23^rdEdition of Advancements in Ophthalmology: Clinical & Surgical Practices

Biography

Kusai Almozawak—FEBO—did his Residency at Rudolf Foundation Hospi­tal in Vienna (under the supervision of Professor Susanne Binder) and Ober Scharrer Group in Nürnberg-Germany (under the supervision of Dr. Scharrer ). He works at Ober Scharrer Group—ARIS Clinic Nürnberg, Germany. He is a Specialist in Anterior Segment Surgery and Lid Surgery.

Abstract

Neurofibromatosis 1 (NF1) and neurofibromatosis 2 (NF2) are characterized by an autosomal dominant pattern of inheritance with irregular penetrance and a broad spectrum of different clinical phenotypes. There are large variations in the age of onset, progression and prognosis. Symptoms are often manifested early in childhood. Characteristics which the two main forms NF1 and NF2 have in common are a positive family history, characteristic skin alterations, such as café au lait macules, axillary or inguinal freckling and neural tumors such as neurofibroma and optic glioma (NF1) as well as (bilateral) vestibular schwannoma (NF2). An interdisciplinary cooperation is necessary for the diagnostics and therapy

Biography

Е Grishina is the leading Research Fellow at the Moscow Regional Clinical and Research Institute, the Doctor of Medical Sciences, the Professor. She is the Author of more than 200 scientific works. She has more than 30 years of experience as an Ocular Oncologist. She was engaged in diagnostics and treatment of tumors of the eye and it’s adnexal. She is a Member of Europe­an Ophthalmic Oncology Group (OOG).

Abstract

Introduction: Orbital solitary fibrous tumor (SFT) is a rare spidle-cell tumor of mesenchymal origin. As a rule, surgeons have little experience in its management.

Purpose: The aim of the work is to report cases of the rare orbital tumor and discuss its treatment.

Methods: Four patients (three women and one man) had SFT. The age of the patients was 72, 63, 47, 23 years, accordingly. The tumors had the huge sizes in the all patients.

Results: Transcutaneous orbitotomy (in one patient) and transconjunctival orbitotomy (3 patients) were performed to remove the tumor completely. Nobody had undergone craniotomy. Histologic examination and immunohistochemical study revealed SFT. Two patients had the benign type of SFT, one patient—the uncertain type of SFT, 1 patient—the malignant type of SFT. Visual acuity of the all patients had improved. Position of the eye ball was correct after treatment. Only onepatient had slightly limited ocular motility. Follow-up period was 6–30 months. Two patients developed recurrence of the tumors (SFT of the uncertain type and SFT of malignant type, accordingly). External beam therapy was performed.

Conclusions: There are some questions in treatment of SFT. Whether additional treatment after full tumor removal is required? When should we perform it?.

Biography

Okonkwo Ogugua Ndubuisi works as a Consultant Vitreoretina Surgery at the Eye Foundation Retina Institute and is the Residency Program Director of the Eye Foundation Ophthalmic Residents Training Program. He also is a Trainer of Vitreoretina Fellows. He has published in several reputable scien­tific journals and is a Reviewer for over 30 scientific journals.

Abstract

Large and myopic macular holes have previously been shown to have poor anatomical outcome following conventional macular hole surgery, but can now be effectively closed with a high degree of predictability using the inverted internal limiting membrane (ILM) flap technique. This is usually followed by an improvement in function, which is seen on visual acuity testing and multifocal electroretinogram (ERG) as well. The immediate closure of the macular hole by this inverted ILM flap technique has been reported to be followed by a continued improvement in the macular microstructure, upto and over 12 months after surgery. The aim was to determine the number of eyes with continued improvement and the extent of foveal and parafoveal remodeling, by comparing immediate post-operative spectral domain optical coherence tomography (SD–OCT) images with scans taken after 10 months or more of follow up in 10 eyes that had inverted ILM flap technique for large size macular holes and also had a minimum post-operative follow up of 10 months. We investigated this by retrospectively reviewing the case records of patients and considered the degree of remodeling or change observed using the spectral domain optical coherence tomography (SD OCT) in the outer retina and then the inner retina. Specific attention was given to the foveal and parafoveal microstructure, including the foveal contour. Four out of the 10 eyes (40%) showed a continued remodeling after surgery with significant improvement in the appearance of foveal microstructure and foveal contour. The other six eyes did not demonstrate this positive change. The most significant change was seen in patient 4 in whom over a 16 month follow-up period, an obvious defect in the outer retina was noted to become gradually smaller and eventually disappeared. This study confirms earlier reports that significant remodeling of the foveal microstructure may occur over a long period of time in some of the macular hole eyes after an inverted ILM flap surgery. However, a majority of the eyes did not show this further positive change. The factors responsible for remodeling in some of these eyes, which may be associated with wound healing, ought to be further investigated

