15th International Congress on Vision Science and Eye August 10 -11, 2017 London, UK

Biography:

Abstract:

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.

Biography:

Abstract:

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.        

Biography:

Abstract:

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.

1. 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.

2. 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 .

OBJECTIVES:

• 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.

Biography:

Abstract:

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.

Biography:

Abstract:

The evolution of antibiotic-resistant pathogens pose significant threat to human health and healthcare systems and account for considerable economic burden world-wide. In particular, the Gram-negative bacteria adapted sophisticated machineries that can overcome all the available pathways targeted by current antibiotics. Agents that target cytoplasmic membranes of prokaryotes are attractive alternatives for combating antimicrobial resistance owing. Cationic antimicrobial host defense peptides have been shown to elicit rapid bactericidal action by targeting cytoplasmic membrane of the bacteria, but their cytotoxicity for mammalian cells limited their therapeutic potential. Our preliminary investigations that the cationic polymer ε-polylysine has superior cellselectivity
than isomeric α-polylysine. Based on this preliminary data, we replaced α-lysine residues in prolific pore forming peptide, melittin from bee venom, with ε-lysine residues and determined their cell selectivity. Melittin elicited toxic effect on both microbial as well as mammalian cells confirming its poor cell selectivity. However, substitution of N-terminal α-lysine with ε-lysine residues increased the cell selectivity while C-terminal substitution did not alter the properties. Multiple substitution of ε-lysyl residues enhanced the cell selectivity significantly. Two such peptides displayed excellent antimicrobial activities against MRSA, vancomycinresistant enterococci, antibiotic-resistant P. aeruginosa, carbapenem-resistant enterobacteriacae and azole-resistant Candida spp strains. The modified melittin peptides display rapid bactericial properties and slightly weaker pore-forming properties than melittin
while non-cytotoxic for mammalian cells. We further confirmed the enhanced cell selectivity upon -lysylation in mastoparan B, the antimicrobial peptide present in harnet’s venom. Together, these results establish the rational modification of multifunctional hostdefense peptides by -lysylation with improved cell selectivity.

Biography:

She graduated from Istanbul University, Istanbul School of Medicine in 1997. She has completed her residency in Istanbul Universtiy, Cerrahpasa School of
Medicine, Department of Ophthalmology in 2002. She has worked in Turkish Diabetes Hospital since 2002. She has held the position of Medical Retina Specialist and Deputy Chief Physician in Dünyagöz Hospital between 2005-2016. She coordinated the initiation of the long-term partnership of Orbis which is a branch of the World Health Organisation and Dünyagöz Hospital Group. She is the ophthalmology consultant of telemedicine systems of GSM operators in Turkey. She coordinated the bionic eye treatment initiation (Argus II Retinal Implant) in Turkey, also incorporating the Frankfurt World Eye Hospital in Germany as a scientific committee and board member of Dünyagöz Foundation and Turkish Medical Academy. She initiated the projects Dunyadiyabet and Athletic Eye Health in order to contribute to ‘Retina Awareness’ as a clinical scientist to prevent the loss of resources that would be used for keeping patients healthy. She has been invited contribute to the Turkish Olympic Committee and is working with the Turkish Paralympic Committee. She aims that the eye would be a symbol for the preventive
medicine globally, starting from athletes.

Abstract:

Retinitis pigmentosa is a degenerative eye disease that causes progressive loss of vision. In RP, there is irreversible degeneration of the outer retina (the photoreceptors) while the inner retinal cells (bipolar cells, retinal ganglion cells) and visual pathway downstream remain intact. Affected people suffer from progressive visual loss which can be profound: 0.5% of people with RP above the age of 45 have no light perception and 25% have ≤1/10 vision in both eyes. A person who suffers with sight loss can experience difficulties relating to maintaining their independence, social isolation, activities of daily living and issues around financial support. Loss of visual field is associated with a decrease in physical mobility and difficulties in adjusting being blind. Treatment options for RP, other than for the associated cataract and macular oedema, are limited. Treatment is mainly aimed at slowing disease progression.
The Argus II system is intended to treat patients at the most advanced stages of RP, for whom there are no other treatment options. It is the only CE-marked and FDA-approved option that can restore vision for end-stage RP patients. The epiretinal prosthesis: Argus II system The Argus II system works by bypassing damaged retinal cells and electrically stimulating retinal ganglion cells, creating visual perceptions (percepts) of light. This is the first example of a system, or any therapy, that has demonstrated improved visual function
in the extremely low-vision range (NLP to HM) in this population. Insertion of an epiretinal prosthesis aims to restore perception of light, movement and shapes by surgically implanting an array of electrodes onto the retina The epiretinal prosthesis has two key components: The eye implant and the external camera system, comprising an eyeglass-mounted video camera and a small patientworn computer (video processing unit, VPU) When the implant is on, the video camera in the patient’s glasses records real-time images and sends them to the VPU. The VPU converts the images into data that are sent back to the glasses and are then wirelessly transmitted to the episcleral receiver unit, which in turn relays the data to the electrode array Electrical impulses are produced which bypass damaged photoreceptors and stimulate the remaining retinal cells. Visual information is then transmitted by the optic nerve to the brain, creating a visual perception. Patient selection must be careful and rigorous and the patient should be counselled to have realistic expectations: if the patient’s expectations of the system are not fulfilled, the patient may stop using the system. To maximise the likelihood that patients receive benefit from the Argus II system, they should be motivated and willing to receive the
recommended training and visual rehabilitation.

Biography:

Abstract:

The most challenging step in sutureless scleral fixation of intraocular lens (SFIOL) is exteriorization of haptics. The conventional handshake technique has a learning curve since it involves intraocular handing over of haptics from one forceps to another. Here, we describe “extraocular needle-guided haptic insertion technique” (X-NIT), a novel technique of exteriorizing haptics that totally eliminates intraocular manipulations. This method involves sequential introduction of two bent 26-gauge needles through the sclera (pars
plicata zone) into the eye which are brought out through a sclerocorneal wound. The intraocular lens haptics are threaded through these needles and exteriorized. Nineteen consecutive patients underwent surgery by this technique. There were no intraoperative complications. The mean best-corrected visual acuity (BCVA) of these patients at 1-month follow-up was 0.5 ± 0.3 (logarithm of the minimum angle of resolution) with 18 of 19 eyes showing one or more lines of improvement in BCVA. X-NIT is a safe, easy, costeffective, and highly reproducible technique, especially for beginners.
Key words: Aphakia, extraocular, scleral fixation of intraocular lens, extraocular needle-guided haptic insertion technique Scleral fixation of intraocular lens (SFIOL) surgery has come a long way since its inception. Conventionally, suture fixation of the intraocular lens (IOL) was practiced. Then, came sutureless SFIOL surgery to avoid suture-related problems.[1] Various techniques exist to secure the exteriorized haptic of the IOL.[1-5] However, exteriorization of the haptics in the first place is a challenging step. The conventional handshake technique has a learning curve since it involves intraocular handing over of haptics from one forceps to another. This step becomes particularly difficult in the setting of small pupil or corneal scar. Here, we describe extraocular needleguided haptic insertion technique (X-NIT), a minimally traumatic, easy, and quick method of exteriorizing the IOL haptics during SFIOL implantation.
 

Results: All surgeries were performed by a single surgeon (PB) on 19 eyes of 19 patients. Table 1 shows demographic and preoperative data. The mean best-corrected visual acuity preoperatively was 0.5 ± 0.3 logarithm of the minimum angle of resolution (LogMAR) units which improved by one or more lines postoperatively in all, but one eye that had preexisting corneal pathology. Table 2 summarizes the visual outcome of our patients. Intraoperative complications such as haptic slippage, IOL drop, and intraocular rebound of leading haptic were not encountered. Postoperative complications such as serous choroidal detachment, wound leak, IOL decentration, or retinal detachment were not encountered. Transient corneal edema occurred in three patients, dispersed vitreous hemorrhage in one patient, and postoperative hypotony in another, all of which resolved by the end of the first postoperative week

Biography:

Abstract:

Statement of the Problem: Contextual modulation is a common phenomenon observed at different levels of the visual system. It mainly represents the modulation of neuronal response from stimuli outside the receptive field and is often described as centersurround interactions. Diverse motion phenomena are related to center-surround interactions in visual information processing. Typically, changes in sensitivity are observed at short stimulus presentation times, while at longer presentation times more often the perceived motion direction and speed are biased. In the present study a large set of stimulus parameters were chosen with the aim to obtain indirect information on the potential contributions of center-surround interactions, tuned and/or untuned normalization and neuronal correlation in motion processing on the perceived motion at longer duration.

Methodology & Theoretical Orientation:
In six experiments we studied the effects of the size of the central region, the total contrast, the motion speed, the motion direction of the surround and the relative orientation of the elongated elements in the stimulus with respect on the motion trajectory on the perceived motion direction of the center in a center-surround configuration. The observers had to determine whether the direction of the central patch moved to the left or to the right of the vertically downward direction. Findings: The surround motion significantly affected both the precision and the sensitivity to the motion direction in the central region. In most cases, the sensitivity is lower when the surround moved in a direction orthogonal to the reference axis or at ±45° of it. The highest sensitivity to motion direction in the central region was observed when the surround moved upwards along the reference axis (at about 180° away from the motion direction of the center). The size of the central region has little effect on the performance, while the effect of the contrast varies depending on the other stimulus characteristics. The deviation of the motion trajectory from elements’ orientation had various effects depending on the contrast of the configuration and the size of the central region. Conclusion & Significance: The observed
effects could hardly be explained by the changes in sensitivity of single neurons due to the presence of surrounding motion. They suggest cooperative activity at the population level in orientation and motion encoding and at different levels of dynamic information processing. The potential functional significance of the observed effects will be discussed

Biography:

Abstract:

Aim: Aim of this study is 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 96 h, 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 96 h 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 was 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 24 h. After transfecting with pAd-LEDGFp52, the number of neurites were significantly increased at 72 and 96 h, their lengths were significantly increased at all the time points but 24 h 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 24 h and the length of neurites was shorter compared to the controls. Similarly, Thy1 mRNA productions were significantly down-regulated at all the time points and proteins expressions were significantly down-regulated at all the time points but 96 h.
 

