Biography:

Korobova Lyudmila Sergeevna is the doctor, anesthesiologist of the Department of Anesthesiology and Intensive Care; a doctor of the highest qualification category, an
aspirant.

Abstract:

Purpose: The goal is to optimize the anesthetic aid for bone-plastic operations in orbit with double access (transconjunctival or transorbital in combination with transnasal endoscopic access). The tasks are 1. To evaluate the efficacy of combined general anesthesia with sevoflurane, propofol with regional anesthesia, including: palatine access to the wing-palatal anesthesia (palatinal); infraorbital anesthesia; the van Lint block; application anesthesia; 2. To evaluate the safety this investigation.

Materials and Methods: The object of the study is children aged 4 to 17 years. Premedication is not performed. For all children in all groups, the induction of anesthesia is performed by inhaling sevoflurane through the facial mask with the preliminary filling of the respiratory circuit of the anesthesia apparatus with a gas-drug mixture with an anesthetic content of 7-8% by volume.Maintenance of anesthesia during spontaneous breathing through ETT is carried out as follows: inhalation of sevoflurane in an air-oxygen mixture with an O2 content of 40% and an anesthetic concentration of 0.7-0.9 MAK and intravenous injection of propofol at a dose of 2 mg/kg immediately after induction; regional anesthesia: anterior-temporal blockade, Wang Lint block, infraorbital anesthesia and palatine anesthesia, application anesthesia.

Results and Conclusions:

1. Stability of hemodynamic parameters

2. Refusal of narcotic drugs

3. Absence of oculocardial and oculogastral reflexes

4. Early readaptation of patients

5. Reduction of postoperative fasting time

6. Comfortable work of surgeons

Keywords: Orbit, contour plastics, regional anesthesia, infraorbital anesthesia, palatal anesthesia.

Biography:

Catherine Favard, is a french retina specialist who has completed an MS degree in neuroscience at Pitie Salpetriere, working on immunolabelling of retinal cells. She has studied VEGF activity in the eye, working with Pr J. Plouet and Pr F. Malecaze. She has performed a post doc fellowship in Boston at the Scheppens Eye Institute and at Harvard University with Pr Aiello. Her main interests are diabetic retinopathy, AMD, uveitis and choroidal tumors. She is currently working at Centre ophtalmologique de l’Odeon and in Pr Brezin department at Cochin hospital where she is involved in clinical trials and publications.

Abstract:

Purpose: The longer wavelenght of swept source OCT (SSOCT), enables better penetration of retinal pigment epithelium and analysis of choroidal tumors. We present here the contribution of SSOCT and SSOCT-angiography (SSOCT-A) to the diagnosis of circumscribed choroidal hemangiomas (CH) .

Methods: 7 CH have been analysed with multimodal imaging : color fundus photography, ultrasonography (US), fluorescein (FA) and infracyanin green angiography (ICGA), and SSOCT and SSOCT-A (DRI SS-OCT Triton, Topcon).

Results : On SSOCT, all 7 CH presented the characteristic signs of CH with an acutely smooth dome-shaped tumor with thick and large spongelike choroidal vessels and partial posterior shadowing associated with subretinal fluid in 3 eyes. On SS-OCTA all cases presented an hypersignal of dilated choroidal tumoral vessels with loops, interspaced by dark areas and surrounded by an hypersignal rim. In 4 cases large abnormal tumoral vessels were observed both at the choriocapillary and choroid level, associated with choriocapillaris alterations on SSOCT and presented an ICGA late phase wash out. In 3 cases, much thinner tumoral vessels were observed on SSOCT-A below a normal choriocapillaris on SSOCT and SSOCT-A, with no late phase ICGA wash out.

Discussion and Conclusion: SSOCT and SSOCT-A enabled us to distinguish 2 types of CH : one associated with large superficial tumoral vessels could correspond to cavernous hemangiomas and one with thinner tumoral vessels below the choriocapillaris which could correspond to mixte or capillary hemangiomas. Therefore, SSOCT and SSOCT-A contribute to the diagnosis of CH and provide new insight for CH vascular pattern analysis.

