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Valéria Nagy

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University of Oxford

Eswar Prasad Korilimilli

Mahindra Ecole Centrale

Rebecca Riggins

Georgetown University

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Ashraf Y Nasr Naiem

Zagazig University

Prof. Dr. Rasime Kalkan

European University of Lefke

Marta Maria Alonso Roldan

Universidad de Navarra

Universidade Federal do Rio Grande do Sul

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Papers by Valéria Nagy

Alport Patients without Classic Ocular Symptoms Have Smaller Lens Diameter

Medical Science Monitor, Mar 28, 2019

The aim of this study was to present ophthalmological findings regarding Alport syndrome and repo... more The aim of this study was to present ophthalmological findings regarding Alport syndrome and report refractometry data and to present possible early signs of the syndrome. Material/Methods: Seven patients suffering from Alport syndrome were referred to the Department of Ophthalmology at the University of Debrecen between January 1 st , 2014, and December 31 st , 2015. All patients underwent slit lamp evaluation and dilated fundus biomicroscopy, with special attention paid to lenticonus and retinal changes. IOL Master, Pentacam HR, and ultrasound biomicroscopy were performed to assess keratometry, corneal thickness, anterior chamber depth, lens size, and axial length data. Results: One patient out of seven had ocular symptoms. Posterior polymorphous corneal dystrophy (PPMD) and dotand-fleck retinopathy were seen. Meanwhile, although keratoconus was not proven, remarkable astigmatism with high myopia was detected. The other six patients were found to have a significantly smaller lens diameter (an average of 7.82±0.66 mm, p=0.035) compared to normal controls (an average of 8.65±0.46 mm). Lenses also tended to be thicker in Alport patients (3.48±0.19 mm) compared to controls (3.4±0.2 mm), although the difference was not significant (p=0.394). The power of the lens also showed a significant difference (p=0.026), with Alport patients having lower lens power. Conclusions: Alport syndrome patients without classical ophthalmological findings have smaller crystalline lens diameter and lower lens power. These signs may support the diagnosis of Alport syndrome. Ophthalmologists should not only seek for the known classic signs, but also the parameters of the crystalline lens, especially if genetic testing is not available.

Analysis of the Association between Retinal Artery Occlusion and Acute Ischaemic Stroke/ST-Elevation Myocardial Infarction and Risk Factors in Hungarian Patients

Medicina

Background and Objectives: We aimed to analyse data on retinal artery occlusion (RAO) patients to... more 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 o...

[Differential diagnosis of Graves' orbitopathy. Case report]

Orvosi hetilap, Jan 21, 2016

Graves' orbitopathy is the extrathyroidal manifestation of Graves' disease, which is the ... more Graves' orbitopathy is the extrathyroidal manifestation of Graves' disease, which is the most common cause of exophthalmos. As eye symptoms usually coincide with the development of thyrotoxicosis, the diagnosis of the disease is rarely difficult. The aim of the authors was to summarize the differential diagnosis of Graves' orbitopathy based on literature review and presentation of their own four problematic cases on this topic. They conclude that symptoms similar to endocrine orbitopathy are present in other disorders. Endocrinologists need to be aware of these other conditions to avoid treatment failures. Orv. Hetil., 2016, 157(8), 310-315.

Die klinik des morning-glory-syndroms: Eine falldarstellung

Klinische Monatsblatter Fur Augenheilkunde, Nov 1, 2002

Background: Handmann was the first to describe the morning glory syndrome in 6 cases in 1929. In ... more Background: Handmann was the first to describe the morning glory syndrome in 6 cases in 1929. In 1970 Kindler published some cases with an unusual congenital anomaly of the optic disc. Since then, several authors have come to the conclusion that both authors described the same disease. Patients and methods: In January 2000, morning glory syndrome was diagnosed in two patients, mother and daughter. Ophthalmological and electrophysiological examinations, furtheron brain scan and magnetic resonance imaging (MRI) of the orbit were performed. Results: Malformation of the optic disc was bilateral in both cases. Optic disc abnormality was accompanied by no other anomalies or malformations. Ultrasound examination and MRI of the orbit did not detect posterior staphyloma in our cases. Thus, our two patients are the first to be described in the literature, where the anomaly of the optic disc occurred in isolation. Discussion: Our cases are different from those described in the literature as far as the characteristic anomaly of the optic disc was bilateral and the occurrence was genetical. It is also noteworthy that no other ophthalmological or general malformations could be detected in our patients besides the anomaly of the optic disc. Morning glory syndrome occurred in isolation, which makes our cases unique.

Hepatitis C Virus Presumably Associated Bilateral Consecutive Anterior Ischemic Optic Neuropathy

European Journal of Ophthalmology, 2008

Purpose To report a case of bilateral nonarteritic anterior ischemic optic neuropathy (NAION) in ... more Purpose To report a case of bilateral nonarteritic anterior ischemic optic neuropathy (NAION) in a hepatitis C (HCV) infected patient and demonstrate the relationship between HCV and the development of NAION. Methods Case report. Results A 43-year-old woman with chronic HCV infection and long-term euthyroid autoimmune thyroiditis suddenly lost vision in her right eye, and 6 months later in her left eye, due to NAION. Slightly elevated levels of aminotransferases suggested liver infection activity. Anti-HCV antibody was detected; the genotype of the virus was 1b and the viral RNA level was 1.8 × 106 IU/mL. Liver biopsy proved chronic active hepatitis (Ishak score grading: 7, staging: 2). Except for the elevated levels of antithyroid antibodies and a weak antinuclear factor, the detailed laboratory examinations (thrombophilia, cryoglobulin, anticardiolipin antibodies, co-infections) revealed no other abnormalities; a causative relationship between the underlying chronic hepatitis C an...

