Day 2 :
President - IREO international
Time : 10:00 AM - 11:00 AM
Prof.Antonio Carlos Centelhas is head of ophthalmology of CRMED Ministery of Health, Nise da Silveira Hospital , Rio de Janeiro, Brazil Ex- Professor of ABC University , SãoPaulo, Brasil and Gama Filho University, Rio de Janeiro, Brazil. Prof. Centelhas is international advisory board Of Delhi Journal of Ophthalmology,New Delhi, India. Panelist in many Congress and Universities (EUA)
The TransPRK( transepithelial photo refractive Keratectomy ) by Amaris 750S a Schwind Thecnology is a refractive procedure with no-contact surgery. Corneal epithelium is removed by the laser without manual interference.It brings more accurity and perfect deepithelization.This innovative laser system delivers an unsurpassed repetition rate of 1050 HZ and consequently an extremely short ablation time of just 1.3 seconds per dioptre. That means even greater safety and comfort for the patient. The risk of the córnea drying out is minimised, and the length of time the patient has to fixate on the green ligth is reduced. The Smart Pulse tecnology use a gemetrical model based on a fullerene structure other, importante instrument of security is the integrated contact free optical pachymetry that provides precision information about the thicness ofthe córnea throughout the entire duration of the treatment.
The 7D eye impresses a apart from the linear movements ( 1st and 2and dimentions).Compensations of the eye rotation around its optical axis.
We treated and studied in two years 621 eyes of 336 patients , 125 males and 211 females.The average degrees of spherical refraction was -2.75 DE and cylindrical refraction was –125DC. We use 1% tetracaine hydrochloride as anesthesia and mitomicin-c 0,01% for 25 minutes or more and contact lens after the application. Drops of moxifloxacin hydrochloride 0,5 for antibiotic therapy.In the postoperatory we use moxifloxacin hydrochloride 0,5 4 drops a day for 7 days, trometamol cetorolac 0,45% 4 drops a day for 7days and carmellose sodium and sodium hyaluronate for 1 month.
We had 96,3 % with 20/20 in the end of two eyes of study and 6 eyes presented a litlle manifestation of haze.93% had epitelial regeneration in 3 days after surgery and all patients in 5 days. 96,3 % showed a spherical refraction target of 0,52 and a cylindrical refraction of 0.5 degrees. The corneal architectural structure becames preserved and we have to pay attention when we have diameters below 9.5 mm which may occur overcorrection in the results. The results modified with a litlle between 12 to 36 months. The dry eye occured in 73% of patients in the first month and kept with the same incidence of all population after
3 months of the surgery.
The TRANSPRK showed an ecxelent and safe procedure with 96,2% of good results of myopia and astigmatism .We need to observe the development of dry eye in the three months of pos –operatory.
- Oculoplasty & Orbital Diseases
Optician, University of Buenos Aires, Argentina. Specialist in Contact Lenses. Specialist and manufacturer of ocular prosthesis. Scientific adviser for ocular prosthesis in APO (Asociación Profesional de Optómetras in Argentina). Precursor and creator of multiperforated orbital implant, JUMAT. Precursor and creator of expander orbit asmotic hydrogel filling for microophthalmia. Director of CEPROC. Director of Ocular Prosthesis Division in Perfect Vision, Santiago, Chile. Developer of one-hour customized ocular prosthesis method, unique in Latinamerica. Precursor and creator of the first prosthetic scleral lens.
51 yearl-old-patient with double corneal transplant in right eye. First corneal transplant in 1999. Never got vision. Leukomatous cornea. Second corneal transplant in 2010. After a year there was considerable deformation in the corneal tissue and the cornea became totally leukomatous, deformed and irregular, and the eyeball descending to lower eyelid (keratoglobe). I met the patient with ophthalmologist diagnosis of eyeball evisceration. Thus the patient was with deep depression. Due to the irregular and deformed cornea neither an ocular prosthesis nor soft prosthetic lens could be adapted. So I tried with a scleral lens. In the first test the general condition of her irregular cornea improved considerably, permitting a good tear film flow between the cornea and the lens. I checked again her cornea and there was neither vision nor light reflection. I consulted the Director of Scleral lenses for Perfect Vision in Chile and suggested using a double flap over the lens. Thus the landing in the sclera was improved and was not ejected. I adapted a scleral lens X-cell Atlantis, base curve 7.50, diameter 17.5 double flap. I put a soft lens painted with black pupil and then a second scleral lens with the same parameters, with perfect adhesion. The patient felt very comfortable, with improved quality of life, could insert herself at work again and now her life has completely changed for the better.