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.

Biography:

Senior Vitreo-retinal consultant at the Jordanian Hospital in Amman. Fayyad graduated from Rome University (La Sapienza) in 1976, and completed his residency program in ophthalmology at the same university between 1977 and 1981 with honors. He then traveled to Canada and completed a two year fellowship program in clinical Retina, at the department of ophthalmology at Ottawa University. He served at the Jordanian ministry of health hospitals and the King Hussein Medical Center as well as at the Jordan University Hospital.An examiner at the Jordanian Board of Ophthalmology. Fayyad is involved in training ophthalmologists in Vitreo-retinal surgery.

Abstract:

Key points

What is bi-manual surgery?

We use both upper ports as active ones i.e. we utilize the upper left port to insert active instruments (like cutters, forceps and scissors). However, we need a light source to substitute for the endo-illuminator.

Indications

Proliferative diabetic retinopathy

Rhegmatogenous retinal detachment

RD complicated with PVR

Trauma

Dislocated lens/ IOL

ROP

Advantages

Better surgical control

Reduced frequency of instruments change during surgery and less iatrogenic complications

Reduce overall time of surgery

Difficult cases become more amenable to surgery

Minimize need for an assistant

Chandelier Lights

My preference is to use a 2 twin lights to eliminate the need to reposition the fiber and minimizes the shadow seen with single-fiber chandelier endo-illumination because the illumination comes from 2 different directions.

Advantages of Chandelier

The working distance for light irradiation is important, and holding the light probes as far away from the retina as possible increases safety.

The self-retaining nature of chandelier endoilluminators frees up my hand from holding a light probe, allowing true bimanual manipulation during surgery.

Conclusion

Bimanual approach is the safest and the most effective approach in the management of complicated diabetic vitrectomies.

Biography:

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.

Abstract:

Dry eye disease is becoming a challenging disease. The more we know about aetiology the more it becomes 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 are often ignored. I will discuss my approach to patients with dry eye and how to make the best outcomes of 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.

Biography:

Petar Markov is currently pursuing his PhD at Cardiff University as part of a joined project between the Schools of Optometry and Vision Sciences, Biosciences and Engineering. He completed his Master’s thesis at Institute of Genetics and Molecular and Cellular Biology (IGBMC) in Strasbourg, France. Having background in Molecular biology and Biophysics, respectively, his Bachelor and Master degrees at Sofia University benefits his investigation of the role of ocular fibroblasts in determining tissue biomechanics in healthy and diseased eyes. He is also a member of the Cardiff Institute of Tissue Engineering and Repair (CITER).

Abstract:

Statement of the Problem: Over 300 million people worldwide are affected by vision impairment. Thus, extensive research efforts are being directed towards developing new and improved treatments. The sclera (white of the eye) is vital for healthy vision because it maintains the eye’s structural stability and shape, properties which are compromised in prevalent conditions such as myopia and glaucoma. To better comprehend the disease mechanisms, we aim to create biomechanical computer models of the eye that incorporate physiological data on both the scleral cell cytoskeletal and extracellular matrix (ECM) components. Specifically, we targeted the scleral region bordering the optic nerve, a key region in glaucoma and myopia development.

Methodology & Theoretical Orientation: We required specimens from closely-matched young adult age because body physiology slows down with time. This is particularly problematic when dealing with human tissues. Therefore, we compared several mammal species to find a suitable human analogue. Wide-angle X-ray scattering (WAXS) was used to map the scleral collagen orientation and distribution, while multi-photon microscopy provided clarity on the depth profile. The geometry of the eyeball was acquired from video motion capture imaging of specimens that were inflated under simulated eye pressure. Planned experiments include studies of fibroblast cytoskeletal reorganization under simulated eye pressure (mimicking glaucoma).

Findings: After comparing 11 mammal species, our results revealed that the peripapillary sclera of the bovine has a tissue structure closely resembling that of humans, including the important annular structure

around the optic nerve, which is vital for its mechanical support. Furthermore, we have optimized protocols for bovine fibroblasts, which will be used to study their pressure-controlled mechanotransduction pathways.

Conclusion & Significance: ECM and cytoskeletal structural information will be used along with geometric data to create integrated models of the eye for driving future scleral-targeted treatments for glaucoma and myopia.

Biography:

Fawzia Bardag-Gorce has been studying ocular surface disease for the last six years, and has published and co authored six peer-reviewed publications in this
field. She began her research on the treatment of limbal stem cell deficiency using Cultured Autologous Oral Mucosa Epithelial Cell Sheet (CAOMECS). During these six years, and under her supervision and guidance, her lab has successfully completed pre-clinical studies related to the efficacy and safety of CAOMECS cell-based therapy. She is currently directing a new study approved by the Institutional Research Board in which subjects are being recruited for the human oral mucosal epithelial cell sheet characterization. The long-term goal of this study is to regenerate corneal epithelium in patient with severe ocular surface diseases using autologous oral mucosa epithelial cell sheet grafts.

Abstract:

PURPOSE: This study focuses on characterizing proteasomes in corneal epithelial cells (CEC) and in cultured autologous oral
mucosal epithelial cell sheets (CAOMECS) used to regenerate the ocular surface.
 

METHODS: Limbal stem cell deficiency (LSCD) was surgically induced in rabbit corneas. CAOMECS was engineered and grafted
onto corneas with LSCD to regenerate the ocular surface. RESULTS: LSCD caused an increase in inflammatory cells in the ocular
surface, an increase in the formation of immunoproteasomes (IPR), and a decrease in the formation of constitutive proteasome
(CPR). Specifically, LSCD-diseased CEC (D-CEC) showed a decrease in the CPR chymotrypsin-like, trypsin-like and caspase-like
activities, while healthy CEC (H-CEC) and CAOMECS showed higher activities. Quantitative analysis of IPR inducible subunit (B5i,
B2i, and B1i) were performed and compared to CPR subunit (B5, B2, and B1) levels. Results showed that ratios B5i/B5, B2i/B2 and
B1i/B1 were higher in D-CEC, indicating that D-CEC had approximately a two-fold increase in the amount of IPR compared to
CAOMECS and H-CEC. Histological analysis demonstrated that CAOMECS-grafted corneas had a re-epithelialized surface, positive
staining for CPR subunits, and weak staining for IPR subunits. In addition, digital quantitative measurement of fluorescent intensity
showed that the CPR B5 subunit was significantly more expressed in CAOMECS-grafted corneas compared to non-grafted corneas
with LSCD.

CONCLUSION: CAOMECS grafting successfully replaced the D-CEC with oral mucosal epithelial cells with higher
levels of CPR. The increase in constitutive proteasome activity is possibly responsible for the recovery and improvement in the treated
corneas. Supported by Emmaus Life Sciences Inc.

Biography:

Yan Ning Neo is an Ophthalmology Registrar in North London. He attended University of Edinburgh with a full undergraduate scholarship and graduated with multiple awards and prizes, including an external grant by the Royal College of Surgeons and Physicians Glasgow to carry out ophthalmology research at Harvard University. During his undertaking of an Ophthalmology Academic Foundation Programme in Scotland, he was rewarded few national research awards and prizes, including FaME Best Junior Doctor Award, TASME UK Young Educator Prize and Novartis Academic Bursary etc.

Abstract:

We sought to report the long-term visual and treatment outcomes in a whole-population, orthoptic-delivered pre-school visual screening (PSVS) programme in Scotland and their associations with socioeconomic backgrounds and home circumstances. Retrospective case review was conducted on 430 children who failed PSVS. Outcome measures included best corrected visual acuity (BCVA) and proportion of amblyopia based on severity (mild, moderate and severe), binocular vision (BV) (normal, poor and none), ophthalmic diagnosis and treatment modalities. Parameters at discharge were compared to those at baseline, and were measured against Scottish Index of Multiple Deprivation (SIMD) and Health Plan Indicator (HPI), which are indices of deprivation and status of home circumstances. The proportion of children with amblyopia reduced from 87.1% at baseline to 27.2% at discharge (p<0.001). 81.3% had good BV at discharge compared to 33.5 at baseline (p<0.001). Association between final BCVA and BV is significant (p<0.001). Children from more socioeconomically deprived areas (OR 2.01, p=0.003) or adverse family backgrounds (OR 3.40, p=0.002) were more likely to attend poorly and become lost to follow-up. Children from worse home circumstances were five times more likely to have residual amblyopia (OR 5.33, p<0.001) and three times more likely to have poor/no BV (OR 3.23, p<0.001) than those from better home circumstances. Orthoptic-delivered PSVS is effective and feasible for the early detection and treatment of childhood amblyopia. Children from unstable homes are more likely to have poorer visual outcomes.

Biography:

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.

