16^th International Conference on Clinical and Experimental Ophthalmology September 18-20, 2017 Hilton Zurich Airport, Zurich, Switzerland

Biography:

Babak Eliassi Rad completed his Medical degree at University of Wisconsin-Madison, the Ophthalmology Residency at Greater Baltimore Medical Center in Baltimore, Maryland, and glaucoma fellowship at Kresge Eye Institute in Detroit, Michigan. He is currently the Director of glaucoma service at Boston University
School of Medicine, Department of Ophthalmology. He has published 10 peer reviewed papers in reputed journals and is on the Editorial Board of Eyewiki and a Reviewer for Journal of Glaucoma.

Abstract:

Glaucoma is one of the leading causes of irreversible loss of vision and blindness worldwide. Glaucoma treatment is by lowering the intraocular pressure (IOP). This involves using medications, laser, or surgery. Glaucoma filtration surgery (trabeculectomy and/or glaucoma drainage implants) is the mainstay of surgical procedures for glaucoma. While effective in lowering the IOP, both procedures are associated with possible vision threatening complications. Therefore, extensive research has been done to develop
procedures that reduce IOP effectively and are safe. Micro-invasive glaucoma surgery (MIGS) has emerged for the treatment of open angle glaucoma (primary or secondary). MIGS is performed via an ab-interno approach, with minimal tissue disruption, therefore a more favorable risk profile, and faster recovery compared to conventional glaucoma surgery. It is usually combined with cataract surgery and performed in patients with mild to moderate glaucoma. The current MIGS devices lower IOP by different mechanisms. These include: increasing conventional trabecular meshwork outflow via a Schlemm’s Canal Device: trabecular micro-bypass shunt (iStent, Glaukos, Laguna Hills, CA, USA), Hydrus micro-stent (Ivantus, Irvine, CA, USA), or ab-interno trabeculotomy: Trabectome (NeoMedix, Tustin, CA, USA), GATT (Gonioscopy-Assisted Transluminal Traculomotomy), Kahook Dual Blade (New World Medical, Rancho Cucamonga, CA, USA), Trab 360 (Sight Sciences, Menlo Park, CA, USA), and ABiC (ab-interno canaloplasty), (Ellex, Adelaide, Australia). Increasing uveal scleral outflow CyPass Micro-Stent (Alcon, Fort Worth, TX, USA), and iStent Supra (Glaukos, Laguna Hills, CA, USA). Use of subconjunctival space: Xen Gel Stent (Allergan, Irvine, CA, USA) and InnFocus MicroShunt (Santen, Miami, FL, USA).

Biography:

Hemant Mehta has 32+ years experience as Consultant Ophthalmic surgeon in UK, with 25+clinical publications in refereed Journals in UK, USA, Europe and Japan and India. He is a Member of the International Intraocular Implant Club. His original observations and publication of Biodegradation of nylon loops of IOLs has contributed to safer implant surgery. His forte has been Ophthalmic microsurgery, and Oculoplasty, with International acclaim, with International acclaim and citations. His book “Oculoplasty – Innovative Simpler Techniques” was published in 2011.

Abstract:

Surgical progress depends on innovations. The aim of this presentations is to outline some of my innovations and improvisations, the circumstances and fundamental concepts leading to their origin, with a view to inviting clinicians to consider breaking away – sensibly – from convention at appropriate times. The context and the qualities required of a would-be innovator are described.
Rigid adherence to prevailing assumptions and practices stifles originality, while a questioning attitude with a smidgen of irreverence facilitates innovations, which may be planned or brought about by serendipity. An innovation by serendipity may be less glamorous, but no less useful. Author’s innovations of quilting of a skin graft, spontaneous reformation of eyelids, simultaneous use of spontaneous repair with partial surgical reconstruction, and other innovations will be described. Working in a small hospital or isolated unit need not be a hindrance to innovating.

Biography:

Edward T Wei received his PhD in Pharmacology at the University of California San Francisco Med Center in 1969. He pursued Post-doc at Stanford University in
69-70, then joined the Faculty at University of California at Berkeley, and retired from active teaching in 2010. He discovered the cooling properties of icilin and gave this molecule its name. He uses the intellectual property medium to express creativity. He is active in drug discovery and development.

