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Recent studies have revealed that inflammation, among other factors, may be involved in the pathogenesis of depression. One line of studies has shown that depression is frequently associated with manifest gastrointestinal inflammations and autoimmune diseases as well as with cardiovascular diseases, neurodegenerative diseases, type 2-diabetes and also cancer, in which chronic low-grade inflammation is a significant contributing factor. Thus depression may be a neuropsychiatric manifestation of a chronic inflammatory syndrome. Another line of studies has shown that the primary cause of inflammation may be the dysfunction of the “gut-brain axis”. Although, this is a bidirectional mechanism, life style factors may primarily affect the symbiosis between host mucous membrane and the microbiota. Local inflammation through the release of cytokines, neuropeptides and eicosanoids may also influence the function of the brain and of other organs. Role of metabolic burst due to inflammation represents a new aspect in both pathophysiology and treatment of the depression. Finally, an increasing number of clinical studies have shown that treating gastrointestinal inflammations with probiotics, vitamin B, D and omega 3 fatty acids, through attenuating proinflammatory stimuli to brain, may also improve depression symptoms and quality of life. All these findings justify an assumption that treating gastrointestinal inflammations may improve the efficacy of the currently used treatment modalities of depression and related diseases. However, further studies are certainly needed to confirm these findings. Orv. Hetil., 2011, 152, 1477–1485.

Purpose To analyze the morphological changes of corneal nerves and its influence on corneal epithelial wound healing in a lacrimodeficient dry eye model in the guinea-pig. Methods Corneal nerve architecture and the rate of corneal epithelial wound healing were studied in guinea-pigs to whom the main lacrimal gland was removed 4 weeks before (dry eye) and in control animals. Eyes were fixed, cryoprotected and incubated with neuronal class III Beta-tubulin antibody. Epithelial migration rate (EMR) and estimated time of healing (ETH) were calculated for 2mm-diameter epithelial corneal debridations stained with fluorescein, photographed regularly until complete closure and analyzed with image processing software. Results Density (16±6 vs 27±11 nerves/mm2) and length (115±45 vs 186±74 µm) of subbasal nerves decreased significantly in dry eye. Subbasal nerves were less branched and tortuous. Epithelial nerve terminals were also reduced. EMR decreased significantly (63±4 vs 110±1 µm/h) and ETH increased significantly (38.6±1.8 vs 20.1±0.1 h) in dry eye. Conclusion The morphological appearance and the decreased density, length and branches of corneal subbasal nerves are suggestive of corneal nerve degeneration at 4 weeks after lacrimal gland removal. Lacrimodeficient eyes presented also a slowing-down in corneal epithelial wound healing suggesting an early trophic defect consecutive to nerve damage. (Supported by: SAF2008-00529, CSD2007-00023, BFU2008-04425, BFU2009-07793 and RETICS RD07/0062/0012 from Ministerio de Ciencia e Innovacion, Spain, and the Leonardo da Vinci Lifelong Learning Program.)

Vitamin D deficiency is pandemic in industrialized countries due to life-style changes. Recent studies suggest that besides bone-metabolism, vitamin D plays a central role in basic cell function like multiplication, differentiation and metabolism. This may explain that low vitamin D levels represent a risk factor for several apparently different diseases such as infective, autoimmune, neurodegenerative and cardiovascular diseases, as well as diabetes, osteoporosis and cancer. Accumulating evidences suggest that an adequate intake of vitamin D may significantly decrease prevalence and clinical outcome of these diseases. Estimated reduction of the economic burden might reach about 10 percent through normalizing vitamin D levels for these diseases. However, high doses of vitamin D monotherapy needs precaution for potential adverse effects and it should be substituted with the recommended doses of vitamin D in combination with synergistic vitamin A and omega 3 fatty acids, such as cod liver oil. Orv. Hetil., 2011, 152, 323–330.

PURPOSE: To evaluate a laser technique and manual technique to perform capsulorrhexis in cataract eyes. METHODS: Anterior capsulotomy was performed with an intraocular femtosecond laser (LenSx Lasers Inc) in 54 eyes (FS group) and manual continuous curvilinear capsulorrhexis was performed in 57 eyes (CCC group). Circularity and area of capsulotomy and IOL decentration were measured using Photoshop CS4 Extended (Adobe Systems Inc) 1 week after surgery. Average keratometry, axial length, and preoperative anterior chamber depth were examined with the Lenstar LS 900 (Haag-Streit AG). RESULTS: No statistically significant differences were noted between groups in axial length, preoperative refractive state, and in the area of capsulotomy. Circularity values were significantly better in the FS group ( P =.032). We found incomplete overlap of capsulotomies in 28% of eyes in the CCC group and 11% in the FS group ( P =.033). Significant correlations were noted between axial length and area of capsulotomy, and between average keratometry and area of the capsulotomy in the CCC group (R=0.278, P =.036; and R=−0.29, P =.033, respectively), but both did not correlate in the FS group ( P >.05). In the CCC group, the pupillary area correlated significantly with the area of the capsulotomy (R=0.27, P =.039). Significant correlation was noted between IOL decentration and axial length in the CCC group (R=0.30, P =.026), but there was no correlation in the FS group ( P >.05). CONCLUSIONS: Femtosecond laser capsulorrhexis was more regularly shaped, showed better centration, and showed a better intraocular lens/capsule overlap than manual capsulorrhexis.

