5^th International Conference on Clinical & Experimental Ophthalmology August 04-06, 2015 Valencia, Spain

Biography:

Yoko Miura has completed her MD in 1997 and PhD in 2002 from Osaka City University in Japan. Clinical training was completed in eye clinic of Osaka City University Hospital and since 2002 a specialist of ophthalmology. In 2005 started research work in University of Kiel in Germany and in 2009 moved to Institute of Biomedical Optics, University of Luebeck. Today engages in the research and clinical works in Institute of Biomedical Optics and Department of Ophthalmology, University of Luebeck. Leading some research projects related to retinal cell biology. Since 2010, he is the adjunct lecturer of Osaka City University.

Abstract:

Retinal microvascular endothelial (RME) cells play a significant role in retinal function as the inner blood-retinal barrier (BRB) whose disruptionis largely relevant to theearly pathological alterations of diabetic retinopathy (DR). Therefore, it is of great importance to elucidate the mechanisms of metabolic and functional alterations of RME cells under diabetic condition, namely under high glucose condition. Although many in vitro and in vivo basic studies have been performed and reported based on this motivation to date, it is still a challenging to monitor the cell metabolisms and functions with living cells. Fluorescence lifetime imaging microscopy (FLIM) is a technique to measure and map the fluorescence lifetime of the fluorophores. Fluorescence lifetime is a fluorophore-intrinsic and moreover, may be influenced by the molecular environments such as temperature, pH, viscosity and molecular protein binding status. FLIM coupled with two-photon microscopy (TPM) enables to measure the fluorescence intensities as well as fluorescence lifetimes of the auto fluorescence of two different coenzymes that are important in cell metabolisms, nicotinamide adenine dinucleotide (NADH) and flavin adenine dinucleotide (FADH). With TPM-FLIM, the redox ratio of NADH/FAD as well as fluorescence lifetimes of NADH (free/protein bound) and FAD (free/protein bound) can be measured. Since these values are largely related to the status of cell metabolisms, it can be used as a non-invasive monitoring method of cell metabolisms. In this study, I will introduce our in vitro experimental results with cultured human RME cells showing the altered intracellular status of NADH and FAD detected with TPM-FLIM under different high glucose conditions. Combined with the results of other experimental procedures to detect cellular oxidative stress or stress-induced protein expressions, TPM-FLIM was found to be a very sensitive and non-invasive method to monitor the status of these metabolisms-related coenzymes in the cells under high glucose conditions. This method might expand the possibility of detecting cell metabolic states in diabetes basic research and eventually in clinical diagnosis.

Biography:

Juturu has a doctoral degree in Clinical Nutrition (Cardiovascular Nutrition) from S.V. University in India (1996) and completed her postdoctoral research in Cardiovascular Nutrition at Penn State University (1997-2000). Dr. Juturu is working as a Manager, Scientific and Clinical Affairs at Omni Active Health Technologies, Inc. She worked in research and development to consumer companies for more than fifteen years. She is an adjunct faculty to teach nutrition courses, NY. She has published research papers in reputed journals, text books, monographs and CEs. She is a reviewer and editorial board member of several national and international journals. She has received awards from Indian Council of Medical Research, Indian Society of Atherosclerosis Research, Cardiology Society of India, American College of Nutrition, Academy of Nutrition and Dietetics and Tinsley Harrison Award from Southern Society of Clinical Investigators. She was honored as honorable speaker, session chair and working committee member for Professional societies such as American Diabetes Association, Academy of Nutrition and Dietetics and American College of Nutrition.

Abstract:

The macular carotenoids (Lutein and RR Zeaxanthin isomers) plays a role in the protection of the retina against light-induced damage, protecting ocular tissue against photo-oxidative damage and acts as antioxidants. Macular carotenoids are necessary to increase macular pigment density in the retina to protect the eyes. Epidemiological and clinical data suggest that an increased intake of macular carotenoids from diet or supplements correlates with macular pigmentation, improve vision performance and a diminished risk for age-related macular degeneration. Macular carotenoids filters blue light and it has been proposed as a possible mechanism of protection in infants and adults. In this presentation main focus will be on current perspectives of macular carotenoids, dietary gaps, how to fill the gaps and how relevant to human life cycle and how to fill the generation gap will be discussed.

Biography:

Joshua J Wang holds MD and MS degrees and is currently an Assistant Professor in Department of Ophthalmology and Department of Medicine at University at Buffalo, the State University of New York. His research interest includes molecular mechanisms of diabetic vascular complications such as diabetic retinopathy, diabetic vascular disease, insulin resistance and diabetic nephropathy.

Abstract:

Increasing evidence suggests that endoplasmic reticulum (ER) stress and inflammation contributes to the pathogenesis of diabetic retinopathy (DR), a leading cause of blindness in working-age population. Muller glia cells which constitute the major glial component of the retina are considered major source of inflammatory factors in DR. In the present study, we investigated the role of ER stress in Muller cell inflammation using conditional knockout (Xbp1Müller-/-) mice that lack X-box binding protein 1 (XBP1) in Muller cells. Diabetes was induced by streptozotocin in male adult Xbp1Muller-/-mice and their littermate controls (Xbp1Muller+/+). Expression of retinal ER stress markers and inflammatory cytokines was examined by real-time qPCR, Western blotting and immunostaining. Retinal vascular permeability was measured by FITC-conjugated dextran method after 2 months of diabetes. Xbp1Müller-/-mice exhibit normal retinal development and retinal function determined by ERG. In diabetic mice, mRNA and protein levels of major inflammatory cytokines (VEGF and TNF-α) were significantly increased in retinas of Xbp1Muller-/- mice compared to control mice. In addition, XBP1 deficiency resulted in greater ER stress in diabetic retinas as evidenced by enhanced expression of GRP78, p-eIF2α, ATF4, CHOP, ATF6 and p-JNK. Consistently, retinal vascular permeability was significantly increased in diabetic Xbp1Muller-/- mice compared to the control. Increased ER stress and inflammatory gene expression was confirmed in retinal Muller cells isolated from Xbp1Müller-/- mice. Taken together, our results indicate that increased ER stress in Muller cell is an important contributing factor in inflammatory cytokine production and inflammation-related vascular damage in DR.

Biography:

Guzel Bikbova has completed her PhD at the age of 27 years from Scientific Research Institute of Eye Diseases Russian Academy of Medical Science, Moscow, Russia. She worked in Ufa Eye Research Institute and now is obtaining another PhD in Chiba University, Japan as scholarship holder from Ministry of Education, Culture, Sport and Technology in Japan. He has published 12 papers in peer reviewed journals and has 4 patents of Russian Federation.

Abstract:

Purpose: To determine the effect of advanced glycation end-products (AGEs) on neurite regeneration in isolated rat retinas and the regenerative affects of different neurotrophic factors. Furthermore, to examine whether nuclear factor-kB (NF-kB) and specificity protein 1 (SP1) expression are correlated with the regenerative effect of each neurotrophic factors. Methods: Retinal explants of 4 adult SD rats were three-dimensionally cultured in collagen gel and incubated in: 1. Serum free control culture media; 2. 100 μg/ml glucose-AGE-BSA, glycolaldehyde-AGE-BSA, glyceraldehyde-AGE-BSA media; 3. Glucose, glycol, glycer+100 ng/ml neurotrophin 4 (NT-4) media; 4. Glucose, glycol, glycer+100 ng/ml hepatocyte growth factor (HGF) media. 5. Glucose, glycol, glycer+100 ng/ml glial cell lines derived neurotrophic factor (GDNF) media and 6. Glucose, glycol and glycer+100 ng/ml tauroursodeoxycholic acid (TUDCA) media; after 7 days, the number of regenerating neurites was counted under a phase-contrast microscope. The explants were immunostained for NF-kB and SP1 transcription factors. Statistical analyses were performed by one-way ANOVA. Results: In retinas incubated with AGEs, the numbers of regenerating neuritis were fewer than in control. Neurotrophic factors increased the number of neurites but more significantly in the NT-4 group. The numbers of NF-kB and SP1 immunopositive cells were higher in retinas exposed to AGEs than in control. Neurotrophic factors decreased the number of NF-kB immunopositive cells but did not significantly affect SP-1 expression. NT-4 shows the best neuroprotective and regenerative effect. Conclusions: High dose AGEs impede neurite regeneration. The inhibition of regeneration is correlated with increased expression of NF-kB and SP1. NT-4 enhances neurite regeneration in AGEs exposed retinas more than other neurotrophic factors such as HGF, GDNF and TUDCA. The regenerative effect of NT-4 is correlated with NF-kB suppression.

Biography:

Dario Vasquez has completed his MD and Ph.D. degree from Chile University and currently has a position as clinical fellow in medical and surgical Retina Fellowship in University of Guadalajara, Mexico. He is a clinical scientist who achieved National Science Committee grant. Recipient of Immunotools Special Research Award in 2013 is currently working in new AMD antiangiogenic therapies.

Abstract:

Introduction: The transcriptional factor hypoxia-induced factor -1 (HIF-1) has been implicated in the pathogenesis of choroidal neovascularization through enhanced transcriptional activity of VEGF. Retinal pigment epithelium (RPE) is the main source of VEGF which activates choroidal vascular endothelial (CVE) cells and generates neovessels into the retina leading to irreversible blindness. Curcumin, a natural diphenol displays HIF-1 inhibitory activity in tumor cells. However, its effect on retinal cells exposed to hypoxia has not been previously reported. Hence, we aimed to study curcumin effects on the expression of VEGF by RPE cells. Material & Methods: RPE (ARPE19) cell lines were challenged with hypoxia (1% O2) in a culture chamber and HIF-1α, VEGF-A165 and VEGF-A189 gene expression were studied. CVE cells (RF6A) were treated with RPE-conditioned medium and migration and angiogenesis were determined by using wound healing and matrigel assays. Results: Curcumin inhibits hypoxia-driven VEGF up regulation in RPE cells. The conditioned medium of hypoxic RPE-cells increases migration and vascular network formation of retinal vascular cells. Curcumin (20 and 40 μM) is able to prevent these effects inhibiting the migration of vascular cells. Discussion: Curcumin prevents hypoxia-mediated increase of VEGF-A gene expression in RPE cells and angiogenesis induced by secreted factors from RPE cells. Further studies with curcumin on retinal cells are needed to establish its potential usefulness as a novel ocular antiangiogenics molecule.

Biography:

Maneli Mozaffarieh is a Glaucoma Specialist working at the University of Basel, Department of Ophthalmology. The focus of her research is on ocular blood flow.

Abstract:

The pathogenesis of the condition remains to be solved. Mechanical compression of the vessel wall or thrombotic occlusion of the vessel lumen sometimes, combined with rheological disorders are often assumed mechanisms. Accordingly, the therapy also either relies on mechanical decompression, lysis of thrombi or improvement of the rheology. Yet whilst the pathophysiological concepts described in the literature so far covers some aspects of the disease, they do not sufficiently explain all the phenomena. A number of observations as for example the occurrence of RVO in younger patients without any signs of atherosclerosis, spontaneous reversibility particularly in young patients, occlusion despite anti coagulation or thrombocytopenia and finally the positive effect of anti-VEGF therapy are not explained by the present pathogenetic concept. As a new concept we previously proposed a local venous constriction induced by vasoactive molecules diffusing from neighboring diseased arteries and/or from neighboring (hypoxic) tissues.

Biography:

Sarah X Zhang is currently a tenured Associate Professor of Ophthalmology, Biochemistry and Neuroscience at School of Medicine and Biomedical Sciences, State University of New York. She is a Faculty Member at the SUNY Eye Institute and Graduate School at SUNY Buffalo. She is a well-established Clinician Scientist and Vision Researcher and has published over 75 peer-reviewed journal articles, reviews and book chapters. Her laboratory studies disease mechanisms and ER stress signaling in diabetic retinopathy, age-related macular degeneration and glaucomatous retinopathy. She has served on Editorial boards for 7 professional journals and on NIH and international grant review panels.

Abstract:

ER chaperones are a group of proteins in the ER that assist in de novo protein folding/refolding and the timely removal of irreversibly misfolded and aggregated proteins to maintain the cellular proteome homeostasis. They are critical components and major downstream targets of the highly conserved unfolded protein response (UPR) that harnessing transcriptional and translational regulatory systems to reduce/eliminate ER stress. Major chaperones and folding enzymes in the ER include: Chaperones of the heat shock protein family such as GRP78 and its co-chaperone partners (e.g., p58IPK); Chaperone lectins such as calnexin and calreticulin and thiol oxidoreductases of the protein disulfide isomerase (PDI) family. Recent work demonstrates that manipulating the UPR or enhancing ER chaperone activities can protect retinal neurons in a wide range of acute or chronic injury models. Over expression of GRP78 orp58IPK attenuates ER stress and protects retinal ganglion cells (RGCs) against apoptosis and cell death. Mice lacking p58IPK are more sensitive to ER stress and RGC loss related to glutamate toxicity or aging. The presentation will discuss the intriguing neuroprotective potential of ER chaperones and UPR manipulation in retinal neurons and RPE cells and highlight their probable implication in the prevention and treatment of retinal degeneration.

