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

Biography:

From the beginning of my career as an eye research scientist, my long-term research goal has been to identify therapeutic targets that rescue and/or protect retinal cells. During the course of my doctoral and postdoctoral research, I have worked on models of retinal degenerative diseases, including retinitis pigmentosa, glaucoma, and age-related macular degeneration (AMD) to identify candidate protective molecules. Currently, my research is focused on identification of potential therapeutic targets for the treatment of the dry form of age-related macular degeneration (AMD). The ideal drugs will prolong the longevity of retinal cells, delay cell death, thereby saving vision.

Abstract:

STATEMENT OF THE PROBLEM: Age-related macular degeneration (AMD), a leading retinal degenerative disease, is a primary cause of irreversible blindness among the elderly population in the United States. AMD ranks third among the global causes of visual impairment and has been listed under the category of priority eye diseases. Dry AMD which manifests as geographic atrophy affects approximately 80-90% of the patients and currently has no available treatments. Therefore, we are in need of treatment strategies for dry AMD. Mitochondrial dysfunction and the subsequent loss of retinal pigment epithelial (RPE) cells have been associated with the development and pathogenesis of AMD. Herein, we hypothesized that a mitochondrial-derived peptide called SHLP2, which is coded from the 16S rRNA gene of the mtDNA, is protective against loss of RPE in AMD cybrid cells.

METHODOLOGY & THEORETICAL ORIENTATION: To prove our hypothesis, we used a series of cell based assays, quantitative RT-PCR, Western blotting, and immunocytochemistry. As an in vitro macular degeneration model, we used ARPE-19 transmitochondrial cybrid cells. All cells were treated with pre-optimized concentrations of SHLP2. Untreated cybrids served as controls.

FINDINGS: Our results revealed that: 1) SHLP2 administration significantly improved mitochondrial function as represented by an increase in the levels of mitochondrial oxidative phosphorylation complex proteins i.e., Complex I (NADH dehydrogenase), Complex II (Succinate dehydrogenase), Complex III (CoQH2-cytochrome c reductase), Complex IV (cytochrome c oxidase), and Complex V (ATP Synthase) in AMD cybrids, and 2) Pretreatment with SHLP2 improved cell viability and preserved mitochondrial number and function in AMD cybrids.

CONCLUSION & SIGNIFICANCE: In conclusion, this novel study identified SHLP2 as a rescue factor that preserved cellular and mitochondrial health in an in vitro macular degeneration model.  Our findings are significant because they demonstrated that SHLP2 could be a potential therapeutic target for the treatment of dry AMD. Further studies are needed to establish the potential of SHLP2 as a mitochondria-targeting treatment option for dry AMD.

Biography:

Dr Samantha Sii is currently an year 2 foundation doctor doing her 4 months academic fellowship in Moorfields Eye Hospital, London as a honorary research fellow supported by the Wellcome Trust. She is passionate about the field of ophthalmology and hopes to be able to further her research in the glaucoma specialty in the UK. The Scottish Intercollegiate Guidelines Network (SIGN) develops evidence based best practice recommendations for NHS Scotland. To our knowledge, there has not been any studies published on the impact of SIGN guidelines 144 on quality of glaucoma referrals in Scotland. We hope that this study can help shed some light on areas which still needs improvement within NHS Scotland.This is a 2 year long retrospective case analysis to enable comparison of before and after SIGN guidelines was introduced. There is no conflict of interest to declare.

Abstract:

Problem: Since the introduction of NICE guidelines 2009¹, the number of glaucoma referrals from the community optometrists to secondary services have increased across the UK, resulting in increase in first visit discharge rates^2-6. SIGN 144 was introduced in March 2016 in Scotland to meet the need for a more refined guideline to reduce unnecessary referrals.This is the first study conducted in a regional eye centre which aims to assess the impact of SIGN 144 on quality of referrals from community optometrists. Methodology: A retrospective case audit of 385 electronic records from (TRAK) of  patients who attended the new glaucoma clinics in Princess Alexander Eye Pavillion(PAEP) was carried out across two major time periods , 1) Oct-Nov 2015, June-July 2016 and 2) Sept-Oct 2016 These periods were selected to enable comparison of before and after SIGN 144. Inclusion criteria:patients from 18 years and above referred to the PAEP glaucoma outpatients clinic for new glaucoma diagnosis. Primary outcome of this study is first visit discharge rate(FVDR). Secondary outcome is the extent of compliance to recommendations by SIGN guidelines.  Results: 233 patients were included in group 1(Pre-SIGN period) and 152 patients were included in group 2 (Post-SIGN period). Our study showed that there is a significant decline in FVDR between the periods.(odds ratio 0.47, p <0.002). 86% of referrals are compliant to SIGN referral criteria while 12.5% still remains non-compliant. Two main reason for non-compliance include no repeatable visual field defects(42%) , and high IOP either not repeated or not according to referral criteria (36.8%). Conclusion & Significance: Patients who were referred after SIGN guidelines have a 47% less chance of being discharged on first visit. Even though compliance to some recommendations in SIGN guidelines have improved, there is still a need to improve adherence to referral criteria based on visual fields and IOP.

Biography:

Hisham MK AbdEl Dayem MD. Consultant eye surgeon, Department of Ophthalmology, Faculty of Medicine, Ain Shams University, Cairo, Egypt

Abstract:

Purpose

To measure Vascular Endothelial Growth Factor in both serum and aqueous of patients suffering from non proliferative and proliferative diabetic retinopathy.