Abstract:

Ocular discomfort is common because the eye surface has a high density of sensory nerve endings. Current methods for rapid (<5 min) and prolonged (>2 hr) relief of symptoms such as irritation, dryness, asthenopia, pruritus, and pain are limited. Physical cooling of the eye surface relieves ocular discomfort, but translating this event to drug treatment has not been much studied. TRPM8,
an ion channel target on nerve endings, is associated with sensations of cooling and cold and was chosen here as drug target for screening lead candidates. The agonists called 1-dialkylphosphorylalkanes (Dapa) were chosen as the best source of prototypes by contrast to e.g. icilin, p-menthane carboxamides, p-menthane esters. In the design of an ideal agent, the goals are to select the correct target, and to deliver the right molecule to the right place at the right time. Dense TRPM8 innervation was found on the mouse eyelid and cornea, but not on the conjunctiva. The eyelid receptors were selected as drug targets. Lead candidates potently and selectively activate TRPM8 (linked to cooling) but not TRPV1 or TRPA1 (linked to nociception). A prototype Dapa called cryosim-3 (C3) was tested in subjects with mild forms of dry eye disease (BMC Ophthalmology 2107). C3 applied to upper eyelids (n=30) elicited cooling
sensations, lasting 46 min and increased tear secretion. C3, 2 mg/mL in water, or water in a single-unit dispenser was applied 4x times daily for 2 weeks (n=20 per group) and data analyzed before and at 1 and 2 weeks thereafter. In questionnaire surveys of ocular discomfort indices (VAS scale, OSDI, and CVS symptoms), the C3 treatment group clearly showed improvement of symptoms at one and two weeks and an increase of basal tear secretion. No signs of irritation or pain were reported. C3 is a promising candidate for relief of ocular discomfort.

Biography:

Richard Blake completed his undergrad at the Brown University and his M.D. at the University of Alabama. He did his residency in Ophthalmology at the
University of Illinois in Chicago. Dr. Blake then completed a glaucoma fellowship with mentor Dr. Mark Sherwood at the University of Florida. After 10 years of private practice in the Carolinas and working in the Veterans Administration as Chief of Ophthalmology, he returned to the University of Florida where he has be in practice for the past 4 years. He is the Physician Director of Quality for the department and is always involved in teaching for the residency program.

Abstract:

Biography:

Jorge Garduno Vieyra, he studied the High school at Missoury Military Academy, USA. His medical career started at Universidad Automa de Guadalajara wherein he specialized in ophthalmology at Cuba in the hospital “league against blindness, Hospital Ramon Pando Ferrer”, the subspecility in retina at México City in the “Hospital General de Mexico”. He made a observership at Moorfields Eye hospital in London, and another one at the Dallas retina center in the USA. He is member of the Mexican Retina Association just to name one. He has been speaker in National and international Meetings, published articles at the Mexican ophthalmology magazine and videos at the eye tube channel. He is the director of the private clinic “Instituto Oftalmologico Privado” that is in Irapuato, Guanajuato Mexico.

Abstract:

Eleven-year-old patient who lives in rural place (ranch), attended the office because of double vision, also he had ptosis in both eyes, and limitation in eye movement. The family claims that the patient is healthy, as an important interrogation, the patient a few weeks ago had fever, joint pain and lack of appetite. He was related with a general doctor who gave him some antibiotics. The family don’t remember what kind but the patient continues with more pain and could not walk for a few days. At that time, we did the Ophthalmology revision, the patient had:VA:20/25 medium midriasis in both eyes, lack of eye movements. Rest of exploration in normal range. So we decided to do some blood tests. According to the findings febrile reactions showed: Brucella 1:320. Antibrucella Huddleson spp 1:2560 Pink bengala (+++) Liver USG with splenomegalia. We interrogated the family and found that the patient drinks unpasteurized milk. We started the treatment with Garamicine 240 mg every 24 hrs for 14 days, Vibramicine 100 mg 1 capsule every 12 hrs for 2 months. Brucella is common in Mexico Latin America, Middle East and Africa, but at very different presentations like vasculitis, anterior uveitis, papilitis, and serous retinal detachments. But in this case, it is rare because it affected the nervous central system along with the optic quiasma.