- Dry Eye
Samer Hamada, MD, is an ophthalmologist and cornea surgeon performing eye surgeries at his practice, the Eye Clinic London. With nearly two decades' experience, Mr. Hamada is recognised as a leading expert in the field of cataract, refractive lens exchange (RLE) and corneal surgeries, and is frequently asked to lecture at international eye conferences. He has performed thousands of cataract surgeries and RLE surgeries using the latest technological advancements in ophthalmology.Mr. Hamada offers laser cataract surgery with the option of artificial lenses, called intraocular lenses (IOLs), to replace the natural eye lens that has been clouded by a cataract. These IOLs are used for the restoration of near, intermediate and far vision. He is one of the very few eye surgeons who offer trifocal intraocular lens implants. Patients who prefer to be less dependent on glasses or contact lenses, even without a significant amount of clouding due to cataracts, could choose laser or non-laser RLE, both of which are very similar to cataract surgery.
Dry eye disease is becoming a challenging disease. The more we know about aetiology the more it become difficult to manage it. Understanding the pathology is important in treatment pathways. Another challenge is the mismatch between signs and symptoms. Moreover, psychological effects of dry eye on patients emotional status is often ignored. I will discuss my approach to patients with dry eye. How to make the best outcomes of your dry eye patients. A systematic approach including focus on signs and symptoms will be discussed. Finally, I will go through the current and future modalities of treatment.
- Vision and Cognition
Gerente General Perfect Vision ZEISS Precision Center, Perfect Vision Opticas Santiago,Chile.
He is a IACLE Member (INTERNATIONAL ASSOCIATION OF CONTACT LENS EDUCATOR) and national and international lecturer and as well as an outstanding consultant Professional at XCEL CONTACS in USA. He is also the Co - author of specializing in contact lenses "Diagnosis and management of corneal ectasia with contact lenses" book. He had a 20 years experience in the field of contact lenses.
For many years Irregular Cornea patients have been a real challenge, because soft lenses give comfort but not good vision therefore soft contact lenses couldn’t be adapted. On the other hand rigid gas permeable contact lenses were a solution only for a little segment of those patients due the discomfort and poor corneal health. Today we are living the best moment in history of contact lenses and patient with Irregular cornea are the ones with more benefits considering the whole segment of people with trouble vision. The last 8 years I have had the opportunity to attend so many patients with bad life quality because they have dropped out theirs RGP lenses due to injuries or extreme discomfort. All the cases have been solved fitting scleral lenses and special soft contact lens in SiHy materials. My presentation is going to show the many successful cases solved giving comfort, good visual acuity and ocular health.
- Ophthalmology and Vision Science
This study determined the effect of 0.5% glucose intake on tear quantity and tear quality in 300 Normoglycemic Emmetropes (150 males and 150 females) between the ages of 18 and 30 years ( mean age 24.94±3.01 years). This Research was carried out in The Federal Capital Territory, Abuja, Nigeria. The fasting blood glucose levels of the subjects were checked, the base line tear quantity and quality were assessed after 30 minutes, 60 minutes and 90 minutes respectively on their Right eyes. Statistical analysis was performed using statistical software package for social sciences (SPSS) version 16. Analysis of variance (ANOVA), and an unpaired t-test was used to compare findings from males and females. ANOVA revealed a significant reduction of tear quantity and quality in both males and females after the administration of 0.5% glucose (p<0.05). Unpaired t-test revealed a highly significant difference (p<0.000). Unpaied t-test revealed a highly significant difference (p<0.000) between the effect of glucose on tear quantity and quality in females as compared to males.
INTRODUCTION : Pseudoexfoliation syndrome is an age related systemic disease with primary Ocular manifestations characterized by deposition of whitish gray fibrillogranular amyloid like materials on the anterior lens capsule, zonules, ciliary body, pupillary margin of the iris, corneal endothelium, anterior vitreous and trabecular meshwork.