Biography:

Iva Dekaris has completed her PhD from University in Zagreb after Postdoctoral Fellowship at Harvard Medical School, Schepens Eye Research Institute. She is currently a Medical Director at Eye Hospital “Svjetlost”, Professor of Ophthalmology at Universities of Zagreb and Rijeka and Associate-Member of the Croatian Academy of Sciences and Arts. She has published 47 papers in CC Journals; works as PI for project “Mechanisms of corneal graft rejection” and has been serving as an Editorial Board Member of 3 and a Reviewer for 6 reputed journals. She has an overall experience of over 20,000 surgeries mainly cataract surgery, corneal transplantations and refractive lens exchange.

Abstract:

Introduction: DSAEK and DMEK are the most popular endothelial keratoplasty techniques. The advantages of DMEK are well known such as the fastest and best visual improvement, near normal anatomical recovery and very low immune rejection rate. Despite that, DSAEK is by far the most often performed technique; mostly because of its better feasibility, lower rebubling rate and since it is less time-consuming. UT-DSAEK, with lamellas thinner than 100µm, it is the technique that could overcome the disadvantages of both methods. Purpose: Evaluation of visual outcomes after ultra-thin DSAEK (lamellas <100 µm) and comparison to conventional DSAEK (lamellas of 100-200 µm) in eyes with pseudophakic bullous keratopathy (PBK). Patients and Methods: A prospective case series of 10 PBK eyes undergoing UT-DSAEK (group 1) and 30 PBK eyes undergo conventional DSAEK (group 2) for the treatment of PBK. UT-DSAEK grafts were obtained with a double-pass technique. All patients underwent serial central grafts thickness measurement with non-contact optical coherence tomography (Zeiss VisanteTM AS-OCT) at various time points after surgery. Differences between the groups regarding best corrected visual acuity (BSCVA) and endothelial cells density loss (ECD) were recorded. Postoperative follow-up was up to 2 years. Results: UT-DSAEK group showed significantly better postoperative BCVA both in quantity (≥0.1 log MAR) and speed of recovery as compared to conventional DSAEK group (P<0.05). Endothelial cell loss in UT-DSAEK was 41.72% after 12 months and was not significantly different to DSAEK group. Conclusion: UT-DSAEK provides faster and more complete visual rehabilitation as compared to conventional DSAEK.

Biography:

Inder Paul Singh is a glaucoma specialist who attends to patients in Racine and Kenosha Counties only. He is the first ophthalmologist in Wisconsin and Illinois to implant iStents, a glaucoma drainage device. This is the latest approved Food and Drug Administration (FDA) device that is minimally invasive, and is being done at the time of cataract surgery. This device helps bring the pressure in the eye down in a very safe and controlled approach with lesser adverse events than other tubes and shunts that are currently being done. Our doctors continue to be on the cutting edge of technology.

Abstract:

Purpose: Compare effective phaco time (EPT) and corneal edema between standard, MultiBurst and MultiBurst with femtosecond phacoemulsification using Stellaris phacoemulsification unit and Victus femtosecond laser platform. Methods: 48 eyes were randomly assigned to each group. Corneal edema evaluated by a masked observer using conventional grading. Results: Cataract grade was comparable amongst groups. Average EPT was 0.45, 2.5, and 4.8 seconds for MultiBurst with femto, MultiBurst and standard phaco groups respectively. Mean corneal edema score was 0.3, 0.8 and 1.5 for MultiBurst with femto, MultiBurst and standard phaco groups respectively. Conclusion: MicroBurst using Stellaris phacoemusification unit and Victus femtosecond laser platform demonstrated significantly less EPT and corneal edema than MultiBurst and standard phacoemulsification.

Biography:

Maneli Mozaffarieh is a Glaucoma Specialist working at the University of Basel, Department of Ophthalmology. The focus of her research is on ocular blood flow.

Abstract:

Increased intraocular pressure (IOP) is a major risk factor for glaucomatous damage and reducing IOP improves prognosis. Nevertheless, there is little doubt that other risk factors besides IOP such as unstable ocular perfusion are involved. Blood flow is unstable if either the IOP fluctuates at a high level (or blood pressure fluctuates at a low level) or if the auto regulation of blood flow disturbed. A common cause for a disturbed OBF auto regulation is a primary vascular dysregulation (PVD) frequently observed in normal tension glaucoma patients. An unstable blood flow leads to recurrent mild reperfusion injury (chronic oxidative stress) affecting particularly the mitochondria of the optic nerve head. OBF regulation can be improved by magnesium, calcium channel blockers as well as with carbonic anhydrase inhibitors.

Biography:

Miguel Rechichi has completed his training in ophthalmology and his PhD from Magna Graecia University and Diploma of Specialist Superior in Ophthalmology from University of Lugano (Switzerland). He’s actually a researcher for Magna Graecia University and founder of corneal and refractive Surgery service of Eye Center Clinic in Catanzaro, Italy. He was a pioneer of cross-linking clinical application and actually is involved in developing new accelerated cxl protocols and topography guided crosslinking for which he’s invited as opinion leader to several meetings. He has published several papers in reputed journals and has been serving as an editorial board member of repute.

Abstract:

Corneal collagen cross-linking (CXL) is being used worldwide as a first- line treatment for keratoconus, pellucid marginal degeneration, and post-LASIK ectasia. CXL has beenshown to be both safe and effective and nowadays patients as young as 10 routinely undergo this form of treatment when they are first diagnosed with keratoconus. As expected, CXL in the early stages of disease is more successful than in the advanced stages. Treatment may help prevent the corneal thinning and apical scarring typical of advanced keratoconus. After CXL, many patients can resume wearing their contact lenses in a few days or a few weeks. Their vision gradually improves weeks to months after treatment, as the cornea undergoes remodeling. In some cases, improvement continues for many years. Evolution of CXL machines alone was incredible and in the near future topography-guided CXL treatment will be available. More than this several procedures that can be actually combined with CXL, such as topography-guided PRK, intracorneal ring segments, and phakic IOLs. The actual target of CXL research is to evaluate various methods of cross linking to provide better option to patientsnot only for halting keratoconus but, when possible, to improve corrected and uncorrected visual acuity.

Biography:

Guzel Bikbova has completed her PhD at the age of 27 years from Scientific Research Institute of Eye Diseases Russian Academy of Medical Science, Moscow, Russia. She worked in Ufa Eye Research Institute and now is obtaining another PhD in Chiba University, Japan as scholarship holder from Ministry of Education, Culture, Sport and Technology in Japan. She has published 12 papers in peer reviewed journals and has 4 patents of Russian Federation.

Abstract:

Purpose: To estimate the results of standard corneal collagen crosslinking (CXL) and transepithelial CXL by iontophoresis of riboflavin. Material & Methods: CXL was performed in a series of 156 eyes of 126 patients with keratoconus I-III Amsler classification (149 eyes) and post LASIC keratoectasia (7 eyes). Depending on the method of CXL patients had been divided into two groups: I group-77 eyes with standard CXL, II group-79 eyes with transepithelial CXL by iontophoresis of riboflavin. I group had been treated with epi-off technique using 0, 1% riboflavin solution with dextran T 500. In the II group the 0.1% riboflavin hypotonic solution was administered by iontophoresis using galvanizator (Potok-1, Russian Federation) for 10 minutes prior surface UVA irradiation. In both groups UVA irradiation (370 nm, 3 mW/cm2) was performed at a 5-cm distance for 30 minutes. Follow up period was 24 months Results: Confocal microscopy showed that in both groups anterior corneal stroma had a “honeycombed” appearance with reduced number of keratocyte’s nuclei, however repopulation of stroma and regaining its normal configuration completed within 6 months in I group and in 3-4 months in II group. Pre and post operative endothelial cell density remained unchanged within 2765±21,15 cells/mm2.CXL in both groups resulted in a decrease of average keratometry from 47.65±0.93 D to 45.580.65 in I group and from 47.16±1.03 D to 45.760.98 in II group 2 year after the procedure. Demarcation line in I group was observed at the depth 288±10 mk and in a II group at 154±22 mk (from14 days up to 1 month after CXL). Conclusion: Transepithelial CXL by iontophoresis is as effective as standard CXL and can be recommended as a method of choice for patients with corneal thickness less than 400 mk.

Biography:

Baswati Prasanth, Specialist in Ophthalmology, has completed her MS Ophthalmology from Armed Forces Medical College, Pune and Fellowship in Glaucoma and Anterior segment from Dr Shroff’s Eye Hospital, New Delhi. She is the winner of A D Patwardhan Gold medal from University of Pune. She is the Director of Ophthalmology, Ahalia Hospital, Abu Dhabi. She has published more than 15 papers in reputed journals and has been part of several clinical trials.

Abstract:

Purpose: To determine the intraocular pressure control and visual outcomes; following combined phacoemulsification with express device, in cases of advanced open angle glaucoma. Design: Retrospective, interventional, consecutive, non-comparative case series. Participants: Patients of advanced glaucoma and cataract not controlled on maximal medication. Methods: Single eye, in 6 patients, with advanced open angle glaucoma, on maximum anti-glaucomatous medical therapy, underwent combined two-site surgery; Phacoemulsification with implantation of acrylic IOL followed by filtrating surgery, Ex-PRESS miniature glaucoma shunt implantation was performed using 0.02% MMC. The standard procedure was performed under peribulbar anaesthesia without complications; implantation was well positioned, whole surgery was performed by the same surgeon, in the Department of Ophthalmology, Ahalia Hospital Abu Dhabi. Post-operatively, we recommended combined antibiotic and steroid drops every four hours in the first week followed by taper. Main Outcome Measures: Evaluated parameters were visual acuity, intraocular pressure control, bleb morphology on 1st, 7th post-operative day, 1, 3 and 6 months after surgery. Surgical success was defined as 5 mm Hg≤intraocular pressure≤18 mm Hg, with or without medications, without further glaucoma surgery. Results: In a case series of six patients, the mean pre-operative intraocular pressure was 30.66±3.59 mm Hg on 3.83±0.37 anti-glaucoma eye drops. The mean day 1, day 7, day 30, 90 and 180 days IOP were 12.83±2.96, 12.67±2.49, 12.0±2.82, 11.0±2.51, 11.34±3.20 mmHg, respectively. Five out of six had IOP<18 mmHg without medication and all had IOP<18 mmHg with anti-glaucoma medication. No intra-operative or post-operative complications were noted. Conclusion: The Express Device demonstrates good IOP control in cases of advanced glaucoma with fewer propensities to hypotony or wipe out.

Biography:

Shahid Wahab is a Professor & Chairman Eye Department Dow University of Health Sciences Karachi, since 2005. There are many international, oral & video presentations to his credit. He is Editor in Chief of Pakistan Journal of Ophthalmology & on the Editorial Board of Ophthalmic Journals. He has been awarded highest Presidential award for excellence. He is regional secretary SAARC academy of Ophthalmology. He has innovated new instruments & techniques. His main interest is in vitreoretinal & is involved in training program. He has developed second sub-speciallity fellowship in vitreoretina for which he is examiner at College of Physician & Surgeons Pakistan.

Abstract:

End stage glaucoma patients are being neglected while using new technologies and technique in Ophthalmology. In this presentation the importance of issues are highlighted while using new methods and technologies. In Phacoemulsification and Vitrectomy new machines are working on high vacuum and high flow rate where bottle height is raised. In expendable gases IOP is raised unpredictably. Silicon oil can cause damage while doing surgery or post-operatively. It is known that after YAG laser IOP is raised, but proper protocol is not followed in many centers. During flap formation in Lasik IOP is raised up to 80mm or more. Now new technologies are being explored to avoid flap formation. Certain Yoga positions are not advised since those positions increase IOP. Intra ocular pressure is doubled during robotic prostatectomy surgery which may take more than two hours. Retained viscoelastics after cataract surgery is known cause of raised IOP. Tight collar or wearing constrictive clothing around the neck can trigger raised IOP intermittently. Poor perfusion for any reason has serious effects. Pressure variations are discussed with recommendations.

Biography:

K Yogesan is the Research Director at the Australian e-Health research Centre, and leads the ophthalmology research. His team is developing the eye test for early detection of Alzheimer’s disease and other chronic diseases. He is an Adjunct Professor at the School of Medicine, University of Notre Dame in WA. He is also a visiting Professor at the Harvard University. He was a Fulbright Scholar at the Byers Eye Institute, Stanford University in 2011. He has been the Director of the Centre of Excellence in e-Medicine and has been part of several start-up companies in Australia and Silicon Valley. He was nominated as one of the finalists for Australian of the Year award in 2015. He was the Past President of the Australasian Telehealth Society and one of the Board of Directors of the International Society for Telemedicine and e-Health. He has developed innovative technologies and service models to bring specialist eye care to the doorsteps of the underserved. He has published more than 150 peer-reviewed papers and 4 textbooks in the field (Teleophthalmology and Digital Homecare). He has won inventor of the year awards for developing low cost easy-to-operate ophthalmic imaging device which is now used by NASA at the International Space Station. He has a patent portfolio of more than 35 patent applications including algorithms for computer-aided disease detection, e.g. diabetic retinopathy.

Abstract:

Tele-ophthalmology is bringing eye care service delivery to the rural and remote areas using medical diagnostic technologies, and information and communication technologies. Presently, telemedicine is used in metro areas to provide tele-diabetic retinopathy screening such that patients could be screened when they go to endocrinology clinics. When mass screenings are done, it is difficult for ophthalmologists to read large number of images. A solution will be to use fully automated computed-aided image readings and identify those who need a referral to see an ophthalmologist. In this way, ophthalmologists could focus on treatment and surgery instead of seeing large number of “normal” patients. The fee for service for image reading is also not an issue here. In this workshop, we will discuss about “practice guide” for tele-ophthalmology with case studies from around the world. Some presentations will cover specific applications of teleophthalmology technologies such as screening of diabetic retinopathy, glaucoma and age related macular degeneration. We will explore in detail the digital medical technologies including imaging and diagnostic devices, disease automation and communication technology.