Plasma E-selectin levels can play a role in the development of diabetic retinopathy

Graefe's Archive for Clinical and Experimental Ophthalmology, 2016

Purpose Diabetic retinopathy is one of the leading causes of blindness. There are several risk fa... more Purpose Diabetic retinopathy is one of the leading causes of blindness. There are several risk factors, such as the duration of diabetes or glycemic control of the patient; however, several biochemical factors also alter the process. Our aim was to investigate the role of soluble E-selectin in the formation of diabetic retinopathy. Patients and methods Fifty-seven patients (37 female and 20 male, aged 61.71 ± 12.31 years) and 14 healthy control subjects (ten female and four male, aged 63.06 ± 10.46 years) were enrolled in the study. We measured the soluble E-selectin level in the plasma of patients by ELISA. All patients underwent careful ophthalmological examination, including ophthalmoscopy and color fundus photography, while diabetic retinopathy grading was performed in line with the 2012 classification of the American Academy of Ophthalmology (AAO). Results The soluble E-selectin level was significantly higher in patients with diabetes compared to controls (32.95 ng/ml vs. 26.55 ng/ml, p = 0.03). Dividing patients into groups by the presence of retinopathy, the E-selectin level was also significantly higher in the retinopathy group (p < 0.05). When we examined diabetic patients by the severity of retinopathy (groups A, B, and C, by the guidelines of the AAO), however, we did not find any significant difference in soluble E-selectin levels, although it tended to be higher in group B. Conclusions An elevated E-selectin level can play a role in the development of diabetic retinopathy, but it does not seem to alter disease severity. However, glycemic control and the reduction of cardiovascular risk factors may also alter the level of E-selectin that might play a role in the prevention of diabetic retinopathy.

Thrombophilic screening in retinal artery occlusion patients

Clinical Ophthalmology, 2008

Background: Retinal artery occlusion (RAO) is an ischemic vascular damage of the retina, which fr... more Background: Retinal artery occlusion (RAO) is an ischemic vascular damage of the retina, which frequently leads to sudden, mostly irreversible loss of vision. In this study, blood thrombophilic factors as well as cardiovascular risk factors were investigated for their relevance to this pathology. Thrombophilic risk factors so far not evaluated were included in the study. Patients and methods: 28 RAO patients and 81 matched control subjects were examined. From blood samples, protein C, protein S, antithrombinopathy, and factor V (Leiden) mutation (FV), factor II gene polymorphism, factor VIII C level, plasminogen activity, lipoprotein(a) and fi brinogen levels, hyperhomocysteinemia and presence of anticardiolipin-antiphospholipid antibodies were investigated. Possibly relevant pathologies such as diabetes mellitus, hypertension, and ischemic heart disease were also registered. Statistical analysis by logistic regression was performed with 95% confi dence intervals. Results: In the group of patients with RAO only the incidence of hypertension (OR: 3.33, 95% CI: 1.30-9.70, p = 0.014) as an average risk factor showed signifi cant difference, but thrombophilic factors such as hyperfi brinogenemia (OR: 2.9, 95% CI: 1.29-6.57, p = 0.010) and the presence of FV (Leiden mutation) (OR: 3.9, 95% CI: 1.43-10.96, p = 0.008) increased the chances of developing this disease. Conclusions: Our results support the assumption that thrombophilia may contribute to the development of RAO besides vascular damage due to the presence of cardiovascular risk factors. Further studies are needed, however, to justify the possible use of secondary prophylaxis in form of anticoagulant/antiplatelet therapy.

Tear fluid proteomics multimarkers for diabetic retinopathy screening

BMC Ophthalmology, 2013

Background: The aim of the project was to develop a novel method for diabetic retinopathy screeni... more Background: The aim of the project was to develop a novel method for diabetic retinopathy screening based on the examination of tear fluid biomarker changes. In order to evaluate the usability of protein biomarkers for prescreening purposes several different approaches were used, including machine learning algorithms. Methods: All persons involved in the study had diabetes. Diabetic retinopathy (DR) was diagnosed by capturing 7field fundus images, evaluated by two independent ophthalmologists. 165 eyes were examined (from 119 patients), 55 were diagnosed healthy and 110 images showed signs of DR. Tear samples were taken from all eyes and stateof-the-art nano-HPLC coupled ESI-MS/MS mass spectrometry protein identification was performed on all samples. Applicability of protein biomarkers was evaluated by six different optimally parameterized machine learning algorithms: Support Vector Machine, Recursive Partitioning, Random Forest, Naive Bayes, Logistic Regression, K-Nearest Neighbor. Results: Out of the six investigated machine learning algorithms the result of Recursive Partitioning proved to be the most accurate. The performance of the system realizing the above algorithm reached 74% sensitivity and 48% specificity. Conclusions: Protein biomarkers selected and classified with machine learning algorithms alone are at present not recommended for screening purposes because of low specificity and sensitivity values. This tool can be potentially used to improve the results of image processing methods as a complementary tool in automatic or semiautomatic systems.

