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History of cataract surgery from ancient times to today

Honorary Lecture at the 13th Conference of the Hungarian Medical Association of America – Hungary Chapter (HMAA-HC) at 30–31 August 2019, in Balatonfüred, Hungary

Developments in Health Sciences
Author: Z. Z. Nagy

Abstract

Cataract surgery is the most frequently performed ophthalmic surgery worldwide. This year approximately 32 million surgeries will be performed. The journey to modern, quick, and safe cataract surgery has been quite long. This review covers topics from ancient couching to the most modern phacoemulsification and femtosecond laser-assisted cataract surgery. The gain in quality of life is the largest with cataract surgery compared to other implant surgeries (e.g. knee, hip replacement, etc.). Ophthalmology has made huge advancements in recent decades. New microsurgical tools and diagnostic equipment have been developed, together with new surgical methods and foldable intraocular lenses, made from biocompatible material. From monofocal lenses, through aspheric, toric, and multifocal lenses, to multifocal toric lenses, today almost all kinds of refractive error can be compensated, including presbyopia. Teamwork, precise preoperative assessment, and fine surgical technique should also be emphasized in order to achieve the best and most predictable postoperative results for both patient and surgeon.

Open access

Abstract

Preeclampsia is a severe, sometimes life-threatening complication of pathological pregnancies. The incidence of neonatal morbidity and mortality is usually increased. Besides general maternal symptoms like hemolysis, low platelet number, elevated liver enzyme level, proteinuria, cardiovascular problems, neurological and cerebral complications, serious ophthalmic symptoms might occur. These include focal or generalized narrowing of the arterioles, flame-shaped retinal haemorrhages, and cotton-wool spots. Rarely, disc swelling, exudative retinal detachment, cystoid macular edema, bilateral occipital lobe infarction, or cortical blindness might occur. In this article, I review the retinal and macular changes, retinal detachment, and the cause of blindness. Optical coherence tomography (OCT) allows ophthalmologists to diagnose early and late changes in choroid vasculature and circulation, and consequent retinal morphological changes. Spectral-domain OCT and enhanced depth imaging provide important insight and possible prognosis for the course of the disease. After termination of the pathological pregnancy, vision returns to normal in most cases; unfortunately, there are some exceptions.

Open access

Abstract

Epidemics and pandemics have happened throughout the history of mankind. Before the end of the 20th century, scientific progress successfully eradicated several of the pathogens. While no one has to be afraid of smallpox anymore, there are some new pathogens that have never caused human disease before. Coronaviruses are a family of enveloped RNA viruses. In the 21st century, three of them have caused serious pandemics, including severe acute respiratory syndrome in 2002 and Middle East Respiratory Syndrome in 2012. In 2019 severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) caused the coronavirus disease-19 (COVID-19) pandemic, which has destroyed hundreds of thousands of lives and continues to rage.

Open access

Although much is known about the protective effect of acute estrogen therapy in cerebral ischemia, relatively little is known about the importance of apoptosis and cerebral plasticity in this mechanism. In this work 10 min global cerebral ischemia was produced by transient bilateral carotid occlusion in 4-month-old ovariectomized female gerbils. In every of our experimental group (sham for ischemia group, ischemia group and ischemia + a high, single dose 17β-estradiol pre-treatment group) apoptotic (bcl-Xl, bax) and cerebral plasticity (GAP-43, synapsin-I, nestin) hippocampal genes’ expression was measured four days after surgery. Expression of the anti-apoptotic bcl-Xl (p<0.01) and the cerebral plasticity marker synapsin-I and nestin (p<0.01) increased with acute estrogen pretreatment in ischemic animals. No change, however, in bax or GAP-43 expression was detected in estrogen treated animals compared to ischemic gerbils. These results suggest that acute estrogen therapy has anti-apoptotic effect and increases cerebral plasticity, which play an important role in cytoprotection or cerebroprotection.