Purpose: To explore the effects of corneal astigmatism and asphericity on posterior elevation values calculated by different reference bodies and to compare their predictive accuracy in the diagnosis of keratoconus. Methods: In this prospective observational case series, 44 eyes of 24 patients with keratoconus and 70 eyes of 41 refractive surgery candidates as a control group were measured by the Pentacam Scheimpflug camera. Discriminating ability and predictors of posterior elevation measurements obtained by best fit toric ellipsoid (BFTE) and best fit sphere (BFS) reference surfaces were compared by receiver operator characteristic curves (ROC) and generalized estimating equation (GEE) models. Bland–Altman plots were used to determine the agreement between different reference surfaces. Results: Receiver operator characteristic curve analysis showed that posterior elevation measured by a BFTE auto had a significantly higher area under ROC curves (0.99) value than BFTE 8-mm or BFS reference surfaces. ROC analysis identified cut-off values for BFTE auto (9.5-μm), for BFTE 8-mm (10.5-μm), for BFS auto (16.5-μm) and for BFS 8-mm (15.5-μm) reference surfaces. According to GEE models, corneal cylinder and posterior asphericity had the least effect in toric ellipsoid models. Bland–Altman plots showed a systematic bias at higher values of average posterior elevation measured BFS reference surfaces. Conclusions: Posterior corneal elevation value measured by the Pentacam camera can effectively discriminate keratoconus from normal corneas although measured values and cut-off points depend on the selection of reference body and corneal asphericity. Toric ellipsoid reference surface seems to be the most sensitive method to differentiate keratoconus.

PURPOSE: To compare the effect of conventional and femtosecond laser–assisted (Alcon LenSx Inc) phacoemulsification on the macula using optical coherence tomography (OCT). METHODS: Twenty eyes of 20 patients underwent uneventful cataract surgery in both study groups: femtosecond laser–assisted (laser group) and conventional phacoemulsification (control group). Macular thickness and volume were evaluated by OCT preoperatively and 1 week and 1 month postoperatively. Primary outcomes were OCT retinal thickness in 3 macular areas and total macular volume at 1 week and 1 month postoperative. Secondary outcomes were changes in retinal thickness at 1 week and 1 month postoperatively, with respect to preoperative retinal thickness values and effective phacoemulsification time. RESULTS: Multivariable modeling of the effect of surgery on postoperative macular thickness showed significantly lower macular thickness in the inner retinal ring in the laser group after adjusting for age and preoperative thickness across the time course ( P =.002). In the control group, the inner macular ring was significantly thicker at 1 week (mean: 21.68 μm; 95% confidence limit [CL]: 11.93–31.44 μm, P P =.09) and became marginally significant. CONCLUSIONS: Results of this study suggest that femtosecond laser–assisted cataract extraction does not differ in postoperative macular thickness as compared with standard ultrasound phacoemulsification.

Purpose To reveal the influence of retrobulbar capsaicin treatment on rats' eyes and to test the protective effects of PEDF, a known neurotrophic and antiangiogenic substance, against neurotrophic keratouveitis. Methods A single retrobulbar injection of capsaicin (50 mg/kg) was performed in young rats, and the effect of subsequent retrobulbar injections of PEDF 3.2 or 6.4 microg was recorded. Tear fluid alterations were evaluated with the Schirmer test and corneal alterations with slit lamp biomicroscopy. Histopathologic alterations were studied with light and electron microscopy. The number of leukocytes (myeloid cells) in the anterior and posterior chambers, peripheral retina, and vitreous were quantitatively evaluated. Results Reduced tear secretion was found in capsaicin-treated rats compared with the control, but this effect was significantly attenuated by PEDF. Corneal ulceration developed and was followed by scar formation and neovascularization in the capsaicin-treated, and it was also significantly attenuated by PEDF treatment. Leukocyte infiltration of the anterior and posterior chambers, as well as the peripheral retina and vitreous, was also observed in capsaicin-treated eyes and was significantly reduced by PEDF treatment. The protective effects of PEDF were dose dependent for each parameter, even if the treatment was initiated at day 14 after the challenge. Conclusions PEDF accelerated the recovery of tear secretion and also prevented capsaicin-induced neurotrophic keratouveitis and peripheral vitreoretinal inflammation. These effects of PEDF, described herein for the first time, may have a clinical application in inflammatory and neovascular diseases of the eye.