Biography:

Miguel Rechichi has completed his training in ophthalmology and his PhD from Magna Graecia University and Diploma of Specialist Superior in Ophthalmology from University of Lugano (Switzerland). He’s actually a researcher for Magna Graecia University and founder of corneal and refractive Surgery service of Eye Center Clinic in Catanzaro, Italy. He was a pioneer of cross-linking clinical application and actually is involved in developing new accelerated cxl protocols and topography guided crosslinking for which he’s invited as opinion leader to several meetings. He has published several papers in reputed journals and has been serving as an editorial board member of repute.

Abstract:

Purpose: To compare functional results in two cohorts of patients undergoing epithelium-off pulsed (pl-ACXL) and continuous light accelerated corneal collagen crosslinking (cl-ACXL) with dextran-free riboflavin solution and high-fluence ultraviolet A irradiation. Design: It is a prospective, comparative, and interventional clinical study. Methods: 20 Patients affected by progressive keratoconus were enrolled in the study. 10 eyes of 10 patients underwent an epithelium-off pl-ACXL by the KXL UV-A source (Avedro Inc., Waltham, MS, USA) with 8 minutes (1 sec. on/1 sec. off ) of UV-A exposure at 30 mW/cm and energy dose of 7.2 J/cm ; 10 eyes of 10 patients underwent an epithelium-off cl-ACXL at 30 mW/cm for 4 minutes. Riboflavin 0.1% dextran-free solution was used for a 10-minutes corneal soaking. Patients underwent clinical examination of uncorrected distance visual acuity and corrected distance visual acuity (UDVA and CDVA), corneal topography and aberrometry (CSO EyeTop, Florence, Italy), corneal OCT optical pachymetry (Cirrus OCT, Zeiss Meditec, Jena, Germany), endothelial cells count (I-Conan Non Co Robot), and in vivo scanning laser confocal microscopy (Heidelberg, Germany) at 1, 3, 6, and 12 months of follow-up. Results: Functional results one year after cl-ACXL and pl-ACXL demonstrated keratoconus stability in both groups. Functional outcomes were found to be better in epithelium-off pulsed light accelerated treatment together with showing a deeper stromal penetration. No endothelial damage was recorded during the follow-up in both groups. Conclusions: The study confirmed that oxygen represents the main driver of collagen crosslinking reaction. Pulsed light treatment optimized intraoperative oxygen availability improving postoperative functional outcomes compared with continuous light treatment.

Biography:

Emmanuel Buys obtained his PhD from the Department of Molecular Biology, Gent University and Flanders Institute of Biotechnology. He is currently an assistant professor in Anesthesia at the Massachusetts General Hospital where he studies the role of nitric oxide-cGMP signaling in cardiovascular disease and primary open angle glaucoma. He has co-authored 52 manuscripts since 2006.

Abstract:

Glaucoma is a progressive optic neuropathy characterized by visual field defects that ultimately leads to irreversible blindness. By the year 2020, an estimated 80 million people will have glaucoma, 11 million of which will be bilaterally blind. Primary open-angle glaucoma (POAG) is the most common type of glaucoma. Elevated intraocular pressure (IOP) is currently the only risk factor amenable to treatment. How IOP is regulated and can be modulated remains a topic of active investigation. Available therapies mostly geared towards lowering IOP, offer incomplete protection, highlighting the need for novel therapeutic approaches and drug targets. Impairment of the nitric oxide (NO)-soluble guanylatecyclase (sGC)-cyclic guanosine monophosphate (cGMP) pathway has been associated with POAG and NO-donors are being developed as novel IOP-lowering agents. This presentation will discuss pre-clinical and clinical studies, illustrating the connection between NO-cGMP signaling and POAG. In addition, pilot data will be presented describing the IOP lowering and/or neuroprotective capabilities of available therapeutics known to increase cGMP signaling.

Biography:

Iva Dekaris has completed her PhD from University in Zagreb after Postdoctoral Fellowship at Harvard Medical School, Schepens Eye Research Institute. She is currently a Medical Director at Eye Hospital “Svjetlost”, Professor of Ophthalmology at Universities of Zagreb and Rijeka and Associate-member of the Croatian Academy of Sciences and Arts. She has published 47 papers in CC journals. She works as PI for project “Mechanisms of corneal graft rejection” and has been serving as an Editorial Board Member of 3 and a reviewer for 6 reputed journals. She has an overall experience of over 20,000 surgeries mainly cataract surgery, corneal transplantations, and refractive lens exchange.

Abstract:

Subjects & Methods: Ninety five patients (204 eyes) underwent bilateral trifocal IOL (AT LISA tri 839MP, Zeiss, Germany) implantation after clear lens extraction. Patients were presbyopes; 95 hypermetropes and 7 myopes between 46 and 68 years. Other 20 eyes with hyperopic or myopic astigmatism received trifocal toric IOL (AT LISA tri toric 939 MP, Zeiss, Germany). Uncorrected distance visual acuity (UCDVA), uncorrected intermediate visual acuity at 80 cm (UCIVA), uncorrected near visual acuity (UCNVA), uncorrected distance visual acuity under 10% contrast level, visual disturbances and subjective satisfaction were measured and compared to Bifocal group (AT LISA 809MP; 42 pts, 84 eyes). Follow up was at least 6 months, up to two years. Results: All patients achieved monocular UCDVA better than 0.8, (76.9% eyes 1.0), monocular UCIVA better than 0.63 was achieved in 96.1% patients (37.5% patients 1.0). All patients could read J2 and better; 72.1% of patients could read J1. UCDVA at 10% contrast level was also excellent; 62.5% of patients could read 1.0. Halo and glare were reported in 9.6% and 7.3% of cases, respectively. There was no need for LASIK/PRK enhancement. Spherical equivalent was equal or less than 0.5 D in 97% of trifocal eyes and within the range of +1.00 to -1.00 D of astigmatism in all trifocal toric eyes. Conclusions: Refractive lens exchange with implantation of trifocal or trifocal toric IOL enables good vision at all distances and spectacle independence. It is excellent choice for younger, active presbyopes in need of good intermediate vision.

Biography:

Francisco Javier Carreras is a Tenured Professor of Ophthalmology, University of Granada. His research has pivoted around the pathogenesis of the glaucomas. He has contributed the description and characterization of the Cameral Mucous Gel in humans. He has described a fluid conducting role for the perivascular glial sheat as well as the fenestrations of the basal lamina in the inner limiting membrane. His description of a pathogenetic role of the misdirection of aqueous humor flow is been incrementally delineated by his late contributions. He has developed a computational model of the optic pathways that helps to understand the structural/functional relationship in glaucoma.

Abstract:

Is aqueous humor toxicity the missing link in glaucoma? Glaucoma is a prevalent disease characterized by axonal loss related to difficulties in aqueous humor outflow that may manifest as increased intraocular pressure. We have shown in perfusion experiments that the optic nerve with a fluid-conducting paravascular glial sheat is easily permeable. There is increasing evidence that in some regions of the CNS, axons rely on lactate rather that glucose for their nourishment. We have communicated that based on the presence of transport molecules; lactate is the main energy source at the astrocyte-rich pre-laminar level of the optic nerve. Along with them, adherens junctions (AJ) rich in N-cadherin depend of calcium ion to maintain the binding. We study the response of the cultured pre-laminar tissue of the pig to calcium ion withdrawal by transmission electron (TEM) and confocal (CLSM) microscopes to detect changes in the exposed N-Cadherin attachments. There is an increase both in apoptosis and increase in the cleft separation in AJ in the cultured pre-laminar region with aqueous humor-levels of calcium reduction. Phosphorylation of Beta-Catenin shown by immune-labeling and incremented apoptosis as measured by Western Blot of caspases is both induced by calcium reduction. Altogether, this suggests that activation of the signaling system related to AJ triggers a wave of anoikis in astrocytes. Axon loss in glaucoma can be linked to astrocyte detachment provoked by aqueous misdirection through the optic nerve. This mechanism opens new avenues for pathogenetically-oriented treatment of axon loss and corresponding visual field defects in glaucoma.

Biography:

Giovana Martini Graduated in Occupational Therapy from Federal University of São Carlos (UFSCar) (2000). Master in Health Program for Children and Adolescents from the State University of Campinas (UNICAMP). Developing activities in clinical practice, research and education with main focus on child development and the interface between health and education for the effectiveness of occupational therapy practices to monitor social and educational inclusion for children with special educational needs. Professor and Supervisor for the Specialization Course in Rehabilitation applied to child neurology (UNICAMP).

Abstract:

Purpose: To assess binocular detection grating acuity using the LEA GRATINGS test to establish age-related norms in healthy infants during their first 3 months of life. Method: In this prospective, longitudinal study of healthy infants with clear red reflex at birth, responses to gratings were measured at 1, 2 and 3 months of age using LEA GRATINGS at a distance of 28 cm. The results were recorded as detection grating acuity values, which were arranged in frequency tables and converted to a one-octave scale for statistical analysis. For the repeated measurements, analysis of variance (ANOVA) was used to compare the detection grating acuity results between different ages. Results: A total of 133 infants were included. The binocular responses to gratings showed development toward higher mean values and spatial frequencies, ranging from 0.55 ±0.70 cycles per degree (cpd), or 1.74 ±0.21 log MAR, in month 1 to 3.11 ±0.54 cpd, or 0.98 ± 0.16 log MAR, in month 3. Repeated ANOVA indicated differences among grating acuity values in the three age groups. Conclusions: The LEA GRATINGS test allowed assessment of detection grating acuity and its development in a cohort of healthy infants during their first three months of life.

Biography:

Maria D. Pinazo-Durán received her medical degree and gained PhD at the University of Valencia (Spain), this latter on the subject of developmental neurodevelopment and toxicology of the visual system, mainly the effects of drug and alcohol exposures. She is the foundational member of the Spanish Society of Developmental Biology and from the Spanish Glial Net. She is active member of various professional societies and reviewer of international journals. She is the founder and managing Director of the Ophthalmology Research Unit “Santiago Grisolia” in Valencia. Currently she is General Research Coordinator of the Health Department Valencia- Univ. Hosp. Dr. Peset (Valencia-Spain).

Abstract:

Purpose: To utilize the tear film as biological source of micro RNAs (miRNAs) in order to analyze its profile in relation to primary open angle glaucoma (POAG). Material and methods: A total of 30 participants (POAG patients (GG; n=15) and matched healthy controls (CG; n=15) were interviewed, ophthalmologically examined and extracted their reflex tears atraumatically from the inferior meniscus (20-30 microL) with a Pasteur micropipette that were stored at -80º until processing. The mercury TM RNA isolation kit (Exiqon, Denmark) was used for RNA extraction. The SPSS 15.0 program was used for statistical analysis by integrating all variables. Results: Mean age of the participants was 70 + 2 years in the GG vs 68 + 2 years in the CG. We extracted RNA from the pooled tear film samples and its quality was evaluated using Agilent Bioanalyzer 2100. Then, pure RNA (< 200 nucleotides) was utilized to generate a sequencing library for small RNAs. It was obtained significantly higher purified RNA in tears from the GG as compared to the CG [11 + 1 ng/mL vs 8 + 2 ng/mL of pure RNA respectively (p<0.001)]. By next generation sequencing it has been detected a high variety of matured miRNAs with a differential expression profile in tears from both groups of participants. Conclusions: Tear film sampling is a non-invasive, relatively simple and efficient process for glaucoma research. The miRNAs obtained from tears can be used for quantitative and qualitative assays to improve knowledge on the molecular basis of POAG. The possibility remain that specific miRNAs can be used as biomarkers for better monitoring the diagnosis and therapy of the glaucomatous patients.

Biography:

Stanka Uzunova has completed her graduate training in Medicine in 1991 at the Medical University of Plovdiv and in Ophthalmology at Medical Academy, Sofia. She specialises in glaucoma and has her own private practice. She has published more than 18 papers in reputed journals and in 2009 established the first Glaucoma School for patients in Bulgaria. She supports initiatives for the early detection of glaucoma and organises free annual screening events. Professional interests also include AMD, the application of stem cells in ophthalmology, clinical trials and research.

Abstract:

An observational study by a single investigator was conducted to evaluate the glaucoma progression during adequate therapy and excellent patient compliance. A quantitative analysis was conducted to establish the accuracy and correlation between two widely-used ultrasound and non-contact CCT devices. A qualitative analysis was performed to determine the fluctuations of IOP and glaucoma excavation over a period of 25 weeks. A two-tailed t-test and Pearson’s correlation were performed for statistical analysis. All participants were clinically proved to have POAG. 70 eyes from 35 patients, 7 men and 28 women (age range 51-85, mean age 65,9) were examined. Each had their CCT measured using Ocuscan RxP Ophthalmic Ultrasound System and IOP using Goldman Applanation Tonometer (GAT), and then compared to IOP and CCT measured with Nidek NT-530P Combination Non-contact Tonometer, Non-contact Pachimeter. Baseline: IOP and cup-to-disc ratio. Follow-up: IOP using GAT (after 12 and 25 weeks) and cup-to-disc ratio (after 25 weeks).

