To evaluate the treatment success and reversal rate of corneal allograft rejections in post-penetrating keratoplasty patients. Retrospective cohort study was performed in post-penetrating keratoplasty patients treated for corneal allograft rejection between September 2015 and August 2024 in a tertiary eye center in Debrecen, Hungary. Indication of keratoplasty, onset of the allograft rejection, best corrected visual acuity (BCVA), corneal transparency on slit lamp examination and applied treatment were recorded. In our institution’s patient registry, 68 allograft rejection episodes were found. Before the rejection, all grafts were completely transparent. The rejection episodes occurred median 21 months after surgery. Diagnosis and treatment took place median 5 days after the onset of symptoms. Allograft rejection could be successfully reversed in 48 of the total 68 cases (70.6

Objective: To present the 30 years of operation of the Eye Bank Debrecen (1994-2023), the demographic characteristics of corneal donors, the procurement, storage, utilization, and distribution of donor tissues, moreover, to disclose the long-term results of eye bank practice. Methods: We performed a retrospective analysis of eye bank practices between 1994 and 2023 at the Department of Ophthalmology, University of Debrecen. We collected data on corneal donation (gender and age of donor, cause of death, time from death to removal, preservation, and finally transplantation of donor tissue), preserved corneas (endothelial cell density), and operations (type of intervention, indication). Our bank collects tissue from cadavers, multiorgan, and living donors. Donors are stored in hypothermic conditions for a maximum of 14 days. Our activities also include the preservation, deep freezing and use of amniotic membrane, as well as the storage and use of fascia lata. Results: The Cornea Bank Debrecen performed 3270 corneal preservations between 1994 and 2023. Based on the data of the preserved corneas, 57.8% of the corneoscleral discs derived from cadaver, 37.6% from multiorgan and 4.6% from living donor. The mean age of donors was 55.5 +/- 11.8 years. The average endothelial cell density of donor corneas was 2235.6 +/- 158/mm(2). The mean time between death and enucleation from the pathology institute was 12.3 +/- 5.2 hours and the mean time between death and preservation was 14.9 +/- 6.3 hours. After preservation (+4.0 degrees C Eusol-C, Alchimia, Italy), donor tissue was used at an average of 6.1 +/- 2.3 days. Of the preserved corneas, 20.3% were discarded, the most common reason being serological positivity (hepatitis B and C in 25.6% of non-transplanted donor corneas). Based on the eye bank data, a total of 2864 corneal transplantations were performed between 1994 and 2023. The most common surgical indication was bullous keratopathy (21.6%). The rate of lamellar surgical techniques was 6.4% from 2011 to 2023. From 2006 to 2023, 312 amniotic membrane transplantations were performed. Conclusion: The Cornea Bank Debrecen has been continuously developing since its foundation, complying with the legal requirements and European professional standards. Donor harvesting from cadaver, multiorgan and living donors is also feasible. In addition to corneas, amniotic membrane and fascia lata tissue are also available in our bank, providing a background for the surgical treatment of various ophthalmological pathologies.

AIM:To report a case of progressive corneal thinning and spontaneous corneal perforation in the setting of recurrent keratoconjunctivitis of undetermined etiology in a 20-year-old female patient. MATERIAL AND METHODS:Longitudinal follow-up of the reported case was performed with regular slit-lamp examination, anterior segment optical coherence tomography, and laboratory evaluation. Relevant scientific literature was reviewed to discover potential etiologies and causes of the reported case. CASE REPORT:Recurrent bilateral keratoconjunctivitis was detected and followed up in a 20-year-old female patient. Long-standing blepharitis and several ocular inflammatory episodes were observed involving the conjunctiva and cornea causing corneal thinning and irregular astigmatism on both eyes. Patient's history, physical and laboratory examination did not reveal any systemic inflammatory or dermatological disorder. After 4 years from the onset of symptoms, spontaneous corneal perforation was observed on the right eye and treated with amniotic membrane transplantation. At that time, eyelid margin culture was positive for Streptococcus mitis. The graft healed completely with paracentral stromal scarring. Best spectacle corrected visual acuity was 20/25 OD and 20/40 OS a month after the procedure. CONCLUSION:Corneal and ocular surface inflammation is a potential multifactorial disease. Bacterial hypersensitivity, atopy and dermatological disorders such as atopic dermatitis and rosacea may play a role in recurrent keratitis, corneal thinning and eventually corneal perforation. Frequent and regular follow-ups are required to detect complications early as well as to discover all possible local and systemic contributing factors of keratoconjunctivitis.