Patients and Methods

70 patients were included in this prospective non randomized non intervention study. The patients were divided into 3 groups: Group (A): 25 eyes  of patients diagnosed with proliferative diabetic retinopathy .Group (B): 25 eyes with non proliferative diabetic retinopathy. Group (C): 20 control eyes in non diabetic patients. To be able to take an aqueous sample all patients were diagnosed with surgically indicated cataract. Aqueous humor sample collection was done for all groups before they underwent their cataract extraction surgery..Patients with previous intra vitreal injection were excluded. Collection of 0.1 - 0.2 ml aqueous humor fluid was conducted in the operating theater just prior to intraocular surgery by way of limbal anterior chamber puncture . Serum samples were collected prior to cataract surgery, for measuring serum, HDL, LDL, Fasting blood glucose, HbA1c and ESR levels. ELISA was used for VEGF concentration in samples. Statistical methods included mean value, Pearson correlations/ p-value, linear regression, and ROC curve analysis

Results:

Mean Age was 56.7 ±7.12 y. Mean values of both aqueous VEGF were 340.6± 31.9, 226.8 ±20.3, and 61.55 ±10.14 (p: 0.0001 compared to controls)  for group A, B, and C respectively. Group B had significantly less number of PDR patients (p: 0.0001) of  diabetic proliferative retinopathy (PDR) than the other two groups.

In group (B) the variation of aqueous VEGF concentration was strongly related to the severity of DM.  Seven patients of this group had aqueous VEGF ≥226 pg (226-260 pg), those patients had cystoid macular edema.

The variation of serum VEGF concentration and its relation with aqueous concentration were analyzed and was strongly related to the severity of DM.

Conclusion:

The aqueous levels of VEGF were significantly elevated in eyes with PDR compared to normal. and also to NPDR without clinically significant diabetic macular edema. These results emphasize the probability that VEGF elevation is induced by retinal ischemia and plays a major role in the development and progression of PDR.NPDR without clinically significant diabetic macular edema eyes had aqueous VEGF levels (albeit high) closer to those of normal control eyes.

Biography:

Masaru Miyao, MD, PhD received his Ph.D. in medical science from the Graduate School of Medicine, Nagoya University in 1985. From 1987 to 1988, he was a Visiting Scholar at the University of California, Berkeley. He is a former professor of Nagoya University. Currently, he is a project guest researcher in the Graduate School of Engineering, University of Fukui. His fields of specialty are ergonomics and industrial health, and his current research focus is on the human interface of 3D displays.

Abstract:

Recently, binocular see-through smart glasses have become available. These glasses stereoscopically overlay a virtual image on a real world image and are used as a form of augmented reality (AR). People can utilize these devices in many ways, including in industrial environments. We aimed to quantitatively estimate the efficiency of information seeking when using these smart glasses. We employed a uniquely developed “Route Tracking Test (RTT)” using 3D imaging and AR technologies. With the help of 143 volunteers participating, we evaluated the ease and accuracy of an information seeking task. A comparison was made between using and not using the smart glasses. Also, we measured their accommodation when they watched 2 targets of real and virtual images. We found that the smart glasses significantly increased the ease and accuracy of the task. Finally, we confirmed the advantage of the smart glasses compared with conventional operational work based on paper instructions. We propose the following guideline for good visual recognition with binocular see-through 3D smart glasses.  1. In AR work guidance, these glasses stereoscopically overlay a virtual image so that the workers can see the operating field and the guidance simultaneously. The viewing distance of the virtual guidance should be the same as or a little closer than the operating objects. Otherwise, the glasses cannot superimpose the guidance and working field. 2. The inter-pupillary distance (IPD) of the smart glasses should be suitable for most users and controllable. If the IPD setting of the glasses is wider than that of users, the users will not be able to recognize the virtual guidance. The IPD setting should be controllable between 57 mm to 69 mm for the 95 percentile of Japanese of both sexes. 3. The luminance of the virtual guidance images and real operating fields should be similar

Biography:

Galina Chernakova  has been studying the problems of eye infections for more than 15 years, has several publications  in this field. She Is engaged in the development and implementation of modern methodological approaches to accurate laboratory diagnosis (PCR), the development of treatment algorithms, ways to monitor the effectiveness of therapy schemes. Galina Chernakova  is the associate professor of the department of ophthalmology and the  opinion-speaker.

Abstract:

Statement of the Problem: In recent years, doctors of all specialties, including ophthalmologists faces the problem of mixed infections. Recurrent inflammation of eye tissues is often the result of infection by several types of pathogens.  

Methodology & Theoretical Orientation:  34 patients (14 men and 20 women) with various forms of inflammatory ophthalmological diseases and a positive result of the determination of the genetic material (DNA) of mycoplasmas (Mycoplasma hominis, Ureaplasma urealyticum) and/or Chlamydia (Chlamydia trachomatis) in tear fluid and/or urine by polymerase chain reaction (PCR) were followed-up for the period from 2013 to 2016. All patients were examined for the presence of DNA of the herpes viruses, adenoviruses and enteroviruses in biological fluids. After consultations of related professionals all patients received local and systemic (antibacterial and antiviral) therapy, after which monitoring laboratory tests were performed.

Findings: among the clinical forms dominated inflammation of anterior segment (conjunctiva, cornea, anterior vascular tract) - 76%. In most patients, mycoplasmas and/or chlamydias formed associations with the herpes viruses (n=19; 56%); only bacterial DNA (Mycoplasma and/or Chlamydia) was detected in 12 cases (35%) – Table 1. In 4 cases Mycoplasma and/or Chlamydia DNA was detected in tear fluid; in urine - in 19 patients; in 10 cases –in both secrets. The appointment of local and systemic causal treatment resulted in relief of the complaints and symptoms, and was also accompanied by negative results of the control laboratory tests.