Biography:

Haya Al Farhan has completed her Ph.D. at the age of 33 years from City University London, UK. She is an associate professor at King Saud University College of Applied Medicine Science. Dr. Haya was head of Optometry and Visual Science department for 7 years at King Saud University, and at the present the Dean of Al-Mana College. She has published 12 papers in reputed journals and cited. Also, serving as an editorial board member of Austin Ophthalmology Journal, and supervise postgraduate students for master and Ph.D. degrees in joint with Salus University in USA.

Abstract:

To compare the precision of Intraocular Pressure (IOP) measurements taken with ORA, TRK-1P, and GAT in healthy eyes. Design: Prospective study. Methods: One eye of fifty seven normal subjects was randomly selected and included in this study. The measurements of the IOP using ORA, TRK-1P, and GAT, and measurements CH, CRF, and CCT were taken with the ORA. Repeatability was assessed by the Coefficient of Variation (CV) and Interclass Correlation Coefficients (ICC). Repeated-measures analysis of variance (ANOVA) was used to test the statistical significance of the repeatability of three intra-observer readings. Agreement among tonometers was assessed by Bland-Altman plots and the one way-ANOVA. Results: The average of IOP for the IOPg, IOPcc, TRK-1P, and GAT (±SD) were 15.13±2.76, 14.39±2.59, 16.54±2.93, and 15.21±2.54 mmHg respectively. The intraobserver were higher for GAT and IOPg compare to TRK-1P. The intra observer for IOPg, TRK-1P, and GAT (CV= 4.99, ICC=0.93), (CV=6.69, ICC=0.86), and (CV=4.22, ICC=0.94) respectively. The Repeated-measures analysis of variance, P values for ORA, TRK-1P, and GAT were 0.13, 0.01, and 0.60 respectively. The results of the one way-ANOVA for the three instruments was statistically significant (P= 0.01). The comparison pair test P values for GAT vs. IOPg, GAT vs. 1OPcc were (p>0.05), and GAT vs. TRK-1P, TRK-1P vs. 1OPg, and TRK-1P vs. IOPcc were (p<0.05). Conclusion: GAT and IOPg were significantly more repeatable than TRK-1P. Both IOPg and IOPcc have good agreement with GAT on normal subjects.

Biography:

Hongwei Deng is the assistant professor of department of pediatric ophthalmology and vice chairman of medical services department of the Shenzhen ophthalmological hospital, China. She has completed her graduation from Henan Medical University in 1995 and M.D in 1999. Hongwei Deng has done her PhD from Jinan University, department of ophthalmology in 2002. She also served as the observer in Krieger Children’s Eye Center at the Wilmer Institute, USA and Children's Hospital of Boston, Harvard University. She was awarded industry research and development award on the Chinese National Invention Patent: 200410027122 for her research on porous carbon - polyvinyl alcohol hydrogel artificial cornea. She has published several papers in reputed journal and has been serving as an editorial board member of reputed journals.

Abstract:

Objective: To investigate effects of bilberry anthocyanin on form-deprivation myopia in guinea pigs and its mechanism. Method: A total of 30 3-week old healthy guinea pigs were randomly assigned to groups A, B and C with ten (10) in each group. The guinea pigs in group A were given bilberry anthocyanin and in group B were given medication after their eyes had been covered for 14 days. In group C were given normal saline. At Days 1, 14 and 28, diopter and length of optic axis were measured. At Day 28, MMP-2 mRNA and Collagen I mRNA were test by quantitative PCR (Q-PCR). MMP-2 and Collagen I proteins were observed by Western blot. Results: After covering for 14 days, optic axis was elongated and diopter progressed toward myopia in the covered eyes of the non-dosing group (group C). No significant change was observed for optic axis or diopter in dosing group (group A). At Day 28, non-medicated group (group C) showed further elongated optic axis in the covered eyes while the diopter further progressed toward myopia and thus a stable myopia model was established. In dosing groups (groups A and B), covered eyes showed reduced expression of MMP-2 and less severe myopia as compared to the covered eyes in group C. Conclusion: By inhibiting MMP-2 protein expression and preventing Collagen I degradation, orally administered bilberry anthocyanin enhances sclera structure and thereby inhibits the formation of form-deprivation myopia in guinea pigs. Orally administered bilberry anthocyanin has preventive effect against form-deprivation myopia in guinea pigs.

Biography:

Armando Sandoval Vaca is an Ophthalmologist with institutional and private practice in Quito, Ecuador. He is a Medical Doctor from the Universidad Central del Ecuador, Residency in Ophthalmology and fellowship in Vitreo-Retina at the Universidad de Chile, Observerships in Vitreo Retina atthe Jules Stein Eye and Cleveland Clinic, USA, Clinique Sourdille Nantes, France and Hospital de la Luz, México DF. He is the International Member of the ASRS and received Honor Award and Senior Honor Award of the ASRS. He is the Retina Panelist of the Best of the Academy for Spanish speaking Ophthalmologists during consecutive 21 years at the AAO. He is also Faculty Professor of Retina and Neuro Ophthalmology at the Post-Graduate Medical School, Universidad Central, Quito, Ecuador.

Abstract:

Background: The separation of the ora serrata may affect any quadrant. Traumatic dialysis is usually in the superotemporal quadrant and spontaneous dialysis in the inferotemporal. ITD is approximately 10% of all the RRD. The clinical features of ITD are: Demarcation lines, retinal cysts, yellow white vitreous opacities, bilateral, juvenile and slow progression. Purpose: To determine the incidence of ITD in the Ecuadorian Andes. Is there an enviromental or genetic reason? This question has no answer. Material & Methods: This is a retrospective non randomized revision of 2 series of patients operated by the author with scleral buckling. First: 17 years, 150 eyes in 131 patients. Second: 5 years, 32 eyes in 29 patients. Exclusion criteria: PVR more than C-1, trauma, GRT or RD in myopic patients with macular hole. Results: In the first group, ITD is the most common type of RRD with 51 eyes, (34%). Considering the number of patients, the most common is the idiopathic with 50 patients (38%) while ITD has 24.4%. In the second group, 11 eyes were ITD (34%) and of the total of patients, 8 were ITD (27.6%) Conclusions: ITD is the most common RRD, is bilateral in 59% of group 1 and 37% of group 2, most common in young males from 15 to 35 years and in autochthonous, native inhabitants. ITD is a benign RRD with slow progression and self limited in some cases. Discussion: Is there a genetic factor? Is there a congenital anomaly of the ora serrata?

Biography:

Daniel Valverde presently working as a Faculty of Medical Sciences at University of Guayaquil. Being Specialist in Retina Medicinal – Ocular Nutrition - Low Vision – Pediatric Vision - Public Health - Community Development Projects in Public Health

Abstract:

More than 99 percent of the diseases have a direct relationship with the imbalance of his immune system in visual and ocular health the same relationship holds the patients who are treated in our clinic everyday are generally seen from the perspectives of treatment of the signs and symptoms is the consequence but not from the perspectives of the cause and the prevention for more than five years we have handled the concept of transfer factors prevention strengthened in the treatment of our patients and we have obtained fully satisfactory results not only in the overall health of the patient but also in visual and ocular health. We apply this auxiliary treatment in patients with different pathologies both general impact at eye level as well as eye diseases in the treatment center. Immune city of Guayaquil and the city of Quevedo, Ecuador reports obtained are highly satisfactory was improved eye health, pressure control intraocular associating the use of enhanced transfer factors and medication prescribed by the treating ophthalmologist as well as visual acuity of patients.

Biography:

Mohammed Othman has completed his PhD from Cairo University and Post-Doctoral studies from Bascom Palmers Eye institute, Miami School of Medicine, Florida, USA. He supervised more than 35 master degree thesis and 7 PhD thesis. He has published more than 12 papers in reputed journals.

Abstract:

Aim: To compare the efficacy and the complications of Conjunctival Limbal Autograft (CLAU) with mitomycin C 0.02% and Amniotic Membrane Transplantation (AMT) with mitomycin C 0.02% for treatment of re-current pterigum. Methods: 80 eyes of 60 patients with recurrent pterigum were divided into two groups , Group A, included 40 eyes underwent pterigum excision and MMC with CLAU, Group B, included 40 eyes underwent pterigum excision and MMC with AMT. Recurrence was defined as fibrovascular tissue extension of more than one mm onto the cornea in the area of previously excised pterigum after period of follow up from 6-9 months. Recurrence was compared in each group by using Ó½2 test. Results : No major post-operative complications occurred during 6-9 months of follow-up. In CLAU group (A), only 5 eyes of recurrence occur (12.5%) after 7 months of follow up. Recurrence occur in 12 eyes (30%) in AMT group (B) after 6 months (P value=0.043, Ó½2 test). Conclusion : CLAU with MMC is more effective than AMT with MMC for treatment of recurrent pterygium.

Biography:

Rola Hamam is an Assistant Professor of Ophthalmology at the American University of Beirut. She is the director of the residency training program and the medical retina fellowship training program. She received her BS degree in biology from the American University of Beirut in 1998 and her MD in 2002. She completed her residency in Ophthalmology at the same institution then had fellowship training at Harvard University in Boston at the Beetham Eye Institute, the Massachusetts Eye and Ear Infirmary, and the Massachusetts Eye Research and Surgery Institution with Doctor C Stephen Foster until 2008. She returned to her home country and joined her Alma matter in 2009 to start the first uveitis specialty referral clinic in the country at the American University of Beirut. Doctor Hamam is a member of several national and international societies. She has organized and lectured on ocular immunology and uveitis in many national and international conferences and scientific meetings. She is involved in multiple research projects on ocular inflammatory and infectious disease and she continues to contribute scientific publications in the field.

Abstract:

Purpose: To review the epidemiology, risk factors and pathophysiology of uveitic macular edema and discuss advances in diagnosis and treatment Methods: Review of the literature and presentation of case series of the use of topical bromfenac for the treatment of uveitic macular edema, also discussion of the effect of intravitreal adalimumab on uveitic macular edema. Results: Advanced age and chronic edema are among the poor prognostic factors. 11 patients (14 eyes) treated with bromfenac 0.09% daily. Median CRT improved from 427 to 257 (p=0.002). 8/10 eyes had resolution of SRF. 6/11 eyes had resolution of CME. Median logMar improved from 0.39 to 0.17 (p=0.3) and 6/14 eyes gained more than 2 lines. 1.5 mg adalimumab injected intravitreally every month for active non infectious uveitis. 5/8 eyes had resolution of macular edema. Median time to resolution was 6 weeks (range: 2-26). Median CRT improved from 317 mm to 277 mm at 6 months (p=0.021).

Biography:

Katta S V has completed his MB, BS, DO from S V University and Fellow of Retina Foundation under beloved Dr Nagpal. He worked for 9 years under Ministry of Health, Algeria. He is Senior Resident in Ophthalmology in Malla Reddy Institute of Medical Sciences, India. He presented the grievance in general body AIOS 2015.

Abstract:

AIOS is second largest society in the world registered under society Act in the constitution of India. Are we justified in learning and also teaching knowingly non-precise/incorrect medical terms to younger generation without even mentioning misnomers and in turn making them habituated? Under article 226 (high court) & 32 (Supreme Court) in the Constitution of India-Grievance; our solution is to change or to teach misnomer along with the word. For the past 10 years, the same concept was being projected to the world as ‘Questionable medical terms in Ophthalmology’. As some of our AIOS governing council (2013-14) defended as lack of law and not authorized to opine on, retired judge was being consulted and the title is changed with law details as ‘Grievance in literature Ophthalmology-our solutions’. Retrospective study of ophthalmic literature shows for the last more than hundred years, imprecise medical terms like ‘retinoscopy’, ‘syringing’, ‘retinal detachment’, ‘intracapsular cataract’ has been in existence. Phaco emulsification came approximately 28 years ago, 10 years ago small incision cataract surgery and 5 years ago computer vision syndrome. These less precise terms are being added to the medical literature during our own generation. No attempt has been made in the past even with appeal to restore precision and greater accuracy to the terminology in current use. Perhaps none took cognizance of the problem or the need for such correction was not taken seriously. It is unethical that evidence based medical terms are being refused to get published in all scientific journals. Even with appeal, knowingly publishing incorrect medical terms in scientific journals and passing on to innocent younger generation is grievance. At present evidence based science is kept on the desk of chairman, ethics committee and international council of ophthalmology for consideration after relooking. Law is applied to all sciences. Ophthalmology is the starter of the procedure.

Biography:

Janardan Kumar is Professor and Former Chair of Natural Sciences. He has earned MS in biochemistry from University of Allahabad and received PhD in chemistry at CDRI, Lucknow affiliated to Kanpur University in India. Being research Assistant Professor in the department of Cell Biology at Duke University in 1998, he developed his research interest to the field of glaucoma and joined the internationally renowned laboratory of Prof David L Epstein at Duke Eye Center, Duke University, Durham, NC (USA). His work at Duke Eye Center provided opportunity to file two patents, one for glaucoma therapy and the other for vitrectomy. At TEI biosciences in 2002, he gained a unique experience on stem cell research. His strategies made him capable of inducing differentiation of insulin producing cells from adult human skin fibroblast stem cells using specific signaling complexes, and successful transplantation of these cells into three diabetic nude mice resulted of maintaining the normal glucose level for approximately a month.