The number of infectious keratitis cases is increasing worldwide. The vast majority of cases are bacterial in origin. Both gram positive (Staphylococcus aureus, Staphylococcus epidermidis, Streptococcus pneumoniae Corynebacterium diphtheriae) and gram negative (Pseudomonas aeruginosa, Acinetobacter species) bacteria can cause serious infections.One of the most common causes is related to contact lens wear. This can be in connection with overwear, overnight wear (orthokeratology), inadequate lens cleaning with tap water, lack of hygiene, and contamination of different solutions. Uncontrolled use of lenses ordered from the internet is also a source of danger. The other main cause is trauma, resulting from surface injuries (e.g. nails, plants), foreign bodies, mechanical and chemical injuries. Certain ophthalmological conditions also predispose to bacterial keratitis, such as dry eye, blepharitis, non‐healing ulceration, and previous eye surgery. Immunosuppressive treatment, autoimmune diseases, diabetes mellitus may also result in development of infection.In serious cases patients typically complain of pain, sensitivity to light, blurred vision, tearing, yellowish purulent discharge and various degree of visual loss. Clinical appearance includes epithelial defect and erosions, ulceration, stromal infiltrates with indistinct margins. In serious forms Descemetocele, even perforation can be present. Hypopyon may also appear in the anterior chamber.Diagnosis is based on the clinical picture. Culturing and smear sampling are necessary when the infiltrate is large and central, when there in contact lens wear in the history, the process is resistant to therapy, and appearance is atypical.Most cases can be successfully treated with empiric therapy. The first choice of treatment is usually fluroquinolone therapy. In severe cases moxifloxacin or cefazolin with tobramycin or gentamycin is advised. Eye drops in every hour should be applied both day and night for the first 48 hours as saturation dose. If there is no improvement in the clinical picture after 48 hours, repeat sampling for microbiological culture recommended. Corticosteroids may be considered after 2 days when the infective organism is identified, and the keratitis is responding to therapy. Cycloplegia may also decrease pain as well as synechia formation. In therapy resistant cases crosslinking may be an additional option if herpetic origin can be excluded. Amniotic membrane transplantation is recommended for non‐healing epithelial defects. In cases of non‐healing and rapidly progressive cases therapeutic corneal transplantation is recommended. However, surgery has a better prognosis in quiet eye.

To evaluate the ocular surface and tear film quality in post-penetrating keratoplasty patients in comparison with healthy individuals. Slit lamp examination of lid parallel conjunctival folds (LIPCOF), tear osmolarity measurement, Schirmer I, fluorescein break-up time (FBUT) and corneal fluorescein staining tests were performed on 38 eyes of 34 patients underwent penetrating keratoplasty for different indications. In addition, 34 eyes of 18 healthy age-matched individuals served as normal controls. Average age was 55.86 ± 16.75 years in the post-keratoplasty group and 51.05 ± 18.85 years in the control group (p = 0.289). There were significant differences in LIPCOF (1.45 ± 0.76 vs. 1.03 ± 0.83; p = 0.035) and FBUT values (5.82 ± 4.48 s vs. 11.03 ± 6.72 s; p < 0.001) between the operated and control eyes. Schirmer I and tear osmolarity tests demonstrated no significant differences. The frequencies of corneal staining (p < 0.001), abnormal LIPCOF (p = 0.030) and artifical tear use (p < 0.001) were significantly higher in the post-keratoplasty group. However, proportions of abnormal FBUT and Schirmer I test were similar in the two groups. Tear osmolarity was slightly higher in the post-keratoplasty group (311.53 ± 23.75 mOsm/l vs. 308.12 ± 15.83 mOsm/l), but the difference was not significant (p = 0.524). There were no significant differences in the proportion of hyperosmolar ocular surfaces between the two groups using cut-off values either ≥ 308 mOsm/l (p = 0.635) or ≥ 316 mOsm/l (p = 0.805). Abnormal dry eye tests are more prevalent in patients after penetrating keratoplasty. Reduced tear film stability, conspicuous corneal staining and lid parallel conjunctival folds represented further deterioration of the ocular surface homeostasis despite normal tear production and osmolarity. These findings highlight the importance of comprehensive ocular surface assessment and management in the postoperative care of keratoplasty patients.

