Huba Kiss

Ageing as a price of cooperation and complexity

The network concept is increasingly used for the description of complex systems. Here, we summarize key aspects of the evolvability and robustness of the hierarchical network set of macromolecules, cells, organisms and ecosystems. Listing the costs and benefits of cooperation as a necessary behaviour to build this network hierarchy, we outline the major hypothesis of the paper: the emergence of hierarchical complexity needs cooperation leading to the ageing (i.e. gradual deterioration) of the constituent networks. A stable environment develops cooperation leading to over‐optimization, and forming an ‘always‐old’ network, which accumulates damage, and dies in an apoptosis‐like process. A rapidly changing environment develops competition forming a ‘forever‐young’ network, which may suffer an occasional over‐perturbation exhausting system resources, and causing death in a necrosis‐like process. Giving a number of examples we demonstrate how cooperation evokes the gradual accumulation of damage typical to ageing. Finally, we show how various forms of cooperation and consequent ageing emerge as key elements in all major steps of evolution from the formation of protocells to the establishment of the globalized, modern human society.

The Effect of Tear Supplementation on Ocular Surface Sensations during the Interblink Interval in Patients with Dry Eye.

Purpose To investigate the characteristics of ocular surface sensations and corneal sensitivity during the interblink interval before and after tear supplementation in dry eye patients. Methods Twenty subjects (41.88±14.37 years) with dry eye symptoms were included in the dry eye group. Fourteen subjects (39.13±11.27 years) without any clinical signs and/or symptoms of dry eye were included in the control group. Tear film dynamics was assessed by non-invasive tear film breakup time (NI-BUT) in parallel with continuous recordings of ocular sensations during forced blinking. Corneal sensitivity to selective stimulation of corneal mechano-, cold and chemical receptors was assessed using a gas esthesiometer. All the measurements were made before and 5 min after saline and hydroxypropyl-guar (HP-guar) drops. Results In dry eye patients the intensity of irritation increased rapidly after the last blink during forced blinking, while in controls there was no alteration in the intensity during the first 10 sec followed by an exponential increase. Irritation scores were significantly higher in dry eye patients throughout the entire interblink interval compared to controls (p<0.004). NI-BUT significantly increased after HP-guar (p = 0.003) but not after saline drops (p = 0.14). In both groups, either after saline or HP-guar the shape of symptom intensity curves remained the same with significantly lower irritation scores (p<0.004), however after HP-guar the decrease was significantly more pronounced (p<0.004). Corneal sensitivity to selective mechanical, cold and chemical stimulation decreased significantly in both groups after HP-guar (p<0.05), but not after saline drops (p>0.05). Conclusion Ocular surface irritation responses due to tear film drying are considerably increased in dry eye patients compared to normal subjects. Although tear supplementation improves the protective tear film layer, and thus reduce unpleasant sensory responses, the rapid rise in discomfort is still maintained and might be responsible for the remaining complaints of dry eye patients despite the treatment.

Corneal Sensitivity and Dry Eye Symptoms in Patients with Keratoconus

Purpose To investigate corneal sensitivity to selective mechanical, chemical, and thermal stimulation and to evaluate their relation to dry eye symptoms in patients with keratoconus. Methods Corneal sensitivity to mechanical, chemical, and thermal thresholds were determined using a gas esthesiometer in 19 patients with keratoconus (KC group) and in 20 age-matched healthy subjects (control group). Tear film dynamics was assessed by Schirmer I test and by the non-invasive tear film breakup time (NI-BUT). All eyes were examined with a rotating Scheimpflug camera to assess keratoconus severity. Results KC patients had significatly decreased tear secretion and significantly higher ocular surface disease index (OSDI) scores compared to controls (5.3±2.2 vs. 13.2±2.0 mm and 26.8±15.8 vs. 8.1±2.3; p<0.001). There was no significant difference in NI-BUT between the two groups (KC: 9.8±4.8 vs. control: 10.7±3.8; p>0.05). The mean threshold for selective mechanical (KC: 139.2±25.8 vs. control: 109.1±24.0 ml/min), chemical (KC: 39.4±3.9 vs. control: 35.2±1.9%CO2), heat (KC: 0.91±0.32 vs. control: 0.54±0.26 Δ°C) and cold (KC: 1.28±0.27 vs. control: 0.98±0.25 Δ°C) stimulation in the KC patients were significantly higher than in the control subjects (p<0.001, for all parameters). No correlation was found between age and mechanical, chemical, heat or cold thresholds in the patients with KC (p>0.05), whereas in the control subjects both mechanical (r = 0.52, p = 0.02), chemical (r = 0.47, p = 0.04), heat (r = 0.26, p = 0.04) and cold threshold (r = 0.40, p = 0.03) increased with age. In the KC group, neither corneal thickness nor tear flow, NI-BUT or OSDI correlated significantly with mechanical, chemical, heat or cold thresholds (p>0.05 for all variables). Conclusions Corneal sensitivity to different types of stimuli is decreased in patients with keratoconus independently of age and disease severity. The reduction of the sensory input from corneal nerves may contribute to the onset of unpleasant sensations in these patients and might lead to the impaired tear film dynamics.