Abstract:

Glaucoma is a group of eye disorders that progressively damages the optic nerve has no symptoms and no cure (yet), is a leading cause of irreversible blindness and everyone from infants to senior citizens are at risk. An estimated 60.5 million cases were found globally in 2010 and it is anticipated that number may increase to almost 80 million by 2020 and to 111.8 million by 2040. In the United States 2.2 million Americans have been diagnosed with glaucoma, of which more than 120,000 have been rendered blind. Glaucoma costs US about $2.86 billion annually. It is a matter of deep concern that many renowned physicians and glaucoma scientists including Dr David Epstein, one of the most prestigious leaders of glaucoma research are no longer with us. Based on statistical analysis it is clear that the rate of the glaucoma affected portion of the population is increasing exponentially but glaucoma research laboratories are neither increasing in number nor gaining in global popularity. The main theme of this special session is to discuss the following fundamental issues: Why has glaucoma research not yet gained popularity among scientists worldwide? What factors of glaucoma research prevent the acceleration of interdisciplinary research activities with other branches of eye research? What is the status of known factors that contribute to the pathogenesis of glaucoma?

Biography:

Jacob Lorenzo-Morales completed his PhD in the University of La Laguna in 2001 and held his Postdoctoral positions at the University of Edinburgh until December 2011 when he was granted a Ramón y Cajal Tenure Track Fellowship by the Spanish Government. His work has been focused on Free-Living Amoebae infections, mainly Acanthamoeba keratitis. He has published more than 60 papers in reputed journals in the parasitology and tropical medicine fields. He has been the Scientific Secretary in the last two editions of the International free-living amoebae meetings (FLAM 2009 and 2011), invited speaker at the symposium of free-living amoebae of the International Congress of Parasitology 2014. In November 2013 he was awarded the Individual Award for Young Canary Islands Citizens by the Canary Islands Government in recognition of his research career.

Abstract:

Acanthamoeba species are also the causative agents of a sight threating infection of the cornea known as Acanthamoeba keratitis (AK) mainly affecting contact lens wearers. Interestingly, AK is increasingly being recognized as a severe sight-threatening ocular infection worldwide. Current diagnosis of AK is challenging, and the available treatments are lengthy and not fully effective against all strains. Moreover, the pathogenesis of Acanthamoeba is still under study, and the identification of the key factors involved in this process should be useful for the development of fully effective therapies. The current lack of available effective treatment is mostly due to the existence of a highly resistant cyst stage of Acanthamoeba. Together with common misdiagnosis of AK in most cases and a lack of a consensus for AK diagnosis, AK is becoming an emerging disease presenting an increased number of cases year after year worldwide. Therefore there is a need for a fast and reliable diagnostic tool and for novel effective therapeutic agents against these pathogens. Our laboratory is developing novel therapies based on the use of siRNAs in order to validate different cellular targets in these amoebae and to search for a chemical substitute or further develop aRNAi-based technology. Moreover, we have recently established a novel therapy based on statins which was elucidated using siRNAs approaches.

Biography:

Iva Dekaris has completed her PhD from University in Zagreb after Postdoctoral Fellowship at Harvard Medical School, Schepens Eye Research Institute. She is currently a Medical Director at Eye Hospital “Svjetlost”, Professor of Ophthalmology at Universities of Zagreb and Rijeka and Associate-member of the Croatian Academy of Sciences and Arts. She has published 47 papers in CC journals. She works as PI for project “Mechanisms of corneal graft rejection” and has been serving as an Editorial Board Member of 3 and a reviewer for 6 reputed journals. She has an overall experience of over 20,000 surgeries mainly cataract surgery, corneal transplantations, and refractive lens exchange.

Abstract:

Subjects & Methods: Ninety five patients (204 eyes) underwent bilateral trifocal IOL (AT LISA tri 839MP, Zeiss, Germany) implantation after clear lens extraction. Patients were presbyopes; 95 hypermetropes and 7 myopes between 46 and 68 years. Other 20 eyes with hyperopic or myopic astigmatism received trifocal toric IOL (AT LISA tri toric 939 MP, Zeiss, Germany). Uncorrected distance visual acuity (UCDVA), uncorrected intermediate visual acuity at 80 cm (UCIVA), uncorrected near visual acuity (UCNVA), uncorrected distance visual acuity under 10% contrast level, visual disturbances and subjective satisfaction were measured and compared to Bifocal group (AT LISA 809MP; 42 pts, 84 eyes). Follow up was at least 6 months, up to two years. Results: All patients achieved monocular UCDVA better than 0.8, (76.9% eyes 1.0), monocular UCIVA better than 0.63 was achieved in 96.1% patients (37.5% patients 1.0). All patients could read J2 and better; 72.1% of patients could read J1. UCDVA at 10% contrast level was also excellent; 62.5% of patients could read 1.0. Halo and glare were reported in 9.6% and 7.3% of cases, respectively. There was no need for LASIK/PRK enhancement. Spherical equivalent was equal or less than 0.5 D in 97% of trifocal eyes and within the range of +1.00 to -1.00 D of astigmatism in all trifocal toric eyes. Conclusion: Refractive lens exchange with implantation of trifocal or trifocal toric IOL enables good vision at all distances and spectacle independence. It is excellent choice for younger, active presbyopes in need of good intermediate vision.

Biography:

Katta S V has completed his MB, BS, DO from S V University and Fellow of Retina Foundation under beloved Dr Nagpal. He worked for 9 years under Ministry of Health, Algeria. He is Senior Resident in Ophthalmology in Malla Reddy Institute of Medical Sciences, India. He presented the grievance in general body AIOS 2015.

Abstract:

AIOS is second largest society in the world registered under society Act in the constitution of India. Are we justified in learning and also teaching knowingly non-precise/incorrect medical terms to younger generation without even mentioning misnomers and in turn making them habituated? Under article 226 (high court) & 32 (Supreme Court) in the Constitution of India-Grievance; our solution is to change or to teach misnomer along with the word. For the past 10 years, the same concept was being projected to the world as ‘Questionable medical terms in Ophthalmology’. As some of our AIOS governing council (2013-14) defended as lack of law and not authorized to opine on, retired judge was being consulted and the title is changed with law details as ‘Grievance in literature Ophthalmology-our solutions’. Retrospective study of ophthalmic literature shows for the last more than hundred years, imprecise medical terms like ‘retinoscopy’, ‘syringing’, ‘retinal detachment’, ‘intracapsular cataract’ has been in existence. Phaco emulsification came approximately 28 years ago, 10 years ago small incision cataract surgery and 5 years ago computer vision syndrome. These less precise terms are being added to the medical literature during our own generation. No attempt has been made in the past even with appeal to restore precision and greater accuracy to the terminology in current use. Perhaps none took cognizance of the problem or the need for such correction was not taken seriously. It is unethical that evidence based medical terms are being refused to get published in all scientific journals. Even with appeal, knowingly publishing incorrect medical terms in scientific journals and passing on to innocent younger generation is grievance. At present evidence based science is kept on the desk of chairman, ethics committee and international council of ophthalmology for consideration after relooking. Law is applied to all sciences. Ophthalmology is the starter of the procedure.

Biography:

Shahid Wahab is a Professor & Chairman Eye Department Dow University of Health Sciences Karachi, since 2005. There are many international, oral & video presentations to his credit. He is Editor in Chief of Pakistan Journal of Ophthalmology & on the Editorial Board of Ophthalmic Journals. He has been awarded highest Presidential award for excellence. He is regional secretary SAARC academy of Ophthalmology. He has innovated new instruments & techniques. His main interest is in vitreoretinal & is involved in training program. He has developed second sub-speciallity fellowship in vitreoretina for which he is examiner at College of Physician & Surgeons Pakistan.

Abstract:

End stage glaucoma patients are being neglected while using new technologies and technique in Ophthalmology. In this presentation the importance of issues are highlighted while using new methods and technologies. In Phacoemulsification and Vitrectomy new machines are working on high vacuum and high flow rate where bottle height is raised. In expendable gases IOP is raised unpredictably. Silicon oil can cause damage while doing surgery or post-operatively. It is known that after YAG laser IOP is raised, but proper protocol is not followed in many centers. During flap formation in Lasik IOP is raised up to 80mm or more. Now new technologies are being explored to avoid flap formation. Certain Yoga positions are not advised since those positions increase IOP. Intra ocular pressure is doubled during robotic prostatectomy surgery which may take more than two hours. Retained viscoelastics after cataract surgery is known cause of raised IOP. Tight collar or wearing constrictive clothing around the neck can trigger raised IOP intermittently. Poor perfusion for any reason has serious effects. Pressure variations are discussed with recommendations.

Biography:

Rola Hamam is an Assistant Professor of Ophthalmology at the American University of Beirut. She is the director of the residency training program and the medical retina fellowship training program. She received her BS degree in biology from the American University of Beirut in 1998 and her MD in 2002. She completed her residency in Ophthalmology at the same institution then had fellowship training at Harvard University in Boston at the Beetham Eye Institute, the Massachusetts Eye and Ear Infirmary, and the Massachusetts Eye Research and Surgery Institution with Doctor C Stephen Foster until 2008. She returned to her home country and joined her Alma matter in 2009 to start the first uveitis specialty referral clinic in the country at the American University of Beirut. Doctor Hamam is a member of several national and international societies. She has organized and lectured on ocular immunology and uveitis in many national and international conferences and scientific meetings. She is involved in multiple research projects on ocular inflammatory and infectious disease and she continues to contribute scientific publications in the field.

Abstract:

Objective: To prove that small amounts of adalimumab may be stored in plastic syringes for intravitreal use in active non infectious uveitis. Also report the favourable results of intravitreal adalimumab for the treatment of active uveitis. Efficacy of adalimumab stored in plastic vials at 4° C and a pilot study on the clinical effect of intravitreal adalimumab on active non infectious uveitis Purpose: Evaluate the efficacy of adalimumab repackaged into plastic polypropylene vials stored at 4° C and the efficacy and safety of intravitreal adalimumab (IVA) for treatment of active non infectious uveitis. Methods: Adalimumab refrigerated in plastic vials at 4° C for 5 weeks were used to neutralize the cytotoxic effect of recombinant human tumour necrosis factor alpha (rh-TNF-α) on mouse fibro sarcoma cell line (L929 cells). Cell survival was assessed after treatment with effective dose of rhTNF-α and with the different concentrations of adalimumab (0.1, 1, 10 μg/ml) stored in plastic using RTCA xCELLigence system. The inhibitory response of adalimumab was measured at one hour interval for up to 48 hours at weeks 1 and 5. In a prospective non comparative interventional case series, eyes with active non infectious uveitis were injected with 1.5 mg IVA at 0, 2 then every 4 weeks for total of 6 months. Change in VA, grade of inflammation (cells, haze and leakage on FA) and central retinal thickness (CRT) were recorded. Results: Adalimumab (1, 10 μg/ml) stored for 5 weeks in plastic vials was able to neutralize the cytotoxic effect of rhTNF-α with 100% L929 cell survival. 7 patients (13 eyes) were treated with IVA. 6 or 7 patients (12 or 13 eyes) completed 6 month treatment. 1 patient (1 eye) failed treatment with worsening VA and inflammation and was taken out of the study at visit 5. Median logMar at baseline was 0.243 (IQR=0.855) it improved to 0.049 (IQR=0.398) at 6 months. 7/12 eyes had improvement of ≥2 ETDRS lines at 6 months. At baseline, 3/13 eyes had AC cells grade ≥1, 10/13 eyes had vit haze grade ≥1. At 6 months, 0/12 eyes had AC grade or vit haze ≥1. Median CRT at baseline was 317 (IQR=199) it improved to 277 (IQR=107.25) at 6 months. At baseline, 8/13 eyes had macular edema 5 of which resolved at 6 months. Median FA score at baseline was 14 (IQR=7.5) it improved to 4 (IQR=4.75) at 6 months. Using Wilcoxon Signed Rank test, the decrease in logMar, CRT and FA score at 6 months compared to baseline was significant (p=0.003, 0.021, 0.002 respectively). No side effects were detected, stratifying the data to include one eye per patient revealed similar results. Conclusions: Adilamumab stored in plastic vials retained its efficacy after five weeks of storage at 4° C at concentration as low as 1 μg/ml. Furthermore, IVA was safe in this pilot study was effective in improving the VA in 7/12 eyes resolving macular edema in 5/8 eyes and decreasing AC cells, vit haze and FA score in 12 eyes while 1 patient (1 eye) failed treatment.

Biography:

Iraldo Bello Rivero did her MD in 1996 and Culminated in the 2006 the Clinical Laboratory specialty in “Hermanos Ameijeiras” Clinical-Surgical Hospital, Havana, Cuba. She finished the Master in Biotechnology, Mention Clinical Trials, at the Center for Genetic Engineering and Biotechnology from Havana, where she was granted the Scientific Category Added Researcher. She’s a Member of the Cuban Society of Clinical Pathology as well as the Cuban Society of Pharmacology.