Biography:

At SuSoS we offer various solutions for surface technology, such as coating products-coated devices or coating chemicals-and services such as coating, surface analysis and contract research. Since 2004, we have focused on researching the chemical interactions between substrates and coatings, in order to broaden our understanding and optimize and fine-tune these interactions for many different applications.

Abstract:

Statement of the Problem: Lubricity, or friction, of contact lenses have been proposed as a predictive quantity of comfort. However, friction is typically evaluated on pristine lenses, ignoring the potential fouling by tear components for one day wearing. In addition, the measured friction force on soft materials is typically not a linear function of the applied normal load, invalidating Amonton’s first law and the concept of a “coefficient of friction”. In this contribution, a method will be presented for in-vitro ageing of soft contact lenses, and a data analysis strategy to convert frictional loss into energy expenditure as an alternative of coefficient of friction as a single figure-of-merit for the lubricity of contact lens materials. Methodology & Theoretical Orientation: The frictional properties of lenses were evaluated by sliding a mucin-coated glass plate against lens sitting on a rounded sample holder, in a tear like fluid. The normal load was varied between 0.25-4 mN, the sliding speed was 1 mm/s and the sliding distance 1 mm. Two contact lens materials were considered: senofilcon A and delefilcon A. The theoretical treatment of the data was done by treating the lens as an elastic foundation. Findings: The energy expenditure of the lenses over a 2 mm sliding distance was determined for pristine and aged lenses (mean±95% CI). On senofilcon A, the energy expenditure changed from 66±7 nJ to 86±11 nJ after ageing. On delefilcon A, the corresponding values were 71±8 nJ and 610±75 nJ. Conclusion & Significance: The frictional properties of contact lens materials are susceptible to simulated ageing. Increases in this energy after a day’s wearing may have an impact on the lens perceived level of comfort. Frictional energy is suggested as an alternative to coefficient of friction when quantifying frictional properties of soft contact lens materials.

Biography:

Ingrid Kreissig is currently working as a Professor at the Department of Ophthalmology, Medical Faculty Mannheim, Heidelberg University, Germany. She did Specialization in Posterior Segment of the Eye at St. Gallen, Switzerland (1963-1965), University Eye Clinic Bonn, Germany (1965-1969) and New York Hospital-Cornell Medical Center, New York (1969-1972). She has worked as the Head of Department of Posterior Segment of the Eye at the University Eye Clinic of the Rheinische Friedrich-Wilhelms University at Bonn, Germany (1972-1979) and as Chairman of Department of Ophthalmology III (Retina and Vitreous Surgery) at the Eberhard Karls University Tuebingen, Germany (1979-2000). She has been working as an Adjunct Professor of Clinical Ophthalmology, New York Presbyterian Hospital-Cornell University, New York since 1982, Adjunct Professor of Ophthalmology, University Eye Clinic of Mannheim-Heidelberg, Germany since 2001, Representative for East Europe of EURETINA since 2002 and Professor H.C. of the Ufa Eye Research Institute, Russia since 2011. Her interests include retinal detachment surgery, diabetic retinopathy, age-related macular degeneration (AMD), posterior segment laser surgery, angiography, OCT, Medical Retina, photodynamic therapy (PDT) and application of intravitreal pharmacotherapy for various edematous and neovascular retinal/macular diseases.

Abstract:

This study discusses about the 8 rules to find the primary break and the missed break in reoperation of a retinal detachment. Later, the surgical technique by closing the break with minimal segmental buckles, preferably in radial orientation, and with coagulations limited to the break without drainage of sub-retinal fluid will be described. Radial buckles provide optimum tamponade. Also, how to minimize the risk of PVR will be discussed. This is followed by a comparison of the various techniques for repair of a retinal detachment in relation to their: morbidity, socioeconomic factors, reoperation and the budget needed for each procedure during long-term follow-up. After that various retinal detachments are presented as a quiz to be discussed by the participants. At conclusion of the course, the attendee will be able to apply a logical examination of a retinal detachment and to know how to close a break with a minimum of trauma for optimal long-term visual function in a retinal detachment.