One-Day Use of Preoperative Topical Nonsteroidal Anti-Inflammatory Drug Prevents Intraoperative Prostaglandin Level Elevation During Femtosecond Laser-Assisted Cataract Surgery

ABSTRACT Purpose: To determine if pretreatment with topical nonsteroidal anti-inflammatory drug (NSAID) prior to femtosecond laser-assisted cataract surgery (FLACS) prevents intraoperative prostaglandin level elevation as a potential risk factor of postoperative complications. Patients and methods: Thirty-six patients with clinically significant cataract and without any concomitant general or ophthalmic disease were enrolled into the three age-matched groups of the study. The mean age of the patients was 62.3 ± 13.1 years. The first group of patients underwent traditional phacoemulsification (Control group), on the second group of patients FLACS was performed, and the third group of patients received topical 0.1% nepafenac pretreatment for 1one day prior to FLACS. Before the phacoemulsification part of the cataract surgery, approximately 110 µL of aqueous humor was collected in all groups. Total prostaglandin concentrations of the collected aqueous humor samples were evaluated by enzyme immunoassay (EIA). Results: The mean of the total prostaglandin concentrations of the aqueous humor samples was 208.8 ± 140.5 pg/mL in patients in the control group, 1449.1 ± 1019.7 pg/mL in the FLACS group (p > 0.001), and 92.2 ± 51.7 pg/mL in the group pretreated with topical NSAID before the FLACS (p > 0.001 compared to FLACS; p > 0.01 compared to control), respectively. Conclusions: FLACS surgery increases intracameral prostaglandin concentration. However, using preoperative 1-day-long nonsteroid anti-inflammatory drops prior to FLACS, this intraoperative increase diminishes. Our study raises the possibility that NSAID pretreatment may be routinely administered before FLACS cataract surgeries to achieve a further decrease in the potential complications of increased total prostaglandin concentration during FLACS surgeries.

Isotonic Glycerol and Sodium Hyaluronate Containing Artificial Tear Decreases Conjunctivochalasis after One and Three Months: A Self-Controlled, Unmasked Study

Dry eye complaints are ranked as the most frequent symptoms of patients visiting ophthalmologists. Conjunctivochalasis is a common dry eye disorder, which can cause an unstable tear film and ocular discomfort. The severe conjunctivochalasis characterized by high LId-Parallel COnjunctival Folds (LIPCOF) degree usually requires surgical intervention, where a conservative therapy would be highly desirable. Here we examined the efficacy of a preservative-free, inorganic salt-free unit-dose artificial tear, called Conheal containing isotonic glycerol and 0.015% sodium hyaluronate in a prospective, unmasked, self-controlled study involving 20 patients. The regular use of the glycerol/hyaluronate artificial tear in three months caused a significant improvement in the recorded parameters. Conjunctivochalasis decreased from a mean LIPCOF degree of 2.9±0.4 on both eyes to 1.4±0.6 on the right (median decrease of -2 points, 95% CI from -2.0 to -1.0), and to 1.4±0.7 on the left eye (median decrease of -1 points, 95% CI from -2.0 to -1.0) (p<0.001 for both sides). The tear film breakup time (TFBUT) lengthened from 4.8±1.9 seconds on both eyes to 5.9±2.3 seconds (mean increase of 1.1 seconds, 95% CI from 0.2 to 2.0) and 5.7±1.8 seconds (mean increase of 0.9 seconds, 95% CI from 0.3 to 1.5) on the right and left eyes, respectively (pright eyes = 0.020, pleft eyes = 0.004). The corneal lissamine staining (Oxford Scheme grade) was reduced from 1.3±0.6 on the right and 1.4±0.6 on the left eye significantly (p<0.001) to 0.3±0.4 and 0.2±0.4 on the right and the left eyes. The Ocular Surface Disease Index (OSDI) questionnaire score indicating the subjective complaints of the patients also decreased from a mean value of 36.2±25.3 to 15.6±16.7 (p<0.001). In this study, the artificial tear, Conheal decreased the grade of the conjunctivochalasis significantly after one month of regular use already, from the LIPCOF degree 3, considered as indication of conjunctival surgery, to a LIPCOF degree 2 or lower requiring a conservative therapy. Our results raise the possibility that vision-related quality of life can be significantly improved by conservative therapies even in severe conjunctivochalasis. Trial Registration Controlled-Trials.com ISRCTN81112701 http://www.isrctn.com/ISRCTN81112701