To evaluate ocular wavefront aberrations owing to keratoconus compared with normal controls and to describe the changes in the axis of line of sight (LoS) among keratoconic patients.Prospective case-control study.Fifty-five eyes of 30 patients with keratoconus and 100 eyes of 50 refractive surgery candidates with normal corneas.Ocular aberrations over a 4.5 mm (undilatated) pupil were measured with a Hartmann-Shack sensor. Corneal topographic measurement was performed with a Tomey corneal topographer. The axis of the displacement of LoS was calculated by vector analysis.Root mean square (RMS) and higher order RMS values, ocular aberrations up to the 6th Zernike order and the distance of the LoS from the pupillary center (x and y offset values) in keratoconic and normal eyes were measured with aberrometry. The steepest and average keratometric values and the axis of the steepest meridian were measured in keratoconic eyes with topography. Correlations were made between the size and the direction of the shift in the LoS and ocular aberrations.The following parameters were significantly higher in the keratoconus group compared to the control group: higher order RMS (P0.001), Z(3)(-1) (P0.001), Z(3)(-3) (P0.002), Z(3)(3) (P = 0.001), Z(4)(-2) (P0.001), Z(4)(2) (P0.001), Z(4)(4) (P = 0.016), Z(5)(-5) (P = 0.03), Z(5)(-1) (P = 0.04), Z(5)(3) (P = 0.01), and y offset value (P0.001). In keratoconic patients there was a significant correlation between the axis of the shift in the LoS and the steepest keratometric axis on topography (r = 0.59; P0.001), the distance of the LoS from pupil center and vertical coma (r = -0.39; P = 0.004), and spherical aberration (SA; r = 0.29; P0.04). There was also a significant correlation between the average keratometry value measured by topography and SA (r = -0.49; P0.001). A factorial regression model testing the interactive effects of vertical coma and SA on the shift of LoS had a good fit on our data (r(2) = 0.69; P0.001).A significant displacement of the LoS is observed in keratoconus and relates to the position of the cone on topography and the induced vertical coma measured by aberrometry.The authors have no proprietary or commercial interest in any of the materials discussed in this article.

Currently, age-related macular degeneration is one of the most common eye diseases causing severe and permanent loss of vision. This disease is estimated to affect approximately 300–500 thousand Hungarians. While no treatment was available earlier, in the recent decade an antioxidant therapy became very popular using combinations of high dosage antioxidant vitamins C, E, beta carotene and zinc. Based on theoretical concepts and mostly in vitro experiences, this combination was thought to be effective through neutralizing reactive oxygen species. According to a large clinical trial (AREDS), it reduced progression of intermediate stage disease to advanced stage, but did not influence early stage disease. This original combination, due to potential severe side effects, is not on the market anymore. However, the efficacy of modified formulas has not yet been proven. Recently, a combination of omega 3 fatty acids, acetyl-L-carnitine and Coenzyme Q10 has been introduced for treating early stage age-related macu...

Purpose: This study aimed to compare preoperatively calculated and postoperatively achieved refraction following phacoemulsification and intraocular lens (IOL) implantation combined with pars plana vitrectomy with internal limiting membrane or epiretinal membrane removal. Methods: Twelve eyes of 12 patients who underwent a combined procedure were enrolled in this study. Ultrasound axial length and macular thickness (optical coherence tomography, OCT) measurements were performed pre- and postoperatively. Intraocular lens power was calculated with the SRK/T formula and the planned refraction was compared with results of postoperative automatic refractometry. Comparisons between IOL calculations using the measured axial length and calculations using an adjusted axial length (by adding the macular thickness measured on OCT to the ultrasound axial length) were also performed. Results: Axial length increased (p = 0.02), whereas macular thickness decreased (p = 0.002). The planned refraction was 0.63 ± 0.38 dioptres, whereas the postoperative refraction error was − 0.16 ± 0.48 D (p = 0.02), with a mean difference of − 0.79 ± 0.24 D. During case-to-case comparisons, differences were observed between IOL calculations using the measured axial length and calculations using an adjusted axial length (0.63 ± 0.38 D versus 0.13 ± 0.48 D, p = 0.005). Correlation analysis showed a significant relationship between the ‘adjusted planned’ and the measured postoperative ametropia (r = 0.93, p