The prevalence and incidence of ectatic corneal disease (ECD) vary greatly in different populations and geographic areas and its presence is reaching nearly 5% according to recent data.Ectasia of the cornea refers to diseases in which the radius of curvature and in parallel its refractive power changes and the cornea thins corresponding to the ectatic part. Ectasias are differentiated according to the form and the area of the cornea where the process occurs. The etiology of the disease is not known, and it used to be classified on clinical appearance. ECD is a heterogeneous disease, genetic and environmental factors may contribute to its pathogenesis. Ectasias are bilateral, progressive, non‐inflammatory, rather sporadic, and familial occurrence has been found in only 6‐20% of cases. The mode of inheritance can be autosomal dominant or recessive.Most common form is keratoconus, a progressive, non‐inflammatory, usually bilateral, asymmetric disease, characterized by epithelial and stromal thinning and weakening. Its special iatrogenic form occurs as a complication of LASIK surgery.In contrast, keratoglobus and keratotorus are very rare. It is characterized by the anterior bulging of the entire cornea in the shape of a sphere or a pear. For this reason, the astigmatism is not great as compared to advanced keratoconus and often remains regular even during the progression. However, if refraction increases, may reach up to 60 Ds or even more. The cornea is very thin, but there is no Fleischer ring, which is an important differential diagnostic sign.Pellucid marginal degeneration is characterized by thinning and protrusion of the cornea in the lower one‐third. There are no signs of inflammation and no vascularization. It usually begins between 20 and 40 years of age. The cause of visual impairment is irregular astigmatism. Scarring occurs in the stroma near the posterior surface, but very rarely spontaneous perforation may occur.Terrien's marginal degeneration is a bilateral disease usually affecting men in their forties. However, significant asymmetry can also occur. In the upper part of the cornea, yellowish‐white stromal opacities are visible 1‐2 mm from the limbus, following its curve. Between the lesion and the limbus, the cornea has a normal structure. As the disease progresses, astigmatism and vascularization develop.The diagnosis of ECD is usually based on patient history and characteristic findings on topography and tomography, slit lamp signs often appear later, as the disease progresses. Typical signs on imaging include inferior steepening, skewing of radial axes, abnormal islands and elevations on anterior and posterior maps and abnormal corneal thinning. The diagnostic focus has shifted from the anterior to the posterior corneal surface.ECDs should be distinguished from senile lesions, infections, pseudopterygium, immunological diseases, dellen.

Célkitűzés: A Debreceni Szembank 30 éves működésének (1994–2023), a szaruhártyadonorok demográfiai jellemzőinek, a donorszövetek beszerzésének, tárolásának és felhasználásának, szétosztásának bemutatása, valamint a szembanki gyakorlat hosszú távú eredményeinek közreadása. Módszerek: A Debreceni Egyetem Szemklinikáján 1994 és 2023 között folytatott szembanki gyakorlatok retrospektív elemzését végeztük el. Összegyűjtöttük a szaruhártya-donációra (a donor neme és életkora, halálának oka, a halál bekövetkeztétől eltelt idő a donorszövet eltávolításáig, valamint a konzerválásáig, végül az átültetéséig), a konzervált szaruhártyákra (endothelium-sejtsűrűség) és a műtétekre vonatkozó (a műtét típusa, indikációja) adatokat. Bankunkban cadaverből, multiorgan és élő donorból egyaránt történik szövetgyűjtés. A donorokat hipotermiás körülmények között maximum 14 napig tároljuk. Tevékenységi körünkhöz tartozik még az amnionmembrán konzerválása, mélyfagyasztása és felhasználása, valamint fascia lata tárolása, felhasználása. Eredmények: A Debreceni Cornea Bankban 1994 és 2023 között 3270 corneakonzerválás történt. A konzervált corneoscleralis korongok 57,8%-a cadaver, 37,6%-a multiorgan és 4,6%-a élő donorból származott. A donorok átlagéletkora 55,5 ± 11,8 évnek adódott. A donorcorneák átlagos endothelsejt-sűrűsége 2235 ± 158/mm 2 volt. A patológiai intézetből származó bulbusok esetében a halál bekövetkezte és bulbus eltávolítása között eltelt idő átlagosan 12,3 ± 5,2 óra, illetve a halál bekövetkezte és konzerválás között eltelt idő átlagosan 14,9 ± 6,3 óra volt. A konzerválás után (+4,0 °C Eusol-C, Alchimia, Olaszország) a donorszövetet átlagosan 6,1 ± 2,3 nappal használtuk fel. A konzervált szaruhártyák 20,3%-át nem használtuk fel, aminek leggyakoribb oka szerológiai pozitivitás (hepatitis B és C a nem transzplantált donorcorneák 25,6%-ában) volt. A szembank adatai alapján 1994 és 2023 között összesen 2864 szaruhártya-átültetés történt. A leggyakoribb műtéti indikáció a keratopathia bullosa volt (21,6%). A lamelláris műtéti technikák aránya 6,4%-nak mutatkozott a 2011-től 2023-ig számított időszakban. 2006 és 2023 között 312 amnionmembrán-transzplantációt végeztünk. Következtetés: A Debreceni Cornea Bank az alapítása óta folyamatosan fejlődik, megfelelve a jogszabályi előírásoknak és az európai szakmai követelményeknek. A donorharvesztáció cadaverből, multiorgan és élő donorból egyaránt biztosított. Bankunkban corneákon kívül amnionmembrán és fascia lata szövet is elérhető, hátteret biztosítva különböző szemészeti kórképek műtéti megoldására. Orv Hetil. 2025; 166(9): 341–350.