Biography:

Abstract:

Purpose: To determine the usefulness of different non-invasive methods using ocular coherence tomography (OCT) for the diagnosis and follow-up of Alzheimer’s disease (AD)

Methods: Layer segmentation and linear discriminant functions were applied on a population of AD patients and age-matched controls. Patients with AD (n=150) and age-matched healthy controls (n=75) were analysed using the segmentation application prototype to automatically segment all retinal layers in a macular scan. Thicknesses of each layer were compared between patients with AD and controls and between patients with disease durations of less than or at least 3 years. Associations between retinal layer thicknesses, disease duration and AD severity were evaluated.

Results: Patients with AD had reduced thickness in the retinal nerve fibre, ganglion cell, inner plexiform and outer nuclear layers (p<0.05). The inner retinal layers were more affected in patients with long disease duration. Ganglion cell and retinal nerve fibre layer thicknesses were inversely correlated with AD duration and severity. Ganglion cell and inner plexiform layers thicknesses were predictive of axonal damage.

Conclusion: The segmentation application revealed ganglion cell and retinal layer atrophy in patients with AD compared with controls, especially in the inner layers of patients with long disease duration. Ganglion cell layer reduction was associated with increased axonal damage and may predict greater disease severity.

Biography:

Martine Mauget-Faÿsse is a Retinal medical ophthalmologist. She did her medical studies and Certification in Ophthalmology at the University of Lyon, France, then post-doctoral training for retinal diseases at the Creteil Hospital in Paris. Since 2012, she is a medical consultant for clinical research for retinal diseases in the Adolphe de Rothschild Foundation investigation clinical Center in Paris, Principal investigator and co-investigator for biomedical protocols. Active member of numerous scientific Societies: SFO, AAO, Macula Society, Fan Club. Reviewer and author of papers on Clinical Research and Retinal diseases.

Abstract:

Purpose: To present a series of patients with clinical findings characteristic of ocular toxoplasmosis and highlight the advantages of OCT Angiography (OCT-A) in delineating the morphologic features of the retinal and choroidal vascular networks during acute, relapsing and quiescent stages of toxoplasmic necrotizing retinochoroiditis.

Patients and method: All patients diagnosed with ocular toxoplasmosis underwent a complete ophthalmic examination including a best-corrected visual acuity (BCVA) test with Snellen eye charts, intraocular pressure measurement with Goldman aplanation tonometry, anterior segment examination, and dilated fundus biomicroscopy. Standard fundus fluorescein angiography (FFA), indocyanine green angiography (ICGA), and optical coherence tomography (SD: Spectral Domain or SS: Swept Source): B, C or Angiography (Spectralis HRA Heidelberg Engineering or SS OCT Triton Topcon) were performed in all patients.

Results: Twenty three patients were enrolled. Five initial cases, 6 scarred cases and 12 cases with toxoplasmosis recurrence were analyzed. For all active retinochoroidal foci, OCT-A showed better than FFA and ICG the vessel rarefaction in the deep retinal capillary plexus (DRCP) more extensive than in the superficial retinal capillary plexus (SRCP); then on treatment, OCT-A showed the partial reappearance of these two capillary layers. On atrophic areas, the residual disorganized ischemic areas were larger in the choroidal segmented layers compared to SRCP and DRCP.  EDI OCT, shows an increased choroidal thickness at the level of active foci.

Discussion: At the level of active and scarred toxoplasmosis foci, OCT-A showed better than FFA and ICG the localization and extension of retinal and choroidal capillary involvements. The partial vessel reappearance after treatment may correspond either to a vessel recanalization or to a disappearance of a masking effect induced by the active foci.

Conclusion: SD and SS OCT-A seem interesting for assessing retinal and choroidal capillary involvement in ocular toxoplasmosis. OCT-A  shows that the retinal and choroidal capillary damages may be partially regressive in the initial outbreaks of toxoplasmosis treated early, which may help to better understand the pathophysiology of the toxoplasmic damage.

