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Célkitűzés: Kórházunk COVID-osztályán kezelt betegek makuláris eltéréseinek felderítése. Továbbá, hogy megvizsgáljuk az esetleges makulatáji eltérések összefüggésben állnak-e a betegség súlyosságával. Módszerek: A Bajcsy-Zsilinszky Kórház COVID-osztályán hospitalizált huszonhét beteg 53 szemén végeztünk multicolor funkcióval is rendelkező optikaikoherencia-tomográfiás (OCT) készülékkel makulatáji OCT, peripapilláris látóidegrost-vastagság (RNFLT) és monokromatikus, valamint multicolor scanning lézerfelvételeket. Osztályos kezelésük után 4-8 héttel 15 páciens mindkét szemén a képalkotó vizsgálatokat megismételtük. Feljegyeztük az osztályra történő felvételükkor készült mellkas komputertomográfia-lelet súlyossági index, C-reaktív protein és D-dimer, oxigénszaturáció és vérnyomásértékeket. A COVID-osztályon végzett OCT-vizsgálatuk napján vérnyomást, oxigénszaturációt, testhőmérsékletet mértünk, dokumentáltuk a friss CRP- és D-dimer-értékeket. A vizsgálat és a kontroll napján kapott eredmények közötti különbség értékeléséhez egymintás t-próbát alkalmaztuk. Eredmények: A COVID-osztályos vizsgálat során huszonhét beteg közül négy páciensnél gyapottépésszerű gócot (GyG) észleltünk. Egy másik páciensnél korábban nem észlelt GyG megjelenését láttuk a kontrollvizsgálaton. Egyéb, a COVID-fertőzéssel esetleg összefüggésbe hozható gyulladásos, vagy tromboembóliás folyamatot nem észleltünk. Nem találtunk különbséget a COVID-19-kezelés és a kontrollvizsgálat során detektált centrális makulavastagság, makulatérfogat, és RNFLT-értékek között. Következtetés: A COVID-19 betegség esetében előfordulhat a makulatáj érintettsége azon betegeknél is, akiknek nincsen akut szemészeti panaszuk. A vizsgálataink a betegek 18,5%-ánál mutattak GyG jelenlétét, amelynek hátterében a COVID-19 betegségben feltárt gyulladásos-trombotikus folyamatok által eredményezett akut retinalis iszkémiás inzultust feltételezzük kórokként. A GyG jelenléte és a betegség súlyosságára vonatkozó általunk vizsgált paraméterek között nem mutatkozott összefüggés.

Aim To analyze the changing trends in penetrating keratoplasty (PKP) indications. Methods This retrospective study included all patients with PKP between 2006 and 2017. Patients were classified using histological diagnoses. Our groups were as the following: pseudophakic or aphakic bullous keratopathy, regraft, acute necrotizing and ulcerative keratitis, keratoconus, Fuchs' dystrophy, corneal dystrophy other than Fuchs', corneal scar, other diagnoses and failed endothelial keratoplasty graft. Additionally, two different time-periods (2006-2012 and 2013-2017) were analysed. Results Totally 1721 histological analyses of 1214 patients were available for review. The diagnoses were pseudophakic or aphakic bullous keratopathy in 487 (28.3%), regraft in 443 (25.7%), acute necrotizing and ulcerative keratitis in 313 (18.2%), corneal scar in 153 (8.9%), keratoconus in 140 (8.1%). Fuchs' dystrophy in 61 (3.5%), corneal dystrophy other than Fuchs' in 46 (2.7%), other diagnoses in 44 (2.6%) and failed endothelial keratoplasty graft in 34 (2.0%) cases. From the first to the second analysed time-period, incidence of acute necrotizing and ulcerative keratitis, corneal scar, Fuchs' dystrophy increased (P≤0.032 for all) and incidence of keratoconus significantly decreased (P=0.015). Conclusion Pseudophakic or aphakic bullous keratopathy is the leading indication for PKP, followed by regraft and acute necrotizing and ulcerative keratitis.

The purpose of this study was to report 3 cases of a single-piece, acrylic, foldable, modified C loop posterior chamber intraocular lens (PCIOL) dislocated into the vitreous cavity after Descemet stripping automated endothelial keratoplasty (DSAEK).We describe the clinical course and management of the 3 cases in which a previously implanted foldable, single-piece, acrylic posterior chamber intraocular lens with modified C loops dislocated into the vitreous in association with DSAEK. Surgical management consisted of pars plana vitrectomy in each case with either PCIOL repositioning (2 cases) or PCIOL exchange (1 case) and with different fixation methods, combined with repeated DSAEK in 1 case with previous primary graft failure.In 2 cases where the cornea cleared after the DSAEK, the cornea kept its clarity and the PCIOL remained stable. In the third case in which the PCIOL exchange was combined with DSAEK, the cornea only partially cleared up, both the PCIOL and the state of the eye remained stable.PCIOL dislocation is a possible and notable complication that requires attention while performing DSAEK on pseudophakic eyes. Not only plate-haptic silicone but also acrylic, single-piece PCIOLs with modified C loops may dislocate into the vitreous in association with DSAEK in cases with compromised capsular or zonular integrity.

