Day 2 :
Al Watany Eye Hospital, Egypt
Keynote: IOFB (Believe it or NOT !!!)
Time : 09:00-09:30
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 (www.ashrafarmiaeyeclinic.com). 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.
Statement of the problem: Neglected repaired rupture globe for two months on a huge foreign body in the anterior segment of a child age 8 years. Distorted anterior segment with traumatic cataract. The video represent how I tried to remove the foreign body with the least trauma and reconstruct the anterior segment for further implantation of an IOL. Methods: Male child who is 8 years old. History of penetrating trauma to the right eye by gunshot in the last two months. Repaired ruptured globe was done in the past 2 months. The pattern of his iris tissue has changed since the trauma. Vision was barely HM, with good macular function and his projection was fair. IOP was 17 mmHg. Cornea was in a good state with shallow AC and no pupil could be detected. Results: The eye was quiet and Mild SK. Formed AC with ++ flair; Vision was 30 cm second day, reached up to 5 meters on the first week with BCVA 0.2 at 2 weeks. Couldn't see clearly second day, but after one week it was clearly seen. IOP was digitally full.
Kuban State Medical University, Russia
Time : 09:30-10:00
Alexander G Zabolotniy is Head of the Scientific Department Interindustry Scientific-Technical complex of Eye microsurgery named after Sv. Fedorov, the Krasnodar branch and Professor of the Department of eye diseases of the Kuban State Medical University. His scientific activity include: Innovative treatment of AMD, glaucoma; organization and quality of ophthalmic medical care; high-tech methods of diagnosis. Field of innovative scientific interests – the study of possibility of applying THzR in diagnostics and treatment of ophthalmopathology in the anterior eye segment.
Studying the possibilities of applying terahertz radiation (THzR) in diagnostics and treatment of the anterior eye segment pathology determines the actuality of the research of THzR influence on cornea in normal and pathological conditions. Purpose: The analysis of THzR impact on cornea of animal eyes in experiment in vivo. Materials & Methods: 10 eyes of 5 Californian rabbits were studied. During the experiment, we exposed one eye of each rabbit to a Terahertz photometer (Institute of Photonics and Optical Informatics), the second eye as control group. The sensitive innervation of cornea was checked after 5 minutes of THz exposure with 25-68 nW power and 0.015-320 RUs intensity, Ø spots – 1.5-5.0mm. Analgesic effect was checked starting from 1 min after the onset by applying mechanical irritation at the main area of cornea with von Frey hair (algesimeter). To evaluate the THz impact on epithelization rate of corneal erosion, the notch of 2.5mm had been made with a scarify superficially in the center of cornea. Photo registration of the corneal epithelization was performed immediately and after the exposure for 1.5 days. The corneas were stained with fluorescein solution. Results: The corneal sensitivity pre-and post THzR exposure was sustained and didn’t change. The corneal epithelization in the experimental group with low-power (26 nW) more intensive during the first 3-4 hours. The total epithelization time (24 hours) the same in both groups. The accelerated epithelization is related, our opinion, to the therapeutic effect of THzR-26 nW on the anterior epithelium of cornea. Conclusion: The most representative was the experiment of applying low-power (26.0 nW) THzR. The radiation of 0.1-2.6 THz is well safe for rabbit eyes: it doesn’t change cornea innervation, doesn’t have analgesic effect and causes acceleration of epithelization of scarified corneas in the first few hours, without changing the total epithelization time.
- Pediatric Ophthalmology | Neuro-Ophthalmology | Clinical Ophthalmology
Location: Zurich, Switzerland
Hospital Sant Joan de Deu de Barcelona, Spain
Ashraf Armia Balamoun
Al Watany Eye Hospital, Egypt
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.
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.
Riga Eastern University Hospital, Latvia
Time : 11:05-11:25
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.
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.
University Hospital Center "Mother Teresa", Albania
Title: Treatment results of extensive retinal ischemia and macular oedema in a case of idiopathic frosted branch angiitis
Time : 11:25-11:45
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.
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.
Centre for Ophthalmic Specialised Care (COS), Switzerland
Title: Washout of pseudoexfoliation material combined with cataract surgery: a new surgical approach to lower intraocular pressure in pseudoexfoliation syndrome
Time : 11.45-12.05
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.
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 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.
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.
Gwynedd Hospital, UK
Time : 12:25-12:50
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.
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.
Laser Vision Schlegel, Reunion Island
Title: Comparison of ranibizumab in monotherapy versus association with intravitreal dexamethasone in diabetic macular oedema
Time : 13:40-14:00
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.
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.
Cathedral Eye Clinic, UK
Title: Accelerated visual recovery in transepithelial phototherapeutic keratectomy in comparison to mechanical epithelial removal followed by cross-linking for progressive keratoconus
Time : 14:00-14:25
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.
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.
Al Watany Eye Hospital, Egypt
Time : 14:25-14:50
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.
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.
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.
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.