Zoltán Zsolt Nagy

Background: Optical coherence tomography angiography (OCTA) provides quantitative metrics of the retinal microvasculature, most prominently vessel density (VD), that are increasingly used as biomarkers in ocular, systemic, and cerebrovascular disease. Because OCTA relies on the detection of flow-related motion contrast, image quality has emerged as a pervasive determinant of these metrics, yet its effect has been reported in fragmentary and non-comparable ways across the literature. Methods: We identified OCTA studies indexed in PubMed that examined the relationship between image quality and quantitative OCTA parameters, and we summarised their methods and findings across the macular, foveal avascular zone, and peripapillary regions and across vascular layers. We integrated directly comparable per-unit scan-quality effects using random-effects meta-analysis and separately synthesized direct cross-sectional Pearson correlations between manufacturer-reported image quality and macular vessel-density outcomes from independent healthy cohorts. Results: Higher image quality was associated with higher measured vessel density in every contributing dataset. On the Optovue scan-quality (SQ, 0–10) scale, superficial macular VD increased by 3.46% (95% CI 1.85–5.07) per SQ unit in controlled signal-attenuation experiments and by covariate-adjusted observational estimates ranging from 0.90% to 2.16% per SQ unit; a combined order-of-magnitude estimate across both estimator types was 1.64% (95% CI 1.15–2.12). Peripapillary estimates were heterogeneous and derived from only two independent cohorts; they were therefore summarised descriptively rather than pooled. Across three independent externally authored healthy cohorts reporting direct cross-sectional Pearson correlations, higher image quality was strongly associated with higher macular vessel-density outcomes (random-effects pooled r = 0.64, 95% CI 0.50–0.75; I² = 49%). Conclusions: Image quality is an important, directional confounder of VD-based OCTA metrics whose magnitude can rival the biological or physiological signal of interest. Platform-appropriate standardisation, transparent reporting, and consideration of image quality in acquisition and analysis are therefore important for the valid interpretation of vessel-density measurements, particularly in functional and longitudinal studies.

Esettanulmányunkban posztoperatív maculaoedemában szenvedő beteg túlnyomásos (hiperbárikus) oxigénterápiával (HBOT) kiegészített kezelését mutatjuk be. Vizsgálatunk célja a HBOT potenciális terápiás hatékonyságának értékelése volt a műtét utáni maculaoedema gyógyulási folyamatának gyorsításában. 58 éves, egészséges férfi betegnél bal oldali multifokális műlencse beültetésével járó phacoemulsifikatiós műtét utáni héten zavaró homályos látás alakult ki, tiszta törőközegek mellett. A bevezetett standard terápia (topikális kortikoszteroid és nemszteroid gyulladáscsökkentő – NSAID) alkalmazása mellett a tünet perzisztált, a beteg centrálisretina-vastagsága a posztoperatív 35. napon 327 μm, látásélessége 0,4 volt. Ekkor a szemészeti konzervatív terápiát folytatva, kiegészítő HBOT-kúrát indítottunk, összesen 11 alkalom, 2,5 ATA/90 perc, 100%-os oxigén légzése, 20/5 levegőszünet protokollal. A beteg a negyedik HBOT-kezelést követően soron kívüli kontrollvizsgálatra jelentkezett, szubjektív homályos látási panaszai jelentősen csökkentek. Ezen vizsgálat alkalmával a látásélessége 0,9-re javult. A HBOT-kezelést a nagyfokú és gyors tünetregresszió ellenére folytattuk az eredmény megtartása és a neuroplaszticitás, az agyi akkomodáció facilitálása érdekében. A záró OCT- (optikaikoherencia-tomográfiás) vizsgálat a HBOT-kúra után egy hónappal történt: látóélessége 1,0, a macula vastagsága 267 μm volt. Hiperbárikus oxigénterápia mellett a posztoperatív maculaoedema okozta homályos látási tünet regressziója jelentősen felgyorsult, az eredményt OCT-vizsgálattal objektivizáltuk, amely nem magyarázható spontán javulással. Az ilyen etiológiájú maculaoedema-kezelésben a HBOT alkalmazása jelentős életminőség-javulást jelenthet azokban az esetekben, amelyeknél a szubjektív megélés vagy a gyógyulás időfaktora jelentős tényező. Orv Hetil. 2026; 167(28): 1120–1126.

