Day 1 :
Keynote Forum
Maria Dolores Pinazo Duran
University of Valencia, Spain
Keynote: Oxidative stress and mitochondrial dysfunction in the pathogenesis of ocular diseases
Time : 09:05-09:30
Biography:
Maria Dolores Pinazo Duran received her medical degree and gained PhD at the University of Valencia (Spain), this latter on lead to 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 the General Research Coordinator of the Health Department Valencia- Univ. Hosp. Dr. Peset (Valencia-Spain).
Abstract:
Mitochondria control pivotal functions in the cells and tissues, among them the cell cycle, apoptosis, iron/sulfur cluster assembly, generation of reactive oxygen species, calcium homeostasis and biosynthesis of many cellular metabolites. Therefore, mitochondrial changes may induce a wide range of pathological situations such as loss of membrane potential, increase in reactive oxygen species, elevations in oxidized proteins, loss of mitochondrial DNA and/or programmed cell death, all these potentially leading to senescence-associated manifestations. A failure to properly control mitochondrial activity may subsequently convert an essential physiologic process such as the oxidative phosphorylation into a dangerous pathologic disorder regarding the eyes and vision. There is growing knowledge on the role of mitochondrial dysfunction and reactive oxygen species in ocular diseases, including glaucoma and age-related macular degeneration. With the scientific evidence reviewed herein, it can be reached most accurate viewpoint as to how the oxidative stress and mitochondrial failure can interplay to build a solid pathogenic theory in glaucoma and age-related macular degeneration.
Keynote Forum
Jacob Lorenzo Morales
University of La Laguna, Spain
Keynote: Novel therapeutic approaches against Acanthamoeba keratitis
Time : 09:30-09:55
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.
- Track 1: Retina and Retinal Disorders
Track 2: Corneal & External Eye Disease
Location: Valencia
Chair
Sarah Xin Zhang
State University of New York, USA
Co-Chair
Miguel Rechichi
Magna Graecia University, Italy
Session Introduction
Yoko Miura
University of Luebeck
Germany
Title: Monitoring of high glucose-induced cell metabolic alteration of retinal microvascular endothelial cells with fluorescence lifetime imaging microscopy
Time : 09:55-10:15
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.
Vijaya Juturu
Omniactives Health Technologies Inc.,
USA
Title: Macular carotenoids current perspectives: Closing the generation gap
Time : 10:15-10:35
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.
Joshua J Wang
State University of New York
USA
Title: Endoplasmic reticulum homeostasis and inflammation in retinal Muller cells
Time : 10:50-11:10
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.
Guzel Bikbova
Chiba University Graduate School of Medicine
Japan
Title: NF-kB and SP1 expression in AGEs exposed retina and influence of different neurotrophic factors on it
Time : 11:10-11:30
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.
Dario Vasquez Zuloaga
University of Chile
Chile
Title: Curcumin is a natural angiogenic that inhibits hypoxia-induced VEGF release in retina cells
Time : 11:30-11:50
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.
Maneli Mozaffarieh
University of Basel
Switzerland
Title: New insights in the pathogenesis of retinal vein occlusions
Time : 11:50-12:10
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.
Sarah Xin Zhang
State University of New York
USA
Title: Manipulating ER chaperones and the UPR for neuroprotection in retinal diseases
Time : 12:10-12:30
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.
Iva Dekaris
University Eye Hospital ‘Svjetlost’
Croatia
Title: Ultra-thin descemet stripping automated endothelial keratoplasty (UT-DSAEK) – Why I prefer this technique
Time : 14:10-14:30
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.
Inder Paul Singh
Eye Centers of Racine & Kanosha in Racine
USA
Title: Femtosecond laser-assisted lens fragmentation: Effects on effective phaco time and postoperative corneal edema
Time : 14:30-14:50
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.
Maneli Mozaffarieh
University of Basel
Switzerland
Title: Flammer-syndrome as one of the risk factors for GON
Time : 14:50-15:10
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.
Miguel Rechichi
Magna Graecia University
Title: New perspectives in non-invasive keratoconus treatment: Single or combined surgical strategy to improve vision through cornea reshaping
Time : 15:10-15:30
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 beenï€ 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.
Guzel Bikbova
Chiba University Graduate School of Medicine
Japan
Title: Comparative study of results of standard corneal collagen cross linking vs. corneal crosslinking by iontophoresis of riboflavin
Time : 15:45-16:05
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.
Baswati Prasanth
Ahalia Hospital
UAE
Title: Combined phacoemulsification with express device: A procedure of choice in advanced open angle glaucoma
Time : 16:05-16-25
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.
Shahid Wahab
Dow University of Health Sciences
Pakistan
Title: Use of new technologies and techniques in glaucoma with vulnerable optic disc
Time : 16:25-16:45
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.
- Workshop on Tele-ophthalmology and tele-eye screenings
Location: Valencia
Session Introduction
K Yogesan
Australian e-Health Research Centre
Australia
Title: Tele-ophthalmology and tele-eye screenings
Time : 13:10-14:10
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.
- Special Session
Location: Valencia
Session Introduction
Miguel Rechichi
Magna Graecia University
Italy
Title: New perspectives in non-invasive keratoconus treatment: Improve vision through cornea reshaping
Time : 16:45-17:15
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.