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Developments in Health Sciences
Authors: A. Gyenes, G.L. Sándor, B. Csákány, Zs Récsán, G. Rudas, Z.Z. Nagy, and E. Maka

Abstract

A case of a 13-year-old girl after being injured on the left eyeball by a stick from a cage, is presented. Along vitreous haemorrhage, retinal oedema and ischaemia, the disc was replaced by a cavity. Multimodal imaging was performed, which confirmed the optic nerve damage. The eye had no light perception anymore. Our case is a demonstration for complete avulsion of the optic nerve after blunt injury.

Open access

Abstract

Purpose

Our aims were to evaluate the primary and clinical evisceration indications and to analyse orbital implant related complications.

Materials/methods

We included in our retrospective review all eviscerations between 2006 and 2016 at the Department of Ophthalmology of Semmelweis University, Budapest, Hungary. Primary evisceration indications were classified into six groups: trauma, surgical diseases, infections or inflammations, systemic diseases, tumours and unclassifiable diseases. Clinical immediate evisceration indications were also classified into six groups: painful blind eye due to glaucoma, atrophia/phthisis bulbi, endophthalmitis, cosmetic reasons, acute trauma and expulsive bleeding.

Results

Evisceration was performed in 46 eyes of 46 patients (54.3% males, age 43.0 ± 18.6 years). The most common primary evisceration indications were trauma (37%), surgical diseases (34.8%), infection or inflammation (10.9%), systemic diseases (6.5%), tumours (8.7%) and unclassifiable diseases (2.2%). Painful blind eye due to glaucoma (34.8%) was the most common clinical indication for evisceration, followed by atrophia/phthisis bulbi (26.1%), endophthalmitis (17.4%), cosmetic reasons (13.0%), acute trauma (6.5%) and expulsive bleeding (2.2%). After evisceration, 91.3% of the patients received orbital implant and during 26.8±28.9 months follow-up implant related complications were found in 14.3% of the cases, including implant extrusion (4.8%), partial wound dehiscence (4.8%), implant exposure (2.4%) and orbital inflammation (2.4%).

Conclusion

Painful blind eye and atrophia/phthisis bulbi due to ocular trauma and surgical diseases represent the most common indications for ocular evisceration. If malignant intraocular tumours can be excluded, evisceration surgery combined with a silicon-based orbital implant is a safe and effective procedure.

Open access

A simultaneous live/dead and acrosome staining, originally described for domestic mammals, was successfully applied on red deer (Cervus elaphus) and fallow deer (Dama dama) spermatozoa collected from the cauda epididymidis and vas deferens of shot stags. The staining is simple enough for routine application. Seven classes of spermatozoa were distinguished in the smears of frozen/thawed semen samples. Morphology, including cytoplasmic droplets, was evaluated as well. Percentage of live cells with intact acrosomes and with no other morphological aberrations might be a practical index of semen quality.

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Abstract

Aims: We investigated the influence of body mass index (BMI) on the prevalence of responder status in chronic heart failure patients after cardiac resynchronization therapy (CRT).

Methods: Data on 169 patients with resynchronization therapy were analyzed. Patients were categorized on the basis of the BMI measured at device implantation according to the WHO classification, as normal (BMI: 18.5–24.9 kg/m2), overweight (BMI: 25–29.9 kg/m2) or obese (BMI:≥30 kg/m2). Patients were considered responders if left ventricular ejection fraction was increased by at least 5% at 6-month follow-up.

Results: The mean age in the study population was 60.9±10.86 years (females 29%). The BMI subgroups did not exhibit any significant differences in baseline characteristics (age, gender, left ventricular ejection fraction or NYHA class). Elevated BMIs were associated with higher prevalence of responder status (overweight: 71.4%, obese: 63.0%) relative to subjects with a normal BMI (44.7%) (p=0.015).