MATERIALS & METHODS: The study included 540 patients of age 45 years and above of either sex who come to the Ophthalmology OPD of MGM HOSPITAL & MEDICAL COLLEGE, AURANGABAD during the period from September 2012 to August 2014.
RESULTS: In present study 540 patients of both gender of age 45 years and above were enrolled, the prevalence of pseudoexfoliation syndrome found to be 5.92% ,out of 540 patients 21(9.05%) male were found to have pseudoexfoliation as compared to 11 (3.98%) females. The prevalence of pseudoexfoliation is found to increase with age in this study. Maximum prevalence is 11.56% in 61-70 years of age group, the youngest patient with pseudoexfoliation was 55 years old. Pseudoexfoliation syndrome may caused spectrum of serious ocular and surgical problems related to cataract surgery. Thus awareness of the structural and functional features of this disorder may help avoid or minimize most of them.
BACKGROUND AND OBJECTIVE: Pterygium excision surgeries have developed over time and have been modified by Ophthalmologist all over the world. The earliest excision surgery for pterygium was with bare sclera. This technique had a higher percentage of recurrence around 60-70%. After this Ophthalmologists developed a method to place a graft over the bare sclera called as “AUTOCONJUCTIVAL GRAFT”. This can be placed over the cornea by sutures, fibrin glue and allograft such as amniotic membrane.
- PTERYGIUM EXCISION WITH AUTOCONJUCTIVAL GRAFT WITH SUTURES-
This technique is simple and cost-effective as compared to fibrin glue and Patient discomfort was also found to be higher.
- PTERYGIUM EXCISION WITH AUTOCONJUNCTIVAL GRAFT WITH GLUE-
- This technique is more costly.
- Also clubbing of patients is required for reducing the cost which is much difficult.
- Patients also experience allergic reaction.
AUTOCONJUNCTIVAL GRAFT PROVIDES BETTER PATIENTS COMFORT AND POST OPERATIVE RESULT, therefore in this study we ANALYZE RESULTS IN PTERYGIUM SURGERY WITH FIBRIN GLUE VERSUS SUTURING OF AUTOCONJUNCTIVAL GRAFT.
AIM: Comparative study to analyze results in pterygium surgery with fibrin glue versus suturing of autoconjunctival graft .
- To compare operative time taken for Auto conjuctival graft with fibrin glue versus suture.
- To compare the comfort level in postoperative period in conjuctival autograft with fibrin glue versus suture.
- To evaluate rate of recurrence in patient with conjuctival autograft after pterygium surgery in fibrin glue versus suture.
MATERIALS AND METHOD:
- This randomized controlled trial on 37 patients with primary pterygium was conducted at Department of Ophthalmology, M.G.M. Medical college Aurangabad,India during the period of Feb 2012 to Aug 2013.
- The patients were divided into 2 groups namely: Group1 (fibrin glue group: n=20) and Group2 (suture group: n=17).
RESULTS AND OBSERVATION:
- In our study female preponderance was seen in both groups. In Group 1 with male to female ratio of 2:8 and in Group 2 it was 1:16.
- There was statistically significant difference in surgical time between Group1 and Group2 (p=0.000).There was significant differences in pain on postoperative day1 between two groups. But there was no significant differences in pain followed up till 12 weeks.
- There was no significant differences in lacrimation on follow up periods till 12 weeks between the two groups.
- There was significant difference in foreign body sensation between 1week to 6 week only.
- There was no significant differences in photophobia and itching on follow ups in both the groups.
CONCLUSION AND INTERPRETATION:
The present study showed better comfort level of fibrin glue in conjuctival auto grafting among the patients undergoing pterygium excision in comparison to sutures. Also fibrin glue significantly reduced the surgical time as compared to sutures.