Conclusion & Significance: More than a half of the patients revealed concomitant viral-bacterial infection (22 cases). The production of bacterial/viral DNA in different biological secrets by PCR method reflects the systemic nature of the infection process, which requires obligate involvement of related specialists (dermatologists, urologists, gynecologists).

Biography:

Abstract:

Idiopathic inflammatory occlusive vascular disease of the retina termed as Eales' disease requires exclusion of systemic and ocular conditions with retinal vasculitis, occlusion and neovascularisation 

Strong association between occlusive vasculitis and tuberculosis reported in Indian studies termed such cases as presumed tubercular retinal peri vasculitis,those with negative work up as idiopathic occlusive vasculitic

First case  - a 30 years old male with decreased vision RE with NVI, sclerosed vessels and non perfusion was investigated ,

Mantaux  positive( 16 x16 mm),CRP raised.Received a course of systemic steroid,ATT and sector laser, had vitreous heamorrhage , under went vitrectomy, PCR of specimen positive for tubercle bacillus,diagnosis-tubercular peri vasculitis.

2nd case a 44 years old female with HM vision LE, RAPD and vit heamorrhage was found to have  vision RE 6/6,NVD,multiple NVEs and sclerosed vessels. Investigations were  normal, diagnosis - idiopathic occlusive vasculitis. Treatment - PRP RE, vitrectomy with silicon oil injection LE,no systemic steroid/ATT.

3rd an interesting case of a 24 years old female with decreased vision RE 2 days after uneventful LSCS, found to have VA PL+,RAPD and fundus showing combined arterial and venous occlusion with exudative RD, LE few retinal haemorrhages. She had high ESR,low Hb,low platelet count(34,000/cc) and low clotting factors,became unconscious, imaging showed saggital vein thrombosis with frontal lobe infarcts. Provisional diagnosis of amniotic fluid embolism causing DIC was made,differentials- thrombocytopenia related retinopathy and anaemic retinopathy. Patient survived the event, VA unimproved.

Factors supporting the diagnosis - young lady with no systemic disease, loss of vision following C section, fundus picture explainable with retinal manifestations of DIC, decreased platelets,clotting factors,increased PT and cerebral venous thrombosis suggestive of DIC though visual loss due to DIC following amniotic fluid embolism is very rare

A 37 years old male with VA of PL+ sluggish pupils, posterior sub capsular cataract, IOP 56 mm of Hg, open angles both eyes, NVA RE was found to have bilateral CRVO. Glaucoma probably was the predisposing factor since systemic work up was normal. No family history of glaucoma.What is the cause of glaucoma? Patient underwent PRP RE ,trabeculectomy BE and was put on anti glaucoma medications. Repeated Enquiry revealed the use of steroid skin ointment for six years. Steroids in any form on long term usage can cause secondary glaucoma, in our case lead to rare event of bilateral CRVO.

A 50 years old female with idiopathic thrombocytopenic perpura on systemic steroid presented with decreased vision RE and fundus picture suggestive of bilateral fungal endophthalmitis, underwent vitreous tap, intra vitreal  injection of Amphoterecin B. Systemic fluconazole was started. Condition deteriorated, underwent vitrectomy both eyes, improved but reported ten months later with  retinal detachment and cataract LE, underwent cataract extraction with RD surgery. At 2 years review vision RE 6/36, LE1/60. What's challenging? Patient had platelet count of 9000/cc, post splenectomy status, h/ o sub diaphragmatic abscess, bilateral fungal endophthalmitis,needs long term systemic steroid. Ocular prognosis is poor and management difficult.

A 41/2 years old child referred for drainage of traumatic hyphema of 15 days duration RE was found to have hazy cornea, PL - ve , total hyphema, increased IOP and ciliary staphylomas. Provisional diagnosis of ? Retinoblastoma was made, confirmed by CT Orbits, CT showing orbital extension,CSF analysis was normal,however bone marrow involvement was present. Patient received 12 doses of high dose chemotherapy and RE enucleation with orbital implant. Adjuant   external beam radiation was given.  Initial Clinical  diagnosis of retinoblastoma was challenging.

Biography:

Laura Fanea’s expertise is in magnetic resonance imaging (MRI) of the central nervous system. During the last 16 years, Laura created new pathways for improving medical imaging. Her research in ocular MRI includes the quantitative evaluation of experimental autoimmune uveitis and visualization of the main rat eye structures, but also of the macrophages infiltrated in the diseased retina. She continued her studies with clinical ocular MRI at 1 T, introducing the concept of automated ocular medical imaging through multiparameters calculated on images acquired from normal and diabetic human eyes. Recently, Laura introduced a complex quantitative scale for automated ocular imaging using multiparametric MRI at 3 T and acquiring high quality images of the normal human eyes showing three layers in the region of the retina/choroid complex. Her future plans focus on the development of a reference multiparametric chart of the human eye for automated medical diagnosis in Ophthalmology using MRI

Abstract:

