Mariann Fodor

Background: In thyroid eye disease (TED) pathogenesis, a major contributor is hyaluronan (HA) overproduction by orbital fibroblasts (OF). TED patients often receive prostaglandin analogues (PGA) for elevated intraocular pressure. Their direct effects on OFs, however, remain unclear. Methods: OFs were established from connective tissues obtained from TED patients (n = 4) and non-TED controls (n = 4) during orbital surgeries. HA levels in primary OF culture media, and in the OFs’ pericellular coat, were measured by ELISA. Cultures were performed with or without platelet-derived growth factor BB (PDGF-BB) stimulation, and treated for 72 h with 40 µM prostaglandin F2α (PGF2α), latanoprost, bimatoprost or tafluprost. mRNA expressions of HA synthases (HAS1, HAS2, HAS3) and HA-degrading enzymes (HYAL1, HYAL2, CEMIP) were quantified by RT-PCR. Proliferation and metabolic activity were analysed using BrdU incorporation and MTT assays. Results: PGF2α and each PGA reduced HA levels in the pericellular coat (p < 0.001), while only PGAs reduced HA concentration in the culture medium. Tafluprost and latanoprost suppressed PDGF-BB-stimulated HA synthesis to or below unstimulated levels, respectively (p < 0.001). Latanoprost markedly decreased HAS2 mRNA expression (p < 0.001), even under PDGF-BB stimulation (p < 0.001). PGF2α and each PGA increased CEMIP mRNA expression (p < 0.001). Latanoprost decreased fibroblast proliferation and metabolic activity with and without PDGF-BB stimulation (p < 0.05). Conclusions: These in vitro findings suggest that PGAs modulate HA turnover in orbital fibroblasts through reduced HA synthesis and potentially enhanced degradation. While these observations are confined to cultured cells, they offer a hypothesis for potential clinical relevance in TED, which requires further in vivo validation.

Purpose: To evaluate the anatomical and functional outcomes of a simplified superior inverted internal limiting membrane (ILM) flap technique with extended ILM peeling for the surgical treatment of large idiopathic macular holes (iMH). Patients and Methods: This retrospective, non-randomized, interventional consecutive case series included 42 eyes of 40 patients with iMH. Patients were grouped according to the CLOSE study classification: Group 1: large holes (n=19, minimum linear diameter [MLD] > 400 to ≤ 550 μm), Group 2: extra-large holes (n=18, MLD > 550 to ≤ 800 μm), and Group 3: XXL holes (n=5, MLD > 800 to ≤ 1000 μm). The mean follow-up time was 20.63 ± 18.32 months. The primary endpoint was MH closure rate. Secondary outcomes included closure type, changes in best-corrected visual acuity (BCVA), ellipsoid zone (EZ) defect, flap position, and surgical complications. Results: Anatomical type 1 closure was achieved in all 42 eyes (100%). The proportion of favorable U-shaped closure decreased significantly with increasing hole size (χ² = 9.26, df = 2, p = 0.010), with rates of 84.2%, 81.3%, and 20.0% in Groups 1, 2, and 3, respectively. BCVA and EZ defect improved significantly over time in all groups. Final BCVA gain was 4.4 ± 3.3, 6.2 ± 2.7, and 7.3 ± 4.7 ETDRS lines in Groups 1, 2, and 3, respectively, without significant inter-group differences (p > 0.05). Final BCVA correlated with preoperative BCVA (r = 0.51, p < 0.001) and final EZ defect (r = 0.39, p = 0.013), but not with iMH size or symptom duration (p > 0.05). No major complications were observed. Conclusion: The described surgical technique, involving the combination of a superior inverted ILM flap with extended ILM peeling and minimal manipulation of the posterior pole is highly effective in achieving anatomical and functional success in large iMHs up to 1000 μm, with a favorable safety profile and consistent structural recovery.

Full-thickness macular holes are central defects in the neurosensory retina that result in significant visual impairment, including reduced visual acuity and central scotomas. While most cases respond well to pars plana vitrectomy combined with internal limiting membrane peeling, a subset of macular holes remains refractory to standard interventions and presents a persistent surgical challenge. Among emerging techniques, autologous neurosensory retinal transplantation has shown considerable promise, particularly in chronic or large-diameter holes where the internal limiting membrane is no longer available for use. This review offers a comprehensive overview of full-thickness macular hole pathophysiology and classification, current surgical approaches for refractory cases, and the accumulating clinical evidence supporting autologous neurosensory retinal transplantation. By conducting a narrative review of peer-reviewed studies in PubMed, anatomical and functional outcomes, procedural advantages, and associated limitations are critically examined. Additionally, recent preclinical developments, such as stem cell-derived retinal grafts, are discussed as potential future directions. Autologous neurosensory retinal transplantation represents a significant advancement in the management of refractory macular holes, while cell-based therapies may hold transformative potential for regenerative retinal surgery.

