In summary, based on the findings to date, biofeedback fixation vision training is a potential strategy for improving residual vision and moderate vision dysfunctions.

ISSUE: Szemészet 2024; 161. évfolyam, 3. szám, 117–124.
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A case of severe vernal keratoconjunctivitis complicated by keratoconus

doi: 10.55342/szemhungarica.2024.161.3.125

Original scientific paper

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Summary

Vernal keratoconjunctivitis is a severe form of childhood allergic conjunctivitis, which typically resolves spontaneously after adolescence. In some cases, it can lead to permanent vision impairment as a result of therapy side effects or inflammatory changes. The condition is often complicated by keratoconus, which is considered a consequence of eye itching and frequent eye rubbing. In our case report, we present an unusually severe and prolonged course of the disease, complicated by keratoconus.

ISSUE: Szemészet 2024; 161. évfolyam, 3. szám, 125–128.
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The role of artificial intelligence in ophthalmic patient care, research and education

doi: 10.55342/szemhungarica.2024.161.3.129

Original scientific paper

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Summary

After a general overview, the article details the history of the application of artificial intelligence in ophthalmology in Hungary and its current areas of application in ophthalmic patient care (patient information, screening, diagnosis, surgery), research and education. It shows through several examples that the rapid development of artificial intelligence-based algorithms effectively increases the accuracy and applicability of the method. However, it draws attention to the still existing shortcomings of artificial intelligence and the importance of their management.

ISSUE: Szemészet 2024; 161. évfolyam, 3. szám, 129–133.
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Anterior Segment Optical Coherence Tomography of Corneal Grafts Underwent Penetrating Keratoplasty

doi: 10.55342/szemhungarica.2024.161.3.134

Original scientific paper

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Summary

Purpose: Imaging techniques, such as Optical Coherence Tomography (OCT) and tomography based on the Scheimpflug principle, are of great importance in the diagnosis and follow-up of corneal pathologies as well as in post-operative monitoring of the cornea. From the high resolution cross-sectional images, the axial curvature of both corneal surfaces, and corneal thickness can be measured, thus total corneal power can be calculated. We compared keratometric and pachymetric data from anterior segment OCT between two groups of post-penetrating keratoplasty patients and healthy individuals. The reproducibility of these data was studied as well in both groups.
Methods: 23 post-penetrating keratoplasty patients were examined using swept-source anterior segment OCT (Anterion, Heidelberg Engineering GmbH, Heidelberg, Germany) on average 73.1±13.4 months after suture removal. The control group comprised data from 56 healthy individuals. Axial curvature of anterior and posterior corneal surfaces and total corneal power at the steep and flat meridians were measured. The mean central value of the total corneal power was also registered. The central corneal thickness and thinnest corneal point thickness were also the parameters that we compared between the two groups. Reproducibility of keratometric and pachymetric data was measured on 13 post-penetrating keratoplasty patients and 15 healthy individuals, obtaining data 3 times on each eye.
Results: Axial curvatures at the steep meridian of anterior (48.3±3.5 D vs. 44.4±3.0 D; p<0.001) and posterior corneal surfaces (–6.9±0.4 D vs. –6.5±0.6 D; p=0.001) were greater in the post-keratoplasty group than in the control group. These values did not differ significantly at the flat meridian (anterior surface axial curvature: 43.5±2.9 D vs. 42.9±2.2 D; p=0.302; posterior surface axial curvature: –6.0±0.5 D vs. –6.1±0.4 D; p=0.276). Total corneal power at the steep meridian (48.5±4.0 D vs. 43.8±3.1 D; p<0.001) and its mean central value (46.1±3.2 D vs. 43.1±2.7 D; p<0.001) were also greater in the post-keratoplasty group. There was no significant difference in the total corneal power at the flat meridian between the two groups (43.7±3.1 D vs. 42.5±2.7 D; p=0.084). The mean central corneal thickness was 567.0±49.9 µm after penetrating keratoplasty, significantly larger than in the control group (537.2±48.8 µm; p=0.016). However, no significant difference was observed between the two groups in the thinnest corneal point thickness (534.9±59.1 µm vs. 526.7±50.4 µm; p=0.534). Intraclass correlation coefficient was greater than 0.9 in both groups for each keratometric and pachymetric parameter.
Conclusions: Swept-source OCT provides reliable, well reproducible data on corneal curvature and thickness in post-keratoplasty patients and healthy individuals as well. Besides best corrected visual acuity, anterior segment OCT is an excellent tool for the assessment and monitoring of the optical results after corneal transplantation.

ISSUE: Szemészet 2024; 161. évfolyam, 3. szám, 134–138.
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History of Ophthalmic Ultrasound

doi: 10.55342/szemhungarica.2024.161.3.139

Original scientific paper

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Summary

This historical article presents the nearly 70-year history of ophthalmic ultrasound diagnostics and biometrics in a global context, as well as the evolution of the method's application, the most famous ophthalmic echographers, and the formation and operation of ophthalmic ultrasound diagnostic societies. The history of ophthalmic echography in Hungary began in 1964, when the first ophthalmic ultrasonography diagnostic laboratory was founded in Budapest at the Mária Street Department of Ophthalmology, which remained the only one for more than ten years. Following that, the method's use grew gradually, aided by the introduction of newer advanced devices and the spread of intraocular lens implantation, which needed precise ultrasonic measuring of the eyeball's length. In 1986, Hungary had four A-scan and two B-scan devices, but by 1998, there were 56 ocular ultrasonic devices in operation in 48 ophthalmic patient care institutes for diagnostics and intraocular lens calculation. Hungarian ophthalmic echographers have gained international recognition and contributed to the development of both local and international echography.

ISSUE: Szemészet 2024; 161. évfolyam, 3. szám, 139–151.
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The role of the prostaglandin analogue eyedrops in glaucoma therapy

doi: 10.55342/szemhungarica.2024.161.3.152

Literature review

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Summary

Aims: to summarize the role of prostaglandin analogue (PGA) eyedrops in glaucoma therapy. The report describes the intraocular pressure lowering mechanism of PGA eyedrops as well as the indications of therapy. The local and systemic side effect were also discussed briefly. We have summarized the practical clinical advances of PGA drops compared to the other intraocular pressure lowering agents.
Methods: The paper was prepared based on several existing scientific works.
Conclusions: the PGA eyedrops has an impressive intraocular pressure lowering potential, as well as a favourable side effect profile. This makes the the PGA eyedrops for a first choice therapy in glaucoma.

ISSUE: Szemészet 2024; 161. évfolyam, 3. szám, 152–155.
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