Purpose To investigate whether diurnal changes in biometric parameters at different times of the day are visible and to analyze whether the variations could have clinical significance in the process of intraocular lens (IOL) power calculation. Methods Phakic eyes measured by IOLMaster 700 above the age of 16 were included, with the exclusion of previous surgery. Measurements were taken between 7:00 and 15:00 and data were treated in hourly groups within this range. Data such as age, sex and biometric parameters (axial length (AL), anterior chamber depth, central corneal thickness, white-to-white distance, keratometry readings, lens thickness) were used besides the hour:minute time of the examination. Results Biometric data from 32,596 eyes were used (38.89% males). There were no statistically significant differences in age and biometric parameters between the office-hour groups (p > 0.05), excluding the AL. The AL at the end of the day was 0.198 mm longer for male and 0.197 mm longer for female compared to the beginning of the office day. Accordingly, the results of IOL power calculation varied between 21.0 and 20.0 D for male, and 21.5 D and 20.5 D for the female population. Conclusion The results suggest that the assessment of AL may be affected by the intraday time of the biometry. This variation is clinically significant and may have implications for the evaluation of AL.

The concept of degeneration means that previously intact tissues are slowly and gradually deteriorating, often to the point where they cannot perform their function properly. As their aetiology is not uniform, their clinical manifestations are also very diverse. The same is true for corneal degenerative conditions. Corneal degeneration may involve deposition of certain substances, thinning of the tissue, vascularization, or a combination of these. What distinguishes them from corneal dystrophies is that they are not hereditary, are often unilateral, and their morphology and localization are much less regular. Corneal degeneration may be peripheral and/or central, superficial and/or deep. It may be primary or secondary according to its origin. They can be grouped in several ways. In origin, they may be (a) age‐related, (b) may develop at the base of other corneal or eye diseases (c) may be the consequence of systemic diseases. (d) may also be caused by drugs and toxins. In many cases the aetiology is obscured. Environmental factors, ultraviolet radiation and oxidative stress are also thought to play a role. Proper diagnosis is essential in choosing effective treatment strategy and thus achieving positive clinical results. When corneal degenerations significantly affect visual acuity, the treatment should aim relieving the primary disease before inducing further changes in the cornea.