Abstract:

The types of non-melanoma skin cancers more common is the Basal Cells Carcinoma (BCC). This lesion appears generally in white patients starting from the fifth decade of their lives, although it may appear in younger patients. The BCC is the malignant tumor most common of the lids. Frequently, it’s in the inferior lid, near the medial rim. Considering previous results, we decide to use HeberFERON as a therapeutic alternative. The HeberFERON is an interferons mixture with antiproliferatives and anti-angiogenic properties, which has been used in several tumors of the skin, such as BCC, SCC (Squamous Cell Carcinoma), advanced skin Epitheliomas and Hemangiomas, showing a high degree of tolerability, very good cosmetic outcomes, low percent of recurrence and a high index of effectiveness. In this study on security, 10 patients were included with a diagnosis of palpebral BCC and in such study, was demonstrated that the product is safe and endorsed by the adverse events presented, in its majority of light intensity and belonging to the pseudogripal syndrome. Out of 10 patients, 6 (60%) obtained a complete clinical response (CR) and 3 (30%) obtained a Partial clinical Response (PR), representing 90% of objective response (CR+PR). There was not progression. The results show that the HeberFERON could be an important option in the therapeutic arsenal of these diseases of the lids, when the surgical option is not possible, in cases that after the surgery the biopsy confirms the tumor presence in the section margins or in recidivates lesions.

Biography:

Abstract:

Introduction and objective: Conjunctival epidermoid carcinoma has not a standardized procedure of treatment. There are preclinical evidences in rabbits and horses and in vitro studies with melanoma cell lines that demonstrate the efficiency of localized cisplatin therapies. The Ophthalmology Service of the Institute of Oncology and Radiobiology of Cuba has developed a scheme of treatment for this pathology consisting in neo and adjuvant chemotherapy combined with conservative surgery for patient who presents recurrences of this kind of tumors. The results are described in the present work. Materials and Methods: A sample of 26 patients (90 % of them with histo-pathologic diagnose of moderate differentiated conjuntival epidermoid carcinoma). Patient were treated with a patented formula that contains cisplatin (1 -3 mg). Such formula was administered subconjuntivally and topically, six doses in 45 days. Results: The simple was composed by 14 men (4 of them HIV carriers) and 12 women. The 81 % of patients was controlled by 40 months alter finishing the treatment. A patient passed away due to another primary tumor in stomach, a year after finishing the treatment. Four patients showed recurrences (3 between 8 and 16 months, one at 60 months after finishing treatment). An orbitary removal was performed in theses cases. All patients are in surveillance and reported as stable. Most frequent adverse effect associated to the procedure were: chemical conjunctivitis, tearing (grade 1, mild) and subconjunctival bleeding (grade 2, moderate) CTC (Common Terminology Criteria, version 4.0, 2009). Conclusion: The procedure is effective and harmless.

Biography:

Kirti Singh completed Post graduation from, All India Institute of Medical Sciences (1989). Faculty in Glaucoma division, Dept of ophthalmology of Maulana Azad Medical College, New Delhi, India for last 19 years. Recipient of AIOS Young Ophthalmologist Scholarship 1999, Commonwealth fellowship 2000, FRCS degree 2000, WHO Scholarship 2010. Authored 3 books, contributed 18 text book chapters, 55 publications in indexed /non indexed journals, over 350 lectures at state, national and international conferences. Head of Low Vision and Contact lens division, honorary faculty of Occupational & Environmental health. Compère for national radio/television in promoting health awareness and published a book on an anthology of poems.

Abstract:

Managing glaucoma presents many challenges to health providers residing in developing nations of Eastern hemisphere. The genetic propensity of Indian race combined with sheer numbers of our young population subjected to the stresses of overcrowding, injuries and sub tropical climate account for large numbers of angle closure and secondary glaucoma patients. Managing such types of recalcitrant glaucoma’s in the primary agragarian environs with lack of homogenous infrastructure coupled with economic adversity over the patient’ s lifetime is a challenge. We have devised certain surgical and non surgical strategies which would be safer, feasible and economically viable options for our patients. The author would present case vignettes depicting surgical strategies to treat glaucoma and cataract by manual small incision fracture combined with trabeculetomy with amniotic membrane (40 eyes), a phacoemulsification machine independent surgery. A modified conjunctival incision in trabeculectomy “Singh’s smile” (40 eyes) contributing to increased comfort and reduced post operative visits. Effective management of the lens in angle closure cases (20 eyes with a 2 year follow up) and traumatic glaucoma cases (2 eyes) to treat intraocular pressure. These case vignettes would be illustrated with requisite surgical videos. Utilizing a novel laser technique to control pressures (6 eyes), indigenously made medication to minimize steroid induced glaucoma (6 eyes) and resurrecting pilocarpine to manage recalcitrant aphakic glaucoma’s (5 eyes) would be presented to highlight adapting science to the required needs of the patient. A short video on innovations in drug delivery to improve patient compliance will also be presented.

Biography:

Dr. Mohamed A. Nasr completed his M.D From Cairo University during May 2006 after fellowship in Ophthalmology in Cairo university hospital. He is a member of the American academy of Ophthalmology since 2010. He is also a member of the international council of Ophthalmology and the Egyptian society of ophthalmology. He is currently an Ophthalmology consultant and Head of Ophthalmology department in New Jeddah Hospital, Kingdom of Saudi Arabia. His area of interest includes cataract surgery, glaucoma and vitreoretinal surgeries.

Abstract:

Objective: To evaluate the safety, benefits and efficacy of initial nucleus sculpting before hydrodisection in different grades of cataract surgery. Subjects and methods: 100 eyes of 68 patients were included in the study with different grades and types of cataract. All underwent coaxial 2.8 mm phacoemulsification using overtly OS3 machine. After capsulotomy an initial groove was made in the nucleus followed by hydrodisection. After hydrodisection and nucleus rotation the groove was further deepened and nucleus was divided by half and then quadrants were emulsified. Pulse mode was used in all stages of emulsification. Bimanual I/A of residual lens cortex and foldable IOL implantation. Postoperative follow up was 6 months after surgery. Results: All patients achieved UCDVA better than 0.7 one week after surgery, sculpting of the nucleus before hydrodisection facilitated the hydrodisection and allowed more fluid to be pushed in the capsular bag. Furthermore nucleus rotation was made easier by the presence of a hinge made by the initial groove. Furthermore it allowed refilling the AC with viscoelastic after the initial groove adding more protection to the corneal endothelium. Conclusion: Initial nucleus sculpting before hydrodisection is an effective and safe phaco technique and it appears to work good in different grades of cataract. Also it decreases the phaco time and protects the corneal endothelium.

Biography:

Abstract:

Purpose of the study is to investigate the effect of mesenchymal stem cells in corneal neovascularization and wound healing and to compare the effectiveness of two possible application routs: subconjunctival injection and amniotic membrane transplantation. Materials and Methods: Animal model was made by application of sodium hydroxide. 7 days after injury animals were divided into 3 groups: Group 1 -subconjunctival injection of BMSCs, Group 2 - transplantation of amniotic membranes, previously seeded with BMSCS, and Group 3 - control group. Eyes were examined weekly with slit lamp. After 4 weeks animals were sacrificed and corneas were harvested for further examinations. Corneal flat mounts were made after ink perfusion for better vessel visualization and capturing. ELISA was performed for VEGF and MMP9. Q-PCR was used for VEGF, MMP9, TLR2 and TLR 4 genes expression. Results:Statistical analyze (One-Way Anova, SPSS) showed significant difference between groups (P=0.002, CI 95%). Difference was between group 1 and group 2 with 3. Measurement of vessels’ area also showed similar result (P=0.01, CI 95%). VEGF level and gene expression had similar pattern of difference between groups (P≤0.05, CI 95), but differences for MMP9, TLR 2 and TLR4 were not significant between groups. BMSCs were previously transduced with GFP gene by lentivirus, but none of the corneal cryosections had cells expressing GFP protein. Thus, the transplanted cells enhanced corneal would healing rather by trophic factor production and immune-regulatory effect, than by direct transdifferentiation into corneal cells. Conclusions: The aim of our study was to observe clinical effect of mesenchymal stem cell transplantation. Results showed that BMSCs enhance corneal wound healing and decrease the area of neovascularization. Further, we compared two possible application routs, and surprisingly, single subconjunctival injection appeared more effective than transplantation with amniotic membrane

Biography:

Atul Bansal is a consultant ophthalmic surgeon with special interest in modern glaucoma and cataract surgery based at University Hospital Coventry & Warwickshire(UHCW). He has extensively including specialist training in Oxford region, advanced specialist training from Birmingham and a clinical and surgical fellowship from Manchester Eye Hospital. He was awarded Birmingham Eye Foundation Roper-Hall Prize Medal in 2004. He specializes in advanced surgical techniques for glaucoma including modern Trabeculectomy, glaucoma drainage implant (Tube surgery), minimally invasive glaucoma surgery (iStent), and lasers and also in complex cataract surgery. He is an author of 15 indexed peer reviewed publications, an MD thesis and chapters in a book on cataract surgery in difficult situations. He has regularly presented at international and national meetings. He has chaired instruction course on glaucoma management and has been an invited speaker and faculty. He has been principal investigator for multicenter clinical trials. Mr. Bansal lead for Quality assurance for postgraduate training for School of Ophthalmology, West Midlands, UK and lead for post graduate medical education and College Tutor for Royal College of Ophthalmologist for UHCW. He is the departmental lead for Clinical Governance, and clinical audit and cataract service for his department.

Abstract:

Surgical Glaucoma management has evolved considerably in recent times. The safety and efficacy of augmented trabeculectomy has increased significantly due to optimisation of the techniques but it still remains a surgery with potential risks, potential of failure over time and more so in certain conditions. Although augmented glaucoma filtration surgery remains the gold standard surgical treatment for most of the patients with uncontrolled glaucoma, there has been a significant increase in the array of options available. Glaucoma drainage device surgery has become safer with refinement of the techniques and is being used more widely and in some conditions they may be used as primary surgical treatment. Modern angle surgery including has provided minimally invasive options in specific situations and MIGS (Minimally invasive glaucoma surgery) have proved to be useful in avoiding the need of more invasive glaucoma filtration surgery. There is increasing use of trabeculoplasty with increased popularity of selective laser trabeculoplasty (SLT) and the refinement of technique of diode laser cycloablation has improved its safety and expanded its indications. Non penetrating surgery may provide an alternative and safer solution in certain situations. There are strong proponents of different types of treatments but each treatment modality has its own risks and benefits and one modality does not fit all uncontrolled glaucoma patients. The optimum treatment depends on number of factors. Disease factors include the type of glaucoma, stages of the disease, level of intraocular pressure (IOP) and the desired target pressure and previously used treatments. Patient factors including age and expected life span, occupation, patients expectation from treatment and their ability and compliance for the necessary post operative management and their ability to afford the treatment or series of treatments. Associated factors like ocular surface disease and atopy influence the outcome of certain modalities more than the other while presence of coexisting conditions like cataract may influence the first choice of treatment by allowing a less invasive treatment. Phacoemulsification and goniosynechialysis in a patient with recent attack of angle closure may be a very useful option before considering trabeculectomy or phacoemulsification and iStent in patient with symptomatic cataract and moderate glaucoma and moderately raised IOP may help avoid or delay need of glaucoma filtration surgery. Whereas at the same time coexistence of a cataract may make the choice difficult in conditions like uncontrolled IOP and advanced cataract in the only eye where prioritisation of one over the other may be sometimes difficult and combination surgery may carry a higher risk and a lower success rate. Trabeculectomy would be the treatment of choice when a large reduction on intraocular pressure is required in an advanced glaucoma case or when an ultra low target pressure is required. A glaucoma drainage device may be the best option in a case of iridocorneal endothelial syndrome and uncontrolled glaucoma or case of repeated failures of trabeculectomy.

Biography:

Inder Paul Singh is a glaucoma specialist who attends to patients in Racine and Kenosha Counties only. He is the first ophthalmologist in Wisconsin and Illinois to implant iStents, a glaucoma drainage device. This is the latest approved Food and Drug Administration (FDA) device that is minimally invasive, and is being done at the time of cataract surgery. This device helps bring the pressure in the eye down in a very safe and controlled approach with lesser adverse events than other tubes and shunts that are currently being done. Our doctors continue to be on the cutting edge of technology.

Abstract:

Purpose: To assess the impact of yttrium aluminium garnet (YAG) vitreolysis for removal of floaters on patient’s satisfaction and to determine rate of complications with this procedure. Methods: This retrospective, observational study included 326 eyes of n=218 patients (mean age, 66 years [range, 38 to 89 years]) who underwent YAG vitreolysis with the Ultra Q Reflex™ (Ellex Medical Lasers, Adelaide, Australia), a neodymium-doped (Nd) YAG laser in an office outpatient setting. [Power range 2.0 mj-7.0mj] A 21 mm lens with hypromellose ophthalmic demulcent solution was placed on the cornea to help visualize the vitreous floaters. Laser was then fired once adequate visualization was achieved. Patient satisfaction was assessed with a 1-10 self-rated scale with higher values indicating greater patient satisfaction as well as a “Yes” or “No” indicating whether they were satisfied with improvement in daily functioning. Information on complications was recorded for all patients. Results: A total of 93% of patients answered “yes” when asked if they were satisfied with their post laser improvement in daily functioning. Average degree of improvement from the subjective questionnaire was 8.3/10. Best results were seen with solitary Weiss rings verses amorphous “clouds”. Average number of sessions per eye is 1.4. Average number of shots: 302-more seen with amorphous floaters. Average power setting used: 4.0 mJ. Conclusions: We observed two cases of intraocular pressure spikes requiring IOP lowering meds. Two phakic lenses were damaged, one of which required cataract surgery. No retinal detachment or other retinal complications were seen and there was no anterior chamber or vitreous reaction. No haemorrhages were observed.