We aimed to determine the effects of night-shift work on corneal parameters in thirty-five healthy individuals (24–59 years) in a retrospective cohort study. Among them, 12 hospital nurses regularly worked two shifts, spending a third of their nights awake, whereas 23 age-matched controls never worked shifts and slept regularly. Measurements were performed at least five times within 12 h. We analyzed the keratometric parameters of the corneal front (F) and back (B) surfaces, including the refractive power in the flattest and steepest axes (K1, K2), astigmatism (Astig); and corneal pachymetry (Pachy) at the thinnest corneal point and pupil center, volume relative to the 10 mm corneal diagonal (Vol D10); and surface variance index (ISV). A multilevel mixed-effects linear regression adjusted for age was applied to 905 measurements. All parameters exhibited significant periodic fluctuations (p ≤ 0.005). The two groups also showed significantly different periodic fluctuations (p ≤ 0.008), except in K1B and AstigB. K1/K2 (F and B), AstigF, Pachy, and ISV differed significantly (p < 0.0001). Surprisingly, prolonged night shift work did not increase the ISV, and no evidence of age-related corneal thinning was observed. Long-term night-shift exposures change various corneal parameters, reflecting both concomitant and adaptive effects. This study highlights the impact of consistent sleep deprivation on corneal properties, warranting further research into understanding the long-term effects of night-shift work.

This prospective cohort study is aimed to investigate circadian variations in corneal parameters, focusing on sleep-deprived subjects. Sixty-four healthy individuals (age range: 21–76 years) actively participated in this study, undergoing examinations at least five times within a 24-hour timeframe. The analysis encompassed keratometric parameters of the cornea’s front (F) and back (B) surfaces, refractive power in flattest and steepest axes (K1, K2), astigmatism (Astig) and its axis (Axis), aspheric coefficient (Asph), corneal pachymetry values of thinnest corneal thickness (Pachy Min) and corneal thickness in the center of the pupil (Pachy Pupil), volume relative to the 3 and 10 mm corneal diagonal (Vol D3, Vol D10) and surface variance index (ISV). Circadian changes were assessed using a hierarchical, mixed-effects linear regression adjusted for age and night shift. A total of 1,636 measurements revealed significant circadian changes in various corneal parameters, including K1 F, K2 F/B, Astig F/B, Asph F/B, Pachy Min/Pupil, Vol D3/10, and ISV (p < 0.0001). Moreover, K1 B exhibited a significant circadian change (p = 0.0002), while Axis F/B remained unchanged. Notably, Corneal thickness peaked before 6 o’clock in the morning and reached its minimum after 12 o’clock. Contrary to previous notions linking corneal diurnal changes with eyelid closure during sleep, our study reveals that these changes persist in the absence of sleep. This research contributes valuable insights into the impact of sleep deprivation on corneal properties, warranting further investigations to deepen our understanding of daily variations in visual quality and guide the planning of refractive eye surgery interventions.

Az aminokinolinok egy régóta használt gyógyszercsoport, amely napjainkban is elengedhetetlen számos kórkép, különösen szisztémás gyulladásos kórképek terápiájában. Az éles látásért felelős retinarész, a macula klorokin és hidroxiklorokin által okozott toxikus károsodása már jól ismert mellékhatás volt a múlt században is. Az ilyen gyógyszert hosszú távon szedő krónikus betegek szemészeti szűrése azóta visszatérő kérdéskör, mely az újonnan megjelenő evidenciák által folyamatosan megújuló vizsgálati protokollokban nyilvánul meg. Tanulmányunkban áttekintjük a jelenleg érvényes nemzetközi irányelveket, kitérve arra, hogy az ezekben újonnan történő változtatások milyen új adatokon alapszanak. Ismertetjük a korszerű szemészeti szűrés műszereit (automata látótérvizsgálat, optikaikoherencia-tomográfia [OCT], fundus-autofluoreszcencia [FAF], multifokális elektroretinográfia [mfERG]), valamint a klorokint vagy hidroxiklorokint szedő betegeknél azonosított rizikófaktorokat, melyek hajlamosítanak a maculopathia kialakulására. Végezetül egy hazai viszonyokra adaptált szűrési protokollt szeretnénk bemutatni. Orv Hetil. 2024; 165(30) 1147–1153.