Biography:

Sultan E AL-Zaaidi is a Consultant Ophthalmologist in Prince Sultan Military Medical City (PSMMC) in Riyadh, Saudi Arabia. He is specialized in Anterior Segment, Cornea, Refractive Surgery & Uveitis and had his training and practiced in major tertiary care hospitals. Being involved in governmental, educational and private sector allowed him to build good skills and experience in his field. Currently, Sultan Al-Zaaidi over many years had chances to operate most of the machines, products & microscopes practicing management of anterior segment diseases in both sectors from simple to complicated applying premium solutions. He has delivered lectures/courses in cataract management and Uveitis in couple of symposium. He holds the Director of Continuous Education in (PSMMC) and working on establishing the permanent microsurgical ophthalmic surgical skills training center and initiating basic science ophthalmology research project under the research center of PSMMC.

Abstract:

Statement of the Problem: Uveitis is one of the leading cause of blindness. The uveitis as specialty was considers somehow poor gain compared to other ophthalmic subspecialties because of the limitations in diagnosing its varieties and treating them. Many years back the treatment of uveitis relayed on the steroids “magic” which is carrying high risks on long term use. Similarly, uveitic cataract was managed until last decade by leaving the patient aphakic. Recently many modifications in diagnosis and treatment became a breakthrough which improved the satisfaction of patients & ophthalmologists. Methodology & Theoretical Orientation: Literatures review of recent articles that covers the changes in uveitis management. The review showed that great steps in diagnosis and management of uveitic entities related to more understanding of its pathophysiology and classification. The management of uveitis moved from broader spectrum therapy toward highly specific treatments targeting the specific immunological triggers. Treatment of uveitis to good extent shifted from systemic medications to local therapy. Surgical management of uveitic complications has also changed toward better outcomes. Conclusion & Significance: Currently, uveitis became more promising specialty for ophthalmologists. With establishment of the specialized uveitis groups that worked hard to standardize diagnosis and management it is getting easier to conduct larger studies. Nevertheless, there are areas for improvement in diagnosis & management.

Biography:

Alina Aligera is a member of ESCRS, EPOS, YBO and National Society of Ophthalmologists. Her recent interest in research is based on in vivo corneal confocal microscopy of diabetic patients in association with diabetic neuropathy and diabetic retinopathy after completing a training course at the University of Manchester. She has a keen interest on cataract surgery, as well as she is involved in medical retina and uveitis treatment and clinical research both adults and children.

Abstract:

Corneal in vivo confocal microscopy (IVCM) is a rapid, non-invasive diagnostic technique that is used as a marker of diabetic neuropathy. The aim of study was to evaluate morphological changes of corneal nerve fibers in patients with DM and to establish the correlation between corneal neuropathy and diabetic retinopathy (DR). 38 patients with DM type 2 and 30 healthy control subjects were scanned using IVCM. Patients with DM were classified into three groups: patients without DR (n=17), patients with non-proliferant DR (n=17) and patients with proliferant DR(n=6). Heidelberg HRT III IVCM was used to get the images and to quantify corneal nerve fiber density (CNFD), corneal nerve branch density (CNBD) and corneal nerve fiber length (CNFL). The duration of DM was significantly lower in group without DR in comparison to the group with non–proliferant DR and proliferant DR (p≤ 0,001). The mean endothelial cell densities and CNFD, CNBD, CNFL were significantly lower in patients with DM compared with healthy control subjects (p=0,018, p<0,001, p<0,001, p<0,001, respectively). CNFD without DR was
25.6±1.9 fibres/mm2, with non–proliferant DR – 19.2±2.5 fibres/mm2 and with proliferant DR – 13.6±2.2 fibres/mm2. CNBD without DR was 47.07±3.2 branches/mm2, with non–proliferant DR – 32.76 ± 2.3 branches/mm2 and with proliferant DR – 17.83±2.8 branches/mm2. CNFL without diabetic retinopathy was 23.6±1.7 mm/mm2, with non–proliferant DR – 19.1±1.5 mm/ mm2 and with proliferant DR – 13.0±1.7 mm/mm2. When comparing the group without DR with the non-proliferant DR and proliferant DR group there was a statistically significant difference between all morphological parameters of corneal sub-basal nerve plexus (p<0,001). Corneal nerve abnormalities occur before the development of diabetic retinopathy. A progressive decrease of CNFD, CNBD and CNFL correlated with increasing severity of diabetic retinopathy.