Abstract:

Cataract surgery is becoming a refractive surgery. The requirements of our patients are changing and most of our patients are looking for glasses independence after cataract surgery. Refractive lens exchange has increased in our practice due to expanding awareness among patients about refractive options past the age of 45. The key elements to success are choosing the most suitable patients, perfect planning, knowledge of available technologies and appreciating the differences so choice to meet patients requirements and life style, surgical techniques, measuring outcomes, and auditing.c

Biography:

Abstract:

Purpose: To assess the learning curve in the initial 100 cases of cataract surgery performed using the femtosecond-laser-assisted-cataractsurgery
(FLACS) by experienced cataract surgeons without prior experience with the femtosecond laser platform.
 

Setting: Tertiary care eye hospital in South India.
 

Methods: First 100 consecutive eyes undergoing FLACS were prospectively studied to understand the docking time, number of docking attempts, problems encountered during docking and complications attributable to docking. Phacoemulsification performed after the femtosecond laser was also studied for complications, need for additional instrumentation and total time required for surgery. Comparison between two operating surgeons was also made.
 

Results: One hundred eyes of 91 participants were included in the analysis. The mean age of participants was 57.8+8.2 years and 68% were men. Surgery was performed by the SMO in 56 eyes and by the JMO in 44 eyes. Successful docking of the femtosecond laser was recorded in 70% eyes at the first attempt. Most of the remaining eyes underwent successful docking at the second attempt. The commonest causes for failure of docking were inadequate suction, air bubble at the docking interface, failed patient registration and eye movement post docking. Seven patients had pre-dock miscellaneous errors such as undetected patient interface, insufficient rise of the table height and
pre-treatment error, which occurred due to inadequate tightness of the patient interface attachment. Only one patient experienced loss of suction during the laser delivery because of sudden movement in the middle of the procedure. The mean time taken for successful docking was 9.3+6.4 minutes. Total time for phacoemulsification surgery across the study period was 12.9+6.2 minutes. Keratome was required to open the corneal incision in 18% eyes. Similarly, 6% eyes showed anterior capsular tags, when the capsulorhexis was uncovered and only one of these evolved into a radial capsular tear. Two eyes with mature cataract had significant miosis after laser, which dilated well with intracameral adrenaline. Only one eye experienced zonular dialysis. There were no other complications during surgery including posterior capsular rupture and vitreous loss. Six eyes had persistent subconjunctival hemorrhage in the first post-operative day and 25 eyes had corneal edema in the first post-operative day, all of which resolved within 1 week of surgery. Eight patients had IOP spike (>21 mmHg) in the first postoperative day, out of which 7 resolved spontaneously and one patient required topical timolol for one-month duration. At 6 weeks follow up, 79% eyes attained UCDVA of 20/20, 19% had UCDVA of 20/30 and only 2 eyes had 20/40. All eyes had BCDVA of 20/20. When surgeries were divided into quartiles (Table 1), a significant reduction was seen in docking time between the first 25 eyes and the remaining 75 eyes. Similarly, successful 1st docking attempts significantly improved from 36% in the first quartile to 80% in the 4th quartile. Three attempts were required in 2 eyes (one in 1st and 3rd quartile) and 4 attempts were required in 1 eye in the first quartile. Additionally, the need to use a keratome to open the corneal incision showed time trends across quartiles. When surgeries were divided into deciles (i.e. groups of 10 each), docking time reduced significantly after the first 30 cases. Similarly, the proportion of successful docking at 1st attempt shows a trend to improve from 1st to 10th decile. The average number of docking attempts per case was 1.44, which improved with learning from 1.6 in the first decile to 1.3 in the last decile. No other significant differences were observed between the deciles. Comparison between the two operating surgeon showed that the senior surgeon performed phacoemulsification surgery significantly faster than the junior, however, he required using the keratome in significantly more number of eyes.

Biography:

Fawzia Bardag-Gorce has been studying ocular surface disease for the last six years, and has published and co‑authored six peer-reviewed publications in this field. She began her research on the treatment of limbal stem cell deficiency using Cultured Autologous Oral Mucosa Epithelial Cell Sheet (CAOMECS). During these six years, and under her supervision and guidance, her lab has successfully completed pre-clinical studies related to the efficacy and safety of CAOMECS cell-based therapy. She is currently directing a new study approved by the Institutional Research Board in which subjects are being recruited for the human oral mucosal epithelial cell sheet characterization. The long-term goal of this study is to regenerate corneal epithelium in patient with severe ocular surface diseases using autologous oral mucosa epithelial cell sheet grafts.

Abstract:

Statement of the Problem: Corneal limbal stem-cell deficiency (LSCD) caused by ocular trauma or by eye disease leads to impaired corneal epithelial regeneration and conjunctivalization, neovascularization, which often results in significant vision impairment. Patients with bilateral or unilateral LSCD are currently treated with ex vivo cultured allogeneic or autologous transplant of limbal stem cells. Allogenic grafts require immunosuppression, and autologous grafts are associated with other risks. The purpose of this study is to use a carrier-free cultured autologous oral mucosal epithelial cell sheet (CAOMECS) graft as a therapeutic approach to improve the health and transparency of the corneal epithelium.

Methodology & Theoretical Orientation: Using a small biopsy from the buccal cheek, epithelial cells were isolated and cultured for two weeks on a temperature responsive surface (CellSeed Inc. Japan). CAOMECS was harvested and grafted onto the cornea of rabbits with experimentally induced LSCD.

Findings: Both rabbit and human CAOMECS grafts resulted to a multi‑stratified epithelium similar to corneal epithelium with basal cell positive for DeltaNp63 (a marker of progenitor stem cell). CAOMECS grafts had a healthy extra‑cellular matrix including balanced pro- and anti‑angiogenic factors and up-regulated levels of adhesion molecules necessary for the epithelial integrity. CAOMECS grafting onto corneas of rabbits with LSCD successfully re‑epithelized the ocular surface, reduced cornea vascularization and reduced fibrotic

tissue re-growth. We also demonstrated that diseased corneas with LSCD showed little or no staining for adhesion molecules, while CAOMECS-grafted corneas showed normal expression of adhesion molecules and junctional complexes, which is indicative of a non-migratory behavior of cells in CAOMECS.

Conclusion & Significance: Carrier-free CAOMECS grafting improved the ocular surface in a rabbit model of LSCD. CAOMECS grafts renewed corneal epithelial cells, including basal cells positive for progenitor stem cells, acted as a barrier to conjunctivalization and neovascularization, and conferred anti-inflammatory as well as anti-fibrotic effects.

Biography:

Miguel Rechichi has completed his training in ophthalmology and his PhD from Magna Graecia University and Diploma of Specialist Superior in Ophthalmology from University of Lugano (Switzerland). He’s actually founder of corneal and refractive Surgery service of Eye Center Clinic in Catanzaro, Italy. He was a pioneer of crosslinking clinical application and actually is involved in developing new accelerated cxl protocols and topography guided crosslinking for which he’s invited as opinion leader to several meetings. He has published several papers in reputed journals and has been serving as an editorial board member of repute.

Abstract:

Corneal collagen cross-linking (CXL) is being used worldwide as a first- line treatment for keratoconus, pellucid marginal degeneration, and post-LASIK ectasia. CXL has been shown to be both safe and effective and nowadays patients as young as 10 routinely undergo this form of treatment when they are first diagnosed with keratoconus. As expected, CXL in the early stages of disease is more successful than in the advanced stages.Treatment may help prevent the corneal thinning and apical scarring typical of advanced keratoconus. After CXL, many patients can resume wearing their contact lenses in a few days or a few weeks. Their vision gradually improves weeks to months after treatment, as the cornea undergoes remodeling. In some cases, improvement continues for many years. Evolution of cxl machines alone was incredible and in the near future topography-guided cxl treatment will be available. More than this several procedures that can be actually combined with CXL, such as topography-guided PRK, intracorneal ring segments, and phakic IOLs. The actual target of cxl research is to evaluate various methods of cross linking to provide better option to patients not only for halting keratoconus but, when possible, to improve corrected and uncorrected visual acuity.

Biography:

Haisheng Zhao has his expertise in “Optic nerve injury and regeneration, neuroprotection on retinal ganglion cells”. He has published six peer-reviewed journal articles. He also has his research interests on Maculopathy and age-related macular degeneration. Based on15 years of research accumulation, he has given 13 international seminar and conference presentations.

Abstract:

Statement of the Problem: Aim of this study is to evaluate none-staining of the internal limiting membrane vitrectomy outcomes for high myopic patients with macular hole (MH) and to compare these outcomes with those of control patients with idiopathic MH.

Methodology & Theoretical Orientation: The study was designed as a retrospective chart review. We performed a retrospective chart review of consecutive cases that underwent none-staining of the internal limiting membrane vitrectomy for MH from 2016.1 to 2017.2. 36 eyes of 36 patients were selected to participate in this study. They were divided into two groups: Nine study eyes with high myopic MH and 27 control eyes with idiopathic MH. The main outcomes were preoperative, postoperative best-corrected visual acuity (BCVA), MH closure rates, and abnormal IOP complications in both groups.

Findings: There was a closure rate of 88% in the study group and 85% in the control groups, and no cases of reopening were reported during the follow-up visits. After surgery, there were significant improvements of mean BCVA in the study group (88%) and in the control group (85%). The amplitude of postoperative BCVA in the study group was significantly higher than that in the control group. Abnormal IOP complications taken place in the study group was 33%，while in the control group was 11%.