Activated protein C resistance in anterior ischaemic optic neuropathy

Acta Ophthalmologica Scandinavica, 2004

Resistance of coagulation factor V (FV) to activated protein C (APC), mostly due to FV Leiden mut... more Resistance of coagulation factor V (FV) to activated protein C (APC), mostly due to FV Leiden mutation, is the most common cause of inherited thrombophilia. The aim of this retrospective study was to determine the prevalence of APC resistance and Leiden mutation in patients with non-arteritic anterior ischaemic optic neuropathy (NAION). Methods: A total of 25 patients with NAION were examined between 1997 and 2002. The patients were screened for APC resistance and FV Leiden mutation as well as for acquired risk factors of vascular disease such as diabetes mellitus, hypercholesterolaemia, hypertonia and ischaemic heart disease. A control group of subjects without ocular vascular disease and with homogenous distribution of the same risk factors was used for comparison. Results: Six of the 25 patients (24%) with NAION had APC resistance due to the heterozygous Leiden mutation of FV. The frequency of the same genetic mutation in the control group was only 5.9%. Odds ratio calculations showed that patients with the Leiden mutation were at a significantly higher risk of NAION than control patients (p 0.021). Conclusion: The high frequency of Leiden mutation in NAION suggests a pathogenic role of the mutation in the disease.

Az Eales-betegség klinikai tünetei, differenciáldiagnosztikai problémái, kezelése

Analysis of optic disc damage by optical coherence tomography in terms of therapy in non-arteritic anterior ischemic optic neuropathy

International journal of ophthalmology, 2016

This study aimed to assess the relationship between the rate of nerve fiber loss in non-arteritic... more This study aimed to assess the relationship between the rate of nerve fiber loss in non-arteritic anterior ischemic optic neuropathy (NAION) and time delay before therapy. Total 24 patients received the same treatment within or after 2wk (early and late groups). There were significantly lower level of destruction of nerve fibers (P=0.0014) and significantly better visual field sensitivity (P=0.039) in early group. The results indicate that therapy should be started within 2wk. The degree of ischemic damage due to NAION correlates well with retinal nerve fiber layer thickness and the ischemia-induced decrease in visual field sensitivity.

Combined Methods for Diabetic Retinopathy Screening, Using Retina Photographs and Tear Fluid Proteomics Biomarkers

Journal of Diabetes Research, 2015

Background. It is estimated that 347 million people suffer from diabetes mellitus (DM), and almos... more Background. It is estimated that 347 million people suffer from diabetes mellitus (DM), and almost 5 million are blind due to diabetic retinopathy (DR). The progression of DR can be slowed down with early diagnosis and treatment. Therefore our aim was to develop a novel automated method for DR screening.Methods. 52 patients with diabetes mellitus were enrolled into the project. Of all patients, 39 had signs of DR. Digital retina images and tear fluid samples were taken from each eye. The results from the tear fluid proteomics analysis and from digital microaneurysm (MA) detection on fundus images were used as the input of a machine learning system.Results. MA detection method alone resulted in 0.84 sensitivity and 0.81 specificity. Using the proteomics data for analysis 0.87 sensitivity and 0.68 specificity values were achieved. The combined data analysis integrated the features of the proteomics data along with the number of detected MAs in the associated image and achieved sensiti...

Graves’ orbitopathy results in profound changes in tear composition; a study of Plasminogen activator inhibitor-1 (PAI-1) and seven cytokines

Thyroid, 2011

Thyroid Graves' orbitopathy results in profound changes in tear composition; a study of Plasminog... more

Die Klinik des Morning-Glory-Syndroms

Klinische Monatsblätter für Augenheilkunde, 2002

Handmann was the first to describe the morning glory syndrome in 6 cases in 1929. In 1970 Kindler... more Handmann was the first to describe the morning glory syndrome in 6 cases in 1929. In 1970 Kindler published some cases with an &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;unusual congenital anomaly of the optic disc&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;. Since then, several authors have come to the conclusion that both authors described the same disease. In January 2000, morning glory syndrome was diagnosed in two patients, mother and daughter. Ophthalmological and electrophysiological examinations, further brain scan and magnetic resonance imaging (MRI) of the orbit were performed. Malformation of the optic disc was bilateral in both cases. Optic disc abnormality was accompanied by no other anomalies or malformations. Ultrasound examination and MRI of the orbit did not detect posterior staphyloma in our cases. Thus, our two patients are the first to be described in the literature, where the anomaly of the optic disc occurred in isolation. Our cases are different from those described in the literature as far as the characteristic anomaly of the optic disc was bilateral and the occurrence was genetical. It is also noteworthy that no other ophthalmological or general malformations could be detected in our patients besides the anomaly of the optic disc. Morning glory syndrome occurred in isolation, which makes our cases unique.