This study aimed to measure mRNA and miRNA expression profile in corneal impression cytology (IC) samples from patients with congenital aniridia (CA) and healthy controls, and to elucidate the key genes and signaling pathways involved in aniridia-associated keratopathy (AAK). Corneal IC samples were collected from 14 patients with CA and 14 healthy controls. RNA sequencing was performed to identify differentially expressed genes (DEGs) and miRNAs. Correlations with age and AAK grade were analyzed, selected miRNAs were validated by RT-qPCR, and Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) analyses were conducted to characterize biological functions and pathways. A total of 695 DEGs and 19 differentially expressed miRNAs were identified. KRT24 expression was negatively associated with age, whereas LY6D expression positively correlated with AAK grade. Several miRNAs were linked to disease severity, including positive correlations for miR-224-5p, miR-224-3p, and miR-452-5p, and negative correlations for miR-204-3p, miR-181b-5p, and miR-181a-5p. RT-qPCR confirmed significant downregulation of miR-204-5p and miR-138-5p in aniridia samples. Functional enrichment analyses showed that DEGs were mainly involved in cell adhesion, extracellular matrix remodeling, inflammatory and immune responses, and neural-related processes. Target genes of dysregulated miRNAs were enriched in transcriptional regulation, cell proliferation, apoptosis, and migration, with significant involvement of PI3K-Akt, AGE-RAGE, and EGFR signaling pathways. Corneal epithelial cells from patients with CA exhibit coordinated mRNA and miRNA dysregulation associated with extracellular matrix disruption, inflammation, and altered signaling pathways. These findings improve understanding of AAK pathogenesis and identify potential biomarkers and therapeutic targets.

Background: Neurovascular coupling (NVC) is a fundamental mechanism that dynamically matches retinal blood flow to neuronal metabolic demand. While dynamic vessel analysis (DVA) has been established for assessing NVC through flicker-light stimulation, the potential of optical coherence tomography angiography (OCTA) to detect NVC during physiological stimuli, such as dark-to-light adaptation, remains unexplored. Methods: In this prospective cross-sectional study, OCTA imaging was performed in both eyes of 22 healthy participants under dark-adapted (scotopic) and light-adapted (photopic) conditions. Each condition was measured three times consecutively. Macular and peripapillary vessel density (VD) were quantified. Results: After adjustment for measurement order and scan quality, light adaptation significantly increased peripapillary small VD (Δ = +1.30%, p = 0.046; 95% CI: 0.03–2.56%). Peripapillary all VD demonstrated a similar trend but remained borderline significant (Δ = +1.19%, p = 0.069). In contrast, macular VD showed no significant association with light adaptation (Δ = −0.91%, p = 0.11; 95% CI: −2.02 to 0.21%), but was significantly affected by scan quality (Δ = 1.62%, p < 0.001, 95% CI: 1.23–2.02%). Conclusions: In healthy older adults, OCTA detected an increase in peripapillary VD associated with dark-to-light adaptation, reflecting retinal vascular reactivity consistent with neurovascular coupling. The pronounced influence of scan quality and measurement order underscores their importance as critical confounding factors that must be carefully controlled in functional and longitudinal OCTA studies. Together, these findings highlight OCTA’s promise as a non-invasive tool for assessing retinal neurovascular reactivity, while emphasizing the need for scan quality standardization and order correction to ensure reliable interpretation.

Purpose: Orthokeratology is an established intervention for myopia control, but long-term European real-world data remain limited. This study evaluated 5-year axial length (AL) progression in Hungarian children undergoing orthokeratology and explored predictors of treatment response. Methods: This retrospective longitudinal study included 100 myopic children (198 eyes) treated with orthokeratology and followed for 5 years. AL was measured annually by optical biometry. By design, only children with uninterrupted follow-up on the same biometry device were included. Marginal multivariable regression with cluster-robust standard errors clustered on participant ID was used as the primary analytical approach; a linear mixed-effects model was applied as a sensitivity analysis. Responder analysis was performed using a biologically anchored threshold of p < 0.001). Younger baseline age was the main predictor of greater AL progression, whereas baseline refractive status and sex showed no significant independent association with AL change. Responder rates were high, with 85.4% at eye level and 83.0% at the participant level. Conclusions: Orthokeratology was associated with low axial elongation over 5 years in this Hungarian paediatric cohort. These findings suggest favourable long-term axial length outcomes during orthokeratology treatment in routine clinical practice and underscore the importance of baseline age, whereas baseline refractive error did not show a significant independent association with treatment response.

Objectives: Our objective was to evaluate the diagnostic accuracy of clinical diagnoses in patients with chronic conjunctival lesions (CCLs) in relation to prevalence data and to identify clinical features that improve diagnostic performance. Methods: Retrospective data were collected for all patients with CCLs at a tertiary eye clinic between 2006 and 2024. A total of 1304 patients were reviewed; 391 had available histopathological data. Results: Misclassification was the highest for clinically benign, non-melanocytic, non-degenerative CCLs (referral rates: 0.446; positive predictive value [PPV]: 0.289). The referral rates for histology assessment were comparable for malignant melanocytic and non-melanocytic CCLs (0.923 and 0.989, respectively) and for benign melanocytic and non-melanocytic CCLs (0.319 and 0.446, respectively). In contrast, the diagnostic agreement was double for melanocytic malignant CCLs (0.800 vs. 0.391) and triple for melanocytic benign CCLs (0.934 vs. 0.289) compared with non-melanocytic CCLs. However, the limbal involvement increased the odds ratio (OR) for proper diagnostic performance to 7.0 (95% confidence interval (CI): 2.7–19.1), whereas the limbal overlapping increased the OR to 11.2 (95% CI: 4.0–35.9) among malignant CCLs. Conclusions: The clinical diagnosis of non-melanocytic CCLs is less frequently and less accurately confirmed histologically. In this CCL subgroup, where the lesion involves or overlaps the limbus, the likelihood of malignancy is increased sevenfold to elevenfold.