To evaluate the possible toxicity of indocyanine green (ICG) dye in macular hole surgery by comparing functional results after successful surgeries performed with and without staining.Prospective observational case series.In a study conducted at our department, 30 eyes of 29 patients with idiopathic macular hole underwent pars plana vitrectomy, with peeling of the internal limiting membrane (ILM). In 21 eyes (group A), ICG staining was used to visualize the membrane; in nine eyes (group B), no dye was applied. Pre- and postoperative examinations (at three, six, 12, and 20 months) included visual acuity (VA) (Snellen chart), slit-lamp biomicroscopy, multifocal electroretinography (mfERG), and optical coherence tomography (OCT). For statistical analysis, the Mann-Whitney U test and Newman-Keuls post hoc analysis were used.The macular hole was closed in all patients. At 20 months, VA improvement (logarithm of minimal angle of resolution units) compared with baseline was more pronounced in group B (P.001) than in group A (P = .022); VA was also better for group B compared directly with group A (P = .048). For mfERG, preoperative responses were subnormal. Postoperatively, responses initially decreased, but at 20 months significant improvement was seen in both groups (P.001). When data from the groups are compared at 20 months, significantly greater mfERG improvement was found in group B in both central and perimacular areas (P.001).The significantly better outcomes without staining may suggest dye toxicity. Alternative internal limiting membrane visualization substances with fewer adverse effects (trypan blue, triamcinolone) may be preferable.

The aim of this study was to present morphological and functional evidence to evaluate whether tear secretion is influenced by neuropeptides released from sensory nerve endings of the conjunctiva. Following unilateral electrical stimulation of the trigeminal ganglion, tears were collected at both sides and assessed for volume and protein concentration; as well as gel electrophoresis and luminol chemiluminescence with immunostaining to immunoglobulin A and lysozyme measurements. Goblet cell density (goblet cells/100 basal cells) was recorded during histopathological examination of removed lids. Rats were pretreated with atropine to block parasympathetic; guanethidine to block sympathetic neuronal pathways; or hexamethonium to block synaptic transmission in ganglia. Capsaicin was used to deplete neurotransmitters from sensory nerve endings or SR140333 to block substance P tachykinin NK1 receptor mediated responses. Effects of inadequate electrode position or incidental lesion of trigeminal ganglion were examined by placing the electrode in false position, or no stimulation at a correct position. Electrical stimulation resulted in 380% increase of tear secretion (p0.001) and 30% decrease of goblet cell density (p0.001) on the the stimulated side compared to the unstimulated side. Atropine, guanethidine and hexamethonium pretreatments had no effect (p0.05), but capsaicin and SR140333 inhibited the effect of stimulation (by 96% and 72%, respectively, p0.001). Inadequate stimulation did not increase the tear secretion (p0.05). Protein concentration decreased, whilst tear volume and total secreted protein increased (p0.005) after stimulation. Electrophoresis showed no difference in protein pattern between stimulated and control side and analysis of equivalent amount of tear protein with luminol chemiluminescence indicated no difference in immunoglobulin A and lysozyme ratio following stimulation (p0.05). We conclude that antidromic electrical activation of conjunctival sensory nerve endings significantly increases water, mucus and protein phases of tear. It is suggested that the sensory neuropeptide substance P plays a pivotal role in this neurogenic regulatory mechanism.

Mitochondrial dysfunctions have been implicated in the pathophysiology of several age-related diseases including age-related macular degeneration (AMD), a progressive neurodegenerative disease affecting primarily the retinal pigment epithelium (RPE). The aims of our electron microscopic and morphometric studies were to reveal qualitative and quantitative alterations of mitochondria in human RPE from AMD and from age- and sex-matched controls. With increasing age a significant decrease in number and area of mitochondria, as well as loss of cristae and matrix density were found in both AMD and control specimens. These decreases were significantly greater in AMD than in normal aging. Alterations of mitochondria were accompanied by proliferation of peroxisomes and lipofuscin granules in both AMD and control specimens, although the difference between groups was significant only for peroxisomes. Unexpectedly, morphometric data showed that the RPE alterations seen in AMD may also develop in normal aging, 10-15 years after appearing in AMD patients. These findings suggest that (i) the severity of mitochondrial and peroxisomal alterations are different between AMD and normal aging, and (ii) the timing of damage to RPE may be critical for the development of AMD. We conclude that besides the well-documented age-related changes in mitochondrial DNA, alterations of mitochondrial membranes may also play a role in the pathogenesis of AMD. These membranes could be a new target for treatment of AMD and other age-related diseases.