Az 1990-es évektől a tomográfiás vizsgálati technikák a szemészetben jelentős fejlődésen mentek keresztül. Az optikaikoherencia-tomográfiának (OCT) döntő szerepe van a retina kórképeinek differenciáldiagnózisában, ez az infravörös fénnyel működő noninvazív technika azonban a szem elülső szegmentumának képalkotására is kiválóan alkalmas. A korábbi „time-domain” rendszerű tomográfiákat a szemmozgásra kevésbé érzékeny, nagyobb felbontásra képes ’spectral-domain’ és ’swept-source’ típusok váltották fel. Mikrométeres felbontású képalkotása a rekonstruált keresztmetszeti képek mellett kvantitatív adatokat biztosít a szemfelszíntől a szemlencséig. Alkalmazási területeihez tartozik a szemfelszín, a cornealis homályok, degenerációk, dystrophiák vizsgálata. A szaruhártyakórképek diagnosztikájában előnye, hogy megbízható adatokat szolgáltat nemcsak az elülső, hanem a hátulsó felszín görbületéről, így a szaruhártya valódi teljes törőerejéről, valamint vastagságáról is. Segítségével a korai keratoconus is kiszűrhető. Emellett kiválóan alkalmazható szaruhártyaműtétek (refraktív sebészet, szaruhártya-átültetés) utáni követésre. Ezeken felül a glaucoma diagnosztikájában, műlencsetervezésben is pontos, megbízható technológia. Az egyik legújabb felhasználási területe az operálómikroszkópba integrált formája, amely műtét közben az operatőr munkáját segíti. Másik, szintén újdonságnak számító formája az elülső szegmentum noninvazív angiográfiás vizsgálata. Orv Hetil. 2024; 165(29): 1112–1121.

Introduction The role of spirituality in health and disease is a complex and emerging area of research. Incorporating spirituality into the bio-psycho-social model of health and disease leading to the bio-psycho-social-spiritual model provides a more comprehensive framework. In this context, chronic disorders like primary Sjögren’s syndrome (pSS) are of interest due to their intricate interactions between biological, psychological, and spiritual factors. Objectives To study possible relationships between spirituality, immune parameters, and disease activity in pSS patients. Methods Patient recruitment for the study took place at the Autoimmune Sjögren specialty clinic, University of Debrecen, resulting in 112 patients. Assessing spirituality of the patients happened through 4 direct questions and the Sprituality Transcendence Scale (24 items). Besides, clinical data of the patients were involved in the study including blood cell counts, rheumatoid factor, immunoglobulin G, Sjögren-specific autoantibodies and disease activity scores (semi-objective and patient reported,). The statistical analysis was conducted applying group comparisons between spiritual and non-spiritual groups, and linear and logistic regression analyses adjusted for sex, age, disease duration, settlement type, education, living in partnership and smoking. Out of the 112 patients 4 gave incomplete response, and therefore got excluded from the analysis, resulting in a total sample size of 108. Results Semi-objective disease activity score (ESSDAI) and perceived vaginal dryness was significantly lower in the non-spiritual group. Spirituality was proven as a significant predictor of anti-SSB autoantibody serum activity and ESSDAI, while engaging in prayer/meditation and its duration predicted significantly anti-SSA autoantibody serum activity, perceived skin and tracheal dryness. Concerning logistic regression analysis, we found that an increase of one unit in spirituality reduces the probability with 81.6% of having a detectable, semi-objective disease activity at all. Significant associations were found between the duration of prayer/meditation and both semi-objective and patient reported disease activity scores and autoantibody anti-SSB with an inverse ratio based on logistic regression model. Conclusions Spirituality is associated with immune parameters and disease activity in pSS. Patients with spiritual attitude are less likely to have increased disease activity. Besides being spiritual, engagement in individual spiritual activities, such as prayer/meditation has beneficial disease modifying effect. These changes are supposedly due to psychoneuroimmunological pathways. In addition to the biologically measurable variables, the alleviation and aggravation of perceived symptoms (e.g. dryness) are important outcomes of spiritual engagement and practice. Disclosure of Interest None Declared

Since the 1990s, tomography examination techniques in ophthalmology have undergone significant development. Optical coherence tomography (OCT) plays a crucial role in the differential diagnosis of retinal pathologies, however, this non-invasive technique that operates with infrared light is also excellent for imaging the anterior segment of the eye. The former time-domain tomographies have been replaced by spectral-domain and swept-source types, which are less sensitive to eye movement and capable of higher resolution. In addition to reconstructed cross-sectional images, its micrometer-resolution imaging provides quantitative data from the ocular surface to the lens. Its fields of application include the examination of the ocular surface, corneal opacities, degenerations, and dystrophies. In the diagnosis of corneal pathologies, the advantage is that it provides reliable data not only on the anterior but also on the posterior curvature, thus on the true total refractive power of the cornea, as well as on its thickness. It can also be used for early keratoconus screening. It is also excellent for follow-up after corneal surgeries (refractive surgery, corneal transplantation). In addition, it is an accurate and reliable technology in the diagnosis of glaucoma and intraocular lens calculation. One of its latest applications is its integrated form in the operating microscope, which assists the surgeon during intervention. Another innovative form is the non-invasive angiographic examination of the anterior segment.