Dept. of Ophthalmology, McGill University, Canada
PURPOSE: Post-operative endophthalmitis (POE) is an uncommon yet potentially devastating complication of cataract surgery. The landmark study by the European Society of Cataract and Refractive Surgeons (ESCRS) clearly demonstrated the benefit of intracameral antibiotic prophylaxis in reducing the incidence of POE. However, it only tested one antibiotic at one concentration. The advent of fourth-generation fluoroquinolones, including Moxifloxacin, have since shown to be the most effective broad-spectrum topical antibiotics. Here, we seek to evaluate the efficacy and liabilities of the available prophylactic intracameral antibiotics, and to devise an optimum dosing and administration protocol for intracameral moxifloxacin.
METHODS: Retrospective review of all cataract surgical cases, performed sequentially by the senior author (S.A.A.), using clear corneal incisions, with no cases excluded. The rates of POE using Intracameral vancomycin were compared with that of intracameral moxifloxacin following practice pattern transition to Moxifloxacin. The administration dosing and regimen of the intracameral antibiotics, as well as microbiological and pharmacodynamics analysis of the medications were reviewed.
RESULTS: Intracameral vancomycin was used in the first 4797 cases, with no POE cases. Following discovery of the risk of Toxic anterior segment syndrome (TASS) with Canada’s generic Vancomycin, transition was made to moxifloxacin. Using intracameral moxifloxacin (100 mcg in 0.1 mL), a single case of POE in 3430 cases occurred with a moxifloxacin-resistant strain of Staphylococcus epidermidis. Increasing the dose and revising the administration technique of intracameral moxifloxacin (450 to 600 mcg) resulted in no cases of POE in 4601 subsequent cases. No adverse side effects or complications were observed.
CONCLUSIONS: Intracameral moxifloxacin injection into the anterior chamber as the final step in cataract surgery is safe and effective. Based on its favorable potency, penetration, and safety profiles, moxifloxacin may provide a superior alternative for intracameral antibiotic in postoperative endophthalmitis prophylaxis.
Dr. Girjesh kain is a consultant Ophthalmic Surgeon in District Eye Hospital. I completed M.B.B.S. from G.R. medical college, Gwalior, Post-Graduation MSOphthalmology from NSCB medical college, Jabalpur (M.P.) and Phacoemulsification Fellowship from Aravind Eye Hospital Coimbatore (T.N.) INDIA.
Purpose: To determine the incidence of cystoid macular edema (CME) by means of clinical evaluation and sub clinical assessment using of ocular coherence tomography (OCT),
Methods: Phacoemulsification plus intraocular acrylic lens implantation was done in normal patients, work excluding patients having Uveitis glaucoma, Choroiditis, diabetes and macular diseased patients. Group A: 20 eyes of normal patients; Group B: 40 eyes of patients with post Phacoemulsification. Postoperative follow-up visits were performed 1 days (basal visit), 7 days, 6 weeks and 12 weeks after surgery. Each visit included OCT, a part from detail clinical workup.
Results: Central macular thickness measured by OCT was significantly increased in group B compared with group A (241.6 versus 204.6 μm; p<0,001). Clinical evidence of CME was found in 3 eyes with decreased visual acuities (14.2%) of group B, although 2 eyes (1.92%) showed macular thickness equal to or greater than 43.74 μm (2 standard deviations of the basal value for group A). The differences between these groups were statistically significant (p<0.001).
Conclusions: This study has shown a low incidence of clinical CME. OCT showed increased macular thickness in group B of patients in a small percentage of cases.
He University, China
Dr Haisheng Zhao has his expertise in optic nerve injury and regeneration, neuroprotection on retinal ganglion cells. He has published 6 peer-reviewed journal articles in this aspect. He also has his research interests on maculopathy and age-related macular degeneration, and he has published 2 peer-reviewed journal articles in this aspect. Based on15 years of research accumulation, he has given 13 international seminar and conference presentations. His conference contribution “Expression of Thy1 in rat retinal ganglion cell cultures is regulated by LEDGFp52”and “A comparison of None-staining of the internal limiting membrane vitrectomy outcomes for high myopic patients with macular hole (MH) and control patients with idiopathic MH” represent his recent research results both in basic and clinic interests. These two results will provide some new looks on RGCs neuroprotection and MH surgery skills.
Statement of the Problem: To investigate LEDGFp52 regulation of primary neurite number and length, mRNA production and protein expression of Thy1 of rat retinal ganglion cells.