Conclusions: In this CRT population, overweight status was associated with a more favorable response to CRT, indicating that the response may possibly be influenced by factors other than those directly related to the heart status or the technical details of the CRT.

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Enterotoxigenic E. coli (ETEC) bacteria frequently cause watery diarrhoea in newborn and weaned pigs. Plasmids carrying genes of different enterotoxins and fimbrial adhesins, as well as plasmids conferring antimicrobial resistance are of prime importance in the epidemiology and pathogenesis of ETEC. Recent studies have revealed the significance of the porcine ETEC plasmid pTC, carrying tetracycline resistance gene tet(B) with enterotoxin genes. In contrast, the role of tet(A) plasmids in transferring resistance of porcine ETEC is less understood. The objective of the present study was to provide a comparative analysis of antimicrobial resistance and virulence gene profiles of porcine post-weaning ETEC strains representing pork-producing areas in Central Europe and in the USA, with special attention to plasmids carrying the tet(A) gene. Antimicrobial resistance phenotypes and genotypes of 87 porcine ETEC strains isolated from cases of post-weaning diarrhoea in Austria, the Czech Republic, Hungary and the Midwest USA was determined by disk diffusion and by PCR. Central European strains carrying tet(A) or tet(B) were further subjected to molecular characterisation of their tet plasmids. Results indicated that > 90% of the ETEC strains shared a common multidrug resistant (MDR) pattern of sulphamethoxazole (91%), tetracycline (84%) and streptomycin (80%) resistance. Tetracycline resistance was most frequently determined by the tet(B) gene (38%), while tet(A) was identified in 26% of all isolates with wide ranges for both tet gene types between some countries and with class 1 integrons and resistance genes co-transferred by conjugation. The virulence gene profiles included enterotoxin genes (lt, sta and/or stb), as well as adhesin genes (k88/f4, f18). Characterisation of two representative tet(A) plasmids of porcine F18+ ETEC from Central Europe revealed that the IncF plasmid (pES11732) of the Czech strain (~120 kb) carried tet(A) in association with catA1 for chloramphenicol resistance. The IncI1 plasmid (pES2172) of the Hungarian strain (~138 kb) carried tet(A) gene and a class 1 integron with an unusual variable region of 2,735 bp composed by two gene cassettes: estX-aadA1 encoding for streptothricin-spectinomycin/streptomycin resistance exemplifying simultaneous recruitment, assembly and transfer of multidrug resistance genes by the tet(A) plasmid of porcine ETEC. By this we provide the first description of IncF and IncI1 type plasmids of F18+ porcine enterotoxigenic E. coli responsible for cotransfer of the tet(A) gene with multidrug resistance. Additionally, the unusual determinant estX, encoding for streptothricin resistance, is first reported here in porcine enterotoxigenic E. coli.

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The mediodorsal prefrontal cortex (mdPFC) is a key structure of the central glucose-monitoring (GM) neural network. Previous studies indicate that intracerebral streptozotocin (STZ) microinjection-induced destruction of local chemosensory neurons results in feeding and metabolic alterations. The present experiments aimed to examine whether STZ microinjection into the mdPFC causes metabolic deficits. To do so, glucose tolerance test (GTT) and measurements of plasma metabolites were performed in STZ-treated or control rats. Intraperitoneal D-glucose load was delivered 20 min or 4 weeks following the intracerebral microinjection of STZ or saline (acute or subacute GTT, respectively). The STZ-treated rats displayed acute glucose intolerance: at the 120th min of the test, blood glucose level of these rats was significantly higher than that of the ones in the control group. When determining the plasma level of various metabolites, 30 min following the intracerebral STZ or saline microinjection, the triglyceride concentration of the STZ-treated rats was found to be reduced compared with that of the control rats. The GM neurons of the mdPFC are suggested to be involved in the organization of complex metabolic processes by which these chemosensory cells contribute to adaptive control mechanisms of the maintenance of homeostasis.

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