Anterior polar cataract as a cause of monocular diplopia

Journal of Cataract and Refractive Surgery, 2004

Trombophilic screening for nonarteritic anterior ischemic optic neuropathy

Graefe's Archive for Clinical and Experimental Ophthalmology, 2005

Nonarteritic anterior ischemic optic neuropathy (NAION) is an ischemic infarction of the optic ne... more Nonarteritic anterior ischemic optic neuropathy (NAION) is an ischemic infarction of the optic nerve head, frequently leading to sudden, mostly irreversible loss of vision. In this study blood thrombophilic factors, as well as cardiovascular risk factors were investigated for their relevance to this pathology. Trombophilic risk factors so far not evaluated were included in the study. 37 NAION patients (4 with sequential second eye involvement) and 81 matched control subjects were examined. From blood, protein C, protein S, antithrombin, von Willebrand antigen levels (vWFAg), and factor V (Leiden) mutation, factor VIIIC level, plasminogen activity, lipoprotein (a) and fibrinogen levels, and presence of anticardiolipin antibodies were investigated. Possibly relevant pathologies [e.g. diabetes mellitus (DM), hypertension, and ischemic heart disease] were also registered. Elevated Lp(a) and vWFAg levels, DM, F V (Leiden), hypercholesterolemia, and hyperfibinogenemia proved to be significant risk factors associated with NAION. Forward stepwise logistic regression analysis revealed that high Lp(a), DM, and FV (Leiden) were the main predictive components, with odds ratios 16.88 (p=0.012), 5.78 (p=0.022) and 4.44 (p=0.033), respectively. Based on our results it appears that thrombophilia is likely to contribute to the development of NAION besides vascular damage due to the presence of cardiovascular risk factors. Further data are needed, however, to justify the suggested use of secondary prophylaxis using anticoagulant/antiplatelet therapy.

Bilateral Central Retinal Vein Occlusion Caused By Malignant Hypertension in a Young Patient

Clinical and Experimental Hypertension, 2010

Central retinal vein occlusion (CRVO) occurring simultaneously in both eyes is a rare condition, ... more Central retinal vein occlusion (CRVO) occurring simultaneously in both eyes is a rare condition, in such cases usually associated with severe systemic disease. Overall, only 10% of all CRVO patients are younger than 40 years. A relatively young patient reported with simultaneous bilateral CRVO associated with chronic kidney disease and malignant hypertension. A case of a 35-year-old male patient presented with the complaint of decreased vision in both eyes. Ophthalmic examination revealed bilateral CRVO. Chronic kidney disease leading to malignant hypertension and hyperviscosity was diagnosed as the underlying cause. Clinical support and medical therapy effectively controlled the hypertension, leading to improvement of both the systemic and ocular changes. To the best of our knowledge, this is the first case report of simultaneous bilateral CRVO in a young patient associated with chronic renal failure and malignant hypertension. Primary care providers, either ophthalmologists or physicians, need to consider both common and atypical risk factors for retinal vein occlusion, in order to prevent further ocular morbidity and systemic complications.

Multimarkers for diabetic retinopathy screening

Acta Ophthalmologica, 2012

ABSTRACT Purpose The aim of the project was to develop a methodology for diabetic retinopathy (DR... more ABSTRACT Purpose The aim of the project was to develop a methodology for diabetic retinopathy (DR) screening based on the examination of tear fluid biomarker changes. To evaluate the usability of protein biomarkers for pre-screening purposes different approaches and machine learning algorithms were used. Methods All persons involved in the study had diabetes. DR was diagnosed by capturing 7-field fundus images. 165 eyes were examined, 55 were diagnosed healthy and 110 images showed signs of DR. Tears were taken from all eyes and state-of-the-art nano-HPLC coupled ESI-MS/MS mass spectrometry protein identification was performed on them. Applicability of protein biomarkers was evaluated by six different optimal parameterized machine learning algorithms. Results Out of the six identified machine learning algorithms, result of the Recursive Partitioning proved to be the most accurate. The performance indicators of the system applying the above algorithm indicated 74 % sensitivity and 48% specificity. Conclusion Neither protein biomarkers nor machine learning algorithms are recommended alone for screening purposes because of low specificity and sensitivity values. This tool can be preferably used to improve the results of image processing methods as a complementary tool in automatic or semiautomatic systems.

Increased level of platelet P-selectin in nonarteritic anterior ischemic optic neuropathy

Graefe's Archive for Clinical and Experimental Ophthalmology, 2012

Purpose P-selectin receptor is expressed in platelets and endothelial cells in a cell-activation-... more Purpose P-selectin receptor is expressed in platelets and endothelial cells in a cell-activation-dependent manner. Platelet P-selectin (CD62) levels may become elevated in a number of vasoocclusive diseases, including arteriosclerosis, atherothrombosis, and diabetes mellitus (DM). Nonarteritic anterior ischemic optic neuropathy (NAION) is associated with a sudden loss of vision due to the vascular insufficiency of ciliary arteries supplying the optic nerve. In this study, our aim was to investigate the presence of increased platelet reactivity in the development of NAION. Methods Twenty-one NAION patients, 39 healthy control subjects, and 44 patients suffering from diabetes mellitus (DM) were examined in our case-control, pilot study. Platelet activation was investigated by flow cytometric analysis of the mean fluorescence intensity (MFI) of CD62 on platelets. These results were compared among the different study groups. Results NAION patients showed considerably although not signifactly (p00.2017) higher P-selectin MFI values (71.98 ±40.30) versus healthy subjects (55.48±20.95), insulindependent DM patients (50.02±13.08), and non-insulindependent DM subjects (54.72±24.74). However, logistic regression analysis resulted in a statistically significant adjusted effect on the odds of NAION when CD62 MFI values were logarithmically transformed (OR: 3.86, 95 % CI: 1.10 to 13.53, p00.0346). Conclusion Elevated platelet CD62 positivity may be related to NAION, suggesting a possible role of enlarged platelet activity in the generation of this type of ischemic optic neuropathy.