Biography:

Arjeta Grezda has completed Faculty of Medicine in 1994, the residency in Ophthalmology in 2000; completed her fellowship in Glaucoma at Aravind Eye Institute, Madurai, in 2001. She has completed her PhD, Doctorial studies and became Assistant Professor in the University of Medicine. She has published 26 papers in congress and journals.

Abstract:

Aim: The aim is to report the treatment algorithm employed in a patient diagnosed with frosted branch angiitis. Methods: Medical records of a patient who presented with FBA were reviewed. Empirical initial treatment consisted of prednisolone (1 mg/Kg/day) for 2 weeks and subsequently taped. Intravitreal anti-VEGF injection plus argon laser photocoagulation were performed due an inferior vein occlusion and macular oedema occurred two and half months follow up. Results: The initial best-corrected visual acuity (BCVA) was 20/400 and 20/20 at the last follow up (14 months). FBA and its consequence were controlled. Conclusions: FBA is an uncommon entity and late extensive retinal ischemia with macula oedema is rarely described. Based on our findings, long-term follow-up examinations are needed to prevent complications in these cases. Ancillary tests, e.g. Fluorescence Angiography can be useful.

Biography:

Abstract:

Purpose: Glaucoma or ocular hypertension can be caused by the presence of pseudoexfoliation (PEX) material and/or pigmented cells in the trabecular meshwork (TM) and/or in the irido-corneal angle (ICA). Accumulation of this material can be highlighted by slit lamp (SL), gonioscopy and ultrasoundbiomicroscopy (UBM). Such material prevents aqueous humor from flowing out and thus induces intraocular pressure (IOP) elevation. A new technique using a special cannula for washing the TM and ICA, combined with cataract surgery can lower IOP and reduce the number of hypotensive drugs needed. Method: This study analysed 11 patients (13 eyes) presenting a pseudoexfoliation glaucoma (XFG) with cataract. They all had cataract surgery combined with the special washing technique. Visual acuity and IOP were noted before surgery, just after surgery and during follow-up. The number of hypotensive drugs needed was also recorded. Mean follow-up time was 34.4 months (range: 21.8-59.2). The first case underwent surgery in 2007 and has a 5-year follow-up time. Local status was controlled by SL, gonioscopy and UBM. Results: Mean age was 79 years (range: 71.6-86.0). Mean visual acuity was 0.37 pre-op (range: 0.05-0.6) and 0.89 post-op (range: 0.05-1.0). Mean IOP before and after surgery was 32.8±8.7 mmHg (range 20-53) and 15.1±3.5 mmHg (range 10-20) respectively. The amount of hypotensive drugs needed was 87% lower after surgery. No PEX material recurrence was seen with SL, gonioscopy and UBM during the mean follow-up of 3 years. No complication was recorded in this study. Conclusion: Cataract surgery combined with the new washout technique of the TM and ICA to remove PEX material or pigmented cells significantly lowers IOP and the amount of drugs needed. Long-term follow-up gives good results with no complication or recurrence. Eye status after surgery remains physiological and further glaucoma surgery can be performed if necessary. More research with a higher number of patients should be initiated to confirm this technique.