Biography:

Waldensius Girsang is a senior consultant ophthalmologist in Retina division at Jakarta Eye Center (JEC) Hospital, the largest eye center in Indonesia. He obtained his medical doctor certification from Faculty of Medicine, University of North Sumatera and his ophthalmologist certification from Faculty of Medicine, University of Indonesia. He joined a fellowship program at JEC and Vitreoretinal Training at Zhongshan Ophthalmologic Center, Sun Yat Sen University, Guangzhou, China. He is now working due to his excellent skills as a general ophthalmologist and as a part of Cataract, LASIK, and Vitreoretina specialist team. Dr. Girsang’s clinical works focus is on diseases of the retina. His practice involves the management and surgery for retinal detachments, diabetic retinopathy and macular disorders - macular holes, epiretinal membranes, vitreomacular traction.  He takes on complex retinal diseases like advanced proliferative vitreoretinopathy, trauma and retinal surgery in combination with anterior segment disease.  In the field of medical retina, he manages patients with age-related macular degeneration, choroidal neovascular and polypoidal disease, diabetic retinopathy and retinal vascular diseases. His area of interest for research is in Medical Retina and Vitreoretinal Surgery, which he has presented his results of research both in national and international conferences. Currently, he is one of the scientific committee members in Indonesia Ophthalmology Association (IOA), Indonesian Medical Association [IMA] – IDI, and European Society of Retina Specialist [EURETINA].

Abstract:

Retinal detachment (RD) remains one of the most challenging cases in vitreoretinal surgery. It becomes more challenging as the condition advances, marked by abnormal cellular accumulation creating traction to the retina known as proliferative vitreoretinopathy (PVR). Treatment of RD often requires complex procedures, particularly those at advanced stage of RD with PVR. The presence of PVR may reduce the anatomical success rate of RD treatment due to double burden and difficulty level of the surgery. Surgical treatment of RD with PVR may involve multiple procedures including scleral buckling, membrane peeling, retinotomy, retinectomy and intraocular tamponande injection.

To date, vitrectomy, membrane peeling, retinotomy with additional silicon oil tamponade has been considered as the best technique for treatment of RD with advanced PVR. Retinotomy has been widely used for their management. Subsequent development of 360 degree, circumferential retinotomy was done for advanced PVR. More recently, peripheral 360 degree retinotomy, anterior flap retinectomy and radial retinotomy were combined to improve anatomical outcomes of RD with advance PVR. These techniques have been reported to have considerable anatomical success rate than previous retinotomy alone. However, recent report has suggested that only a small portion of patients achieved good visual acuity and there were substantial number of post-operative complications such as persistent hypotony, corneal damage and retinal redetachment.

Theoretically, in retinal detachment, there is tangential force caused by PVR that plays key role in creating the tractionand ultimately reduce the success rate of postoperative retinal reattachment. Therefore, any procedures performed during surgical treatment of RD with PVR should aim to reduce or eliminate this tangential force to achieve anatomical reattachment of the retina. This review aimed to show novel method of radial relaxing retinectomy to eliminate this tangential force caused by PVR, showed its anatomical success and postoperative complications of this method during 6 months follow-up.

Biography:

Abstract:

Purpose: To compare and evaluate images of macular cysts with different degrees of reflectivity (from gray to black signal) as observed in B-scan Spectral Domain OCT (SDOCT) and En Face OCT with decorrelation signal obtained with OCT-angiography (OCTA) in eyes with cystoid macular edema (CME) secondary to diabetic retinopathy (DR) and retinal vein occlusion (RVO).