Curbside Consultation in Neuro-Ophthalmology—49 Clinical Questions. Eds: Andrew G. Lee, Paul W. Brazis and Lanning B. Kline. ISBN: 978-1-55642-840-1 SLACK Incorporated

Graefe's Archive for Clinical and Experimental Ophthalmology, 2010

Alport Patients without Classic Ocular Symptoms Have Smaller Lens Diameter

Medical Science Monitor, Mar 28, 2019

The aim of this study was to present ophthalmological findings regarding Alport syndrome and repo... more The aim of this study was to present ophthalmological findings regarding Alport syndrome and report refractometry data and to present possible early signs of the syndrome. Material/Methods: Seven patients suffering from Alport syndrome were referred to the Department of Ophthalmology at the University of Debrecen between January 1 st , 2014, and December 31 st , 2015. All patients underwent slit lamp evaluation and dilated fundus biomicroscopy, with special attention paid to lenticonus and retinal changes. IOL Master, Pentacam HR, and ultrasound biomicroscopy were performed to assess keratometry, corneal thickness, anterior chamber depth, lens size, and axial length data. Results: One patient out of seven had ocular symptoms. Posterior polymorphous corneal dystrophy (PPMD) and dotand-fleck retinopathy were seen. Meanwhile, although keratoconus was not proven, remarkable astigmatism with high myopia was detected. The other six patients were found to have a significantly smaller lens diameter (an average of 7.82±0.66 mm, p=0.035) compared to normal controls (an average of 8.65±0.46 mm). Lenses also tended to be thicker in Alport patients (3.48±0.19 mm) compared to controls (3.4±0.2 mm), although the difference was not significant (p=0.394). The power of the lens also showed a significant difference (p=0.026), with Alport patients having lower lens power. Conclusions: Alport syndrome patients without classical ophthalmological findings have smaller crystalline lens diameter and lower lens power. These signs may support the diagnosis of Alport syndrome. Ophthalmologists should not only seek for the known classic signs, but also the parameters of the crystalline lens, especially if genetic testing is not available.

Analysis of the Association between Retinal Artery Occlusion and Acute Ischaemic Stroke/ST-Elevation Myocardial Infarction and Risk Factors in Hungarian Patients

Medicina

Background and Objectives: We aimed to analyse data on retinal artery occlusion (RAO) patients to... more 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 o...

[Differential diagnosis of Graves' orbitopathy. Case report]

Orvosi hetilap, Jan 21, 2016

Graves' orbitopathy is the extrathyroidal manifestation of Graves' disease, which is the ... more Graves' orbitopathy is the extrathyroidal manifestation of Graves' disease, which is the most common cause of exophthalmos. As eye symptoms usually coincide with the development of thyrotoxicosis, the diagnosis of the disease is rarely difficult. The aim of the authors was to summarize the differential diagnosis of Graves' orbitopathy based on literature review and presentation of their own four problematic cases on this topic. They conclude that symptoms similar to endocrine orbitopathy are present in other disorders. Endocrinologists need to be aware of these other conditions to avoid treatment failures. Orv. Hetil., 2016, 157(8), 310-315.

Die klinik des morning-glory-syndroms: Eine falldarstellung

Klinische Monatsblatter Fur Augenheilkunde, Nov 1, 2002

Background: Handmann was the first to describe the morning glory syndrome in 6 cases in 1929. In ... more Background: Handmann was the first to describe the morning glory syndrome in 6 cases in 1929. In 1970 Kindler published some cases with an unusual congenital anomaly of the optic disc. Since then, several authors have come to the conclusion that both authors described the same disease. Patients and methods: In January 2000, morning glory syndrome was diagnosed in two patients, mother and daughter. Ophthalmological and electrophysiological examinations, furtheron brain scan and magnetic resonance imaging (MRI) of the orbit were performed. Results: Malformation of the optic disc was bilateral in both cases. Optic disc abnormality was accompanied by no other anomalies or malformations. Ultrasound examination and MRI of the orbit did not detect posterior staphyloma in our cases. Thus, our two patients are the first to be described in the literature, where the anomaly of the optic disc occurred in isolation. Discussion: Our cases are different from those described in the literature as far as the characteristic anomaly of the optic disc was bilateral and the occurrence was genetical. It is also noteworthy that no other ophthalmological or general malformations could be detected in our patients besides the anomaly of the optic disc. Morning glory syndrome occurred in isolation, which makes our cases unique.

Hepatitis C Virus Presumably Associated Bilateral Consecutive Anterior Ischemic Optic Neuropathy

European Journal of Ophthalmology, 2008

Purpose To report a case of bilateral nonarteritic anterior ischemic optic neuropathy (NAION) in ... more Purpose To report a case of bilateral nonarteritic anterior ischemic optic neuropathy (NAION) in a hepatitis C (HCV) infected patient and demonstrate the relationship between HCV and the development of NAION. Methods Case report. Results A 43-year-old woman with chronic HCV infection and long-term euthyroid autoimmune thyroiditis suddenly lost vision in her right eye, and 6 months later in her left eye, due to NAION. Slightly elevated levels of aminotransferases suggested liver infection activity. Anti-HCV antibody was detected; the genotype of the virus was 1b and the viral RNA level was 1.8 × 106 IU/mL. Liver biopsy proved chronic active hepatitis (Ishak score grading: 7, staging: 2). Except for the elevated levels of antithyroid antibodies and a weak antinuclear factor, the detailed laboratory examinations (thrombophilia, cryoglobulin, anticardiolipin antibodies, co-infections) revealed no other abnormalities; a causative relationship between the underlying chronic hepatitis C an...