Conclusion & Significance: None-staining of the internal limiting membrane vitrectomy results in satisfactory anatomical and visual acuity improvement in patients with high myopic MH and in patients with idiopathic MHs. However, abnormal IOP complications taken place in the high myopic MH group was higher than that in the idiopathic MHs group. Therefore, pay much more attention to control and regulate IOP in the duration and post of surgery.

Biography:

Nadejda Bocheva is an Associate Professor at Institute of Neurobiology, Bulgarian Academy of Sciences. Her research interests include “Human visual information processing, spatial vision, motion perception, visual recovery of 3D shape and ageing”. She has more than 40 publications in scientific journals. She has received a Fogarty International Collaborative Award in 2002. She is member of American Psychological Association and of the Sofia section of the Bulgarian Physiological Society.

Abstract:

Statement of the Problem: The optic flow pattern occurring during the observer’s motion through the environment is a powerful cue for the direction of self-motion (heading). Most of the existing theories on visual heading determination considered only the contribution of the instantaneous flow field. The aim of the present study is to evaluate the relative contribution of spatial and temporal information integration in heading estimation.

Methodology & Theoretical Orientation: Four different conditions simulated the observer’s motion towards a wall with stationary eyes and head. In the static condition a single snapshot of an instantaneous flow field was presented and the heading direction was specified by the orientation of paired dot elements. In the flicker condition, a random sequence of snapshots with paired dots was presented. In the motion condition the heading direction was specified by the trajectory of the moving dots, while in the combined condition it was specified both by the trajectory of motion and the orientation of paired dots. In all conditions except the static one the lifetimes of the dots was limited to 100 ms and on every frame one-third of the dots were randomly re-positioned. In all conditions, 30% of the dots had random direction and/or orientation. The observers had to determine whether the heading direction was shifted away from straight ahead.

Findings: The heading direction was estimated with highest sensitivity in the combined condition. The improvement in this condition could not be predicted by an optimal combination of the information in the static and motion displays, but is well described by the combination of the information in the flicker and motion displays.

Conclusion & Significance: The results imply that temporal information integration plays a significant role in heading perception and that the determination of self-motion direction is not based solely on the instantaneous optic flow.

Biography:

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.

Abstract:

Keratoconus is an aggressive and progressive disease in younger patients. There is very little known about keratoconus in children. In my presentation, I will show how keratoconus is a childhood disease. I will go through diagnosis, monitoring, and treatment options. I will discuss in details our results in keratoconus in children where we have cross linked more than 60 children with progressive keratoconus. Large proportions of these children are younger than 12 years. I will discuss in details interesting corneal topography findings, methods of diagnosing the disease in small children and epithelial-off off versus epithelial-off on crosslinking in children. Special precautions are essential in treating children which will be highlighted as well.

Biography:

She graduated from Istanbul University, Istanbul School of Medicine in 1997. She has completed her residency in Istanbul Universtiy, Cerrahpasa School of
Medicine, Department of Ophthalmology in 2002. She has worked in Turkish Diabetes Hospital since 2002. She has held the position of Medical Retina Specialist and Deputy Chief Physician in Dünyagöz Hospital between 2005-2016. She coordinated the initiation of the long-term partnership of Orbis which is a branch of the World Health Organisation and Dünyagöz Hospital Group. She is the ophthalmology consultant of telemedicine systems of GSM operators in Turkey. She coordinated the bionic eye treatment initiation (Argus II Retinal Implant) in Turkey, also incorporating the Frankfurt World Eye Hospital in Germany as a scientific committee and board member of Dünyagöz Foundation and Turkish Medical Academy. She initiated the projects Dunyadiyabet and Athletic Eye Health in order to contribute to ‘Retina Awareness’ as a clinical scientist to prevent the loss of resources that would be used for keeping patients healthy. She has been invited contribute to the Turkish Olympic Committee and is working with the Turkish Paralympic Committee. She aims that the eye would be a symbol for the preventive
medicine globally, starting from athletes.

Abstract:

Over 382 million people in the World have diabetes, 46% of globally diabetes population is undiagnosed. Up to 50% of diabetes is detected with a clinical complication. Diabetic population will increase 54% while the number of ophthalmologists will increase by 2%. Will present activities address the magnitude of the issues that are coming up? This massive problem requires a high level solution. Advanced glycation end products (AGEs) are proteins that become glycated as a result of exposure to sugars. The HbA1C test is currently one of the best ways to check diabetes is under control. These glucose molecules are still “sticky,” with the same affinity for protein, including collagen within the lens. The non-enzymatic, chemical bonding between glucose and lens proteins forms irreversible glyco-protein aggregates. AGEs accumuate in these proteins over a persons lifetime. Lens autoluorescence may have a clinical utility is suggested by its physiological basis, which is the accumulation of AGEs, a heterogenous family of yellow-brown and fluorescent proteins that have been modified by glycation.

MATHERIAL AND METHOD

Studies of the autoflurescence of the human crytalline lens have established that lens autofluorescence intensity increases with the age of the subject and that lens autofluorescence is further increased in patients with diabetes mellitus.The transparency of the ocular media (cornea, aqueous and lens) provides a unique opportunity to shine an excitatory light source on fluorescent AGEs within the human lens and correlate that fluorescence with the degree of AGE deposition.The only technology available in the U.S. cleared by the U.S. Food and Drug Administration (FDA) for the non-invasive measurement of lens autofluorescence is the CLEARPATH DS-120™, manufactured by Freedom Meditech, Inc. (San Diego, CA). 

RESULTS

The CLEARPATH DS-120™ accurately measures a person’s lenticular fluorescence and reports if the result is at normal, high, or low limits versus age-adjusted normative data. Thus, since the glycation process in the lens has been reported to be irreversible, one can think of lens autofluorescence as a tool to obtain information about a person’s glucose excursions over a lifetime. On the other side, lens autofluorescence measurement can identify patients with lens fluorescence lower than expected as under the green line. Thus fluorescein ratio provides information on the mobility of the person, the calories they get / the calories burned and
it should be investigated by further studies whether it will be an athletic performance indicator such as an athlete's pulse.

CONCLUSION

The clinical data indicated that the fluorescence ratio could provide better discrimination between individuals with and without diabetes than fluorescence intensity.If we think of fasting blood sugar and postprandial blood sugar as photograph, HbA1c as fragman, fluorescein ratio can be considered as whole film of life until cataract operation and
it should be considered as a metabolic credit note of the person. Noninvasive measurements of lens autofluorescence may have clinical utility for general health beyond the diabetes and its complication.

Biography:

Douglas Borchman is a Professor of Ophthalmology and Visual Sciences at University of Louisville. He is also an adjunct Professor in Department of Chemistry, and Physiology and Biophysics. He completed his PhD in Chemistry at Wayne State University and is the author of over 100 peer reviewed articles. He was a Principal or Co-investigator of seven major peer awarded grants totaling over 10 million dollars to study cataract and dry eye. His 1^st and last major NIH grants scored in the top 5% and 2% of the nation, respectively. He has given over 250 scientific presentations around the world

Abstract:

Our study addresses the question why do rats get cataracts at two years, dogs at eight years and whales do not get catarcts for over 200 years? The cholesterol and phospholipid content of bow head whale lenses were measured using ¹H and ³¹P NMR spectroscopy, respectively. Lens lipid structure was measured using FTIR spectroscopy. Whale lens lipid phase transitions were compared to the lipid phase transitions of rabbit, guinea pig, bovine, camel and human lenses. The major phospholipids of the whale lens were sphingolipids which composed 60 to 100% of the total phospholipid. The average molar cholesterol/phospholipid ratio for all four samples was similar 10 moles cholesterol per mole phospholipid. There was a linear correlation between the percentage of lens sphingolipid and lens lipid hydrocarbon chain order until about 60% sphingolipid. The percentage of lens sphingolipid correlated with the lens lipid phase transition temperature. The expected lifespan of the bowhead whale (200 y) and the percentage of whale lens sphingolipid fit well in the correlation between the percentage of lens sphingolipid and expected lifespan measured for other species. In conclusion, bowhead whale lens membranes have a high sphingolipid content that confers resistance to oxidation, allowing these lenses to stay clear for a relatively longer time than is the case in many other species. If human lenses could be made to have a lipid composition similar to bowhead whales, like the whale, one could hope humans would not develop cataracts for over 200 years.

Biography:

Senior Vitreo-retinal consultant at the Jordanian Hospital in Amman. Fayyad graduated from Rome University (La Sapienza) in 1976, and completed his residency program in ophthalmology at the same university between 1977 and 1981 with honors. He then traveled to Canada and completed a two year fellowship program in clinical Retina, at the department of ophthalmology at Ottawa University. He served at the Jordanian ministry of health hospitals and the King Hussein Medical Center as well as at the Jordan University Hospital.An examiner at the Jordanian Board of Ophthalmology. Fayyad is involved in training ophthalmologists in Vitreo-retinal surgery.

Abstract:

Eye trauma including retained IOFBs carries many challenges in the management and prognosis depends on the severity of the initial trauma. Traditional good prognostic factors include; small foreign bodies with anterior location, clear media, no afferent pupillary defect and good vision at presentation. Traditional poor prognostic factors are; globe rupture, large retained IOFBs with posterior location, afferent pupillary defect, media opacity and poor vision at presentation. No light perception (NLP) is not a contra-indication for surgery, unless a combined lesion involving the optic nerve is present.

