18^th European Ophthalmology Congress December 04-06, 2017 Rome, Italy

Ms Anna Praidou received her medical degree, completed her PhD thesis and her residency at the University of Thessaloniki, Greece. She completed an MSc in Medical Research Methodology at the University of Thessaloniki, Greece and another MSc in Health Unit Management at the Open University of Patra, Greece. After completion of her training in Ophthalmology she was working at Alder Hey Hospital, Liverpool in Paediatric Ophthalmology, at Royal Liverpool University Hospital in Medical retina, Uveitis and Ocular Oncology Services. She was previously also working at Moorfields Eye Hospital, London in the Cataract Service and at the Royal Free Hospital, London in Medical Retina and Cataract services. She is currently working as a Consultant Ophthalmic Surgeon in NHS.

Statement of the Problem: The purpose of this case report is to present an usual presentation of macula hole which is associated with commotio retinae post blunt ophthalmic trauma in a paediatric patient. Methodology and Theoretical Orientation: A case of 12-year-old male patient was referred to our eye department due to blurry vision post blunt trauma on his left eye. On examination ocular motility was normal while his best corrected visual acuity (BCVA) was decreased to 20/200 in his left eye. Findings: Slit-lamp examination of the anterior segment was normal, while fundoscopy revealed vitreous and retinal haemorrhages, commotio retinae of the posterior pole with cherry red macular spot, and macula hole. The patient underwent optical coherence tomography investigation which confirmed the initial diagnosis. One week follow up showed vitreous detachment and spontaneous closure of the macula hole, while BCVA remained decreased due to diffuse vitreous haemorrhage. Conclusion & Significance: The patient was followed up closely during the first few weeks after his trauma in order to be monitored and treated for potential complications. Traumatic macula hole is a rare complication which is associated with commotio retinae of the posterior pole after blunt ophthalmic trauma. Spontaneous vs. surgical closure of the macula hole could be expected in a few cases. While some patients recover completely, some patients will remain visually impaired with reduced vision or paracentral scotoma

Purpose: To compare Impression Cytology and Tissue Biopsy for Ocular Surface Squamous Neoplasia. Methods: A hospital based prospective comparative study of all patients suspicious of Ocular Surface Squamous Neoplasia from its clinical features, presenting over a period of one year was carried out. Impression cytology and Tissue Histology were performed on all the included cases. Results: A total number of 30 cases were included. Ocular Surface Squamous Neoplasia was seen most commonly seen in males in the older age group (Mean age-52.27 years. They presented most commonly with mass, redness and foreign body sensation. Squamous cell carcinoma mostly presented as papilliform sessile masses (70%) and Carcinoma in situ as gelatinous masses (57.1%). All the cases of squamous cell carcinoma involved both conjunctiva and cornea. The most common histologic report was Squamous Cell Carcinoma (33%), followed by Carcinoma in situ (23%) and Dysplasia (20%). Compared with histologic findings, impression cytology had a sensitivity of 86.9% and specificity of 85.71%. The positive and negative predictive accuracy of impression cytology was 95.23% and 50%, respectively. Conclusion: This study shows that impression cytology might have a promising role in diagnosing Ocular Surface Squamous Neoplasia for its high sensitivity, specificity and positive predictive accuracy compared with tissue histology. However, a fair negative predictive accuracy indicates that impression cytology is a valuable screening technique, but it is not a “gold standard.‟

Young Cheol Yoo has run a busy cataract and glaucoma surgical practice with special expertise in complex cataract removal using the latest technologies including toric lenses as well as multifocals. He is an expert on optical coherence tomography and standard automated perimetry. Current research interests includes: structure-function relationship in glaucoma, glaucoma in myopia, minimally invasive glaucoma surgery, and validating and commercializing new medical devices

Purpose: To assess the relationship between daily alcohol consumption and intraocular pressure (IOP) in Korean men and women Methods: We explored the effect of daily alcohol intake on high IOP in 7,532 adults who participated in the 2010-2012 Korean National Health and Nutritional Examination Survey (KNHANES). Multiple logistic regression analysis was used to assess the relationship between average daily alcohol consumption and an IOP of ≥ 18mmHg after adjusting for age, body mass index, hypertension, diabetes mellitus, and smoking in each sex group. Results: When adjusted for related factors, the odds of high IOP was 2.57 times (95% confidence interval, 1.239 to 5.314) higher in men with a daily heavy alcohol intake than men with a heavy alcohol intake < 1 per month. However, increased odds of high IOP with daily alcohol consumption were not found among women. Conclusions: After adjusting for age and other confounders, there was a significant relationship between daily alcohol consumption and high IOP in men, whereas the relationship was not significant in women.