Statement of the Problem: Blindness and visual impairment related problems have become a major socioeconomic issue during the last decades. Most of them can be avoided, prevented or treated through appropriate programs. Such programs could potentially focus on the implementation of MRI techniques in Ophthalmology due to lower energy deposition in the tissue imaged, no requirement for a transparent light path through the eye during image acquisition, and deep tissue penetration. MRI offers both qualitative and quantitative information in a slice-by-slice manner in scanning times of only a few minutes. Visualization of both superficial and internal ocular anatomical pathophysiology with a wide ranging coverage of physicochemical eye properties can be achieved using MRI. The purpose of this study is to develop a human eye MRI chart for future automated medical diagnosis and MRI implementation in Ophthalmology. Methodology & Theoretical Orientation: 15 healthy subjects volunteered to undergo MRI of both eyes. 3T MRI was performed using a circular surface coil detector with a 15 minute acquisition protocol. The reference MRI parameters: relaxation times (T₁ and T₂) and retina/choroid complex layer thicknesses were calculated in the eye regions visualized. Findings: Visualization of the main eye structures, including three layers in the retina/choroid complex region of the normal human eye was achieved. An MRI chart of the normal human eye was developed using the reference parameters calculated on the post-processed images. A scale for future automated medical diagnosis in Ophthalmology is also proposed based on the reference MRI parameters calculated. Conclusion & Significance: Multiparametric MRI can be used to, non-invasively, diagnose, stage, and evaluate ocular pathology. Feasibility of MRI implementation in Ophthalmology is demonstrated in this study. Hardware and software developments of anatomically-shaped scanners will make the implementation of the MRI techniques in Ophthalmology more affordable, but also medical staff and patient friendlier.

Biography:

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

Abstract:

Statement of the Problem: Physical inactivity, along with hypertension, obesity, smoking, and hyperglycaemia are considered as potential risk factors for diabetic disease. A prospective study was conducted to investigate if any correlation between levels of physical inactivity and severity of diabetic retinopathy. Methodology and Theoretical Orientation: Patients with diabetes type 2 (patients with moderate and patients with severe non-proliferative diabetic retinopathy, and patients with proliferative diabetic retinopathy) were compared with non-diabetic patients. Physical activity of patients was assessed by the international physical activity questionnaire. Levels of HbA1c and BMI were also recorded in diabetics. Comparisons between all four groups were attempted for levels of physical activity. Findings: Physical activity was decreased significantly in patients with severe non-proliferative diabetic retinopathy and proliferative diabetic retinopathy as compared to patients with moderate non-proliferative diabetic retinopathy and to the control group. Significant negative correlation was detected between HbA1c levels, BMI, the severity of diabetic retinopathy and physical activity. Conclusion & Significance: Physical inactivity is associated with more severe levels of diabetic retinopathy.

Biography:

Dr Vladislav Dzinic MD,PhD, DiSSO is ophthalmologist with the particular interest in anterior-posterior segment surgery and medical retina. He finished his MSc degree in 2008, PhD in 2016. and European school of advance studies in ophthalmology (ESASO) in 2012. Fellowships and practice skills  he finished at Dr.P.N.Mahendra Eye Institute and Khairabad Eye Hospital India, University Eye clinic Giessen and Eye Clinical-Center of the University of Tubingen, Germany. Member of EVRS, EURETINA and ESCRS. Working at University Eye clinic Novi Sad and Private Eye centar Dzinic.

Abstract:

Diabetic retinopathy is the fifth most common cause of blindness according to new researches. The number of people with moderate to severe visual loss due to the DR is constantly growing. Treatment modalities are improving moving the shift from laser photocoagulation to intravitreal injections (anti-VEGF, corticosteroids). Advances in technology of modern vitreoretinal surgical systems, usage of vitreal dyes and smaller gauges (MIVS) allow us to intervene earlier in the course of the disease. Our study presents the results of laser photocoagulation and anti-VEGF treatment approach as well as combined bimanual 4 port pars plana phaco-vitrectomy for advanced proliferative stages and epimacular membranes  with or without ILM removal in the first surgery course. 53 eyes (50 patients) were followed. Visual acuity (VA) ranges from light perception to 0,3. In 18 eyes silicon oil as a tamponade agent was used and removed after 3-6 months after the surgery and in 35 eyes tamponade agent was air. In 29 eyes ILM was peeled primary. In 24 eyes in which ILM was not peeled in the first surgery after 9-12 months epi-macular membrane with significant macular traction was observed in 7 (29,2%) eyes in which additional surgery with ILM peeling was performed. Mean VA at the end of the follow-up period was 0.3 (0,03 - 0,6). According to our results combined phaco-vitrectomy procedure presents the treatment of choice for patients with severe visual loss, vitreous haemorrhages combined with epimacular membrane and retinal proliferations. Primary peeling of internal limiting membrane ILM has beneficial effect in preventing reoccurrence of epi-macular membrane in diabetic patients. Further investigations are needed in order to confirm safety and potential damage to the nerve fibre layer in order to establish ILM peeling as primary procedure. 

Biography:

Joseph G. Chacko, M.D. has been the director of neuro-ophthalmology at the Harvey and Bernice Jones Eye Institute at the University of Arkansas for Medical Sciences (UAMS) since 2005. Dr. Chacko is professor of Ophthalmology, Neurology, and Neurosurgery in the UAMS College of Medicine.

Dr. Chacko received his medical degree from the Medical College of Pennsylvania in Philadelphia (now Drexel University College of Medicine) in 1991.  He completed a residency in ophthalmology at the Medical College of Georgia in Augusta in 1995.  He then went on to complete a fellowship in neuro-ophthalmology at Bascom Palmer Eye Institute at the University of Miami in 2005.

His research interests include ischemic optic neuropathy, giant cell arteritis, divergence insufficiency, and pseudotumor cerebri.

Dr. Chacko has been board-certified by the American Board of Ophthalmology since 1996.  He became a Fellow in the North American Neuro-ophthalmology Society (NANOS) in 2010.

Abstract:

Giant cell arteritis (GCA) can cause sudden and potentially bilateral sequential visual loss in the elderly. Therefore, it is considered a medical emergency in ophthalmology and a significant cause of morbidity in an increasingly aging population.

Our study goal was to determine the clinical characteristics, treatment, and outcomes of the two histopathological patterns considered positive for giant cell arteritis: active arteritis and healed arteritis.