There are possible causes of permanent NLP vision in the injured eye, including total destruction of the eyeball, loss of posterior retina and major optic nerve trauma. There are many possible causes of potentially reversible NLP vision in the injured eye and this includes patients with altered mental status, severe lid edema with inability to open, corneal wound with edema, Hyphema, traumatic cataract, severe vitreous hemorrhage, retinal edema with hemorrhage, retinal detachment, subretinal hemorrhage and suprachoroidal hemorrhage.

In the management of eye trauma there is no specific protocol to follow, and the choice of treatment depends on personal experience and experience of others. In perforating eye injuries closure of the posterior wound is often impossible, with the risk of retinal incarceration. Primary surgery includes the closure of the entrance and exit wounds if it is anterior to the equator, with anterior segment reconstruction if needed and limited PPV to remove the vitreous traction between the entrance and exit wounds. Secondary surgery to follow within 100 hours. Chorioretinectomy lowers the PVR rate, prevents retinal folds and improves prognosis.   The final goal of our treatment should be to restore the best possible vision and to prevent immediate and late complications.

Biography:

Rajamani Lakshminarayanan completed his PhD in Department of Chemistry at National University of Singapore. He was a recipient of the Singapore Millennium Foundation, Post-doctoral Fellow and then obtained further Post-doctoral training at University of Southern California. Since 2009, he has been working as a Principal Investigator II at Singapore Eye Research Institute. His major interests include antimicrobial polymers and peptides, antimicrobial coatings for medical devices, new crosslinking methods for electrospinning of hydrogel polymers and protein aggregation diseases. He has published more than 80 papers in reputed journals and three book chapters.

Abstract:

In the era of increasing evolution of antimicrobial resistance to antibiotics treatment, there is a perceived need for antiseptics with high biocompatibility index for the management of topical infections. Since the fitness cost for microbes to modify microbial membranes is higher, agents that target cytoplasmic membranes of prokaryotes are attractive alternatives for combating antimicrobial resistance. Cationic antimicrobial polymers have been shown to elicit rapid bactericidal action by targeting cytoplasmic membrane of the bacteria, but their cytotoxicity for mammalian cells limited their therapeutic potential. In this work, we tested the antimicrobial activity and mammalian cell cytotoxicity of cationic polymers with varying back bones and side chain functional groups. Among the various polymers compared, polymers with ethylenimine (polymer1) or isopeptide (polymer 7) backbones displayed good selectivity for microbial cell membranes over mammalian cell membranes. Both the polymers abrogated the adverse effects of bacteria or bacterial secretomes on cell morphology and cell migration, respectively. Polymer 7 displayed broad-spectrum antimicrobial properties which include carbapenem-resistant Enterobacteriaceae, vancomycin-resistant enterococcus, MRSA, multi-drug resistant Pseudomonas aeruginosa and filamentous fungal pathogens. The polymer elicits rapid bactericidal activity, anti-biofilm properties and inhibits fungal hyphae as well. Topical instillation of the polymer (0.3% w/v in PBS) restored the re-epithelialization in a rabbit corneal scratch wound model, indicating good biocompatibility. In a rabbit model of bacterial keratitis, topical instillation of polymer 7 decreased the bacterial bio-burden, corneal edema and conjunctival redness when compared to topical antibiotics. Together, these results establish excellent safety and efficacy of the polymer for treating topical infections.

Biography:

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.

Abstract:

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.

Biography:

Abstract:

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).

Biography:

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.

Abstract:

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.

Biography:

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.

Abstract:

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.

Biography:

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.

Abstract:

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.

Biography:

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.

Abstract:

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.

Biography:

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.

Abstract:

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.

Biography:

Dr. Bardag-Gorce has been studying ocular surface disease for the last 6 years, and has since published and co‑authored 6 peer-reviewed publications in the field. She began her research on the treatment of limbal stem cell deficiency using cultured autologous oral mucosa epithelial cell sheet (CAOMECS). During these six years, and under her supervision and guidance, her lab has successfully completed pre-clinical studies related to the efficacy and safety of CAOMECS cell-based therapy [see above cited publications]. She is currently directing a new study approved by the Institutional Research Board in which subjects are being recruited for the human oral mucosal epithelial cell sheet characterization. The long-term goal of this study is to regenerate corneal epithelium in patient with severe ocular surface diseases using autologous oral mucosa epithelial cell sheet grafts. 

Abstract:

Statement of the Problem: Corneal limbal stem-cell deficiency (LSCD) caused by ocular trauma or by eye disease leads to impaired corneal epithelial regeneration and conjunctivalization, neovascularization, which often results in significant vision impairment. Patients with bilateral or unilateral LSCD are currently treated with ex vivo cultured allogeneic or autologous transplant of limbal stem cells.  Allogenic grafts requires immunosuppression, and autologous grafts are associated with other risks. 

The purpose of this study is to use a carrier-free cultured autologous oral mucosal epithelial cell sheet (CAOMECS) graft as a therapeutic approach to improve the health and transparency of the corneal epithelium. 

Methodology & Theoretical Orientation: Using a small biopsy from the buccal cheek, epithelial cells were isolated and cultured for two weeks on a temperature responsive surface (CellSeed Inc. Japan). CAOMECS was harvested and grafted onto the cornea of rabbits with experimentally induced LSCD.

 Findings: Both rabbit and human CAOMECS grafts resulted to a multi‑stratified epithelium similar to corneal epithelium with basal cell positive for DeltaNp63 (a marker of progenitor stem cell).  CAOMECS grafts had a healthy extra‑cellular matrix including balanced pro- and anti‑angiogenic factors and upregulated levels of adhesion molecules necessary for the epithelial integrity. CAOMECS grafting onto corneas of rabbits with LSCD successfully re‑epithelized the ocular surface, reduced cornea vascularization and reduced fibrotic tissue re-growth.  We also demonstrated that diseased corneas with LSCD showed little or no staining for adhesion molecules, while CAOMECS-grafted corneas showed normal expression of adhesion molecules and junctional complexes, which is indicative of a non-migratory behavior of cells in CAOMECS. 

Conclusion & Significance: Carrier-free CAOMECS grafting improved the ocular surface in a rabbit model of LSCD.  CAOMECS grafts renewed corneal epithelial cells, including basal cells positive for progenitor stem cells, acted as a barrier to conjunctivalization and neovascularization, and conferred anti-inflammatory as well as anti-fibrotic effects.

Biography:

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.

Abstract:

Cataract surgery is becoming a refractive surgery. The requirements of our patients are changing and most of our patients are looking for glasses independence after cataract surgery. Refractive lens exchange as well has increased in our practice due to expanding awarness among patients about refractive options past the age of 45. The key elements to success are choosing the most suitable patients, perfect planing, knowledge of available technologies and appreciating the differences so choice to meet patients requirements and life style, surgical techniques, measuring outcomes, and auditing own results.

Biography:

Miguel Rechichi has completed his training in ophthalmology and his PhD from Magna Graecia University and Diploma of Specialist Superior in Ophthalmology from University of Lugano (Switzerland). He’s actually founder of corneal and refractive Surgery service of Eye Center Clinic in Catanzaro, Italy. He was a pioneer of crosslinking clinical application and actually is involved in developing new accelerated cxl protocols and topography guided crosslinking for which he’s invited as opinion leader to several meetings. He has published several papers in reputed journals and has been serving as an editorial board member of repute.

Abstract:

Corneal collagen cross-linking (CXL) is being used worldwide as a first- line treatment for keratoconus, pellucid marginal degeneration, and post-LASIK ectasia. CXL has been shown to be both safe and effective and nowadays patients as young as 10 routinely undergo this form of treatment when they are first diagnosed with keratoconus. As expected, CXL in the early stages of disease is more successful than in the advanced stages.Treatment may help prevent the corneal thinning and apical scarring typical of advanced keratoconus. After CXL, many patients can resume wearing their contact lenses in a few days or a few weeks. Their vision gradually improves weeks to months after treatment, as the cornea undergoes remodeling. In some cases, improvement continues for many years. Evolution of cxl machines alone was incredible and in the near future topography-guided cxl treatment will be available. More than this several procedures that can be actually combined with CXL, such as topography-guided PRK, intracorneal ring segments, and phakic IOLs. The actual target of cxl research is to evaluate various methods of cross linking to provide better option to patients not only for halting keratoconus but, when possible, to improve corrected and uncorrected visual acuity.

Biography:

Senior Vitreo-retinal consultant at the Jordanian Hospital in Amman. Fayyad graduated from Rome University (La Sapienza) in 1976, and completed his residency program in ophthalmology at the same university between 1977 and 1981 with honors. He then traveled to Canada and completed a two year fellowship program in clinical Retina, at the department of ophthalmology at Ottawa University. He served at the Jordanian ministry of health hospitals and the King Hussein Medical Center as well as at the Jordan University Hospital.An examiner at the Jordanian Board of Ophthalmology. Fayyad is involved in training ophthalmologists in Vitreo-retinal surgery.