Plasma E-selectin levels can play a role in the development of diabetic retinopathy

Graefe's Archive for Clinical and Experimental Ophthalmology, 2016

Purpose Diabetic retinopathy is one of the leading causes of blindness. There are several risk fa... more Purpose Diabetic retinopathy is one of the leading causes of blindness. There are several risk factors, such as the duration of diabetes or glycemic control of the patient; however, several biochemical factors also alter the process. Our aim was to investigate the role of soluble E-selectin in the formation of diabetic retinopathy. Patients and methods Fifty-seven patients (37 female and 20 male, aged 61.71 ± 12.31 years) and 14 healthy control subjects (ten female and four male, aged 63.06 ± 10.46 years) were enrolled in the study. We measured the soluble E-selectin level in the plasma of patients by ELISA. All patients underwent careful ophthalmological examination, including ophthalmoscopy and color fundus photography, while diabetic retinopathy grading was performed in line with the 2012 classification of the American Academy of Ophthalmology (AAO). Results The soluble E-selectin level was significantly higher in patients with diabetes compared to controls (32.95 ng/ml vs. 26.55 ng/ml, p = 0.03). Dividing patients into groups by the presence of retinopathy, the E-selectin level was also significantly higher in the retinopathy group (p < 0.05). When we examined diabetic patients by the severity of retinopathy (groups A, B, and C, by the guidelines of the AAO), however, we did not find any significant difference in soluble E-selectin levels, although it tended to be higher in group B. Conclusions An elevated E-selectin level can play a role in the development of diabetic retinopathy, but it does not seem to alter disease severity. However, glycemic control and the reduction of cardiovascular risk factors may also alter the level of E-selectin that might play a role in the prevention of diabetic retinopathy.

Thrombophilic screening in retinal artery occlusion patients

Clinical Ophthalmology, 2008

Background: Retinal artery occlusion (RAO) is an ischemic vascular damage of the retina, which fr... more Background: Retinal artery occlusion (RAO) is an ischemic vascular damage of the retina, which frequently leads to sudden, mostly irreversible loss of vision. In this study, blood thrombophilic factors as well as cardiovascular risk factors were investigated for their relevance to this pathology. Thrombophilic risk factors so far not evaluated were included in the study. Patients and methods: 28 RAO patients and 81 matched control subjects were examined. From blood samples, protein C, protein S, antithrombinopathy, and factor V (Leiden) mutation (FV), factor II gene polymorphism, factor VIII C level, plasminogen activity, lipoprotein(a) and fi brinogen levels, hyperhomocysteinemia and presence of anticardiolipin-antiphospholipid antibodies were investigated. Possibly relevant pathologies such as diabetes mellitus, hypertension, and ischemic heart disease were also registered. Statistical analysis by logistic regression was performed with 95% confi dence intervals. Results: In the group of patients with RAO only the incidence of hypertension (OR: 3.33, 95% CI: 1.30-9.70, p = 0.014) as an average risk factor showed signifi cant difference, but thrombophilic factors such as hyperfi brinogenemia (OR: 2.9, 95% CI: 1.29-6.57, p = 0.010) and the presence of FV (Leiden mutation) (OR: 3.9, 95% CI: 1.43-10.96, p = 0.008) increased the chances of developing this disease. Conclusions: Our results support the assumption that thrombophilia may contribute to the development of RAO besides vascular damage due to the presence of cardiovascular risk factors. Further studies are needed, however, to justify the possible use of secondary prophylaxis in form of anticoagulant/antiplatelet therapy.

Tear fluid proteomics multimarkers for diabetic retinopathy screening

BMC Ophthalmology, 2013

Background: The aim of the project was to develop a novel method for diabetic retinopathy screeni... more Background: The aim of the project was to develop a novel method for diabetic retinopathy screening based on the examination of tear fluid biomarker changes. In order to evaluate the usability of protein biomarkers for prescreening purposes several different approaches were used, including machine learning algorithms. Methods: All persons involved in the study had diabetes. Diabetic retinopathy (DR) was diagnosed by capturing 7field fundus images, evaluated by two independent ophthalmologists. 165 eyes were examined (from 119 patients), 55 were diagnosed healthy and 110 images showed signs of DR. Tear samples were taken from all eyes and stateof-the-art nano-HPLC coupled ESI-MS/MS mass spectrometry protein identification was performed on all samples. Applicability of protein biomarkers was evaluated by six different optimally parameterized machine learning algorithms: Support Vector Machine, Recursive Partitioning, Random Forest, Naive Bayes, Logistic Regression, K-Nearest Neighbor. Results: Out of the six investigated machine learning algorithms the result of Recursive Partitioning proved to be the most accurate. The performance of the system realizing the above algorithm reached 74% sensitivity and 48% specificity. Conclusions: Protein biomarkers selected and classified with machine learning algorithms alone are at present not recommended for screening purposes because of low specificity and sensitivity values. This tool can be potentially used to improve the results of image processing methods as a complementary tool in automatic or semiautomatic systems.