Prof.Choun-Ki Joo has his expertise in cataract, cornea, and other basic studies. He is a dean of the college of Medicine, The Catholic University of Korea, and also president of the Catholic Institute for Visual Science

Trehalos has been known to stabilize bilipid membranes and proteins against desiccation, and to have a protective effect against desiccation and oxidative insult in the mammalian eye, which has been made into some tear preparations. In this trial, the efficacy and safety of a novel mixture of 0.01% or 0.02% cyclosporine A(CsA) with 3% trehalose in dry eye were analyzed. Dry eye patients with corneal staining score more than 2 were randomly assigned to receive mixture of 3% trehalose and topical 0.01%(low dose treatment) or 0.02%(high dose treatment) CsA, or placebo to be administered twice daily for 12 weeks. The primary efficacy outcome was a change from baseline in corneal fluorescein staining scores at week 12, and changes at week 4 and 8 were reported as secondary endpoints. Additional endpoints included score changes from baseline in conjunctival staining, strip meniscometry, tear breakup time(TBUT), Standard patient evaluation of eye dryness questionnaire(SPEED) at week 4, 8 and 12 and ratio of 100% clearance in corneal staining. At week 12 of treatment, corneal staining scores were improved in patients treated with high-dose treatment, with significant difference compared to the placebo treatment (p=0.0361). There were no significant difference between low-dose treatment and placebo in corneal and conjunctival staining, strip meniscometry, TBUT, SPEED at week 4, 8 and 12. There were no significant difference between high-dose treatment and placebo in corneal staining at week 4, 8, conjunctival staining, strip meniscometry, TBUT, SPEED at week 4, 8 and 12. Ratio of 100% clearance in corneal staining were 53.13% in placebo, 55.17% in low-dose treatment, 78.57% in high-dose treatment. High-dose treatment is shown to alleviated corneal staining signs of dry eye patients comparably to placebo. Further evaluations would be needed for this mixture to demonstrate being a novel therapeutic agent for dry eye syndrome

Statement of the problem:Novel method of utilization of medical students for house to house screening to obtain population based data on ophthalmic diseases in India. There is paucity of population based data, due to shortage of trained manpower for screening. The purpose of this study is to describe utilization of medical students to conduct house to house screening in rural India around a medical college who can be the source of trained manpower for data collection for ocular and systemic diseases. Methodology and theoretical orientation: Trained III year MBBS students were provided a questionnaire and deployed for house to house screening in villages spanning a 20 km radius around a tertiary care center on every Sunday for a year assisted by staff in rural maternity and child welfare centers. In Children <3 years, vision and amblyopia were assessed by fixation pattern and LEA symbol charts. In those >3 years, E chart were used. Population was screened for anterior and posterior segment diseases. Non mydriatic fundus camera was used. Findings: Of the 25,375 screened, 51% were females. Children (0-6 years) comprised 9 %and 2% were>80 years. Commonest among the young were infections of lids & conjunctiva and refractive errors, among 40-60 years presbyopia, glaucoma, cataract and in >60 years cataract. 17% with severe visual impairment had not accessed eye care services. 10 % had refractive errors / anterior segment diseases. 3.5% had posterior segment diseases. 30% of diabetics had not consulted an ophthalmologist. 20 % with visual impairment were not interested in availing ophthalmic care. Conclusion and significance: House to house screening can provide data on prevalence of diseases in the population. Utilization of medical students a novel method can make up for lack of trained manpower. Recommendations: If all medical colleges in the country were to conduct screening programs with uniform protocol, authentic data at national level can be obtained which can provide an insight into the problems associated with implementation of national program for control of blindness in rural India and implementable measures can be planned.

