Day 2 :
Ballsbridge University, Dominica
Keynote: Stem cells therapy: Intravitreal regenerative effect in rabbits with retinal-neuronal lesions
Time : 10:00-10:40
Luis E. Abad is a Chair and Distinguished Professor of Ophthalmology at Ballsbridge University, President at Abad Eye Research Group, Dominica. Honourable Member Council, Board of Quality Standards, UK. Doctorate in Genetics and Master of Business Administration, Bircham International University, Spain. Ophthalmologist and vitreoretinal surgeon. Doctor in Medicine, National University of Cordoba, Argentina. Awards: Doctor of Philosophy, International Philosophical Institute , India. Doctor of Letters in Medicine, Maha Sastra University, Cambodia. Doctor of Sciences in Ophthalmology, Ballsbridge University, Dominica. Honorary Fellow, Institute the Chartered Professionals, UK. Doctor of Sciences, Research Training & Treatment Institute, India. Marquis Who’s Who in America, New York, USA. Fellow, the New York Academy of Medicine, USA. Doctor Honoris Causa in Ophthalmology, Bircham International University, Spain. Author of seven books of ophthalmology with more than sixty scientific publications in international journals. Patents: surgical system for the retinal detachment and Intrascleral microimplant of slow Ranibizumab release, Spain
Stem cells have been studied in several fields of Medicine, and their applications are not too far from the clinical practice. Retinal impairment by neuronal death has been considered incurable due to the limited regenerative capacity of the central nervous system. The capacity of stem cells to regenerate tissues, as well as their plasticity makes them a potential source for retinal repair. The stem cells are a great promise for the therapy of inherited retinal disorders and retinal-neuronal degenerative diseases, such as retinitis pigmentosa and allied retinal dystrophies, which can result in blindness. So far, the results of a few studies are consistent with the belief that cell-based therapies using mesenchymal stem cells may be effective when it comes to retinal damaged tissue repair.
Objective: To evaluate the regenerative effect of typified stem cells after intravitreal injection into rabbit eyes with chorioretinal damage induced by diode laser photocoagulation.
Participants: Thirty New Zealand white male rabbits, with an average weight of 3,5 Kg, aged five to six months.
Intervention: Stem cells were implanted by intravitreal injection. The regenerative action of these cells was studied in chorioretinal lesions induced by red diode 670 nm laser photocoagulation. The stem cells were implanted 24 hours after laser photocoagulation. The regenerative activity of stem cells was studied in the chorioretinal tissue 90 days later. The amount of retinal recovery induced by stem cells implantation was compared with that of one control group formed by 20 rabbits which were similarly treated by laser photocoagulation and did not undergo stem cells implantation. Results: A recovery of 90% of the chorioretinal burns was observed in 23 rabbits (n=45 healed burns); a recovery of 50% of the chorioretinal burns (n=25) was observed in two rabbits; 42% (n=21) recovery was observed in three rabbits and 36% (n=18) in two rabbits.
- Glaucoma | Ophthalmology Practice | Ophthalmology Surgery
Joseph G. Chacko
UAMS College of Medicine, USA
Cluj County Emergency Hospital, Romania
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
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.
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: 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.
University Eye Clinic, Serbia
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.
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.
UAMS College of Medicine, USA
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.
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.
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
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.
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.