A retrospective chart review was performed on 22 patients with biopsy-proven GCA.  Eleven patients had active arteritis and eleven patients had post-inflammatory alterations consistent with healed arteritis.  We sought to compare presenting symptoms, ischemic ocular events, inflammatory markers (erythrocyte sedimentation rate [ESR], C-reactive protein [CRP], and platelet count), relapses, and dosage requirements of long-term steroids between the two groups.

Seven of 11 patients with active arteritis had an initial ocular ischemic event while 3 of the 11 patients with healed arteritis had an initial ischemic event to the eye.  There was no statistical difference in initial ESR between the two groups, but CRP and platelet counts on initial presentation were statistically higher in the active group (p = 0.0002 and p <0.0001 respectively).  Patients with active arteritis on biopsy required higher doses of steroids over a 2-year follow-up compared to the healed group:  on average 11 mg/day vs. 1 mg/day at 1 year (p = 0.0008), and 7 mg/day vs. 0.5 mg/day at 2 years (p = 0.0208), respectively.  During the follow-up period, 2 of the 11 patients in the active group demonstrated a recurrent ischemic event to the same or fellow eye while in the healed group there were no recurrent ischemic events.

Patients with healed arteritis on pathological examination of temporal artery biopsy appear to have better prognoses and may require less aggressive treatment than those with active inflammation.

Biography:

Fusun Uzunoglu has been graduated from The Faculty of Medicine of  University of Istanbul, and has completed her speciallty in Ophthalmology at the same university. She is a member of Uveitis Society of Turkish Ophthalmological Association,  Intraocular Inflammation Society  (IOIS) and EURETINA. She has been working  as a uveitis specialist since 1992 and as a retina specialist since 2000. She has been entitled  FICO (Fellow of International Council of Ophthalmology) on 2016

Abstract:

Steroids are the first rank sight saver when uveitis is concerned. Be it systemic, topical or local, they are the standard therapy for uveitis, regardless of etiology, 50 % being linked to  systemic diseases. Even though uveitis has an autoimmune basis unrelated to location in the eye, it may as well be triggered by infectious diseases : parasitic, bacterial, viral and fungal. Steroids are started in concert with targeted therapy according to the real cause, which can at times be lethal if not diagnosed at the referral. Premature steroid use may obscure diagnostic tests and lead to supression of clinical signs which may be valuable clues for the uveitis specialist. “Masquerade syndromes” including   intraocular tumors and foreign bodies may be another topic of concern before intending  steroid therapy for uveitic diseases.

Biography:

Abstract:

Purpose: To study the status of vision related and health related quality of life of adult glaucoma patients with over 5 years duration of glaucoma.

Methods: In this historical cohort study, we interviewed patients with glaucoma using modified pre-tested Arabic version of vision related quality of life (VQL) and WHO recommended health-related quality of life (HQL) questionnaires. A 5-point Likert scale was used to grade responses. A review of health records was used to collect data on patient demographics, visual acuity, visual fields and optic nerve head status of the good eye at the last follow visit. VQL & HQL were associated to demography and clinical parameters of glaucoma.

Results: Fifty-nine glaucoma patients (mean age 56.6 ±18.4 years; 34 males) were interviewed. The mean VQL difficulty score was 73.2±9.0. VQL was graded as poor (<75% of total difficulty score) in 31 (52.5% (95% CI 39.8 – 65.3) patients. The mean HQL score was 39.0±10.6. The association of VQL with gender (P=0.03), and history of glaucoma surgery (P = 0.06) were statistically significant. There was no statistically significant association between VQL and: visual disability (P=0.8); age (P=0.9); duration of glaucoma (P=0.8) and severity of visual field defect (P=0.6). The HQL score was not associated with any of the demographic or glaucoma related variables.  

Conclusion: Patients perceived VQL and HQL are negatively affected among patients with glaucoma for more than 5-years duration. Gender and previous surgery for glaucoma were associated to the VQL.

Biography:

She holds a degree in Medicine from the Faculty of Medical Sciences of State University of Campinas - BR (1985), master's degree in Medicine by Faculty of Medical Sciences of the State University of Campinas -BR(1997) and PhD in Medicine from the Faculty of Medical Sciences of the State University of Campinas –BR (2001). She is currently a State University of Campinas, a founding member and the Brazilian Cornea and Eye Bank.

She is Medical assistant of the discipline of ophthalmology of the Clinical Hospital of the State University of Campinas (CH Unicamp), Chief sector of cornea and external diseases of the ophthalmology discipline of CH Unicamp and Physician responsible for corneal transplant team of the CH Unicamp.

She has experience in the area of Medicine, with emphasis in Ophthalmology, acting mainly in the following subjects:

Ophthalmology, cataract, cornea and external diseases, prevention of blindness

Abstract:

The term ulcer comes from the Latin ULCUS defined as "injury" with superficial loss of tissue, usually associated with inflammation.

Corneal ulcers rarely occur in normal and / or healthy eyes. The quest for a causal factor must be considered.

In order for a pathogen to cause damage to the cornea, 4 concomitant factors are necessary: ​​access, adhesion, penetration and proliferation of the microorganism on the ocular surface and corneal epithelium.

The eye has different defense mechanisms: anatomical, immunological, chemical and natural, responsible for maintaining the balance of a system that includes eye and microbiota.

The clinical history of exposure to predisposing factors such as contact lens wearers, foreign body and corneal trauma, use of chronically topical medications, ocular surface alteration associated with or not tear film abnormality, previous eye surgery, including refractive surgery or exposure to potentially contaminated water and abusive use of contact lenses are associated with increased risk of infection.