Abstract:

Eye trauma including retained IOFBs carries many challenges in the management and prognosis depends on the severity of the initial trauma.Traditional good prognostic factors include; small foreign bodies with anterior location, clear media, no afferent pupillary defect and good vision at presentation. Traditional poor prognostic factors are; globe rupture, large retained IOFBs with posterior location, afferent pupillary defect, media opacity and poor vision at presentation. No light perception (NLP) is not a contra-indication for surgery, unless a combined lesion involving the optic nerve is present. There are possible causes of permanent NLP vision in the injured eye, including total destruction of the eyeball, loss of posterior retina and major optic nerve trauma. There are many possible causes of potentially reversible NLP vision in the injured eye and this includes patients with altered mental status, severe lid edema with inability to open, corneal wound with edema, Hyphema, traumatic cataract, severe vitreous hemorrhage, retinal edema with hemorrhage, retinal detachment, subretinal hemorrhage and suprachoroidal hemorrhage. In the management of eye trauma there is no specific protocol to follow, and the choice of treatment depends on personal experience and experience of others. In perforating eye injuries closure of the posterior wound is often impossible, with the risk of retinal incarceration. Primary surgery includes the closure of the entrance and exit wounds if it is anterior to the equator, with anterior segment reconstruction if needed and limited PPV to remove the vitreous traction between the entrance and exit wounds. Secondary surgery to follow within 100 hours. Chorioretinectomy lowers the PVR rate, prevents retinal folds and improves prognosis. The final goal of our treatment should be to restore the best possible vision and to prevent immediate and late complications.

Biography:

Dr. Borchman is a Professor of Ophthalmology and Visual Sciences at the University of Louisville.  He is also an adjunct Professor in the Departments of Chemistry, and Physiology and Biophysics.  He earned a Ph.D. in Chemistry from Wayne State University and is the author of over 100 peer reviewed articles. He is/was principal or co-investigator on seven major peer awarded grants totaling over 10 million dollars to study cataract and dry eye.  His 1st and last major NIH grants scored in the top 5% and 2% of the nation, respectively. He has given over 250 scientific presentations around the world.

Abstract:

Our study addresses the question why do rats get cataracts at two years, dogs at eight years and whales do not get catarcts for over 200 years? The cholesterol and phospholipid content of bow head whale lenses were measured using ¹H and ³¹P NMR spectroscopy, respectively. Lens lipid structure was measured using FTIR spectroscopy. Whale lens lipid phase transitions were compared to the lipid phase transitions of rabbit, guinea pig, bovine, camel and human lenses. The major phospholipids of the whale lens were sphingolipids which composed 60 to 100 % of the total phospholipid. The average molar cholesterol/phospholipid ratio for all four samples was similar 10 moles cholesterol per mole phospholipid. There was a linear correlation between the percentage of lens sphingolipid and lens lipid hydrocarbon chain order until about 60 % sphingolipid. The percentage of lens sphingolipid correlated with the lens lipid phase transition temperature.  The expected lifespan of the bowhead whale (200 y) and the percentage of whale lens sphingolipid fit well in the correlation between the percentage of lens sphingolipid and expected lifespan measured for other species. In conclusion, bowhead whale lens membranes have a high sphingolipid content that confers resistance to oxidation, allowing these lenses to stay clear for a relatively longer time than is the case in many other species. If human lenses could be made to have a lipid composition similar to bowhead whales, like the whale, one could hope humans would not develop cataracts for over 200 years.

Biography:

Dr. Tsioumas is a surgeon Opthamologist and graduate of the Medical School of the University of Modena in Italy. He is a master in Aesthetic Medicine, having completed his specialization at the “Agios Savvas” Oncology hospital; ,and his areas of specification include toxins, fillers, mesotherapy, peels, threads , tumour removal and painless, bloodless and suture-free blepharoplasty with Plexr. Dr Tsioumas is also a lecturer at the University of Camerino and President of S.A.M.N.A.S (Society Aesthetic Medicine Non Ablative Surgery. Moreover his persistent research and devotion on Aesthetic Medicine made him write his first book “Manual of Aesthetic Medicine “ that was translated in three languages.

Abstract:

The survey aims to highlight new noninvasive techniques on Oculoplastic focusing on the eyelid. Research and test object were 80 patients, age range 40-78 years, who had problems of small, medium and high degree of ptosis and problems from older surgical blepharoplasties. Common factor and 80 cases were surgical avoidance desire, due to cost and fear in the process. The method of solving the mentioned problems was the bloodless blepharoplasty using Plasma Exeresis. For the evaluation of the results through Plasma Exeresis method, set a satisfaction scale of 1 to 5 (1 = not at all satisfied - 5 = completely satisfied). All patients have described the results of treatment as 5 .

Biography:

Dr. R. Lakshminarayanan obtained his PhD from the Department of Chemistry at the National University of Singapore. He was a recipient of the Singapore Millennium Foundation Postdoctoral Fellow and then obtained further postdoctoral training at the University of Southern California. Since 2009, he has been working as a Principal Investigator II at the Singapore Eye Research Institute. His major interests include antimicrobial polymers and peptides, antimicrobial coatings for medical devices, new crosslinking methods for electrospinning of hydrogel polymers and protein aggregation diseases. He has published more than 80 papers in reputed journals and 3 book chapters. 

Abstract:

In the era of increasing evolution of antimicrobial resistance to antibiotics treatment, there is a perceived need for antiseptics with high biocompatibility index for the management of topical infections. Since the fitness cost for a microbes to modify microbial membranes is higher, agents that target cytoplasmic membranes of prokaryotes are attractive alternatives for combating antimicrobial resistance. Cationic antimicrobial polymers have been shown to elicit rapid bactericidal action by targeting cytoplasmic membrane of the bacteria, but their cytotoxicity for mammalian cells limited their therapeutic potential. In this work, we tested the antimicrobial activity and mammalian cell cytotoxicity of cationic polymers with varying back bones and side chain functional groups. Among the various polymers compared,  polymers with ethylenimine (Polymer1) or isopeptide (Polymer 7) backbones displayed good selectivity for microbial cell membranes over mammalian cell membranes. Both the polymers abrogated the adverse effects of bacteria or bacterial secretomes on cell morphology and cell migration, respectively. Polymer 7 displayed broad-spectrum antimicrobial properties which includes carbapenem-resistant enterobacteriocae, vancomycin-resistant enterococcus, MRSA, multi-drug resistant Pseudomonas aeruginosa and filamentous fungal pathogens. The polymer elicits rapbid bactericidal activity, antibiofilm properties and inhibits fungal hyphae as well. Topical instillation of the polymer (0.3% w/v in PBS) restored the re-epithelialization in a rabbit corneal scratch wound model, indicating good biocompatibility. In a rabbit model of  bacterial keratitis, topical instillation of Polymer 7 decreased the bacterial bioburden, conreal edema and conjuntival redness when compared to topical antibiotics. Together, these results establish excellent safety and efficacy of the polymer for treating topical infections. 

Biography:

Dr. Tsioumas is a surgeon Opthamologist and graduate of the Medical School of the University of Modena in Italy. He is a master in Aesthetic Medicine , having completed his specialization at the “Agios Savvas” Oncology hospital; , and his areas of specification include toxins , fillers , mesotherapy , peels , threads , tumour removal and painless , bloodless and suture-free blepharoplasty with Plexr. Dr Tsioumas is also a lecturer at the University of Camerino and President of S.A.M.N.A.S (Society Aesthetic Medicine Non Ablative Surgery. Moreover his persistent research and devotion on Aesthetic Medicine made him write his first book “Manual of Aesthetic Medicine “ that was translated in three languages.

Abstract:

The survey aims to highlight new noninvasive techniques on Oculoplastic focusing on the eyelid. Research and test object were 80 patients, age range 40-78 years, who had problems of small, medium and high degree of ptosis and problems from older surgical blepharoplasties. Common factor and 80 cases were surgical avoidance desire, due to cost and fear in the process. The method of solving the mentioned problems was the bloodless blepharoplasty using Plasma Exeresis. For the evaluation of the results through Plasma Exeresis method, set a satisfaction scale of 1 to 5 (1 = not at all satisfied - 5 = completely satisfied). All patients have described the results of treatment as 5 .

Biography:

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 sclera lens

Abstract:

This implant was created considering the good qualities of previous ones and improving their flaws. To start the fabrication I looked for material that was easy to get in the market and with low cost. JUMAT is made with hypoallergenic high-density polymethylmethacrylate. It is made in different sizes, from 10 mm to 22 mm. This is really helpful for the surgeon as he counts with different sizes at the operation theater and can select on site the most suitable one. This is essential for the successful adaptation of the implant.

JUMAT Orbit implant has multiple perforations of different diameters, being the principal one, the one that marks the implant axis and crosses it completely. This perforation has larger diameter in the back area and smaller in the front one. All other perforations connect with the principal one and interconnect among themselves too. This system of perforations is essential to foster an excellent vascularization.  Within ten days of surgery the patient is ready to start with the testing for the adaptation of a prosthethic eye.

As from 2010 to present time, 235 JUMAT implants have been implanted with only two expulsions reported. These cases were studied in detail. It was observed that both cases involved children with retinoblastoma. They were enucleated and were implanted with JUMAT.

These two children were derived  to Children's Garrahan Hospital in Buenos Aires, leading children’s hospital in Argentina. They were under radiotherapy and chemotherapy. These two processes avoided tissue vascularization by necrosia, which determined the expulsion of the implant.

Considering material, cost of material, availability of various implant dimensions, surgeon possibility of choosing exact measure during operation, JUMAT implant proves to be the best option.

Biography:

Petar Markov is currently doing his PhD at Cardiff University as part of a joined project between the Schools of Optometry and Vision Sciences, Biosciences and Engineering. Previously an Erasmus student, he completed his Master’s thesis at the Institute of Genetics and Molecular and Cellular Biology (IGBMC) in Strasbourg, France. Having a background in Molecular biology and Biophysics, respectively his Bachelor's and Master's degrees from Sofia University benefits his investigation of the role of ocular fibroblasts in determining tissue biomechanics in healthy and diseased eyes. Petar is also a member of the Cardiff Institute of Tissue Engineering and Repair (CITER), which coincides with his interests in further studying ocular diseases and developing new treatments.