Biography

Fatima Zahra Alaoui specialist of internal medicine University hospital Ibn Rochd Casablanca Morocco Head of department of medicine in 2013-2017 Professor of internal medicine since 2007 Fields : auto-immune diseases , uveitis , Behcet disease , vascularisation , rheumatological inflammatory diseases Member of international society of Behcet disease.

Abstract

Background: Behcet’s disease (BD) is a chronic systemic inflammatory disorder of unknown etiology. It’s characterized by recurrent oral aphtosis and genital ulcer. Ocular involvement has been recognized since the time of Hypocrates. Estamates of the prevalence vary in different countries and may represent differences in the disease, in access to health care and in availabale treatments.

Aim: The aim of this study is to describe the epidemiological and clinical characteristics in Moroccan patients with ocular BD.

Methods: It’s a monocentric study, realized in an internal medicine department over 13 years and including 221 patients with ocular BD. The diagnosis was performed by the International Study Group for BD and/or the Davatchi Criteria for BD.

Results: 221 patients had ocular involvement and the prevalence was estimated at 43%. It was 158 men and 63 women (sex ratio M/F: 2:5). The mean age at the onset of ocular involvement was 30.5 years. This reached was inaugural in 18.55 % of cases and the average time of diagnosis in other cases was 3,41 years. The ocular involvement was serious from the start in the half-patients and visual acuity was less than 5/10 in 71.56% of affected eyes.

There was a high prevalence of uveitis: 97%

Conclusion: Up to 70% of patients with the BD will get eye involvement and current estimates from around the world indicate that severe visual impairment occurs in 25 % of involved eyes. Accordingly, the early detection and appropriate treatment of this reached is vital to preserve visual function of our patients.

Biography

Pranav Radkar has completed his Post-graduation in Ophthalmology from MGM Medical College, Aurangabad, India and is doing Cornea Fellowship from Sankara Eye hospital, Shimoga, India. He has also done Phacoemulsi­fication Fellowship from Sankara Nethralaya, Chennai, India. He has worked in Aditya Birla Memorial Hospital, Pune and Centre for Sight, New Delhi. His areas of research interest are Cataract Surgery, Refractive Surgery and Oc­ular Trauma

Abstract

Many options for correcting aphakia have been known like glasses, contact lens and intraocular lenses. The options in intraocular lens (IOL) includes: 1) anterior chamber IOL (ACIOL), 2) scleral fixated IOL and 3) iris fixated IOL, both anterior and posterior. For an anterior segment surgeon, the iris claw lens comes across as a savior with advantages of ease of surgery, less intraocular maneuvering and lesser learning curve. Iris claw lens can be used as a primary or secondary fixation. A study by Nana Madhukar Vare at PBMA’s H. V. Desai Eye Hospital, Pune, Maharashtra, India, concluded that the 6-month results of endothelial count, CME, lens stability, and visual acuity validate the role of posterior iris-fixated lenses in aphakic patients. We at Sankara Eye Hospital have been using iris claw since a long time with decent results. This presentation will include the surgical steps involved (video based) and tricks to make it easy for the surgeon. In our experience, insertion of posterior iris-fixated IOL is well within the skill sets and maneuvers familiar to a cataract surgeon and provides a very easy, simple, and affordable option with no serious adverse effect during the follow-up period.

Biography

Xiaoyi Hou is a MD student of Ophthalmology Department in University of Cologne. The objectives of her main research is to understand the relation­ship between gene mutation and the prognosis of malignant uveal mela­noma,and she also participates in the research of age related macular de­generation, the efficacy of lateral tarsal strip in the treatment of senile ectro­pion, and the ocular surface changes in patients after cataract surgery. She has MSc degree from Chongqing Medical University (China) in Research of Cataract and Glaucoma and BSc from Chongqing Medical University(China) in Clinical Medicine. She speaks Chinese, English and some German.