Fungal keratitis

The first report of fungal keratitis dates back to 1879 when Leber described a case of aspergillus sp keratitis, evolving with a hypopyon. Until 1951 only 63 cases of fungal keratitis had been described, but with increasing use of corticosteroids and antibiotics, an increasing number of cases were observed.

The main causative agents are filamentous fungi (aspergillus sp and fusarium sp) and yeast (candida sp)

The risk factors for filaments are vegetal trauma and for yeast infections are prior eye surgery, chronic keratitis, exposure keratitis, immunodepressed.

Clinical features - lesion of slow progression, cottony appearance or hyphal infiltrate, satellite lesions, hypopio, endothelial plaque, infiltrate that invades the anterior chamber and ring infiltrate.

Treatment consists of two classes of drugs: polenos and imidazole drugs which can be used topically or systemically. Adjuvant treatments in non-responsive cases may be used as corneal transplantation, tissue adhesives, conjunctival flaps.

Treating a fungal keratitis is a major challenge, given the difficulty in obtaining drugs for topical treatment, its penetration in the tissues, the low adherence to the treatment by the patient, prolonged treatment time, recurrence of the disease.

Biography:

Dr. Hossam E. Elbarbary was graduated in 2001 from Faculty of medicine, Alexandria University, Egypt. He has completed the Master degree of Ophthalmology in 2006 and his M.D. and PhD in 2011 from Faculty of Medicine, Alexandria University, Egypt.   He is a Lecturer and Staff university member of Ophthalmology Department of Alexandria Medical School. He is a consultant of Orbit, Lid, and Lacrimal Surgery in the Alexandria University Hospitals. Also he is a skilled cataract and refractive Surgeon. Now he is a consultant ophthalmologist in Al-Jedanny Hospital, Jeddah, Kingdom of Saudi Arabia.

Abstract:

Purpose: To evaluate the cosmetic and functional outcomes of subciliary incision for external dacryocystorhinostomy (DCR).

Methods: This study was a prospective interventional case series. Thirty eyes of external DCR for primary acquired nasolacrimal duct obstruction were done through the subciliary skin approach. Successful functional outcome was defined as relief from epiphora, and normal Fluorescein Disappearance Test (FDT). The cosmetic outcome of the scar was evaluated objectively by the surgeon and subjectively by the patients using the scar grading scale of the postoperative photographs: 0, invisible incision; 1, minimally visible incision; 2, moderately visible incision; and 3, very visible incision. ^(1,2) The followup visits were done over a period of 6 months after surgery.

Results: The study included thirty eyes of 26 patients. Primary external DCR through subciliary approach was done for all cases over a period of 3 years starting from June 2013 to May 2016. Four patients (5.5%) of these 26 patients had bilateral DCR. Epiphora was markedly improved in all cases with average reduction of Fluorescein Disappearance Test (FDT) from 17.8 minutes to 3.1 minutes. Objective grading of the scars was 100% invisible (grade 0) and Subjective scar grading by the patients was 100% invisible (grade 0) at the end of the postoperative follow up visits without any other complications related to surgery.

Conclusions: The subciliary incision for external DCR has a high functional success outcome with the advantage of an excellent cosmetic and satisfying scar outcome to the surgeon and the patient. The subciliary approach was simply an attempt to combine the best of 2 worlds, namely subciliary incision and external DCR. ⁽²⁾

Biography:

Abstract:

Purpose: We describe a technique for phacoemulsification of hard (brunescent and white) cataract after implantation of a foldable acrylic posterior chamber IOL (PCIOL) between the hard nucleus and the posterior capsule. This new technique was compared with the standard phacoemulsification.

Methods: Interventional randomized case series of 64 eyes of 56 patients with senile mature white or hard brunescent cataract. The first 32 eyes were randomized for standard phacoemulsification using stop and chop technique and foldable soft acrylic PCIOL with soft haptics. The second 32 eyes were randomized for the same type of PCIOL implanted between the hard nucleus and the posterior capsule before starting phacoemulsification “the implant pre-phaco” group.

Results: In each groups 2eyes developed transient corneal edema. Iris phaco-burn developed in 2 eyes of the standard phacoemulsification group and one eye of the “implant pre-phaco” group. Posterior capsule rupture (PCR) with vitreous prolapse occurred in 3 eyes of the standard phacoemulsification group. In the “implant pre-phaco” group one eye developed PCR with no vitreous prolapse. The difference in PCR between the 2 groups was not statistically significant but the vitreous prolapse in the AC was significantly higher in the standard phacoemulsification group. IOL decentration or dropped lens fragments did not occur in either groups.

Conclusion:  The IOL behind the hard nucleus acts as barrier shield that covers and protects the posterior capsule and the anterior vitreous face.  This could make phacoemulsification of hard cataracts safer.

Biography:

Dr. Deyar Ibrahim graduated from Tishreen University Medical School in 2009 and completed his specialization in Ophthalmology at Tishreen Educational and Research Hospital in 2013 ( MD with Excellent degree) and worked there until 2014. His practice and experience is especially in surgical retina, medical retina, ocular trauma, cataract refractive surgery, lasers and medicolegal ophthalmology.. He has been working at his own office since 2014 in Erbil (Kurdistan region of Iraq). Dr. Deyar is member of both some national and international ophthalmological associations and societies

Abstract:

Purpose: To report two cases of unilateral retinal detachment (RD) after myopic LASIK.

Case presentation:

First case: A 17 year old male with Axial Length (AL) 27 mm in right eye (OD) and 27.62 mm in left eye (OS) underwent Lasik. 43 days later he complained of sudden loss of vision in his left eye secondary to macula off RRD with superior temporal large horseshoe and inferior holes

Second case: A 27 year old female with Axial Length (AL) 25.50 mm in (OD) and 25.06 mm in (OS) complained after 8 months of LASIK surgery from sudden loss of vision in her right eye secondary to superotemponasally RD with macula off due to giant tears and many circular micro holes superiorly.