Activated protein C resistance in anterior ischaemic optic neuropathy

Acta Ophthalmologica Scandinavica, 2004

Resistance of coagulation factor V (FV) to activated protein C (APC), mostly due to FV Leiden mut... more Resistance of coagulation factor V (FV) to activated protein C (APC), mostly due to FV Leiden mutation, is the most common cause of inherited thrombophilia. The aim of this retrospective study was to determine the prevalence of APC resistance and Leiden mutation in patients with non-arteritic anterior ischaemic optic neuropathy (NAION). Methods: A total of 25 patients with NAION were examined between 1997 and 2002. The patients were screened for APC resistance and FV Leiden mutation as well as for acquired risk factors of vascular disease such as diabetes mellitus, hypercholesterolaemia, hypertonia and ischaemic heart disease. A control group of subjects without ocular vascular disease and with homogenous distribution of the same risk factors was used for comparison. Results: Six of the 25 patients (24%) with NAION had APC resistance due to the heterozygous Leiden mutation of FV. The frequency of the same genetic mutation in the control group was only 5.9%. Odds ratio calculations showed that patients with the Leiden mutation were at a significantly higher risk of NAION than control patients (p 0.021). Conclusion: The high frequency of Leiden mutation in NAION suggests a pathogenic role of the mutation in the disease.

Az Eales-betegség klinikai tünetei, differenciáldiagnosztikai problémái, kezelése

Analysis of optic disc damage by optical coherence tomography in terms of therapy in non-arteritic anterior ischemic optic neuropathy

International journal of ophthalmology, 2016

This study aimed to assess the relationship between the rate of nerve fiber loss in non-arteritic... more This study aimed to assess the relationship between the rate of nerve fiber loss in non-arteritic anterior ischemic optic neuropathy (NAION) and time delay before therapy. Total 24 patients received the same treatment within or after 2wk (early and late groups). There were significantly lower level of destruction of nerve fibers (P=0.0014) and significantly better visual field sensitivity (P=0.039) in early group. The results indicate that therapy should be started within 2wk. The degree of ischemic damage due to NAION correlates well with retinal nerve fiber layer thickness and the ischemia-induced decrease in visual field sensitivity.

Combined Methods for Diabetic Retinopathy Screening, Using Retina Photographs and Tear Fluid Proteomics Biomarkers

Journal of Diabetes Research, 2015

Background. It is estimated that 347 million people suffer from diabetes mellitus (DM), and almos... more Background. It is estimated that 347 million people suffer from diabetes mellitus (DM), and almost 5 million are blind due to diabetic retinopathy (DR). The progression of DR can be slowed down with early diagnosis and treatment. Therefore our aim was to develop a novel automated method for DR screening.Methods. 52 patients with diabetes mellitus were enrolled into the project. Of all patients, 39 had signs of DR. Digital retina images and tear fluid samples were taken from each eye. The results from the tear fluid proteomics analysis and from digital microaneurysm (MA) detection on fundus images were used as the input of a machine learning system.Results. MA detection method alone resulted in 0.84 sensitivity and 0.81 specificity. Using the proteomics data for analysis 0.87 sensitivity and 0.68 specificity values were achieved. The combined data analysis integrated the features of the proteomics data along with the number of detected MAs in the associated image and achieved sensiti...

Graves’ orbitopathy results in profound changes in tear composition; a study of Plasminogen activator inhibitor-1 (PAI-1) and seven cytokines

Thyroid, 2011

Thyroid Graves' orbitopathy results in profound changes in tear composition; a study of Plasminog... more

Die Klinik des Morning-Glory-Syndroms

Klinische Monatsblätter für Augenheilkunde, 2002

Handmann was the first to describe the morning glory syndrome in 6 cases in 1929. In 1970 Kindler... more Handmann was the first to describe the morning glory syndrome in 6 cases in 1929. In 1970 Kindler published some cases with an &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;unusual congenital anomaly of the optic disc&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;. Since then, several authors have come to the conclusion that both authors described the same disease. In January 2000, morning glory syndrome was diagnosed in two patients, mother and daughter. Ophthalmological and electrophysiological examinations, further brain scan and magnetic resonance imaging (MRI) of the orbit were performed. Malformation of the optic disc was bilateral in both cases. Optic disc abnormality was accompanied by no other anomalies or malformations. Ultrasound examination and MRI of the orbit did not detect posterior staphyloma in our cases. Thus, our two patients are the first to be described in the literature, where the anomaly of the optic disc occurred in isolation. Our cases are different from those described in the literature as far as the characteristic anomaly of the optic disc was bilateral and the occurrence was genetical. It is also noteworthy that no other ophthalmological or general malformations could be detected in our patients besides the anomaly of the optic disc. Morning glory syndrome occurred in isolation, which makes our cases unique.