Background/Objectives: PAX6 haploinsufficiency-related congenital aniridia is a panocular disease affecting multiple ocular structures. The aim of this study was to determine the biometric properties of eyes affected by PAX6 haploinsufficiency-related classical congenital aniridia using a non-contact device. Methods: Fifty-nine eyes from 31 aniridia patients (48.39% male; mean age 27.0 ± 17.65 years, range 7–56) and 99 eyes from 50 healthy controls (44.00% male; mean age 28.56 ± 21.73 years, range 4–81) were examined using the Movu biometer (Argos Inc.). Axial length (AL), corneal diameter (CD), central corneal thickness (CCT), anterior chamber depth (ACD), lens thickness (LT), pupil size (PS), and mean keratometric value (K-mean) were measured. Results: Linear mixed-effects models showed significant effects of diagnosis on CCT (β = 182.39, p < 0.001), CD (β = −0.55, p = 0.02), and K-mean (β = −1.10, p = 0.03), while axial length was associated with gender (β = −0.90, p = 0.03). Mann–Whitney testing showed no interocular asymmetry (all p ≥ 0.07; η² ≤ 0.04) overall. Conclusions: PAX6-related congenital aniridia eyes are associated with increased CCT and reduced CD, and K-mean, while AL appears to be mainly influenced by gender. The absence of marked interocular asymmetry suggests relatively symmetrical bilateral involvement. These differences should be considered in corneal and lens surgery planning.

PAX6 haploinsufficiency-related congenital aniridia is frequently associated with ocular surface disease, including meibomian gland dysfunction (MGD), dry eye, limbal stem cell deficiency (LSCD), aniridia-associated keratopathy (AAK), and inflammation. This study measured ocular surface temperature (OST) at the corneal center and four paracentral points (2 mm from center) in patients with congenital aniridia and examined factors influencing OST. Forty-five eyes from 26 aniridia patients (55.6% female; 26.29 ± 17.78 years) with PAX6 pathogenic variants and 47 eyes from 25 controls (68.1% female; 24.81 ± 4.73 years; p = 0.1639) were included. Body temperature, OSDI, and OST (TG-1000) were recorded; clinical assessment evaluated MGD, LSCD, AAK, iris malformation, epithelial defects, Salzmann nodules, glaucoma and previous ocular surgery. Body temperature and OSDI did not differ in aniridia and controls (p ≥ 0.606). LSCD was mainly Grade 2 (46.7%) or Grade 4 (40.0%), and AAK Grade 1 (33.3%) or Grade 2 (31.1%). MGD affected 51.1%, Salzmann nodules 22.2%, epithelial defects 2.2%, glaucoma 60.0%, and previous ocular surgery 35.5%. Superior OST was higher in aniridia (34.98 ± 0.55 °C vs. 34.75 ± 0.47 °C; p = 0.012). Exploratory univariate analyses identified that higher AAK grade correlated with lower inferior OST (p = 0.030), iris malformation with reduced central/paracentral OST (p ≤ 0.029), and Salzmann nodules with lower OST overall (p ≤ 0.011). However, in a multivariate model, age, Salzmann nodular degeneration, and prior ocular surgery emerged as key determinants of OST. OST may serve as a noninvasive biomarker in congenital aniridia.

Geographic atrophy (GA) is a progressive cause of central vision loss with limited rehabilitation options. This prospective case series aimed to evaluate the effects of biofeedback fixation training (BFT) on visual function and vision-related quality of life (QoL) in patients with GA. Eighteen patients with total central vision loss in one eye underwent BFT on the fellow eye (study eye) using the Macular Integrity Assessment (MAIA) system, which was used to select a new, previously chosen preferred retinal locus (PRL) to stabilize fixation or adopt a new fixation locus. Patients were followed for an average of 13.2 months (range 3–26 months). Functional outcomes included best corrected visual acuity (ETDRS chart), reading performance (Radner test), and contrast sensitivity (Spot Checks test). MAIA parameters comprised average retinal sensitivity, fixation distance and stability (P1, P2), and changes in the bivariate contour ellipse area (BCEA). Vision-related quality of life was assessed using the National Eye Institute Visual Functioning Questionnaire-25 (NEI-VFQ-25). Following BFT, visual acuity, reading ability and contrast sensitivity improved significantly (p value: p < 0.02), and fixation stability and NEI-VFQ-25 scores showed a positive trend. These findings indicate that BFT is a feasible and promising rehabilitation approach for patients with GA.