Results of femtosecond laser-assisted cataract surgery using the new 2.16 software and the SoftFit® Patient Interface

INTRODUCTION Femtosecond laser-assisted cataract surgery improved the results of cataract surgeries. AIM Outcome analysis of femtosecond laser-assisted cataract surgery using the novel 2.16 software and the SoftFit(®) Patient Interface. METHOD The novel software and the newly developed Patient Interface were used in 100 eyes of 100 patients. RESULTS Length of femtosecond laser pretreatment decreased to 45-60 seconds. The smaller size of the new patient interface resulted in easier docking even on pediatric eyes. Suction force used for docking decreased from 40-50 mmHg to 16-20 mmHg. Incidence rate of subconjunctival suffusion decreased from 40% to 15-20% and its clinical severity was reduced, too. No corneal microfolds evolved, thus the incidence rate of the free-floating capsulotomies increased from 30% to 97%. The total energy of femtosecond laser pretreatment was decreased by almost 50%. Corneal wounds had the desired structure, and they were easy to open and closed precisely. CONCLUSIONS The SoftFit(®) patient interface and the novel software widened the possible uses of the femtosecond laser-assisted cataract surgery, e.g. in pediatric ophthalmology. Innovations improved the safety and the predictability of the method.INTRODUCTION Retinopathy of prematurity is a leading cause of childhood blindness around the world. AIM The Department of Ophthalmology at the Semmelweis University and the Peter Cerny Neonatal Emergency and Ambulance Service started an innovative Premature Eye Rescue Program to reduce the non-essential transport of premature babies suffering from retinopathy of prematurity. METHOD During the first 5 years 186 eyes of 93 premature babies were treated at the bedside with stage 3 retinopathy of prematurity in the primary hospitals. RESULTS In this first 5-years period the authors reduced the number of transports of premature babies for laser treatment; 93 children avoided the unnecessary transport, saving altogether a distance of 21,930 kilometers for children, as well as the ambulance service. CONCLUSIONS The Premature Eye Rescue Program offers a good and effective alternative for treatment of retinopathy in the primary hospitals. The authors propose the national extension of this program.

A szaruhártya felszíni hőmérséklete és légáramlási viszonyainak alakulása refraktív célú lézeres beavatkozás közben három különböző típusú és ismétlési frekvenciájú excimer lézerberendezésnél

Absztrakt Bevezetes: A cornea torőerejenek excimer lezerrel tortenő modositasa kozben a termikus viszonyok alakulasa fontos tenyező lehet a sebgyogyulas es a hosszu tavu eredmenyek szempontjabol. Celkitűzes: A tanulmany celja a refraktiv műtet soran a szaruhartya felszini hőmersekletenek vizsgalata harom kulonboző lezerplatformnal Modszer: A vizsgalatot 90 beteg egyik kezelt szemen vegeztek, amelyeken Carl Zeiss MEL 70 es MEL 80, illetve Wavelight Allegretto tipusu lezerrel tortent photorefractiv keratectomia kezeles. EBRO TLC 730 infravoros hőmerővel vegeztek merest kozvetlenul a hameltavolitas előtt, valamint kozvetlenul a kezeles előtt es utan. A betegek atlageletkora 25,5 ± 3 ev volt. Minden fenytoresi hiba myopias vagy myop astigmias volt, atlaguk –3,2 ± 0,8 Dpt volt. Eredmenyek: A felszini cornea hőmersekletenek alakulasaban statisztikailag szignifikans kulonbseg volt a MEL 80 es a masik ket tipusu lezer kozott. Kovetkeztetesek: A lezerkeszulekek szoveti gőzok eltavolitasara szolgalo elszivorendszer...