Methods: Images from 3033 patients affected by CME secondary to diabetes or RVO examined OCTA (Optovue XR Avanti, Optovue, USA) at the University Eye Clinic of Creteil, Hopital Intercommunal, France, and at the University Eye Clinic of Cagliari, “San Giovanni di Dio” Hospital, Italy, were retrospectively examined. The deep capillary plexus OCTA images and the corresponding EnFace OCT images, both acquired with the same automatic segmentation, were overlapped to compose RGB color images as red and green channels, respectively, using ImageJ software (National Institutes of Health, Bethesda, MD). Then, linear regions of interest were traced on the color images to obtain the profiles of OCTA and EnFace gray values. Number of pixels, mean gray value and standard deviation of the area traced in OCT-A and EnFace image were respectively analyzed and statistically correlated. Data were exported to Excel to create the plots.

Results: We found 94 patients with DME and 27 patients with RVO showing intraretinal macular cystoid spaces with similar homogeneous, gray-looking content, and 73 patients with DME and 113 patients with RVO showing macular cystoid spaces with homogeneous, black-looking content, as observed at SD-OCT, EnFace and OCTA scans. Interestingly, the limits of macular cystoid spaces are clearly detectable with OCTA. The analysis of red and green profiles demonstrated a clearly visible overlapping between the average OCTA and En Face signal observed around cystoid spaces, that could be attributed to a relationship between the dynamic vascularization and structural density of the tissue.

Conclusions: This is the first investigation which characterizes and correlates OCTA and enface signals on images of macular cystoid spaces in DR and RVO. The low intensity OCTA signals observed inside cystoid spaces, pose a relevant question about their nature, as to whether they are due to the presence of corpusculated material poured out from bloodocular-barrier or must be considered OCTA artifacts.

Biography:

Abstract:

Purpose: To study peripapillary choroidal thickness (PPCT) in a wide area around the optic disc and established different zones in healthy subjects using a new swept source optical coherence tomography (SS-OCT) device. To evaluate PPCT differences between primary open-angle glaucoma (POAG) patients and age and sex marked healthy controls.

Methods:  A total of 246 subjects were consecutively recruited: 111 healthy subjects and 135 glaucoma patients. The group of healthy subjects was divided in two populations: the teaching population (composed by 25 controls and used to establish choroidal zones) and the validating population (composed by 86 controls and used to compare measurements with POAG patients). An optic disc 6.0×6.0 mm three dimensions scan was obtained using Deep Range Imaging (DRI) OCT Triton. A 26×26 cube-grid centered in the optic disc is generated to automatically measure choroidal thickness. Fourchoroidal zones were established and used to compare peripapillary choroid between healthy and POAG patients.

Results: PPCT was significantly thinner in Zone 3 of POAG group, mainly located in the superior, temporal and nasal peripapillary choroid (p=0.038); and Zone 4, corresponding to the superior area, farthest from the optic disc (p=0.023). Choroid followed a similar pattern in controls and POAG; it was thicker in superior region, followed by temporal, nasal and inferior region.

Conclusions: Glaucoma patients present peripapillary choroidal thinning compared with healthy subjects, especially in farther areas from the optic disc. Peripapillary choroidal tissue shows a concentrical pattern, increasing thickness as you move away from the optic nerve. The new SS-OCT could be a useful tool to evaluate choroidal thinning and its applications in clinical practice.

Biography:

Obrubov Anatoly S MD, PhD is an Ophthalmologist of City Clinical Hospital named after S P Botkin, Moscow, Russia, and Associate Professor of the Department of Ophthalmology of Russian Medical Academy of Continuing Professional Educations, Russia.

 

 

Abstract:

Purpose: To analyze the experience of local and systemic antifungal therapy in patients with severe keratitis and corneal ulcers.

Materials and methods: For 4,5 years, 27 patients (27 eyes) were followed. The causes of the disease: wearing contact lenses – 12 patients, secondary attachment of fungal infection – 6 patients, eye trauma – 7 patients, postoperative infection – 2 eyes. 21 patients treated by 0,2% fluconazole in eye drops form and/or in subconjunctival injections (in 2 cases in combination with oral administration), 17 patients received 0,02% or 0,05% chlorhexidine gluconate solution (in 13 cases in combination with fluconazole), 5 patients – 0,3% amphotericin B in eye drops form (in 4 cases in combination with fluconazole and chlorhexidine gluconate), 2 patients – 0,1% voriconazole in eye drops form. Itraconazole was given orally in 7 cases in combination with local medications.