Biography:

Jorge Garduno Vieyra, he studied the High school at Missoury Military Academy, USA. His medical career started at Universidad Automa de Guadalajara wherein he specialized in ophthalmology at Cuba in the hospital “league against blindness, Hospital Ramon Pando Ferrer”, the subspecility in retina at Mexico City in the “Hospital General de Mexico”. He made a observership at Moorfields Eye hospital in London, and another one at the Dallas retina center in the USA. He is member of the Mexican Retina Association just to name one. He has been speaker in National and international Meetings, published articles at the Mexican ophtalmolgy magazine and videos at the eyetube channel. He is the director of the private clinic “Instituto Oftalmologico Privado” that is in Irapuato, Guanajuato Mexico.

Abstract:

It is a technique using reusable systems for vitrectomy, and for the cataract surgery, we do a manual surgery, because you can use it in all kind of cataracts. The technique starts placing the trocars in the upper side of the eye (m I -m xII - MX) or as normal vitrectomy, leaving the cataract surgeon space to work, we do the sclerotomies with a 22g syringe, and place our trocars (23-25g) 3mm from limbo and 3.5 the one that we will place the infusion line, depends on the type of the IOL (foldable or rigid). We do a scleracorneal tunnel an insition of 300 microns with a diamond knife and a crescent (inverted smile shape). With a 15-degree knife insition (depends on the surgeon M IX or MIII the most common). With a 3.2 knife, we open the tunnel, the insition its self-sealed. We place viscoelastic and a gentian violet dilution at 0.05% and realize the capsulotomy, and after that we realize the hydro expresion, the cataract is now in anterior chamber (the nucleus), we can crush or just use hydro expresion we can take the nucleus out, and using a single system (double via cannula) to absorb the rest of the cataract. Place the IOL, and do the vitrectomy, at the end just do some water-air exchange retire our trocars, and inject some antibiotics and asteroid were our sclerotomies were done. Conclusion: Its cheaper, any kind of cataracts (soft or very hard), no need the use of ultra sound that can cause more damage to the endothelium. And only need a vitrector 23 g or 25g, forget about the extracapsular cataract technic.

Biography:

Hemant Mehta has more than 32 years of experience as Consultant Ophthalmic surgeon in UK, and more than 25 clinical publications in refereed Journals in UK, USA, Europe Japan & India. He is a member of the International Intraocular Implant Club. His original observations and publication of Biodegradation of nylon loops of IOLs has contributed to safer implant surgery. His forte has been Ophthalmic microsurgery, and Oculoplasty, with International acclaim and citations. His book “Oculoplasty - Innovative Simpler Techniques” was published in 2011.

Abstract:

The myotarsal (MT) flap devised by this author is obtained from the upper eyelid and consists of a tarsal strip of 2mm or 3mm from the upper edge of the tarsal plate with the levator and Müller muscles attached - both muscles carrying their blood supply for the viability of the flap. The flap has very little conjunctiva that carries hardly any direct blood supply for the viability of the flap, though it plays a crucial role in providing a smooth mucosal lining. The anterior surface of the flap is formed by the levator, and the front surface of the 3-mm tarsal strip. The inferior border formed by the tarsal strip is free like its medial, and lateral borders. The horizontal width of the flap is adjusted to the requirement of its ultimate use. The flap is very versatile, multipurpose, and effective. With the same basic technique of acquiring it, the flap as a common denominator can be used for three different operations: (i) myogenic ptosis correction (ii) correction of retraction of the upper lid, and (iii) full thickness reconstruction of shallow as well as deep defects of 25% to nearly the full horizontal extent of the lower eyelid. The anterior lamina is formed with a full thickness skin graft (FTSG) secured with the author’s quilting technique. The flap is severed in a week without jeopardizing its own viability and that of the overlaid FTSG. The presentation will be amply illustrated.

Biography:

Zuzana Schlegel completed her specialisation in ophthalmology in 2002, in the Department of Ophthalmology of F.D. Roosevelt University Hospital, headed by Prof. Milan IZAK, PhD, FEBO, and from 2005 she continued and upgraded her training and surgical skills in France, particularly in A de Rothschild Foundation and National Centre of Ophthalmology Quinze-Vingts, headed by Prof. Thanh HOANG-XUAN and Prof. Christophe Baudouin respectively. She is working in Reunion Island as a Consultant and Surgeon in her own private practice. She had published and communicated at least 23 scientific papers and indexed international Ophthalmological journals, reviews and conferences.