Combined cataract surgery and vitrectomy is a surgical technique used to address both cataract and vitreoretinal disorders. With the advances in surgical tools, simultaneous removal of cataract associated with vitreoretinal disorders is gaining popularity. This technique offers several advantages over separate surgeries, including reduced surgical time and anaesthesia exposure, as well as quicker visual rehabilitation. However, the optimal timing and approach for combined cataract surgery and vitrectomy remain controversial. Indications for combined cataract surgery and vitrectomy include various vitreoretinal conditions, such as retinal detachment, diabetic retinopathy, macular holes, and epiretinal membranes. The timing of surgery depends on the severity of the cataract and the vitreoretinal pathology, as well as the surgeon's preference. The most common surgical techniques include phacoemulsification with posterior chamber intraocular lens implantation, followed by pars plana vitrectomy. The filling of the vitreous cavity is possible with several types of tamponades, such as different gases, but in extreme cases even with silicone oil. After gas tamponade, proper positioning of the patient is of great importance. Complications associated with combined cataract surgery and vitrectomy include posterior capsule rupture, intraocular lens dislocation, postoperative inflammation, and intraocular pressure elevation. However, the overall complication rate is low, and the visual outcomes are generally favourable. In conclusion, combined cataract surgery and vitrectomy is a useful technique for managing various vitreoretinal conditions. Proper patient selection, careful surgical planning, and close postoperative monitoring are critical for achieving optimal outcomes.

Célkitűzés: A szaruhártya-kórképek diagnosztikájában, követésében, valamint a szaruhártyaműtétek utáni állapot ellenőrzésében az optikai koherencia tomográfián (OCT) és Scheimpflug-elven működő képalkotó módszerek nagy jelentőséggel bírnak. Segítségükkel nagy felbontású keresztmetszeti képek nyerhetőek, valamint a szaruhártya vastagsága, elülső és hátulsó görbülete, így optikai törőereje válik meghatározhatóvá. Jelen tanulmányunkban elülső szegmentum optikai koherencia tomográfiával mért keratometriai és pachymetriai értékeket hasonlítunk össze perforáló keratoplasztikán átesett és egészséges szemek csoportján. Vizsgáltuk továbbá a műszer által mért értékek reprodukálhatóságát mindkét csoportban. Módszerek: 23 perforáló keratoplasztikán átesett szemen végeztünk méréseket swept-source elven működő elülső szegmentum optikai koherencia tomográfiával (Anterion, Heidelberg Engineering GmbH, Heidelberg, Németország) átlagosan 73,1±13,4 hónappal a varratszedés után. Kontrollcsoportnak 56 egészséges szem adatait vettük alapul. Mindkét csoportban vizsgáltuk az elülső és hátulsó felszíni axiális, valamint a teljes cornealis törőerőt a meredek és a lapos tengelyben. A teljes cornealis törőerő esetén a centrális átlagértéket is megmértük. Továbbá a centrális cornealis vastagságot és a szaruhártya legvékonyabb pontjának értékét hasonlítottuk össze a két csoport között. A mért keratometriai és pachymetriai adatok reprodukálhatóságát is mértük 13 keratoplasztika utáni és 15 egészséges szemen, a méréseket egyénenként 3-szor megismételve. Eredmények: A meredek tengelyben mért axiális törőerő nagyobb volt az elülső (48,3±3,5 D vs. 44,4±3,0 D; p<0,001) és a hátsó felszínen (–6,9±0,4 D vs. –6,5±0,6 D; p=0,001) keratoplasztika után a kontrollcsoporthoz képest. Ugyanezen értékek a lapos tengelyben azonban nem különböztek a két csoportban (elülső axiális görbület: 43,5±2,9 D vs. 42,9±2,2 D; p=0,302; hátulsó axiális görbület: –6,0±0,5 D vs. –6,1±0,4 D; p= 0,276). A teljes cornealis törőerő meredek tengelyben mért (48,5±4,0 D vs. 43,8±3,1 D; p<0,001) és átlagos centrális értékei (46,1±3,2 D vs. 43,1±2,7 D; p<0,001) szintén nagyobbak voltak a műtéten átesett csoportban. A lapos tengelyben mért teljes cornealis törőerő nem különbözött szignifikánsan a két csoportot összehasonlítva (43,7±3,1 D vs. 42,5±2,7 D; p=0,084). A szaruhártya centrális vastagsága keratoplasztika után 567,0±49,9 µm volt, amely szignifikánsan vastagabb volt az ép kontrollszemekhez képest (537,2±48,8 µm; p=0,016). A legvékonyabb pontot mérve azonban nem adódott szignifikáns különbség a két csoport közt (534,9±59,1 µm vs. 526,7±50,4 µm; p=0,534). Az intraclass korrelációs együttható (ICC) mindkét csoportban az összes vizsgált keratometriás és pachymetriás paraméterre nézve 0,9 feletti értéket mutatott. Következtetések: A swept-source OCT a szaruhártya görbületéről és vastagságáról megbízható, jól reprodukálható adatokat biztosít mind egészséges, mind keratoplasztikán átesettek körében. A korrigált látóélesség meghatározása mellett az elülső szegmentum OCT kiváló eszköz a műtét utáni optikai eredmény ellenőrzésére, követésére.