Abstract:

Statement of the Problem: Over 300 million people worldwide are affected by vision impairment. Thus, extensive research efforts are being directed towards developing new and improved treatments. The sclera (white of the eye) is vital for healthy vision because it maintains the eye’s structural stability and shape, properties which are compromised in prevalent conditions such as myopia and glaucoma. To better comprehend the disease mechanisms we aim to create biomechanical computer models of the eye that incorporate physiological data on both the scleral cell cytoskeletal and extracellular matrix (ECM) components. Specifically, we targeted the scleral region bordering the optic nerve, a key region in glaucoma and myopia development.

Methodology & Theoretical Orientation: Because body physiology slows down with time we required specimens from closely-matched young adult age. This is particularly problematic when dealing with human tissues. Therefore, we compared several mammal species to find a suitable human analogue. Wide-angle X-ray scattering (WAXS) was used to map the scleral collagen orientation and distribution, while multi-photon microscopy provided clarity on the depth profile. The geometry of the eyeball was acquired from video motion capture imaging of specimens that were inflated under simulated eye pressure. Planned experiments include studies of fibroblast cytoskeletal reorganisation under simulated eye pressure (mimicking glaucoma).

Findings: After comparing 11 mammal species our results revealed that the peripapillary sclera of the bovine has a tissue structure closely resembling that of humans, including the important annular structure around the optic nerve, which is vital for its mechanical support. Furthermore, we have optimized protocols for bovine fibroblasts, which will be used to study their pressure-controlled mechanotransduction pathways.

Conclusion & Significance: ECM and cytoskeletal structural information will be used along with geometric data to create integrated models of the eye for driving future scleral-targeted treatments for glaucoma and myopia.

Biography:

Kristin Smedley, from Bucks County, Pennsylvania, is an award winning non-profit leader, TEDx speaker, and author - but she never planned on any of that. Kristin did plan to be a really great third grade teacher, however her personal path to greatness took an unexpected turn when two of her three children were diagnosed as blind. She had to learn the tools of blindness and build a team of experts that would help her navigate this path that she had not been trained for. Kristin’s two blind sons are now thriving as gifted high school and middle school students, elected student council officials, baseball championship winners, International Braille competition finalists, and social butterflies.In 2011 Kristin founded the Curing Retinal Blindness Foundation (www.crb1.org), the only patient organization in the world for her sons’ blindness, CRB1 LCA/RP. Kristin has led the CRBF to raise over $1 Million, introduced the first ever legislation in the United States in Braille, and has moved rare eye diseases from rarely talked about to being discussed in key circles worldwide. In 2017 Kristin published her first book, Thriving Blind: Stories of Success Without Sight. Kristin enjoys speaking about her journey and pointing out where she can find the fun in fundamentally challenging situations life delivers. Kristin’s inspirational and humorous style leaves audiences of all sizes wanting to hear more.

Abstract:

Overview:
This dynamic session will provide concrete examples of how connecting blind individuals to resources creates a bridge from diagnosis to potential treatment, thereby enabling the individual to lead a successful life without sight.

Background:
A diagnosis of blindness is devastating. Whether it is an adult that finds out they are losing their sight or a parent finding out their baby has no sight, it is a traumatic experience. Typically, clinicians say nothing more than “I’m sorry” to the patients and their caregivers. Parents’ dreams for their child are destroyed and they feel hopeless, which usually causes them to completely alter the way in which they parent that blind child. Adults that lose their sight often end up unemployed and depressed. In fact, 70% of blind adults are unemployed. Although the impact of blindness is affecting more and more people, most sighted people have no idea of what blind individuals are capable of and therefore a stigma of sadness and pity is misappropriated to the blind community. This stigma creates a vicious cycle of low expectations, under achievement and dependence for blind individuals.

Changing The Blindness/Visual Impairment Diagnosis Delivery:
Kristin Smedley is raising two sons that are blind due to CRB1 LCA/RP. In the seventeen years she has been a parent of blind children she has connected with many successful blind adults to guide her in raising her expectations of her boys and getting all the resources they need to level the educational and social playing field of their peers. She connected with other families raising CRB1 LCA/RP children to share resources. Smedley leads the Curing Retinal Blindness Foundation, the only patient organization in the world for CRB1 LCA/RP. The CRBF is a leader in the rare eye disease community. The CRBF has created a resource toolkit for clinicians, educators, and caregivers to change the way a blindness/visual impairment diagnosis is delivered such that patients are empowered to lead a full life.

Results:
Due to consistent exposure to blind role models and proper resources as well as maintaining high expectations for a full life, Smedley’s two blind sons have achieved success much greater than many blind children their age: baseball and swimming championships, elected student council executives, International Braille competition awards, gifted programs in regular public schools and more. In addition, the CRBF has forged collaboration in the rare eye disease community where multiple organizations are combining resources to affect many more patients, clinicians, researchers and caregivers for a positive impact worldwide.

Biography:

Kristin Smedley, from Bucks County, Pennsylvania, is an award winning non-profit leader, TEDx speaker, and author - but she never planned on any of that. Kristin did plan to be a really great third grade teacher, however her personal path to greatness took an unexpected turn when two of her three children were diagnosed as blind. She had to learn the tools of blindness and build a team of experts that would help her navigate this path that she had not been trained for. Kristin’s two blind sons are now thriving as gifted high school and middle school students, elected student council officials, baseball championship winners, International Braille competition finalists, and social butterflies.

In 2011 Kristin founded the Curing Retinal Blindness Foundation (www.crb1.org), the only patient organization in the world for her sons’ blindness, CRB1 LCA/RP. Kristin has led the CRBF to raise over $1 Million, introduced the first ever legislation in the United States in Braille, and has moved rare eye diseases from rarely talked about to being discussed in key circles worldwide. In 2017 Kristin published her first book, Thriving Blind: Stories of Success Without Sight.
Kristin enjoys speaking about her journey and pointing out where she can find the fun in fundamentally challenging situations life delivers. Kristin’s inspirational and humorous style leaves audiences of all sizes wanting to hear more.

Abstract:

Overview:
This dynamic session will provide concrete examples of how connecting blind individuals to resources creates a bridge from diagnosis to potential treatment, thereby enabling the individual to lead a successful life without sight.

Background:
A diagnosis of blindness is devastating. Whether it is an adult that finds out they are losing their sight or a parent finding out their baby has no sight, it is a traumatic experience. Typically, clinicians say nothing more than “I’m sorry” to the patients and their caregivers. Parents’ dreams for their child are destroyed and they feel hopeless, which usually causes them to completely alter the way in which they parent that blind child. Adults that lose their sight often end up unemployed and depressed. In fact, 70% of blind adults are unemployed. Although the impact of blindness is affecting more and more people, most sighted people have no idea of what blind individuals are capable of and therefore a stigma of sadness and pity is misappropriated to the blind community. This stigma creates a vicious cycle of low expectations, under achievement and dependence for blind individuals.

Changing The Blindness/Visual Impairment Diagnosis Delivery:
Kristin Smedley is raising two sons that are blind due to CRB1 LCA/RP. In the seventeen years she has been a parent of blind children she has connected with many successful blind adults to guide her in raising her expectations of her boys and getting all the resources they need to level the educational and social playing field of their peers. She connected with other families raising CRB1 LCA/RP children to share resources. Smedley leads the Curing Retinal Blindness Foundation, the only patient organization in the world for CRB1 LCA/RP. The CRBF is a leader in the rare eye disease community. The CRBF has created a resource toolkit for clinicians, educators, and caregivers to change the way a blindness/visual impairment diagnosis is delivered such that patients are empowered to lead a full life.

Results:
Due to consistent exposure to blind role models and proper resources as well as maintaining high expectations for a full life, Smedley’s two blind sons have achieved success much greater than many blind children their age: baseball and swimming championships, elected student council executives, International Braille competition awards, gifted programs in regular public schools and more. In addition, the CRBF has forged collaboration in the rare eye disease community where multiple organizations are combining resources to affect many more patients, clinicians, researchers and caregivers for a positive impact worldwide.

Biography:

He has more than 20 years of experience in molecular biology research. His research interest includes retinal circadian biology as well as ocular microRNA. He is interested in characterizing microRNA molecules and investigating their role in the expression of genes related to ocular diseases like age-related macular degeneration, diabetic retinopathy, and retinal vascular diseases. He is a member of the Association for Research in Vision and Ophthalmology.

Abstract:

Angiotensin (Ang) II is the most physiologically active component of RAS that mediates its effect through two G-protein coupled receptors, Ang II type 1 or type 2 (AT1R and AT2R), having different functional properties and signal transduction mechanisms. Most of the known cardiovascular effects of Ang II are mediated by AT1R. Prorenin has long been considered as an inactive precursor of renin, without any biological function of its own. However, prorenin binding to a receptor called (pro)renin receptor (PRR) has recently been reported to exert biological effects in the neuronal retina and retinal pigment epithelium (RPE). All the components of the RAS including PRR are expressed in RPE, retinal endothelial cells, and other ocular cell types. It is also known now that Prorenin is highly elevated in ocular fluid of diabetic patients with proliferative retinopathy, which all suggest that Prorenin and the system RAS are very important in the eye. Using RNA interference tools, we have shown that both the receptors are implicated in hyperglycemia-induced increase of vascular endothelial growth factor (VEGF), VEGFR2, and transforming growth factor beta (TGFβ1). In order to block the effect of Ang II through AT1R and AT2R, in our experiments we inhibited angiotensin converting enzyme (ACE) by perindopril, where Ang II formation is blocked. We have shown that the increased prorenin synthesis due to hyperglycemia has been attributed to the activation of PRR and VEGF by a mechanism involving NADPH oxidase activity, miRNA-21, HIF1-α and NF-κB. Furthermore, we have demonstrated that the downstream targets of miR-21 are three important genes Smad7, an inhibitor of TGF-β1-induced VEGF expression, Pten, a negative regulator of PI3 kinase/Akt signaling pathway, and Spry1, a negative regulator of ERK signaling pathway. The PRR-mediated induction of VEGF under hyperglycemic conditions occurs via Rac1 signaling by regulating miR-21 expression. Our studies suggest that hyperglycemica-induced PRR signaling may play a role in the VEGF-induced angiogenesis that may lead to proliferative diabetic retinopathy, wet AMD and other vascular complications in the eye.