Methodology & Theoretical Orientation: Primary RGCs were isolated and cultured. After 36 h in culture, LEDGFp52(2.0 × 10-4 g/L) and Ab-LEDGF(2.5 × 10-4 g/L) were added into cultures of RGCs; pAd-LEDGFp52 (2.5 × 10-4 g/L) and siRNA-LEDGFp52 (6.0 × 10-4 g/L) were transfected into RGCs. After 12, 24, 36, 48, 72 and 96h, in culture changes in neurite number and length were investigated using contrast phase microscopy, and an IPP image analysis. The Thy1 mRNA production and proteins expression were assayed after 24, 48, 72 and 96h in culture using RT-PCR and immunofluorescence, respectively. Findings: The primary neurite numbers on single RGCs in the +LEDGF treatment groups were not significantly different, but the neurite length is much longer and Thy1 mRNA production and proteins expression were much more than the control group, meanwhile, the number and length of primary neurites on single RGCs in the Ab-LEDGF group were significantly less than the control group at 72 and 96 h, and Thy1 mRNA production were much less than the controls at all the time points, however, its proteins expression was just less than controls at 24h. After transfecting with pAd-LEDGFp52, the number of neurites were significantly increased at 72 and 96h, their lengths were significantly increased at all the time points but 24h compared to control group, moreover, Thy1 mRNA production and proteins expression were much more than the control group at all the time points . However, the introduction of siRNA-LEDGFp52 significantly decreased the number at all the time points but 24h and the length of neurites was shorter compared to the controls, similarly, Thy1 mRNA production were significantly down-regulated at all time points and proteins expression were significantly down-regulated at all time points but 96h.
Conclusion & Significance: RGC neurite growth and Thy1 expression can be controlled by the LEDGFp52. The LEDGFp52 may be beneficial to RGCs in vitro, and Thy1 levels are closely related to RGCs growth.
- The Visual System and the Eye
Krasnoyarsk State Medical University, Russia
Fluorimetry of an eye is a perspective technique for research and diagnostics in Ophthalmology. It is connected to the structural and functional characteristics of eye that is, actually, the optical system allowing transferring the radiation both for excitation and for registration of fluorescence in different eye’s compartments: cornea, lens, vitreous body, and fundus of the eye. At present, different models of ophthalmologic fluorophotometers for the analysis of eye fluorescence as well as more advanced models – scanning fluorophotometers - are offered. Assessment of corneal status in persons wearing contact lenses or in patients with pathological changes (i.e. diabetes mellitus) would give us an opportunity to identify the initial manifestations of corneal pathology in the presymptomatic phase. The goal of this study was to develop the method of anterior eye camera assessment with UV-induced fluorescent spectroscopy in persons wearing contact lenses. As a result, we have developed spectrofluorimetric method for the diagnostics of limb areas in the human eye. Spectral criterion for characterizing the state of the limb area as the ratio of the fluorescence intensity on the wave lengths of 465 nm and 503 nm, respectively, is proposed. Our method is sensitive enough to register pathological changes in the absence of clinical manifestations (presymptomatic phase).
- Visual Neuroscience
Department of Health Eye Center-East Avenue Medical Center, Philippines
Joy Sheril R. Penilla has completed her Doctor of Medicine in San Beda College of Medicine. She is an ophthalmology resident in Department of Health-East Avenue Medical center, Quezon City, Philippines.
The objective of this paper is to present an unusual case of bilateral optic atrophy secondary to a dolichoectatic arterial compression of the prechiasmal optic nerve. Optic neuropathy is a frequent cause of vision loss. Internal carotid artery dolichoectasia is rare, and can compress on the optic nerve resulting to eventual loss of vision. This is an observational case report; seen in a national eye referral center of a developing country. The patient is a 50-year old female from Albay with a history of loss of vision on the left eye. Patient was evaluated to have bilateral optic neuropathy caused by compressive effect of a dolichoectatic internal carotid artery, as revealed by magnetic resonance imaging. Optic atrophy due to dolichoectatic anomaly is uncommon, but should be considered on a patient with unexplained progressive vision loss. Clinical suspicion of this disease entity is highly warranted after more common causes of optic nerve atrophy have been excluded. MRI with MRA confirms the diagnosis for possible neurosurgical intervention.