Day 1 :
Centro di Medicina Rigenerativa Oculistica, Italy
Keynote: Retinal Stem Cells Reprogramming
Graduated in Medicine in 1973, specialized in Ophtalmology in 1977 University Researcher and Teacher at Rome and Chieti University 1974-1980 Pioneer in Refractive Surgery specialized in Moscow 1982 Ideated the first Cataract Extraction with no stitches 1982 Presentation at I.S.R.S. Atlanta Congress, as Course Director, of new Mini-Ark for Keratoconus micro surgery 1995 Pioneer in Excimer Laser Refractive Surgery, director of “First International Congress on Excimer-Laser Micro-Surgery” in Rome 1992 Ideated Asymmetric Radial Keratotomy for Keratoconus Correction ( A.R.K.) 1987 Ideated LASIK in 1990 ( pig eyes experimentation) Homotoxicology Specialization in 2007 Has performed the First Stem Cells Implant in the Eye in Colonia Germany in 15\2\ 2008 Has ideated and performed the First Regenerative Retrobulbar Injection with homotoxicology natural blend Regenerating Retinal Stem Cells in Maculopathy in 2010
Homotoxicology-Pharmaceuticals blend Therapy: through retrobulbar injections. The author reports his experience derived
from his first Autologous Stem Cells live explantation from “mallow bone” ( through the Hip ) and re-implantation into
the retrobulbar fat of the Eye. To define a new concept of “ Re-informational Therapy “ for “ Regenerative Medicine “ using a
system for “ Reformatting “of “ Pathological Retina “ through the therapeutical “ Re-regulation “ of affected Tissues of the Inner
Eye no more capable to regulate normal biological functions.
Queen Victoria Hospital, UK
Keynote: Dry Eye Management: The Journey
Time : 09:45-10:30
Mr. Hamada is a highly trained and experienced consultant ophthalmologist and cornea surgeon with special interest in cornea, cataract and laser and lens refractive surgeries in adults and children. He has over 20 years experience in ophthalmology. Areas of expertise include laser refractive surgery, intraocular lens (non-laser) refractive surgery, advanced cataract surgery, intraocular lens procedures including premium lenses (multifocal, toric, or phakic lenses) and management of laser refractive surgery complications. Pioneer in managing corneal diseases in children he is one of the very few eye surgeons in the world who have educational, academic and clinical skills to manage corneal diseases in children. Achievement awards as a distinguished ophthalmologist whose work contributed to the new advances in ophthalmology, Mr. Hamada has received the distinguished achievement award from the American Academy of Ophthalmology in 2013. This in addition to many awards and prizes that he earned as a result of his excellence in patients’ care. Mr Hamada is a teacher, educator and lecturer at many international eye conferences
Dry eye disease is one of the most common eye conditions that every ophthalmologist and Pharmacist face in their daily practice.
The history of dry eye management is very interesting. Our approach has changed over the years from merely treating dry eye symptoms towards addressing the root problem and the pathophysiogy of the disease. The International Dry Eye worKshop reports (DEWS) had changed the way we diagnose, manage, and predict prognosis of dry eye disease.
The future holds a very promising therapies to dry eye patients.
I will cover the past, current, and future therapies of dry eye disease with focus on medicinal treatment.
- Retina & Its Disorder | Ophthalmology Surgery | Ocular Diseases
Martin L Fox
Hahnemann Medical College, USA
Gavin Herbert Eye Institute, USA
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.
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.
Moorfields Eye Hospital, United Kingdom
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.
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 rates2-6. 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.
Ain Shams University hospitals, Abassia, Cairo, Egypt
Hisham MK AbdEl Dayem MD. Consultant eye surgeon, Department of Ophthalmology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
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
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.
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.
University of Fukui, Japan
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.
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
Federal State Institution; ”Herpes clinic” Russia
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.
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).
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.