Purpose To evaluate intravitreal aflibercept for treatment of macular edema secondary to central retinal vein occlusion (CRVO). Design Randomized, double-masked, phase 3 study. Methods A total of 177 patients with macular edema secondary to CRVO were randomized to receive 2 mg intravitreal aflibercept (n = 106) or sham (n = 71) every 4 weeks for 20 weeks. From weeks 24 to 48, patients were monitored every 4 weeks; the former group received intravitreal aflibercept as needed (PRN), and the sham group received sham. From weeks 52 to 76, patients were monitored every 8 weeks, and both groups received intravitreal aflibercept PRN. The primary endpoint (proportion of patients who gained ≥15 letters) was at week 24. This study reports exploratory outcomes at week 76. Results The proportion of patients who gained ≥15 letters in the intravitreal aflibercept and sham groups was 60.2% vs 22.1% at week 24 (patients discontinued before week 24 were considered nonresponders; P P P .001). Mean μm change from baseline central retinal thickness was −448.6 vs −169.3 at week 24 ( P P P = .1122). Over 76 weeks, the most common ocular serious adverse event in the intravitreal aflibercept group was macular edema (3.8%). Conclusions The visual and anatomic improvements seen after fixed, monthly dosing at week 24 were largely maintained when treatment intervals were extended. Patients with macular edema following CRVO benefited from early treatment with intravitreal aflibercept.

The aim of this pilot study was to determine the presence of complement activation products in tears from pre- and postkeratoplasty eyes and the fellow eyes in order to investigate the activation of the classical and alternative pathways of the complement system in the early postkeratoplasty period.Tear samples from both eyes of 19 prekeratoplasty patients were tested. From 10 patients, samples were taken before operation, one week and 3 weeks after penetrating keratoplasty. Only baseline and 1 weak samples, and baseline and 3 week samples were available from 5 and 2 patients, respectively, while only baseline tear samples were collected from 2 patients. Tear concentration of two complement activation products, C1rs-C1inh and C3bBbP were determined by enzyme-linked immunosorbent assay.There was no difference (p = 0.339) between baseline samples of the eyes waiting for operation (0.93 +/- 0.51 AU/ml, mean +/- SEM) and the fellow eyes (0.33 +/- 0.33 AU/ml) in respect of mean C1rs-C1inh complex concentration. The one-week samples of the operated eyes revealed significantly (p = 0.006) elevated levels of C1rs-C1inh complexes (18.8. +/- 6.37 AU/ml), compared to their baseline samples (1.18 +/- 0.64 AU/ml), whereas the one-week values of the fellow eyes did not differ from the baseline values. Compared to the increased one-week values, the three-week values decreased to the baseline values in the operated eyes. C3bBbP could be detected in 3/68 tear samples.In our study we demonstrated the increased concentration of C1rs-C1inh complex in several tear samples taken early after human penetrating keratoplasty. These findings provide direct evidence that the classical pathway of complement may be activated in the early postoperative period after penetrating keratoplasty.

Reactive hyperemia following occlusions of 15, 30, 60 and 120 sec duration was studied in the left coronary vascular bed of the isolated fibrillating dog heart perfused with arterial blood at constant pressure or constant volume. Except for repayment, linear correlations were found between occlusion time and the characteristics of reactive hyperemia. At a basal perfusion pressure of 50 mm Hg the postocclusion reaction was absent. The maximum hyperemic response was observed at 100 mm Hg, while on a further increase of perfusion pressure reactive hyperemia decreased. The postocclusion reaction was more marked but of briefer duration under constant pressure perfusion. The results can be explained by the joint effects of metabolic, myogenic, and physical factors on coronary vascular tone.

In order to evaluate whether perfusion pressure or coronary flow affect myocardial oxygen metabolism, oxygen consumption of the isolated fibrillating blood-perfused canine heart was investigated at perfusion pressures of 100, 150, and 200 mm Hg. To obtain different coronary flow rates at a given coronary perfusion pressure, alpha-adrenergic blockade by phenoxybenzamine (10 mg/kg b.w.) was applied, resulting in an increase in coronary flow and a decrease in myocardial oxygen extration. Myocardial oxygen consumption was increased by elevation of perfusion pressure in both the control and phenoxybenzamine-pretreated group. At the same level of perfusion pressure there was no significant difference between the oxygen consumption of control and phenoxybenzamine-pretreated preparations. It can be concluded that in the isolated fibrillating canine heart oxygen consumption is primarily regulated by perfusion pressure, and is independent from coronary blood flow.

In order to evaluate whether alpha and beta adrenergic mechanisms participate in the coronary reactive hyperaemia, effects of phenoxybenzamine (10 mg per kg b.w.) or propranolol (2 mg per kg b.w.), or phenoxybenzamine + propranolol on reactive hyperaemic responses following 15, 30, 60 and 120 s occlusions of left coronary vessels were investigated on isolated fibrillating, blood-perfused dog heart preparations. Hearts were either perfused at constant pressure or at constant volume on the basal perfusion pressure of 150 mm Hg.