A szemfelszín allergiás és immunpatológiás betegségei gyulladások, amelyek előfordulhatnak enyhe, de súlyos, látásromlást okozó tünetekkel is. Az allergiás gyulladások elsősorban a conjunctivát érintik akut és/vagy krónikus conjunctivitist okozva. Több formáját különböztetjük meg: szezonális allergiás conjunctivitis, conjunctivitis vernalis, atopiás keratoconjunctivitis, kontaktallergia, óriás papillaris conjunctivitis. A leggyakoribb a szezonális forma, amely évszakhoz kötött. Az allergiás szemfelszíni folyamatok lokális kezelést igényelnek, műkönnyekkel, antiallergiás szemcseppekkel. Komplikációk előfordulásakor lokális kortikoszteroid- és ciklosporin-kezelés is alkalmazható. A szemfelszín immunpatológiai gyulladásai szisztémás betegségekhez kapcsolódnak. A keratoconjunctivitis sicca, bár szisztémás betegség nélkül is előfordul, a Sjögren-szindróma, illetve kollagénbetegségek gyakori kísérője. Az ocularis pemphigoid a nyálkahártya-pemphigoidok csoportjába tartozik. A kezdeti conjunctivitises tünetek után subconjunctivalis fibrosis kezdődik, amely elvezet a sym- és ankyloblepharon kialakulásához. A végső stádiumban a szemfelszínt heges kötőszövet fedi be (ocularis cikatrizáló pemphigoid), amely gyakorlatilag a látás elvesztését jelenti. A perifériás ulcerativ keratitisek általában kollagén vascularis betegségekhez, rheumatoid arthritishez kapcsolódnak. A limbus mellett kezdődő, 3–4 mm hosszú, íves beszűrődés kifekélyesedik, majd perforál, amelyen az iris előeshet. Elsősorban szisztémás kezelés szükséges, amely interdiszciplináris feladat. Lokálisan kortikoszteroid- és ciklosporin-szemcseppek adhatók. A cornea perforációjakor amnionfedés és/vagy keratoplasztika alkalmazható. Orv Hetil. 2023; 164(43): 1686–1692.

Szaruhártya-átültetés (keratoplasztika) akkor szükséges, amikor különböző kórállapotok következtében konzervatív kezeléssel nem gyógyítható, súlyos látáscsökkenéssel járó szaruhártyahomályok alakulnak ki, vagy a cornea szabályos szerkezete, görbülete torzul, funkciója elvész. A humán transzplantációk között a keratoplasztika a legsikeresebb műtéti eljárás. Az utóbbi évtizedekben a perforáló keratoplasztikák helyét egyre inkább átveszik a lamelláris transzplantációk, amikor csak a cornea kóros rétegét ültetjük át. Az elülső forma a mély elülső lamelláris keratoplasztika („deep anterior lamellar keratoplasty” – DALK), mely elsősorban keratoconusban ajánlott. A hátsó lamelláris transzplantáció fő formája a Descemet leválasztásos automatizált endothelialis keratoplasztika („Descemet’s stripping automated endothelial keratoplasty” – DSAEK) és a Descemet-membrán endothelialis keratoplasztika („Descemet’s membrane endothelial keratoplasty” – DMEK). Indikációja az endothelium pusztulásával járó szürkehályog-műtét után kialakuló keratopathia bullosa és a Fuchs endothelialis dystrophia. A lamelláris keratoplasztikáknak több előnyük van a perforáló műtétekkel szemben. Jobb a posztoperatív látóélesség, gyorsabb a sebgyógyulás, a betegrehabilitáció, és az esetleges immunológiai kilökődés lefolyása is enyhébb és jobban kezelhető. Orv Hetil. 2023; 164(28): 1087–1093.