Both patients were managed by pars plana vitrectomy (PPV) with silicon oil tamponade which extracted after 3 months in both patients. The retina was attached post operatively and the BCVA was recovered to the same BCVA after Lasik surgery.

The other eye of both patients was treated with Argon laser photocoagulation around lesions were detected with fundoscopy, and remain stable anatomically and functionally

Conclusion: RD after myopic Lasik can be a serious complication; patients should be informed about possibility of this complication. Each patient should undergo a very thorough dilated fundoscopy and treatment of any retinal lesion predisposing for the development of RD before LASIK surgery is performed.

Keywords: Lasik , myopia, retinal detachment, PPV.

Biography:

Abstract:

Purpose. Long-term mitomycin C (MMC) effects in photorefractive keratectomy (PRK) were compared in simple myopic and astigmatic patients. Methods. In this observational cohort study, subjects were selected based on preoperative and postoperative data collected from medical records; they were divided into simple myopia with/without MMC and myopic astigmatism with/without MMC groups. Haze, uncorrected visual acuity (UCVA), best-corrected visual acuity (BCVA), subjective refraction, and K- reading were evaluated at 1-, 3-, 6-, and 12-month follow-ups. Results. One-hundred-fifty-nine eyes of 80 subjects (34 women and 46 men; mean age, 26.81 ± 7.74 years;range, 18–53 years; spherical powers, -0.50 to -8.00 DS; cylindrical powers, -0.25 to -5.00 DC) were enrolled. One year postoperatively, the simple myopia with/without MMC groups showed no difference in UCVA (P = 0.187), BCVA (P = 0.163), or spherical equivalent (P = 0.163) and a significant difference (P = 0.0495) in K-reading; the haze formation difference was non-significant (P = 0.056). Astigmatic groups with/without MMC showed a significant difference in K-reading (P < 0.0001). MMC groups had less haze formation (P < 0.0001). Conclusion. PRK with intraoperative MMC application showed excellent visual outcomes. MMC’s effect on astigmatic patients was significantly better with acceptable safety and minimal side effects.

Biography:

Abstract:

PURPOSE:To evaluate choroidal thickness in patients with unilateral amblyopia using spectral doman optical coherence tomography(SD-OCT)

METHODS: In this prospective study 41 patients aged 5- 40 years with unilateral amblyopia (anisometropia and strabismic) underwent evaluation using SD-OCT scanning for measuring choroidal thickness at department of Ophthalmology out patient department. The choroidal thickness was measured in subfoveal and at other locations  0.5 mm, 1mm, 1.5 mm away from fovea in nasal and temporal quadrants in both amblyopic and  normal  eye of the same patient. In this study, we are correlating subfoveal  choroidal thickness in amblyopic and normal  fellow eye. Various other parameters like age , sex , axial length, k reading , orthoptic evaluation and refractive errors  were recorded.  T- test was used to compare measurement between ambyopic and normal fellow eye in patients  with amblyopia.

RESULTS : Mean age of patients was 21.85 ±11.17 years .The subfoveal choroidal thickness at fovea was greater in cases of amblyopic eye as compared to normal fellow eye  . Subfoveal choroidal thickness in amblyopic eye was found to be 335 ± 61.54 µm whereas in normal fellow eye  313.90 ± 48.01µm.  The subfoveal choroidal  thickness in  amblyopic group(p=0.043) is greater as compared to normal fellow eye. In case of strabismic amblyopia (p=0.056),subfoveal choroidal thickness is  not significantly greater. In anisometropic amblyopia , (p =0.042), subfoveal choroidal thickness is significantly greater as compared to normal fellow eye. 

CONCLUSION :  In subfoveal area, the choroid was thicker in amblyopic eye than in  the normal fellow eyes .  A thicker choroid is  related to amblyopia, and this may be a useful diagnostic parameter for amblyopia irrespective of age especially in orthophoric eyes.

Biography:

Gleb M. Arslanov studied general medicine in Bashkir State Medical University (Ufa, Russian Federation) and passed Department of Ophthalmology with Institute of Postgraduate Education course on specialty "Ophthalmology" in 2014. Medical work builds on principles of evidence-based practice. Main professional interests are devoted to diagnosis and treatment of retinal (age-related macular degeneration, diabetic retinopathy and retinal vein occlusions), optic nerve (glaucoma) and choroid diseases (uveitis)

Abstract:

Statement of the Problem: A significant part of cases (according to the literature about 40%) peripapillary choroidal neovascular membranes (PCNV) not associated with anything retinal pathology and described as "idiopathic". This presents difficulties in determining the tactics of these patients. PCNV remains poorly understood and requires further research. The purpose of this study is describe the results of treatment three patients (intravitreal bevacizumab) in case series with active PCNV which not associated with other retinal pathology (AMD, polypoidal vasculopathy, angioid streaks, degenerative myopia, serpiginous choroiditis). Methodology & Theoretical Orientation: Three eyes were included in the study (3 patients, 1 male and 2 woman). The median age was 71.3 years old (65-76). The methods of examination and control were BCVA, ophthalmoscopy, fundus photography and optical coherence tomography (OCT). Fluorescence angiography (FA) was performed to confirm the activity of PCNV and further according to indications, depending on changes in the clinical findings and OCT. Injections were administered monthly in the first three months, then treatment was repeated (depending of activity PCNV on OCT and FA). The median follow-up period was 6.6 months (4-10). The median number of injections was 4.6 (3-6). Findings: Improvement BCVA was observed in one patient (from 20/50 to 20/30), one noted stable (at 20/40) and one was reduction (from 20/30 to 20/50), despite the monthly treatment (5 injections) and continued edema by OCT. Thus, inhibition of PCNV activity confirmed by OCT and FA was observed only in two patients. There were no any systemic and side effects. Conclusion & Significance: Intravitreal administration of bevacizumab (as first-line therapy) is sustainable, effective and safe approach to prevent loss of vision in cases of PCNV. There are refractory cases which requires a revision of approaches in treatment. We suggested that they should respond better to combination therapy

Biography:

A/Prof Nagib du Toit has his expertise in ocular trauma having published studies in the field and having completed his PhD on Open Globe Injuries. The large number of assault cases presenting with eye injuries in Cape Town, South Africa lent itself to doing research in this field. Studies with interesting findings, which are relevant to practice in eye care generally, have consequently been published.