Ms Anna Praidou received her medical degree, completed her PhD thesis and her residency at the University of Thessaloniki, Greece. She completed an MSc in Medical Research Methodology at the University of Thessaloniki, Greece and another MSc in Health Unit Management at the Open University of Patra, Greece. After completion of her training in Ophthalmology she was working at Alder Hey Hospital, Liverpool in Paediatric Ophthalmology, at Royal Liverpool University Hospital in Medical retina, Uveitis and Ocular Oncology Services. She was previously also working at Moorfields Eye Hospital, London in the Cataract Service and at the Royal Free Hospital, London in Medical Retina and Cataract services. She is currently working as a Consultant Ophthalmic Surgeon in NHS.

Statement of the problem: Idiopathic intracranial hypertension (IIH) was described over a century ago; although its pathogenesis remains unknown, diagnostic and therapeutic developments during the past two decades have substantially advanced patient management. The purpose of this case report is to present an usual presentation of IIH in a paediatric patient. Methodology and Theoretical Orientation: A case of an 11 year-old male patient was referred to Dept. of Ophthalmology due to blurred vision in the last week on both eyes. On presentation Ishihara colour vision was normal and his best corrected visual acuity was 6/12 on his right eye and 6/9 on his left eye. Findings: Fundoscopy revealed papilloedema and macular oedema bilaterally. The patient underwent optical coherence tomography and visual fields investigation which showed visual field abnormality. The boy is not obese and his blood tests were normal. Magnetic resonance imaging and lumbar puncture confirmed a diagnosis of increased intracranial pressure (ICP). Patient was treated medically with acetazolamide 250 mg 3 times per day. One week follow-up showed improvement in macular oedema, while one month follow-up showed improvement in papilloedema and good recovery of visual function. Six month follow-up showed almost resolution of papilloedema, while there are remaining visual field defects. Conclusion and Significance: The treatment goal for patients with IIH is to preserve optic nerve function while managing ICP. Optic nerve function should be carefully monitored with an assessment of visual acuity, colour vision, optic nerve head appearance, and perimetry. Patients without visual loss most often are treated with a carbonic anhydrase inhibitor (acetazolamide) to lower the ICP. In patients with severe symptoms, early visual field loss, or poor response to standard medical therapy, some clinicians utilize a short course of high-dose oral corticosteroids. Both prompt diagnosis and management are important to prevent permanent visual loss.

Introduction : Idiopathic intracranial hypertension (IIH), also known as primary pseudo tumor cerebri, is a disorder of increased intracranial pressure (ICP) with normal Neuroimaging and CSF composition and no underlying etiology .The incidence of IIH in many Middle East countries has been estimated at 2.02–2.2/100,000 in the general population, which is higher than the Western rate. When vision impartment in a patient with papilledema is persistent , prompt treatment is required in hopes of preventing permanent loss of vision . If medical treatment is not effective, we can have surgical option like venrticulo -peritoneal shunt , lumbo- peritoneal shunt or optic nerve sheath decompression. Methods : Retrospective, non comparative, interventional case series. Thirty cases underwent by using ONSD medial approach in Ophthalmology Department in Prince Sultan Military Medical City from 1995 to 2017. All these patient was referred from the Neurology Department. 26 patient was diagnosed as increase idiopathic intracranial pressure and 4 patient with secondary increase intracranial pressure . All patients underwent full Neuro ophthalmic assessment including visual acuity, visual field pre-operative and post operative . The treatment of IIH patients depends on their symptoms and vision status. The indications for ONSD Progressive visual loss who fail maximum medical therapy , severe bilateral disc swelling or visual loss in patients who do not comply with medical therapy. Secondary increase in ICP due to non-respectable tumor and Presence of additional risk factors like Renal failure, Hypertension ,SLE and others. Results : Main outcome measures the visual acuity, visual fields, and surgical complications will be discussed. Thirty patient underwent ONSD, in one eye with the worst visual field , 26 patients out of 30 (86%) cases due to idiopathic increase intracranial pressure, four patient (13%) cases due to secondary increase ICP. After ONSD 22 patient 73% improved visual field in both eyes. Six patient 20% stabilized visual field in both eyes, one patient 3% deteriorated post operative vision secondary to operative complication. CONCLUSSION Optic Nerve Sheath Decompression effectively stabilizes or improves visual function in the majority of patients with PTC and visual loss. However, it may fail at any time after surgery; patients with PTC need to be followed-up routinely with visual field assessment to detect deterioration of visual function. Bilateral disc edema resolved and visual filed improvement seen most cases when only one eye underwent optic nerve sheath decompressed.