Results: According to the inoculation, the fungal etiology of keratitis has been confirmed in 5 cases, in others cases the etiology of the disease has not been established under laboratory condition, but in respect that the anamnesis, clinical picture and course of disease, a fungal or mixed etiology of the disease has been suggested. Surgical treatment was required for 4 patients. In 1 patient enucleation was performed (morphologically fungal etiology was confirmed). 2 patients received through keratoplasty, 1 patient was additionally treated by corneal cross-linking. In other 23 patients, persistent opacity of the cornea of varying severity was formed at the endpoint. It was not the recurrence of infection in all cases.

Conclusions: In patients with long-term keratitis and corneal ulcers with a worn-out disease pattern, the drug of choice is fluconazole. In patients with keratitis associated with the wearing of contact lenses, combined therapy of antifungal drugs in combination with chlorhexidine gluconate is appropriate. In melting of the cornea with the spread of the process inside the eye, the drugs of choice are amphotericin B and voriconazole. It is necessary to combine the methods of administration and prescribing several drugs treating a severe fungal infection of the eye.

Biography:

Abstract:

The source material for our study was 23 samples of silicone oil, aspirated from the vitreous cavities of the eyes of patients after a tamponade about the rheumatogenic and traction retinal detachment. The average life of silicone oil in the eye was 3.5 months. In all cases, a 1300 cSt – viscosity Oxane silicone oil, Baush + Lomb, the UK, was used for tamponade. All samples were stabilized, resulting in colloidal systems consisting of a direct emulsion of two cross-saturated (aqueous and oily) liquid phases. The density of samples aspirated from the patients’ eyes was measured at a temperature of 20.00 ± 0.05°C by a pycnometric method, taking into account the adjustment for a loss of body weight in the air (0.00129 g/cm3). The viscosity measurement method using the Ostwald capillary viscometer (at a temperature of 20.00 ± 0.050°C) was used to measure the relative viscosity of samples by a three-time adjusting the viscometer for water phases against the distilled water (checking the viscosity measurement results against a 96% ethyl alcohol and acetone), and the viscometer for oil phases against a 100% dimethylpolysiloxane (checking the viscosity measuring results against glycerin). The criteria for complications were the development of proliferative vitreoretinopathy with reccurence of retinal detachment or an increase of intraocular pressure above 21 mm Hg. in the postoperative period. Depending on the density of the oil phase, patients were divided into 4 groups:

Group 1- the density of the oil phase (o.p.) – less the density of distilled water and practically corresponding to the density of silicone oil (d20 = 0.9700-0.9799 g/cm3);

Group 2- the density of the o.p. – less the water density, but greater than the density of pure silicone oil (d20 = 0.9800-0.9981 g/cm3);

Group 3- the density of the o.p. – practically equal to the density of distilled water (d20 = 0.9982-1.0049 g/cm3); and

Group 4 – density of the o.p. – above the density of distilled water (d20 = 1.0050-1.0100 g/cm3).

The study revealed that the physicochemical properties, such as the density (growing and in some cases exceeding the density of distilled water) and the viscosity (significantly decreasing), were changing in most patients (with a different magnitude) in the process of tamponade and continuous presence of silicone oil in the vitreous cavity of the eye. The density of the oil phases of aspirated samples had an exponential relation to the viscosity. The number of postoperative complications such as development of proliferative vitreoretinopathy followed by formation of a recurred retinal detachment and an increase of the intraocular pressure above 21 mm Hg. depended on the density of a silicone bubble.

