Day 1 :
Keynote: Long-term results of accelerated trans-epithelial cross-linking for keratoconus with osmotic riboflavin solution (ParacelTM)
Time : 09:10-09:40
Roberto Pinelli graduated in Medicine and Surgery at the State University of Milan, and specialized in Ophthalmology. He trained in refractive surgery with Dr Michael Gordon at the Vision Surgery Laser Center in San Diego, the United States (currently the Gordon-Weiss-Schanzlin Vision Institute). In 2013 he undertook a new project in the Canton of Ticino, SERI Switzerland Eye Research Institute in Lugano, an eye surgery and ophthalmology research institute and care centre for visual defects and all kinds of eye diseases. Until 2014, he was a lecturer in corneal pathology and refractive surgery techniques at the ESASO, European School for Advanced Studies in Ophthalmology in Lugano. An ophthalmology and eye surgery specialist with the FMH (Swiss Medical Association), he has pioneered leading-edge surgery and innovation in ophthalmology, including P-Curve for presbyopia correction, osmotic transepithelial corneal cross-linking for the treatment of keratoconus, and the ParaCel eyewash. He was invited to join the exclusive International Intra-Ocular Implant Club (IIIC) for surgeons founded by Sir Harold Ridley. In 2009-10, in view of his groundbreaking research activity in the field of refractive surgery and the science of vision, he was invited to join the executive committee of the world’s most prominent ophthalmology association, the American Academy of Ophthalmology (ISRS/AAO). Currently a member of the Scientific Advisory Board of Biosyntrx (Colorado Springs, Colorado), a biotech company operating in the field of ophthalmology, and the Medical Advisory Board of Avedro (Waltham, Massachusetts), a leading company in the calibration of instruments and devices for eye pathologies.
Aim: The aim is to present the long-term results of accelerated transepithelial cross-linking (CXL) for keratoconus with osmotic riboflavin solution. Methods: Patient with progressive keratoconus had accelerated transepithelial CXL. Visual and refractive outcomes and the endothelial cell density /ECD) were evaluated preoperatively and postoperatively. Results: Thirty-five patients were examined unilaterally; postoperatively 35 eyes were evaluated at 3 months, 6 months, 1 year and 2 years form the treatment. No intraoperative or postoperative complications occurred. The mean uncorrected distance visual acuity improved significantly form 1.12 ± 0.60 logMAR preoperatively to 0.68 ± 0.49 logMAR at the last follow up and the mean corrected visual acuity form 0.37 ± 0.25 logMAR to 0.09 ± 0.15 logMAR, respectively. The mean steep and the mean flat keratometry readings decreased significantly form 54.71 ± 5.26 diopters (D) and 46.82 ± 3.29, respectively, preoperatively to 46.82 ± 3.69 D and 44.93 ± 3.61 D, respectively, at the last follow-up. The mean corneal astigmatism improved significantly from -6.75 ± 4.38 D preoperatively to -2.50 ± 3.10 D at the last follow-up. No significant ECD alteration occurred. Conclusion: Accelerated trans-epithelial CXL was effective and safe in keratoconic patients over a long-term follow-up.
Hospital Sant Joan de Deu de Barcelona, Spain
Time : 09:40-10:10
Joan Prat has completed studies in Medicine (Autonomous University of Barcelona) and Ophthalmology in 1991. From 1991 to 2002 he worked in orbital diseases in Bellvitge Hospital (Barcelona) and later became the Head of Department of Pediatric Ophthalmology in Hospital Sant Joan de Déu de Barcelona until today. He has innovated in eyetracking both in research and development of medical devices for pediatric use and has been attending conferences in WCPOS and EPOS. He is now the Director
of Master’s degree in Pediatric Ophthalmology in Barcelona University and President of Spanish Society of Ocular and Orbital Plastic Surgery.
Psychiatric disorders are usually evaluated through different specific methods such as interviews, questionnaires or family references. The lack of known biomarkers is an important problem to have an objective diagnosis, that is why researchers have been studying the presence of ocular signs associated to several psychiatric disorders in the last two decades. Ocular motility alterations have been found using eye-tracking devices consisting on infrared video cameras and a computer vision software. Schizophrenia has been the most studied disorder, characterized by some defects in smooth pursuit movements. Patients can not follow a target in a medium velocity and have more frequent compensatory and intrusive saccades. Convergence defects and abnormal patterns of scene scanning have been observed, too. Other physical observations are thick retinal venules and thin retinal nervous fiber layer with OCT. These biomarkers can be used to identify adolescents with risk to present psychotic disorders, due to these alterations can appear earlier. Other disease well documented in children is the attention deficit hyperactivity disorder (ADHD). The characteristic failure of inhibitory systems of ADHD seems to produce abnormalities in saccades, specifically in antisaccades. Likewise, an improvement of saccades has been observed after treatment with amphetamines. One of the most important advances are related with early diagnosis of autism (ASD). In visual preferences test, ASD toddlers show preference to look at geometric images instead of faces and other social images, contrary to well-developed children. Moreover, several studies including 6 to 24-month children show a correlation between the performance of the test and the presence and severity of the disorder. In conclusion, the study of ocular biomarkers by noninvasive eye-tracking techniques in psychiatric disorders can help to obtain an early diagnosis, a better categorization and a better treatment. We encourage pediatric ophthalmologists to collaborate with mental health professionals in eye-tracking diagnosis of psychiatric diseases.
- Retina & Retinal Disorders | Cornea & External Eye Disease | Ophthalmology Surgery
Location: Zurich, Switzerland
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.
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).
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.
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.
University of California, USA
Time : 11:20-11:45
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.
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.
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.
Instituto Oftalmológico Privado, Mexico
Time : 12:05-12:25
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.
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.
- Special session on "Contact Lens Friction"
Location: Zurich, Switzerland
SuSoS AG, Switzerland
Time : 12.05-12.25
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.
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.
- Teaching Course on Primary Retinal Detachment: Diagnostics, options for repair and their comparison. Quiz of retinal detachments
Location: Zurich, Switzerland
University of Mannheim - Heidelberg, Germany
Title: Teaching Course on Primary Retinal Detachment: Diagnostics, options for repair and their comparison. Quiz of retinal detachments
Time : 13:40-16:40
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.
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.