Biography:

Kirti Singh completed Post graduation from, All India Institute of Medical Sciences (1989). Faculty in Glaucoma division, Dept of ophthalmology of Maulana Azad Medical College, New Delhi, India for last 19 years. Recipient of AIOS Young Ophthalmologist Scholarship 1999, Commonwealth fellowship 2000, FRCS degree 2000, WHO Scholarship 2010. Authored 3 books, contributed 18 text book chapters, 55 publications in indexed /non indexed journals, over 350 lectures at state, national and international conferences. Head of Low Vision and Contact lens division, honorary faculty of Occupational & Environmental health. Compère for national radio/television in promoting health awareness and published a book on an anthology of poems.

Abstract:

Managing glaucoma presents many challenges to health providers residing in developing nations of Eastern hemisphere. The genetic propensity of Indian race combined with sheer numbers of our young population subjected to the stresses of overcrowding, injuries and sub tropical climate account for large numbers of angle closure and secondary glaucoma patients. Managing such types of recalcitrant glaucoma’s in the primary agragarian environs with lack of homogenous infrastructure coupled with economic adversity over the patient’ s lifetime is a challenge. We have devised certain surgical and non surgical strategies which would be safer, feasible and economically viable options for our patients. The author would present case vignettes depicting surgical strategies to treat glaucoma and cataract by manual small incision fracture combined with trabeculetomy with amniotic membrane (40 eyes), a phacoemulsification machine independent surgery. A modified conjunctival incision in trabeculectomy “Singh’s smile” (40 eyes) contributing to increased comfort and reduced post operative visits. Effective management of the lens in angle closure cases (20 eyes with a 2 year follow up) and traumatic glaucoma cases (2 eyes) to treat intraocular pressure. These case vignettes would be illustrated with requisite surgical videos. Utilizing a novel laser technique to control pressures (6 eyes), indigenously made medication to minimize steroid induced glaucoma (6 eyes) and resurrecting pilocarpine to manage recalcitrant aphakic glaucoma’s (5 eyes) would be presented to highlight adapting science to the required needs of the patient. A short video on innovations in drug delivery to improve patient compliance will also be presented.

Biography:

Rola Hamam is an Assistant Professor of Ophthalmology at the American University of Beirut. She is the director of the residency training program and the medical retina fellowship training program. She received her BS degree in biology from the American University of Beirut in 1998 and her MD in 2002. She completed her residency in Ophthalmology at the same institution then had fellowship training at Harvard University in Boston at the Beetham Eye Institute, the Massachusetts Eye and Ear Infirmary, and the Massachusetts Eye Research and Surgery Institution with Doctor C Stephen Foster until 2008. She returned to her home country and joined her Alma matter in 2009 to start the first uveitis specialty referral clinic in the country at the American University of Beirut. Doctor Hamam is a member of several national and international societies. She has organized and lectured on ocular immunology and uveitis in many national and international conferences and scientific meetings. She is involved in multiple research projects on ocular inflammatory and infectious disease and she continues to contribute scientific publications in the field.

Abstract:

Objective: To prove that small amounts of adalimumab may be stored in plastic syringes for intravitreal use in active non infectious uveitis. Also report the favourable results of intravitreal adalimumab for the treatment of active uveitis. Efficacy of adalimumab stored in plastic vials at 4° C and a pilot study on the clinical effect of intravitreal adalimumab on active non infectious uveitis Purpose: Evaluate the efficacy of adalimumab repackaged into plastic polypropylene vials stored at 4° C and the efficacy and safety of intravitreal adalimumab (IVA) for treatment of active non infectious uveitis. Methods: Adalimumab refrigerated in plastic vials at 4° C for 5 weeks were used to neutralize the cytotoxic effect of recombinant human tumour necrosis factor alpha (rh-TNF-α) on mouse fibro sarcoma cell line (L929 cells). Cell survival was assessed after treatment with effective dose of rhTNF-α and with the different concentrations of adalimumab (0.1, 1, 10 μg/ml) stored in plastic using RTCA xCELLigence system. The inhibitory response of adalimumab was measured at one hour interval for up to 48 hours at weeks 1 and 5. In a prospective non comparative interventional case series, eyes with active non infectious uveitis were injected with 1.5 mg IVA at 0, 2 then every 4 weeks for total of 6 months. Change in VA, grade of inflammation (cells, haze and leakage on FA) and central retinal thickness (CRT) were recorded. Results: Adalimumab (1, 10 μg/ml) stored for 5 weeks in plastic vials was able to neutralize the cytotoxic effect of rhTNF-α with 100% L929 cell survival. 7 patients (13 eyes) were treated with IVA. 6 or 7 patients (12 or 13 eyes) completed 6 month treatment. 1 patient (1 eye) failed treatment with worsening VA and inflammation and was taken out of the study at visit 5. Median logMar at baseline was 0.243 (IQR=0.855) it improved to 0.049 (IQR=0.398) at 6 months. 7/12 eyes had improvement of ≥2 ETDRS lines at 6 months. At baseline, 3/13 eyes had AC cells grade ≥1, 10/13 eyes had vit haze grade ≥1. At 6 months, 0/12 eyes had AC grade or vit haze ≥1. Median CRT at baseline was 317 (IQR=199) it improved to 277 (IQR=107.25) at 6 months. At baseline, 8/13 eyes had macular edema 5 of which resolved at 6 months. Median FA score at baseline was 14 (IQR=7.5) it improved to 4 (IQR=4.75) at 6 months. Using Wilcoxon Signed Rank test, the decrease in logMar, CRT and FA score at 6 months compared to baseline was significant (p=0.003, 0.021, 0.002 respectively). No side effects were detected, stratifying the data to include one eye per patient revealed similar results. Conclusions: Adilamumab stored in plastic vials retained its efficacy after five weeks of storage at 4° C at concentration as low as 1 μg/ml. Furthermore, IVA was safe in this pilot study was effective in improving the VA in 7/12 eyes resolving macular edema in 5/8 eyes and decreasing AC cells, vit haze and FA score in 12 eyes while 1 patient (1 eye) failed treatment.

Biography:

Mohamed A Nasr completed his MD in Ophthalmology from Cairo University. He is a Member of the American Academy of Ophthalmology since 2010. He is also a Member of the International Council of Ophthalmology and the Egyptian Society of Ophthalmology. He is currently an Ophthalmology Consultant and Head of Ophthalmology Department in New Jeddah Hospital in Jeddah KSA. He has an experience mainly in Cataract Surgery, Glaucoma and Vitreoretinal Surgeries.

Abstract:

Objective: To evaluate the safety, benefits and efficacy of initial nucleus sculpting before hydrodissection in different grades of cataract surgery. Subjects & Methods: 100 eyes of 68 patients were included in the study with different grades and types of cataract. All underwent coaxial 2.8 mm phaco-emulsification using oertli OS3 machine. After capsulotomy an initial groove was made in the nucleus followed by hydrodissection. After hydrodissection and nucleus rotation the groove was further deepened and nucleus was divided by half and then quadrants were emulsified. Pulse mode was used in all stages of emulsification; Bimanual I/A of residual lens cortex and foldable IOL implantation. Postoperative follow up was 6 months after surgery. Results: All patients achieved UCDVA better than 0.7 one week after surgery, sculpting of the nucleus before hydrodissection facilitated the hydrodissection and allowed more fluid to be pushed in the capsular bag. Furthermore nucleus rotation was made easier by the presence of a hinge made by the initial groove. Furthermore it allowed refilling the AC with viscoelastic after the initial groove adding more protection to the corneal endothelium. Conclusion: Initial nucleus sculpting before hydrodissection is an effective and safe phaco-technique and it appears to work good in different grades of cataract. Also it decreases the phaco-time and protects the corneal endothelium.

Biography:

Shahid Wahab is a Professor & Chairman Eye Department Dow University of Health Sciences Karachi, since 2005. There are many international, oral & video presentations to his credit. He is Editor in Chief of Pakistan Journal of Ophthalmology & on the Editorial Board of Ophthalmic Journals. He has been awarded highest Presidential award for excellence. He is regional secretary SAARC academy of Ophthalmology. He has innovated new instruments & techniques. His main interest is in vitreoretinal & is involved in training program. He has developed second sub-speciallity fellowship in vitreoretina for which he is examiner at College of Physician & Surgeons Pakistan.

Abstract:

End stage glaucoma patients are being neglected while using new technologies and technique in Ophthalmology. In this presentation the importance of issues are highlighted while using new methods and technologies. In Phacoemulsification and Vitrectomy new machines are working on high vacuum and high flow rate where bottle height is raised. In expendable gases IOP is raised unpredictably. Silicon oil can cause damage while doing surgery or post-operatively. It is known that after YAG laser IOP is raised, but proper protocol is not followed in many centers. During flap formation in Lasik IOP is raised up to 80mm or more. Now new technologies are being explored to avoid flap formation. Certain Yoga positions are not advised since those positions increase IOP. Intra ocular pressure is doubled during robotic prostatectomy surgery which may take more than two hours. Retained viscoelastics after cataract surgery is known cause of raised IOP. Tight collar or wearing constrictive clothing around the neck can trigger raised IOP intermittently. Poor perfusion for any reason has serious effects. Pressure variations are discussed with recommendations.

Biography:

Yaquelin Duncan Roberts did her MD in 1996 and Culminated in the 2006 the Clinical Laboratory specialty in “Hermanos Ameijeiras” Clinical-Surgical Hospital, Havana, Cuba. She finished the Master in Biotechnology, Mention Clinical Trials, at the Center for Genetic Engineering and Biotechnology from Havana, where she was granted the Scientific Category Added Researcher. She’s a Member of the Cuban Society of Clinical Pathology as well as the Cuban Society of Pharmacology.

Abstract:

The types of non-melanoma skin cancers more common is the Basal Cells Carcinoma (BCC). This lesion appears generally in white patients starting from the fifth decade of their lives, although it may appear in younger patients. The BCC is the malignant tumor most common of the lids. Frequently, it’s in the inferior lid, near the medial rim. Considering previous results, we decide to use HeberFERON as a therapeutic alternative. The HeberFERON is an interferons mixture with antiproliferatives and anti-angiogenic properties, which has been used in several tumors of the skin, such as BCC, SCC (Squamous Cell Carcinoma), advanced skin Epitheliomas and Hemangiomas, showing a high degree of tolerability, very good cosmetic outcomes, low percent of recurrence and a high index of effectiveness. In this study on security, 10 patients were included with a diagnosis of palpebral BCC and in such study, was demonstrated that the product is safe and endorsed by the adverse events presented, in its majority of light intensity and belonging to the pseudogripal syndrome. Out of 10 patients, 6 (60%) obtained a complete clinical response (CR) and 3 (30%) obtained a Partial clinical Response (PR), representing 90% of objective response (CR+PR). There was not progression. The results show that the HeberFERON could be an important option in the therapeutic arsenal of these diseases of the lids, when the surgical option is not possible, in cases that after the surgery the biopsy confirms the tumor presence in the section margins or in recidivates lesions.

Biography:

Charikleia Papandreou is a Trust Specialty Trainee in Ophthalmology in East and North Herdfordshire NHS Trust. She has completed training as a Foundation Doctor in Accident and Emergency and General Surgery as well as a Core Trainee Doctor in Cardiothoracic Surgery in London. She has completed a Master’s degree from University of Charles Bernard in Lyon, France and graduated from the Faculty of Medicine of the National and Kapodistrian University of Athens, Greece in 2011. She has done 25 presentations in national and international medical conferences in Europe. She has 200 CME credits from courses and seminars in which she attended and actively participated.

Abstract:

Introduction: There are two main complications of diabetic retinopathy that cause visual loss: Proliferative Diabetic Retinopathy (PDR) and Diabetic Maculopathy. Diabetic maculopathy may appear in two forms: Diabetic macular oedema (DMO) and Diabetic macular ischemia (DMI). DMO is caused mainly by disruption of the blood-retinal barrier. VEGF-A is a major contributor to the inflammatory process and in particular, to angiogenesis and permeability. Ranibizumab monotherapy is recommended for the treatment of DMO. In clinical practice, decisions on treatment continuation, interruption and re-initiation are most likely to be based on the combination of OCT and VA (visual acuity). Based on the results of clinical trials (READ-2, RESOLVE, RESTORE, DRCR.net and VISTA-DME) and the NICE guidelines as well as the Royal College of Ophthalmologists’ recommendations, we decided to perform an audit assessing the use of ranibizumab for DMO in our department. Methods: We performed a retrospective departmental study from March 2013-March 2015 with a sample of 45 patients with DMO receiving a minimum of 3 ranibizumab injections. We collected data from the patients’ notes, Ranibizumab pathway sheet as well as the Heidelberg electronic system. Central retinal thickness (CRT) was assessed by OCT. Results: In the clinical data, the majority of our sample, 51% of our sample had 6/12 12 hence73% received the retreatment as per protocol. 29 patients had CRT>400 microns but there was a 25% with CRT<400. After the completion of the total number of injections in average, VA in 74% of our patients was same or increased. The time interval between listing and 1st injection, 1st and 2nd injection as well as 2nd and 3rd injection was ≤1 month for 64%, 40% and 33% respectively. Regarding the complications, only one patient had multiple visits to Urgent Eye Clinic post injections for corneal abrasions which is not statistically significant (p=0.022). Conclusion: Intravitreal ranibizumab is a highly effective and safe therapy for improving vision and reducing vision loss in patients with DMO. We identified that pre listing CRT was different for the responsible specialist doctor involved because we interpret the OCT data in a different way. In our recent audit meeting, those issues were addressed, we identified the defaults and we are ready to repeat our study based on our updated recommendations. In a nutshell, so far the results of administration of ranibizumab for DMO in our department are promising and encouraging.