Allergic and immunopathological diseases of the ocular surface are inflammations that can occur with mild to severe symptoms that cause visual impairment. Allergic inflammations mainly affect the conjunctiva, causing acute and/or chronic conjunctivitis. Several forms are distinguished: seasonal allergic conjunctivitis, vernal conjunctivitis, atopic keratoconjunctivitis, contact allergy, giant papillary conjunctivitis. The most common is the seasonal form, which is linked to seasons. Allergic ocular surface processes require local treatment with artificial tears, anti-allergic eye drops. If complications occur, topical corticosteroid and cyclosporin treatment may be used. Immunopathological inflammations of the ocular surface are associated with systemic diseases. Keratoconjunctivitis sicca, although occurring in the absence of systemic disease, is a common companion of Sjögren's syndrome and collagen diseases. Ocular pemphigoid belongs to the group of mucous membrane pemphigoids. After the initial conjunctivitis symptoms, subconjunctival fibrosis begins, leading to the development of sym- and ankyloblepharon. In the final stage, the ocular surface is covered by scar tissue (ocular cicatricial pemphigoid) which practically results in loss of vision. Peripheral ulcerative keratitis is usually associated with collagen vascular disease, rheumatoid arthritis. A 3-4 mm long, curved infiltration starting near the limbus becomes ulcerated and then perforates, on which the iris may prolapse. First, systemic treatment is required, which is an interdisciplinary task. Topical corticosteroid and cyclosporine eye drops may be administered. In the case of corneal perforation, amniotic membrane transplantation and/or keratoplasty may be performed. Orv Hetil. 2023; 164(43): 1686-1692.

Corneal transplantation (keratoplasty) is necessary when various disorders result in corneal opacities with severe visual loss that cannot be treated conservatively, or the regular structure and curvature of the cornea is distorted, and its function is lost. Among human transplantation, keratoplasty is the most successful surgical procedure. In recent decades, penetrating keratoplasties have been increasingly replaced by lamellar techniques, where only the abnormal layer of the cornea is transplanted. The anterior form is deep anterior lamellar keratoplasty (DALK), recommended mainly for keratoconus. The main forms of posterior lamellar keratoplasty are Descemet's stripping automated endothelial keratoplasty (DSAEK) and Descemet's membrane endothelial keratoplasty (DMEK). The indications are bullous keratopathy after cataract surgery with endothelial destruction and Fuchs endothelial dystrophy. Lamellar keratoplasty has several advantages over penetrating surgery. Postoperative visual acuity is better, wound healing, patient rehabilitation are faster and the course of any immune rejection is milder and can be better managed. Orv Hetil. 2023; 164(28): 1087-1093.

Semi-quantitative scoring is a method that is widely used to estimate the quantity of proteins on chromogen-labelled immunohistochemical (IHC) tissue sections. However, it suffers from several disadvantages, including its lack of objectivity and the fact that it is a time-consuming process. Our aim was to test a recently established artificial intelligence (AI)-aided digital image analysis platform, Pathronus, and to compare it to conventional scoring by five observers on chromogenic IHC-stained slides belonging to three experimental groups. Because Pathronus operates on grayscale 0-255 values, we transformed the data to a seven-point scale for use by pathologists and scientists. The accuracy of these methods was evaluated by comparing statistical significance among groups with quantitative fluorescent IHC reference data on subsequent tissue sections. The pairwise inter-rater reliability of the scoring and converted Pathronus data varied from poor to moderate with Cohen’s kappa, and overall agreement was poor within every experimental group using Fleiss’ kappa. Only the original and converted that were obtained from Pathronus original were able to reproduce the statistical significance among the groups that were determined by the reference method. In this study, we present an AI-aided software that can identify cells of interest, differentiate among organelles, protein specific chromogenic labelling, and nuclear counterstaining after an initial training period, providing a feasible and more accurate alternative to semi-quantitative scoring.