Biography:

Theophile Kabesha has completed his PhD at the age of 28 years from Lubumbashi University and postdoctoral studies in ophthalmology from Institute of Tropical Ophthalmology of Africa in Bamako-Mali. He also completed his studies in epidemiology and clinical research from ISPED Bordeaux-France and has been trained in medical retina at Creteil - Paris XII university ophthalmic center (France) under the ICO fellowship program sponsoring. He is the director of Bukavu eye Clinic, a provincial ophthalmologic referral center. He has published more than 10 papers in reputed journals and has been serving as the blindness prevention pioneer in eastern Congo of repute (1000 cataract surgery a year and 14000 patients performed). He actually is a professor at Bukavu official university school of medicine.

Abstract:

Ophthalmology practice in low income countries remains a very big problem up today because of inaccessibility to eye care in most of people. Blindness prevention and V2020 plan applicability in this area is up today a dream while blindness is at his highest level in most of these countries, especially in Democratic republic of the Congo. The aim of our study is to present a five years’ experience of ophthalmology practice in eastern Congo, for an advocacy for a real integration of primary eye care into the primary health care system and a support of blindness prevention program in this area. On a total 73,068 patients examination performed in our service these last 5 years, the blindness rate is 1.4 %. The blindness rate is increasing each year because of unoperated cataract (53%), uncorrected refractive errors (14.7%), glaucoma (8%), corneal pathologies, diabetic retinopathy (7.2%), traumatic pathologies (11.1%), in this area where have been made many atrocity and human right violation due to the war which destabilizes this region from 1996 up today. Many factors like the absence of qualified human resources (only 3 ophthalmologists for 8.2 millions) and specialized infrastructures (only 2 in the region), and poverty reinforces the situation. The absence of international partners and NGO involved in the eye health care in this area and no implication of the government. The national program of blindness prevention is not supported and primary eye care is not integrated in primary health care system. Prevalence of blindness is increasing in low income countries. Urgent action are required to ameliorate the situation such as training of human resources, eye care integration in primary health care system, and amelioration of eye care delivery, with government and NGO accompaniment.

Biography:

Abstract:

Proper evaluation of the general condition of a premature baby with retinopathy helps the ophthalmoanesthesiologist to choose an anesthetic for this category of patients. One group of children strictly needs an endotracheal anesthesia, in another group of patients in this age group, it is sufficient to use a laryngeal mask. What is the approach?

Purpose: To develop methods of anesthetic support for laser and surgical treatment of retinopathy of prematurity.

Materials and Methods: The number of subjects studied was 208 children, of them with moderate prematurity (31-36 weeks of gestation) -108 children, and with deep premature (24-30 weeks gestation) -100 children. 1 group (107 children) - 55 deeply premature babies with PH3+ stage-4a stage (26 patients) and PH 4b stage-5a (29 children). And 52 moderately premature patients with PH3+ stage-4a (20 patients), and with PH 4b-5 stage-32 children. 2 group (101 children) - 45 deeply premature infants with PH3+ - 4a stage (28), and PH 4b - stage 5 (17) and 56 moderately premature patients with PH3+ - 4a stage (37), and with PH 4b - stage 5 (19 patients). Children with retinopathy PH3+ stage-4a stage needed laser coagulation of the retina or they performed a shvartectomy, and prematurely with PH 4b-5 stage carried out lensswartectomy. The heavier the anamnesis of a premature patient, the greater the risk of apnea episodes in the postoperative period. This is especially true for children who have long-term ventilation, who have asphyxia in childbirth, attacks of apnea in the first month of life, in an anamnesis of BPD and IVH 2-3 st. Therefore, such children need ETA, and in postoperative supervision in the conditions of the intensive care unit. With mild and moderate morfunctional immaturity, it is possible to carry out an anesthetic aid with a laryngeal mask.

Results: In the 1^st group: of the deeply premature infants, 13 children had apnea in the postoperative period, and from moderately premature infants-11. In the 2^nd group, respectively, 12/9 patients.

Conclusions: ETA is administered to children with severe neonatal anamnesis, or with inadequate breathing after the installation of the laryngeal mask. The use of a laryngeal mask is an alternative to ETA at PH.