Abstract:

Introduction: To evaluate the efficacy of single intravitreal injections of ranibizumab compared with association with dexamethasone implant in diabetic macular oedema in anatomical, functional, safety and observance terms. Material and Methods: 60 patients suffering from diabetes mellitus were randomized into two groups. 30 patients received ranibizumab (R) injection as monotherapy, in three loading doses during first three months and thereafter depending on development of their visual acuity. Other 30 patients received, the simultaneous intravitreal injection of dexamethasone sustained-release implant (Ozurdex) with the first injection of ranibizumab (RD). The variation of BCVA and other criteria was observed monthly up to the twelve months. Results: The improvement of BCVA was superior in the combination treatment group RD than in monotherapy group R. The RD group patients gained 13 letters and the R group 10 letters, p = 0,031. The reduction of central retinal thickness was equally more important in the RD group, -177 μm, than in the R group, -127 μm, p < 0,001, compared to the income values, the chorioretinal atrophy was not remarked. Discussion: Up to this date there exists very few papers about the simultaneous administration of the two products, other than LuceDex study in the ARMD, whose results was also in favour of association of the intravitreal ranibizumab with dexamethasone implant. Conclusion: One year outcomes reveal the functional and anatomical superiority, safety and diminution of total number of interventions conducting in better observance, using combined RD intravitreal treatment versus single R monotherapy in diabetic macular edema.

Biography:

Jonathan E Moore completed a Medical degree from Queens University Belfast (QUB), and trained in Ophthalmology in the Department of Ophthalmology, Belfast. Then he carried out an anterior segment clinical fellowship in Adelaide South Australia and then achieved a PhD in Ophthalmology from Queens University Belfast and with a year of this as a research fellowship position in Harvard Medical School, Boston. He is also Medical Director of Cathedral Eye Clinic which offers specialist expertise in laser, refractive surgery, cataract surgery, anterior segment surgery, multifocal IOLs, medical and surgical retina and Oculoplastic surgery. He has personally completed 16,000 cataract and refractive procedures.

Abstract:

Purpose: To evaluate the outcomes of a series of patients who were treated with either simultaneous transepithelial phototherapeutic keratectomy (trans-PTK) or mechanical epithelial removal prior to corneal collagen crosslinking (CXL) for progressive keratoconus. Methods: This study was a retrospective non-randomized comparative case series on 60 progressive keratoconic eyes (60 patients) who underwent epithelial debridement with trans-PTK using Amaris excimer laser (Schwind, GmbH) (group 1; 30 eyes) or mechanical epithelial debridement (group 2; 30 eyes) for epithelial removal prior to CXL (3mW/cm2) for 30 minutes using 0.1% topical riboflavin sodium phosphate. Uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), keratometry, pachymetry (Topcon, Inc), corneal tomography indices (Oculus Pentacam), differences among anterior and posterior corneal surfaces (Oculus Pentacam), and subjective questionnaires were analysed. Follow up was six months. Results: No complications were observed in either group. Group 1: mean UDVA, CDVA and Kmax improved from 0.83±0.42 logMAR, 0.30±0.22 logMAR and 48.71±4.00 dioptres (D) preoperatively to 0.55±0.19 log MAR (P<0.05), 0.19±0.15 logMAR (P<0.05) and 46.36±4.49D (P<0.05) at six months, respectively; additionally in group 2, 0.80±0.23 logMAR, 0.26±0.18 logMAR and 46.35±4.55D preoperatively improved to 0.62±0.18 logMAR (P<0.05), 0.21±17 logMAR (P<0.05) and 45.47±4.65D (P<0.05) at six months, respectively. The mean magnitude of change observed in UDVA, CDVA, Kmax and QOV scores of group 1 was greater than group 2 (six months). Conclusions: Initial findings suggest that epithelial removal using trans-PTK during CXL results in possible early enhanced visual and refractive outcomes compared with mechanical epithelial debridement. Long-term follow up is required.

