Day 3 :
- Special Session
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.
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?
- Track 5: Ocular Microbiology & Immunology
Track 7: Novel Approaches to Ophthalmology Therapeutics
Track 8: Ophthalmic Research and Drug Development
University of La Laguna, Spain
Maulana Azad Medical College, India
Eye Centers of Racine & Kanosha in Racine
Title: Vitreous floaters- An under-appreciated and under treated problem: Patient satisfaction and complications of YAG vitreolysis
Time : 10:00-10:20
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.
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.
Maulana Azad Medical College
Title: Edifice of adaptive strategies on foundations of science: Innovations necessary for children from Eastern half
Time : 10:20-10:40
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.
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.
American University of Beirut
Title: The efficacy of adalimumab stored in plastic vials at four degrees celsius and the effect of intravitreal adalimumab on the treatment of active non-infectious ocular inflammation
Time : 10:40-11:00
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.
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.
Time : 11:15-11:35
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.
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.
- Video Presentations
Time : 11:55-12:10
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.
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
University of Oviedo
Title: Plasma rich in growth factors in eye drops for the treatment of ocular surface disease in patients with glaucoma
Time : 12:10-12:25
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).
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.