Biography:

She graduated from Istanbul University, Istanbul School of Medicine in 1997. She was completed her residency in Ophthamology, Istanbul Universtiy, Cerrahpasa School of Medicine, Department of Ophthalmology in 2002. She has worked in Turkish Diabetes Hospital since 2002. She has held the position of Medical Retina Specialist and deputiy Chief Physician in Dünyagöz Hospital between 2005-2016. She coordinated the first bionic eye operational procedures in Turkey; incorporating the Frankfurt World Eye Hospital in Germany as scientific committe initiative and a board member of Dünyagöz Foundation. She initiated the projects Dunyadiyabet and Athletic Eye Health in order to contribute to ‘Retina Awareness’ as a clinical scientist to prevent the loss of resources that would be used for keeping patients healthy. She aims that the eye would be a symbol organ/logo for the preventive medicine globally, starting from athletes. She is the consultant ophthalmologist for the Association of Turkish Family Medicine and the Turkish Family Medicine Federation and active member of AAO, Euroretina, ARVO, Board member of Turkish Medicine Academy, Turkish Society of Pharmacogenomic and Personalized Medicine, Turkish Diabetes Association and Turkish Association of Ophthalmology. She works with the international program of the Orbis, married with two children.

Abstract:

INTRODUCTION

Over 382 million people in the World have diabetes, 46% of globally diabetes population is undiagnosed. Up to 50% of diabetes is detected with a clinical complication. Diabetic population will increase 54% while the number of ophthalmologists will increase by 2%. Will present activities address the magnitude of the issues that are coming up? This massive problem requires a high level solution. The average lag between onset and diagnosis of type 2 diabetes is 7 years. If diabetes cannot be prevented, the best way to ensure better patient outcomes is to detect early and manage continuously. Fortunately technological developments can make a significant difference in perception.

Advanced glycation end products (AGEs) are proteins that become glycated as a result of exposure to sugars. AGEs affect nearly every type of cell and molecule in the body. In the blood stream glucose sticks to the haemoglobin to make a 'glycosylated haemoglobin' molecule, called haemoglobin A1C (HbA1c) which is most recognised one among the large molecular family of AGEs. HbA1c is measured primarily to identify the three-month average plasma glucose concentration. The HbA1C test is currently one of the best ways to check diabetes is under control.

In a similar way fructosamine testing, typically reflect albumin glycation that is rarely used in clinical practice, because albumin has a half-life of approximately 20 days, the plasma fructosamine concentration reflects relatively recent (1-2 week) changes in blood glucose.

Although most proteins in living system turn over with sufficient rapidity to avoid signficant accumuation of AGEs, published evidence shows that with the appearance of glucose in the blood, glucose also appears in the aqueous humor of the eye and is subsequently transported within the crystalline lens. These glucose molecules are still “sticky,” with the same affinity for protein, including collagen within the lens. The non-enzymatic, chemical bonding between glucose and lens proteins forms irreversible glyco-protein aggregates. AGEs accumuate in these proteins over a persons lifetime.

Lens autoluorescence may have a clinical utility is suggested by its physiological basis, which is the accumulation of AGEs, a heterogenous family of yellow-brown and fluorescent proteins that have been modified by glycation.

MATHERIAL AND METHOD

Studies of the autoflurescence of the human crytalline lens have established that lens autofluorescence intensity increases with the age of the subject and that lens autofluorescence is further increased in patients with diabetes mellitus. Thus lens autofluorescence as a noninvasive measure of AGE accumulation, can be regarded as a measure of cumulative tissue damage due to elevated sugar in plasma and interstitial fluids. The clinical application of lens autofluorescence with a scanning confocal lens fluorescence biomicroscope enables the clinican to measure lens autofluorescence in routine examinations. Patients with lens fluorescence significantly higher then expected for their ages may have accelereted accumulation of AGEs and increased risk for the pathologies associated with diabetes and AGEs. AGEs throughout the body, including lenticular AGE’s, are higher in people with diabetes and pre-diabetes than the rest of the population. An interesting characteristic of AGE’s is that they will fluoresce when exposed to light, and the amount of fluorescence can be detected by an optical sensor. The transparency of the ocular media (cornea, aqueous and lens) provides a unique opportunity to shine an excitatory light source on fluorescent AGEs within the human lens and correlate that fluorescence with the degree of AGE deposition. The only technology available in the U.S. cleared by the U.S. Food and Drug Administration (FDA) for the non-invasive measurement of lens autofluorescence is the CLEARPATH DS-120™, manufactured by Freedom Meditech, Inc. (San Diego, CA). 

RESULTS

The CLEARPATH DS-120™ accurately measures a person’s lenticular fluorescence and reports if the result is at normal, high, or low limits versus age-adjusted normative data. Thus, since the glycation process in the lens has been reported to be irreversible, one can think of lens autofluorescence as a tool to obtain information about a person’s glucose excursions over a lifetime. Over 60 peer-reviewed published studies have shown a significant correlation between higher than average age-dependent lens autofluorescence, associated degenerative changes in the lens, and the presence of AGE’s, which are considered a hallmark of uncontrolled glucose. Patients with measurements above the 95% prediction interval should be referred by the clinician to primary care for a follow-on glycemic control evaluation. For patient’s whose measurements fall between the 80% and 95% prediction intervals, the clinician may decide to perform a clearpath evaluation annually to monitor if a patient’s fluorescence ratio moves up to the 95% prediction interval. Patients with an autofluorescence measure below the 80% prediction interval are suggested for a clearpath evaluation again in three years time. By placing a patients’s lens autofluorescence measure the clinician can identify patients with lens fluorescence that is higher than expected as red or orange line. Patients with measurements above the 95% prediction interval should be referred by the clinician to primary care for follow on glycemic control evalution. Above the red line means that is highly likely they will receive a differential diagnosis of prediabetes or diabetes. Orange colour code means the patient has higher than expected AGE accumulation again. It is likey they have had poor glucose control over their lifetime. Green line means the patient is likely within normal range and has had less than expected AGE accumulation, if the subject has diabetes, it is possible their glucose levels have been under good control such as diabetic patients with normal HbA1c. It is also possible the patient has latent autoimmune diabetes in adults or other metabolic issues such as pancreatitis, infections, and certain drugs maybe in green due short duration of out of control glucose. On the other side, lens autofluorescence measurement can identify patients with lens fluorescence lower than expected as under the green line. Thus fluorescein ratio provides information on the mobility of the person, the calories they get / the calories burned and
it should be investigated by further studies whether it will be an athletic performance indicator such as an athlete's pulse.

CONCLUSION

The clinical data indicated that the fluorescence ratio could provide better discrimination between individuals with and without diabetes than fluorescence intensity. This new parameter expresses metabolic control as longterm for patients with or without diabetes. Whereupon the crystalline lens has a new dimension which is providing information other than its own function related to visual function and cataract, as HbA1c that provides information other than haemoglobin’s own function If we think of fasting blood sugar and postprandial blood sugar as photograph, HbA1c as fragman, fluorescein ratio can be considered as whole film of life until cataract operation and it should be considered as a metabolic credit note of the person. Noninvasive measurements of lens autofluorescence may have clinical utility for general health beyond the diabetes and its complication.

Biography:

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.

Abstract:

Statement of the Problem:  To evaluate None-staining of the internal limiting membrane vitrectomy outcomes for high myopic patients with macular hole (MH) and to compare these outcomes with those of control patients with idiopathic MH.

Methodology & Theoretical Orientation:  The study was designed as a retrospective chart review. We performed a retrospective chart review of consecutive cases that underwent None-staining of the internal limiting membrane vitrectomy for MH from 2016.1 through 2017.2. 36 eyes of 36 patients were selected to participate in this study. They were divided into 2 groups: 9 study eyes with high myopic MH and 27 control eyes with idiopathic MH. The main outcomes were preoperative, postoperative best-corrected visual acuity (BCVA), MH closure rates, and abnormal IOP complications in both groups.

Findings: There was a closure rate of 88% in the study group and 85% in the control groups, and no cases of reopening were reported during the follow-up visits. After surgery, there were significant improvement of mean BCVA in the study group（88%）and in the control group （85%）. The aplitude of postoperative BCVA in the study group was significantly higher than that in the control group. Abnormal IOP complications taken place in the study group was 33%，while in the control group was 11%. Conclusion & Significance: None-staining of the internal limiting membrane vitrectomy results in satisfactory anatomical and visual acuity improvement in patients with high myopic MH and in patients with idiopathic MHs. However，abnormal IOP complications taken place in the high myopic MH group was higer than that in the idiopathic MHs group. Therefore，pay much more attention to control and regulate IOP in the duration and post of surgery.