Biography:

Ashraf Armia, Consultant Eye Surgeon, has more than 20 years’ experience in Ophthalmology. He has completed his MBBCh from Cairo University of Egypt. He completed his Master degree MSc in Ophthalmology from Cairo University of Egypt. Finally, he finished his FRCS in Ophthalmology from Glasgow, United Kingdom. He became an Associate of the American College of Surgeons (AACS). He is a Consultant Eye Surgeon at the Egyptian Ministry of Health. He is a Consultant Eye Surgeon at Al Watany Eye Hospital (WEH) in Egypt and a shareholder at the same hospital. He is a Consultant Cataract and Refractive Surgeon and Anterior Segment Reconstruction. He also has his own Eye Centre. He is a member of the American Academy of Ophthalmology (AAO), American Society of Cataract and Refractive Surgery (ASCRS), European Society of Cataract and Refractive Surgery (ESCRS) and European Society of Retina.

Abstract:

Statement of the problem: A female patient who is 96 years old; bilateral mature cataract with PX; Right eye was neglected in the last 3 years with hard black cataract; ECCE was done for 4 months in the right eye with a post-operative refraction -2.00 Sph, -2.00 Cly. and vision 0.5. Left eye was neglected for 12 years with intumescent cataract but with deep AC and severe PX; Vision was HM, GP, border line Macular function.; IOP was 17 mmHg. Methods: Decision was made to do a simple ECCE +/- implantation. The video presentation will represent how the Morgagnian cataract was done and once the nucleus was out, the capsular bag was in the anterior chamber. The bag was going back and front, by my manipulations with the use of viscoelastic in so dancing way. At the end, I succeeded to restore the bag in the posterior chamber with no vitreous loss and implantation in the bag. Results: The eye was quiet and vision was 6/36.IOP was 15 mmHg. Mild SK in the cornea was found and; AC was deep with a RRR pupil. The patient was happy and satisfied that she is seeing by her eye after all these years.

Biography:

Sultan E AL-Zaaidi is a Consultant Ophthalmologist in Prince Sultan Military Medical City (PSMMC) in Riyadh, Saudi Arabia. He is Specialized in Anterior Segment, Cornea, Refractive Surgery & Uveitis and had his training and practiced in major tertiary care hospitals. Being involved in governmental, educational and private sector allowed him to build good skills and experience in his field. Currently, Sultan Al-Zaaidi over many years had chances to operate most of the machines, products & microscopes practicing management of anterior segment diseases in both sectors from simple to complicated applying premium solutions. He gave a lectures/courses in cataract management and Uveitis in couple of symposium. He holds the Director of Continuous Education in (PSMMC) and working on establishing the permanent microsurgical ophthalmic surgical skills training center and initiating basic science ophthalmology research project under the research center of PSMMC.

Abstract:

Statement of the Problem: Cataract is the leading treatable cause of blindness worldwide (48%). Its impact on people living in the underdeveloped and developing countries. Here will review the progress in the management of cataract over centuries and the critical milestones. There is no doubt that we are seeking the perfection and we almost there but are we done? Are the solutions cost effective? The current options are so good to the extent that not every cataract surgeon is excellent in it. More than 3-4 decades back; ophthalmology was not too much to tell but now is too much to remember in fact. Methodology & Theoretical Orientation: Literature review of the revolution in cataract management to highlight its major changes and how it became sophisticated is enough to step backward and try to consider what could be the effective change later. Improving the outcomes & reducing the risks is the standard medical before being a quality goal. Pathophysiology, biochemistry, physics, optics, diagnosing, encoding and best affordable management these are pieces of the old puzzle. Findings: Review of literature’s & the technology changes pointing with a convincing evidence that we are about to arrive to our goal but its cost going to be up. We moved from couching/needling to femtosecond laser assisted and premium primary or secondary implants; surprisingly looking around in the world, all options are alive. Conclusion & Significance: Cataract is a major health issue that we must work on it targeting probably genetics? Or biochemistry reversing the lens clarity at least for the non-traumatic ones.