Az éleslátás helyén a neuroretina teljes vastagságú anyaghiányát maculalyuknak nevezzük. Műtéti megoldása a retina belső határhártyájának eltávolítása vitrectomia során gázfeltöltéssel. A sikeres műtét után ismét kialakuló vagy műtét ellenére is nyitva maradó refrakter maculalyukak (kb. 5%) zárására számos műtéti technikát írtak le. Jelen cikkben egy nagy méretű, refrakter maculalyuk miatt Magyarországon elsőként végzett autológ neuroszenzoros retinatranszplantációt mutatunk be, a maculalyukak sebészetének rövid áttekintésével. Betegünk bal szemén hónapok óta fennálló látásromlás miatt, 6%-os látásélesség mellett szürke hályog, epiretinalis membrán és nagy méretű maculalyuk miatt 2022. szeptemberében szürkehályog-műtéttel kombinált vitrectomiát végeztünk ERM/ILM peelinggel és SF6-gáz-feltöltéssel. A beteg figyelmét felhívtuk a fej posztoperatív pozicionálásának fontosságára, melyet figyelmen kívül hagyott. 4%-os látásélesség mellett, refraktív maculalyuk (alapjánál: 983 μm, legkisebb átmérőnél: 609 μm) miatt 2022 december 14-én autológ neuroszenzoros retinatranszplantációt végeztünk intraoperatív OCT segítségével (Zeiss ARTEVO 800). A műtét végén, a transzplantátum helyben tartását elősegítendő, dekalint hagytunk a szemben, majd a beteg 5 napot hanyatt fekvő helyzetben töltött. Újabb műtéttel a dekalint eltávolítottuk, majd C3F8-gáz-feltöltést végeztünk. 8 héttel a műtét után 20%-os látásélesség mellett záródott maculalyukat dokumentáltunk, mely a féléves követés alatt stabilnak mutatkozott. A refrakter maculalyukak megoldására szóba jövő lehetőségek közül a betegnek egyértelmű látásjavulást eredményező autológ neuroszenzoros retinatranszplantáció megfontolásra érdemes beavatkozás. A műtét elvégzésében nagy segítséget jelentett az intraoperatív OCT. Az ideiglenesen szemben hagyott dekalin segít a transzplantátum helyben tartásában, azonban folyamatos hanyatt fekvő helyzetet igényel, és eltávolításához újabb műtét szükséges. További tapasztalatokra van szükség a műtét pontos indikációs körének megállapításához. Orv Hetil. 2023; 164(38): 1511–1517.

Background and Objectives: We aimed to analyse data on retinal artery occlusion (RAO) patients to explore correlations with acute ischaemic stroke (AIS), ST-elevation myocardial infarction (STEMI), and cardio/cerebrovascular comorbidities. Patients and Methods: Our retrospective cohort study included 169 RAO and 169 age- and gender-matched control patients. We examined the association of AIS, STEMI, and related comorbidities such as hypertension (HT), type 1 and type 2 diabetes (T1DM and T2DM, respectively), hyperlipidaemia, and ischaemic heart disease (IHD) with RAO. We also recorded atrial fibrillation in our RAO patients. Results: Our results demonstrated that RAO patients developed both AIS and STEMI at a significantly higher rate compared to controls (p < 0.001 for both). We also found that RAO patients had a significantly higher prevalence of HT and hyperlipidaemia (p1 = 0.005, p2 < 0.001) compared to controls. Multiple risk factors together significantly increased the odds of developing AIS and STEMI. Conclusions: Our results suggest that through identifying and treating the risk factors for RAO patients, we can reduce the risk of AIS, STEMI, and RAO of the fellow eye. Considering that ophthalmologists are often the first detectors of these cardiovascularly burdened patients, collaboration with colleagues from internal medicine, cardiology, and neurology is essential to achieve secondary prevention.

Thyroid autoimmunity in Graves’ disease (GD) is accompanied by Graves’ orbitopathy (GO) in 40% of the cases. Orbital fibroblasts (OF) play a key role in the pathogenesis and cigarette smoking is a known deteriorating factor. Alongside conventional cigarettes (CC) new alternatives became available for smokers, including heated tobacco products (HTP) and E-cigarettes (ECIG). We aimed to study the cellular effects of smoke extracts (SE) in orbital fibroblasts. Primary OF cultures from GO and NON-GO orbits were exposed to different concentrations of SE (1%, 50%) and the changes were followed using Real Time Cell Electronic Sensing (RT-CES). Untreated GO and NON-GO cells had different maximum cell index (CI) values of 3.3 and 2.79 respectively (p < 0.0001). CC, HTP and ECIG treated NON-GO fibroblasts exhibited peak CIs of 2.62, 3.32 and 3.41 while treated GO cells’ CIs were higher, 5.38, 6.25 and 6.33, respectively (p < 0.0001). The metabolic activity (MTT) decreased (p < 0.001) and hyaluronan production doubled (p < 0.02) after 50% of CC SE treatment in all cell cultures. GO fibroblasts were more sensitive to low concentration SE then NON-GO fibroblasts (p < 0.0001). The studied SEs exerted different effects. RT-CES is a sensitive technique to detect the effects of very low concentration of SE on fibroblasts.

Purpose: To find immunomediator combinations which could sensitively indicate keratoconus progression. Methods: Tear samples of 42 patients with keratoconus were collected at baseline and at the end of a one-year follow-up. The concentrations of 13 mediators were measured by CBA. Based on Pentacam HR examination, eyes were divided into a non-progressive and a progressive group. Results: At the end of the follow-up, significant differences were observed in the release of IFNγ, IL-13, IL-17A, CCL5, MMP-13 and PAI-1 between the two groups. Changes in five Pentacam parameters correlated positively with changes in IFNγ, IL-13, IL-17A, CXCL8, CCL5, TIMP-1 and t-PA. We found that tear level of IL-13 in combination with NGF can predict the progression of keratoconus with 100% specificity and 80% sensitivity. Conclusion: The findings of our longitudinal study may underscore the importance of NGF and IL-13 tear levels in the prediction of keratoconus progression.