Anterior polar cataract as a cause of monocular diplopia

Journal of Cataract and Refractive Surgery, 2004

Trombophilic screening for nonarteritic anterior ischemic optic neuropathy

Graefe's Archive for Clinical and Experimental Ophthalmology, 2005

Nonarteritic anterior ischemic optic neuropathy (NAION) is an ischemic infarction of the optic ne... more Nonarteritic anterior ischemic optic neuropathy (NAION) is an ischemic infarction of the optic nerve head, frequently leading to sudden, mostly irreversible loss of vision. In this study blood thrombophilic factors, as well as cardiovascular risk factors were investigated for their relevance to this pathology. Trombophilic risk factors so far not evaluated were included in the study. 37 NAION patients (4 with sequential second eye involvement) and 81 matched control subjects were examined. From blood, protein C, protein S, antithrombin, von Willebrand antigen levels (vWFAg), and factor V (Leiden) mutation, factor VIIIC level, plasminogen activity, lipoprotein (a) and fibrinogen levels, and presence of anticardiolipin antibodies were investigated. Possibly relevant pathologies [e.g. diabetes mellitus (DM), hypertension, and ischemic heart disease] were also registered. Elevated Lp(a) and vWFAg levels, DM, F V (Leiden), hypercholesterolemia, and hyperfibinogenemia proved to be significant risk factors associated with NAION. Forward stepwise logistic regression analysis revealed that high Lp(a), DM, and FV (Leiden) were the main predictive components, with odds ratios 16.88 (p=0.012), 5.78 (p=0.022) and 4.44 (p=0.033), respectively. Based on our results it appears that thrombophilia is likely to contribute to the development of NAION besides vascular damage due to the presence of cardiovascular risk factors. Further data are needed, however, to justify the suggested use of secondary prophylaxis using anticoagulant/antiplatelet therapy.

Bilateral Central Retinal Vein Occlusion Caused By Malignant Hypertension in a Young Patient

Clinical and Experimental Hypertension, 2010

Central retinal vein occlusion (CRVO) occurring simultaneously in both eyes is a rare condition, ... more Central retinal vein occlusion (CRVO) occurring simultaneously in both eyes is a rare condition, in such cases usually associated with severe systemic disease. Overall, only 10% of all CRVO patients are younger than 40 years. A relatively young patient reported with simultaneous bilateral CRVO associated with chronic kidney disease and malignant hypertension. A case of a 35-year-old male patient presented with the complaint of decreased vision in both eyes. Ophthalmic examination revealed bilateral CRVO. Chronic kidney disease leading to malignant hypertension and hyperviscosity was diagnosed as the underlying cause. Clinical support and medical therapy effectively controlled the hypertension, leading to improvement of both the systemic and ocular changes. To the best of our knowledge, this is the first case report of simultaneous bilateral CRVO in a young patient associated with chronic renal failure and malignant hypertension. Primary care providers, either ophthalmologists or physicians, need to consider both common and atypical risk factors for retinal vein occlusion, in order to prevent further ocular morbidity and systemic complications.

Multimarkers for diabetic retinopathy screening

Acta Ophthalmologica, 2012

ABSTRACT Purpose The aim of the project was to develop a methodology for diabetic retinopathy (DR... more ABSTRACT Purpose The aim of the project was to develop a methodology for diabetic retinopathy (DR) screening based on the examination of tear fluid biomarker changes. To evaluate the usability of protein biomarkers for pre-screening purposes different approaches and machine learning algorithms were used. Methods All persons involved in the study had diabetes. DR was diagnosed by capturing 7-field fundus images. 165 eyes were examined, 55 were diagnosed healthy and 110 images showed signs of DR. Tears were taken from all eyes and state-of-the-art nano-HPLC coupled ESI-MS/MS mass spectrometry protein identification was performed on them. Applicability of protein biomarkers was evaluated by six different optimal parameterized machine learning algorithms. Results Out of the six identified machine learning algorithms, result of the Recursive Partitioning proved to be the most accurate. The performance indicators of the system applying the above algorithm indicated 74 % sensitivity and 48% specificity. Conclusion Neither protein biomarkers nor machine learning algorithms are recommended alone for screening purposes because of low specificity and sensitivity values. This tool can be preferably used to improve the results of image processing methods as a complementary tool in automatic or semiautomatic systems.

Increased level of platelet P-selectin in nonarteritic anterior ischemic optic neuropathy

Graefe's Archive for Clinical and Experimental Ophthalmology, 2012

Purpose P-selectin receptor is expressed in platelets and endothelial cells in a cell-activation-... more Purpose P-selectin receptor is expressed in platelets and endothelial cells in a cell-activation-dependent manner. Platelet P-selectin (CD62) levels may become elevated in a number of vasoocclusive diseases, including arteriosclerosis, atherothrombosis, and diabetes mellitus (DM). Nonarteritic anterior ischemic optic neuropathy (NAION) is associated with a sudden loss of vision due to the vascular insufficiency of ciliary arteries supplying the optic nerve. In this study, our aim was to investigate the presence of increased platelet reactivity in the development of NAION. Methods Twenty-one NAION patients, 39 healthy control subjects, and 44 patients suffering from diabetes mellitus (DM) were examined in our case-control, pilot study. Platelet activation was investigated by flow cytometric analysis of the mean fluorescence intensity (MFI) of CD62 on platelets. These results were compared among the different study groups. Results NAION patients showed considerably although not signifactly (p00.2017) higher P-selectin MFI values (71.98 ±40.30) versus healthy subjects (55.48±20.95), insulindependent DM patients (50.02±13.08), and non-insulindependent DM subjects (54.72±24.74). However, logistic regression analysis resulted in a statistically significant adjusted effect on the odds of NAION when CD62 MFI values were logarithmically transformed (OR: 3.86, 95 % CI: 1.10 to 13.53, p00.0346). Conclusion Elevated platelet CD62 positivity may be related to NAION, suggesting a possible role of enlarged platelet activity in the generation of this type of ischemic optic neuropathy.

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Graefe's Archive for Clinical and Experimental Ophthalmology, 2010