Vision Restoration with Implants

Up until now there has been no available treatment for diseases causing the permanent impairment of retinal photoreceptors.

Crosslinking kezelés hatása a szaruhártya hámosodására

INTRODUCTION AND AIM To analyse the effect of crosslinking (CXL) on corneal epithelial healing. PATIENTS AND METHOD 39 keratoconus patients following CXL and 11 patients following PRK were enrolled in this study. 21, 45 and 69 hours after CXL and 16, 37 and 61 hours following PRK slitlamp photographs were taken using fluorescein staining and the size of the epithelial defect and the time of epithelial closure was determined. As the observation time-points differed in both groups, the size of the epithelial defect following PRK was calculated for the time points used for analysis of CXL patients. These data were compared using chi-quadrat test. RESULTS Following crosslinking, epithelial closure occured within 3, following PRK within 4 days. In the area of epithelial erosion 45 and 69 hours after CXL or PRK treatment statistically significant difference (p = 0.005 and p<0.001) was verified. CONCLUSION Our results show beneficial effect of crosslinking on corneal epithelial healing. Orv. Hetil., 2017, 158(10), 376-379.Absztrakt: Bevezetes es celkitűzes: A crosslinking kezeles szaruhartya-hamosodasra gyakorolt hatasanak vizsgalata. Betegek es modszer: Vizsgalatunkba 39 keratoconusos beteget vontunk be crosslinking kezeles utan, es 11 pacienst fotorefraktiv keratectomiat kovetően (kontroll) crosslinking kezelest kovetően 21, 45 es 69 oraval. A festődő szaruhartyaham-hiany teruletet a fotorefraktiv keratectomiat kovetően 16, 37 es 61 oraval meghataroztuk. A fotorefraktiv keratectomia kezelesek utani kontrollok időpontja nem egyezett a crosslinking kezelest kovető kontrollidőpontokkal, igy a fotorefraktiv keratectomias csoportnal a hamhiany feltehető meretet a crosslinking kezelesi csoport meresi időpontjaira szamitottuk, es χ2-teszt segitsegevel hasonlitottuk ossze a ket csoportban a hamhiany meretet. Eredmenyek: A cornea crosslinking kezelest kovetően a szaruhartya hamjanak zarodasa a kezelestől szamitott harom napon belul, fotorefraktiv keratectomiat kovetően negy napon belul kovetkezett be. 45 es 69 ora elteltevel a ke...

Szabadgyök-felszabadulás vizsgálata femtoszekundum lézerrel asszisztált capsulotomiát követően

Absztrakt Bevezetes: A femtoszekundum lezer alkalmazasa forradalmi, innovativ kezelesi eljaras a szurkehalyog-sebeszetben. Celkitűzes: Tanulmanyunk celja a femtoszekundum lezeres capsulotomia soran az elulső csarnokban kepződő szabad gyok mennyisegenek meghatarozasa sertesszemben. Modszer: Hetven friss sertesszemet vontunk be a vizsgalatba, amelyeket post mortem 2 oran belul 4 oC hőmersekleten szallitottunk, a kezelest pedig 7 oran belul vegeztuk el. Harmincot szemet vizsgaltunk a kontroll- es a femtoszekundum lezeres capsulotomia csoportban is. Luminoldependens kemilumineszcens modszer segitsegevel vizsgaltuk a csarnokviz szabadgyok-fogo kapacitasat, mint a szabadgyok-termelődes indikatorat. Az emittalt fotonok mennyiseget relativ fenyegyseg szazalekban fejeztuk ki. Eredmenyek: A relativ fenyegyseg szazalek alacsonyabb volt a kontrollcsoportban (median 1%, interkvartilis tartomany 0,4–3%), mint a femtoszekundum lezeres capsulotomia csoportban (median 4,4%, interkvartilis tartomany 1,5–21%) (p = 0,01). Ko...