Biography:

Ronald Avila Sanchez completed his training as a physician at the age of 26 years (National University of Colombia). He has completed postgraduate studies in: R & D of drugs, Health Management, have an MBA. Currently he is completing his training as an ophthalmologist at the Hospital Universitario Central de Asturias, and is a doctoral candidate to the research of Ophthalmology and Vision Sciences (Univesidad of Oviedo, Eye Research Foundation, ophthalmological Institute Fernandez-Vega). Results of his research have been presented at national and international congresses ophthalmology. The research results are pending publication (5 articles of international journals).

Abstract:

Purpose: To evaluate the effectiveness that has the eye drops plasma rich in growth factors (PRGF) for the Treatment of Ocular Surface Diseases (ESD) in patients with glaucoma. Material & Methods: Longitudinal, observational and descriptive study included 6 patients diagnosed with open-angle glaucoma who received surgical treatment (EPNP and or trabeculectomy) and medical (1-3 hypotensive eye drops) to control IOP (Intraocular pressure) which developed different ESD (Dry Eye Syndrome: Evaporative and or production shortfall, corneal ulcers, limbal stem cell deficiency, viral keratitis) unresponsive to conventional treatment. The variables analyzed were: VAS (Visual Analog Scale: Frequency and severity of symptoms), dry eye Psychometric Survey (OSDI: Ocular Surface Disease Index) Visual acuity (VA) far (LogMAR), tear breakup time (TBUT), Schirmer test and IOP; such measures were taken before starting treatment with PRGF, the next week, month and in subsequent visits, patients were followed for nearly a year. Results: Patients was aged between 58 and 79 years (mean age, 71±7.2). Treatment cycles with PRGF were between 2 and 6 (1 cycle=6 weeks). They target the AV (logMAR) improved 44.5% (p=0.012), the test OSDI decreased 58.5% (p=0.027), the VAS in frequency was decreased 53.5% (p=0.026), the VAS in severity decreased 44.57% (p=0.027) and IOP decreased by 16.5% (p=0.010); TBUT and Schirmer test improving trend was also evident. One patient reported itching in both eyes as a side effect (SE) but continued with the treatment until the end and the remaining patients reported no SE. Conclusions: In patients with glaucoma and have ESD unresponsive to conventional treatments can now use the eye drops PRGF showing clinical improvement and reduction of IOP.

Biography:

Syed Shoeb Ahmad obtained his Masters in Ophthalmology from India in 1997. Subsequently, he obtained a Fellowship from the renowned Aravind Eye Hospital. He also got a Fellowship from the Contact Lens Research Institute in India. Subsequently, he joined the Ministry of Health, Kingdom of Saudi Arabia where he worked at the prestigious King Fahad Specialist Hospital. In 2006, he was appointed by the Ministry of Health, Malaysia. Since then, he has been working at the tertiary-care hospital: Queen Elizabeth Hospital. He is a keen researcher having published nearly 2 dozen papers in various journals. He has also presented posters at various international forums. His primary interest is in glaucoma. He is also an Editorial Board Member of the Journal of Acute Disease (JAD).

Abstract:

The trabecular meshwork is the single most important structure which controls the amount of aqueous humor exiting the eye. Thus, most types of glaucoma are caused by a dysfunction in this area. It is interesting to recap the newer concepts in aqueous humor outflow and their control by structures situated in this part of the eye. This presentation shall be answering pertinent questions related to pathophysiological mechanisms which modulate aqueous outflow and regulate the IOP and how an understanding of these processes is helping in the development of newer modalities to manage glaucoma. Subsequent to our understanding of the mechanisms of aqueous outflow, we shall take a look at the medications which have been studied to control aqueous humor outflow. These agents are used to perform what is being called “pharmacologic trabeculectomy”. Conventionally, anti-glaucoma agents reduce intra-ocular pressure by decreasing aqueous production or by increasing aqueous outflow through the unconventional ciliary body pathway. However, there is a group of agents which have been investigated for their role in increasing aqueous outflow through the trabecular meshwork. Thus, this presentation shall be focusing on basic pathophysiology of aqueous outflow as well as “pharmacologic trabeculectomy” to manage intra-ocular pressure more physiologically.

Biography:

Noor Al Anazi is 5th year Medical Student (final year) at King Saud University. Graduation date from college of medicine was 7th of May 2015. She will start her internship in July 2015. She is a Member in Ophthalmology Interest Group at King Saud University.

Abstract:

Intraocular Pressure (IOP) is the fluid pressure inside the eye; it is a fundamental parameter in conditions of ocular health. Despite the development of other modes of IOP measurement, the Goldmann tonometer (GT) remains the gold standard in the clinical environment. GT need calibration process periodically. These machines may give false readings if left un-calibrated for long time which may lead to deterioration of ocular health. This study was conducted to estimate the calibration errors of GT in different ophthalmology departments and to clarify the importance of keeping these machines calibrated and maintained. The study aims to raise awareness among health care practitioners. This Observational cross sectional study based on estimating the calibration errors in two major hospitals, King Abdulaziz Medical City and King Abdulaziz University Hospital in different ophthalmology clinics and departments using a special device called Calibration Error Weight Bar at three different levels (0, 20 and 60) mmhg and readings is recorded. Calibration errors were classed to <=0.5, 1 and >=1.5 mmhg; the machines with error readings above 0.5 needs to be calibrated. A total of 30 machines were evaluated in regular clinics, emergency department, wards and screening clinics. A small number of machines used in clinics had error more than 0.5, the other machines in emergency, wards and screening clinics had error less than 0.5. This study suggests GT in the clinics are prone to error, so a more rigorous maintenance program for calibration need to be considered. We recommend conducting a similar study at tertiary Ophthalmology centers.

Biography:

Rohit Sanjay Laul has completed his MBBS and MS Ophthalmology from Maharashtra University of Health Sciences, Nashik, India in 2008 and 2013 respectively. Then he joined as long term Vitreoretina fellow at Dr Agarwal’s Retina Foundation, Chennai, India (A Retina care unit of Dr. Agarwal’s Eye Hospital, Chennai) under one of the world’s finest Ophthalmic Surgeon and also Chairman cum Managing Director of Dr Agarwal’s Group of Eye Hospitals Ltd., Prof. Amar Agarwal, where he underwent rigorous training in medical and surgical management of vitreoretinal diseases. He passed optics & refraction, basic sciences and clinical sciences examinations conducted by International Council of Ophthalmology UK. He has presented several posters in state conferences and has publications to his name in the International Journal of Medical Research. He is now working under Dr. Atif Ali Mir, Senior Vitreoretinal Surgeon & Director Retina services of all Dr. Agarwal’s Eye Hospitals in the golden quadrilateral of Tamil Nadu. The area of his interest is management of advanced diabetic eye diseases, macular diseases and age related macular degeneration.

Abstract:

Purpose: To find out the effectiveness of vitrectomy with intraoperative bevacizumab injection in pseudophakic patients with proliferative diabetic retinopathy. Material & Method: A total of 45 pseudophakic eyes of 45 patients with proliferative diabetic retinopathy underwent standard 23G Pars Plana with intraoperative bevacizumab injection and were followed up for 6 months. Patients age ranged from 46-83years of which 30(66.66%) were males and 15(33.34%) were females. After detailed history taking, they underwent assessment of visual acuity, slit lamp biomicroscopy, fundus examination using 78D lens, indirect ophthalmoscope with 20D lens & B-scan. Standard 23 G pars plana vitrectomy with intraoperative bevacizumab injection was performed in all the cases. Follow up examination was done on next day, at 15 days, 3 months and 6 months following the surgery. The visual acuity, recurrence of hemorrhage and need for another vitrectomy were analysed. Results: The visual acuity improved in 34 eyes (75.55%), after vitrectomy with intraoperative bevacizumab injection. The mean postoperative visual acuity was significantly better than mean preoperative visual acuity. Recurrence of hemorrhage was noted in 4 eyes (8.88%) out of which only 1 eye (2.22%) required another vitrectomy for clearance of hemorrhage. Conclusion: These results demonstrates that vitrectomy with intraoperative bevacizumab injection is an effective procedure in, treating proliferative diabetic retinopathy in pseudophakic patients , reducing the recurrence of hemorrhage and need for another vitrectomy.

Biography:

Charikleia Papandreou is a Trust Specialty Trainee in Ophthalmology in East and North Herdfordshire NHS Trust. She has completed training as a Foundation Doctor in Accident and Emergency and General Surgery as well as a Core Trainee Doctor in Cardiothoracic Surgery in London. She has completed a Master’s degree from University of Charles Bernard in Lyon, France and graduated from the Faculty of Medicine of the National and Kapodistrian University of Athens, Greece in 2011. She has done 25 presentations in national and international medical conferences in Europe. She has 200 CME credits from courses and seminars in which she attended and actively participated.

Abstract:

Introduction: There are two main complications of diabetic retinopathy that cause visual loss: Proliferative Diabetic Retinopathy (PDR) and Diabetic Maculopathy. Diabetic maculopathy may appear in two forms: Diabetic macular oedema (DMO) and Diabetic macular ischemia (DMI). DMO is caused mainly by disruption of the blood-retinal barrier. VEGF-A is a major contributor to the inflammatory process and in particular, to angiogenesis and permeability. Ranibizumab monotherapy is recommended for the treatment of DMO. In clinical practice, decisions on treatment continuation, interruption and re-initiation are most likely to be based on the combination of OCT and VA (visual acuity). Based on the results of clinical trials (READ-2, RESOLVE, RESTORE, DRCR.net and VISTA-DME) and the NICE guidelines as well as the Royal College of Ophthalmologists’ recommendations, we decided to perform an audit assessing the use of ranibizumab for DMO in our department. Methods: We performed a retrospective departmental study from March 2013-March 2015 with a sample of 45 patients with DMO receiving a minimum of 3 ranibizumab injections. We collected data from the patients’ notes, Ranibizumab pathway sheet as well as the Heidelberg electronic system. Central retinal thickness (CRT) was assessed by OCT. Results: In the clinical data, the majority of our sample, 51% of our sample had 6/12 12 hence73% received the retreatment as per protocol. 29 patients had CRT>400 microns but there was a 25% with CRT<400. After the completion of the total number of injections in average, VA in 74% of our patients was same or increased. The time interval between listing and 1st injection, 1st and 2nd injection as well as 2nd and 3rd injection was ≤1 month for 64%, 40% and 33% respectively. Regarding the complications, only one patient had multiple visits to Urgent Eye Clinic post injections for corneal abrasions which is not statistically significant (p=0.022). Conclusion: Intravitreal ranibizumab is a highly effective and safe therapy for improving vision and reducing vision loss in patients with DMO. We identified that pre listing CRT was different for the responsible specialist doctor involved because we interpret the OCT data in a different way. In our recent audit meeting, those issues were addressed, we identified the defaults and we are ready to repeat our study based on our updated recommendations. In a nutshell, so far the results of administration of ranibizumab for DMO in our department are promising and encouraging.

Biography:

Ronald Avila Sanchez completed his training as a physician at the age of 26 years (National University of Colombia). He has completed postgraduate studies in: R & D of drugs, Health Management, have an MBA. Currently he is completing his training as an ophthalmologist at the Hospital Universitario Central de Asturias, and is a doctoral candidate to the research of Ophthalmology and Vision Sciences (Univesidad of Oviedo, Eye Research Foundation, ophthalmological Institute Fernandez-Vega). Results of his research have been presented at national and international congresses ophthalmology. The research results are pending publication (5 articles of international journals).

Abstract:

Purpose: To evaluate the effectiveness that has the eye drops plasma rich in growth factors (PRGF) for the Treatment of Ocular Surface Diseases (ESD) in patients with glaucoma. Material & Methods: Longitudinal, observational and descriptive study included 6 patients diagnosed with open-angle glaucoma who received surgical treatment (EPNP and or trabeculectomy) and medical (1-3 hypotensive eye drops) to control IOP (Intraocular pressure) which developed different ESD (Dry Eye Syndrome: Evaporative and or production shortfall, corneal ulcers, limbal stem cell deficiency, viral keratitis) unresponsive to conventional treatment. The variables analyzed were: VAS (Visual Analog Scale: Frequency and severity of symptoms), dry eye Psychometric Survey (OSDI: Ocular Surface Disease Index) Visual acuity (VA) far (LogMAR), tear breakup time (TBUT), Schirmer test and IOP; such measures were taken before starting treatment with PRGF, the next week, month and in subsequent visits, patients were followed for nearly a year. Results: Patients was aged between 58 and 79 years (mean age, 71±7.2). Treatment cycles with PRGF were between 2 and 6 (1 cycle=6 weeks). They target the AV (logMAR) improved 44.5% (p=0.012), the test OSDI decreased 58.5% (p=0.027), the VAS in frequency was decreased 53.5% (p=0.026), the VAS in severity decreased 44.57% (p=0.027) and IOP decreased by 16.5% (p=0.010); TBUT and Schirmer test improving trend was also evident. One patient reported itching in both eyes as a side effect (SE) but continued with the treatment until the end and the remaining patients reported no SE. Conclusions: In patients with glaucoma and have ESD unresponsive to conventional treatments can now use the eye drops PRGF showing clinical improvement and reduction of IOP.