Abstract:

Background:

Most post-traumatic acute infectious endophthalmitis occurs within a week of open globe trauma, necessitating early antibiotic prophylaxis. There are few randomised studies that demonstrate the benefits of prophylactic antibiotics. This randomised controlled non-inferiority trial was aimed at determining the incidence of post-traumatic endophthalmitis using established intravenous/oral prophylaxis and comparing this to the incidence using oral antibiotics only.

Methods:

All adult patients admitted with open globe injury were included. Those with proven endophthalmitis, those with high-risk features, those who underwent primary evisceration and those allergic to the trial antibiotics were excluded. Patients were randomised to receive either intravenous cefazolin and oral ciprofloxacin or oral ciprofloxacin and oral cefuroxime for three days from admission. Acute endophthalmitis was the primary outcome measure. Patients completed the study if they were followed up for six weeks post-injury.

Results:

Three hundred patients were enrolled, with 150 in each arm. There were 99 exclusions. Seven patients developed endophthalmitis despite prophylaxis - 2.0% (three cases) in the standard arm and 2.7% (four cases) in the oral arm - this difference was not statistically significant (p = 0.703).

Conclusion:

The incidence of endophthalmitis with prophylaxis was 2-3%. Patients who suffer open globe injury should be treated for endophthalmitis if already infected; be eviscerated if warranted by severe injuries; and receive intravitreal injections of prophylactic antibiotics if risk factors for infection are present. The remainder may receive either intravenous cefazolin and oral ciprofloxacin, or oral cefuroxime and oral ciprofloxacin – the latter has the advantage of shortening patients’ hospital stays and reducing costs. Non-inferiority study design limitations should be taken into account, however.

Biography:

Ahmed Shawkat Abdelhalim;lecturer of ophthalmology in the ophthalmology department in Minia University Hospital,Faculty of Medinicine of Mina University,subspecialized in the vitroretinal field and interested in vitroretinal surgery

Abstract:

Congenital optic disc pit (ODP) appears as a localized oval or round depression within the nerve head. It may develop secondary to a defect in the primitive epithelial papilla. Some pits have also been seen in eyes with optic nerve or retinochoroidal coloboma. In these cases the incomplete closure of the embryonic fissure may play an etiological role.

Retinal detachment is more commonly seen with large temporally located pits and usually involves the macula. Centrally located pits are generally not associated with retinal detachment. Macular retinoschisis has been also described in eyes with congenital optic pits and retinal detachment

Purpose: To evaluate the anatomical and functional results of pars plana vitrectomy (PPV) combined with internal limiting membrane (ILM) peeling, endolaser photocoagulation and gas tamponade in management of optic disc pit (ODP) maculopathy. In a prospective interventional non comparative case series study

Patients and Methods: Nine patients with optic disc pit maculopathy underwent PPV combined with ILM peeling, endolaser photocoagulation and C3F8 gas tamponade between April 2011 and April 2016. Patients were followed up clinically and by coherence tomography (OCT) for 6 months postoperatively.

Results: Resolution of subretinal and intraretinal fluid occurred in 77.7% of the patients at the end six month follow up. There was significant improvement in visual acuity in all eyes. No intraoperative or postoperative complications encountered in all cases

Biography:

Hisham MK AbdEl Dayem MD. Consultant eye surgeon, Department of Ophthalmology, Faculty of Medicine, Ain Shams University, Cairo, Egypt

Abstract:

Objective

To compare expression of Multidrug-resistant protein 1/P-glycoprotein (MDR1/Pgp) in retinoblastoma in eyes treated by primary enucleation due to advanced tumor at initial presentation and those enucleated after being resistant to chemotherapy.

Design and Methods

A prospective non randomized masked analysis. of pathology specimens obtained from twenty retinoblastoma patients presenting at the retinoblastoma clinic at ophthalmology department, Ain Shams University Hospitals.  Specimens from  patients who had enucleation were divided into 2 groups. Patients in group 1 underwent primary enucleation due to advanced tumor at presentation. Patients in group 2 underwent secondary enucleation after failure of conservative treatment. Immuno histochemical studies were performed searching for expression of Multidrug-resistant protein 1/P-glycoprotein (MDR1/ Pgp) in the two groups. Patient demographic and eye examination data we collected and reviewed.

Results

Analysis of the primary enucleation group showed high positive, low positive and negative expression in 1 (10%), 2 (20%) and 6 cases (70%) respectively. In secondary enucleation group 5 cases (50%), 3 cases (30%) and 2 cases (20%) showed high positive, low positive and negative expression respectively.

Conclusion

This pilot study though, not being able to demonstrate statistical significance in MDR1 expression in primary enucleated  vs. secondary enucleated resistant cases, demonstrated  p value  low enough to indicate a trend for more MDR1 expression in resistant cases.( P= 0.068),  . Further study with a larger sample size is warranted