Abstract

Objective: To analysize the dry eye syndrome of age-related patients after cataract surgery using Keratograph D.

Methods: 35 cases (50 eyes) with cataract selected from December 2013 to March 2014 in the Department of Ophthalmology in our hospital were involved in this study. All of them took phacoemulsification, combined with intraocular lens implantation. We observed and recorded the following indicators one day before, seven days and one month after the surgery, respectively. The score of dry eye symptoms such as, Meibo-Scan, non-invasive tear break up time (NIBUT) and tear meniscus height were measured by Keratograph D.

Result: Compared with one day before surgery, the score of dry eye symptoms was obviously higher, the tear meniscus height reduced significantly and the tear break up time shortened in seven days and one month after the operation, the differences were statically significant (p=0.05); the meibomian gland orifices and glandular tubes had no change after the operation.

Conclusion: Cataract surgery can influence the ocular surface and break the stability of tear film in a short time after the operation, inducing postoperative dry eye syndrome that should be treated actively

Biography

Md Shafiqul Islam—MS—is working as Assistant Professor in the Depart­ment of Ophthalmology of Sher-e-Bangla Medical Hospital, Barisal, Bangla­desh. He was trained in Singapore and Nepal. His areas of interest are Pha­co Surgery, Medical Retina, Lasik and Ocular Trauma. He is the Focal Person of Diabetic Retinopathy Screening Program of southern part of Bangladesh. He is the life Member of the Ophthalmological Society of Bangladesh and All India Ophthalmological Society. He has good number of publications and has participated in many international seminars. He was awarded the Prof. Yasuo Tano Travel Grant as Young Ophthalmologist for his paper at APAO Conference 2017.

Abstract

Background: Eye injury is a common ophthalmic problem. It is an important and preventable public health problem worldwide.

Purpose: To assess the magnitude, pattern, extent, severity, causes and visual outcome of ocular injury in a tertiary hospital.

Materials & Methods: This cross-sectional study was done at the Eye Department of Sher-e-Bangla Medical College, Barisal over a period of two years. All patients who were admitted with eye injury through the outpatient or emergency routes were included in the study. They were examined to note the areas injured, type and extent of injury and impact on vision.

Results: Ocular injuries were 18.5% of total admitted patients and 16.3% of all operative cases. Out of total 406 cases, 74.3% were male and 25.6% were female. The average age was 26.3 years. Paediatric eye trauma constituted 29.8% of total cases which mostly occurred during playing. 71.4% cases arrived to our centre within 24 hours and 28.5% presented after 24 hours. Majority of the cases comprised of monocular trauma (93.8%). Blunt injuries constituted about 59.1% while 19.7% had sharp injuries. Open globe injuries were 23.8%. More than 1/3 of the patients had visual acuity worse than 3/60 at presentation and 5.4% cases were NPL

Biography

Rukiye Aydin Medipol University Hospital Ophthalmology Specialist Op. went to Columbia University within the scope of 2219 TUBITAK Overseas Doctoral Research Scholarship. Aydin will conduct research at the Edward S. Harkness Eye Institute at Columbia University Hospital in order to prevent the development of juvenile retinoschisis, which starts at an early age and cause severe vision loss, and to explore its treatment. Aydin aims to prevent vision loss by avoiding the disease that has no definite treatment with the study. The main areas of interest and treatment are: Vision Disorders and Lens Diseases.

Abstract

Purpose: To emphasize the efficacy of anti-VEBF treatment in iris metastases.

Case 1: A 65-year-old woman presented with an iris mass in her left eye. The patient had already undergone a radical mastectomy coupled with radiotherapy, and chemotherapy. At presentation, her visual acuity was 20/20 in both eyes. Intraocular pressures were measured to be 16 mmHg in both eyes with applanation tonometry. The iris mass was brown– gray with well-defined borders and located temporally close to iris root. Its size was measured to be 4.3 mm x 2.5 mm. Tumor surface was covered with a well-developed vascular network. Slit-lamp and fundus examinations of both eyes did not reveal any other pathology. Fluorescein angiography confirmed the presence of a well-developed vascular tumor network, which leaked in the late phases of the angiogram. 1.25 mg of bevacizumab was injected intravitreally five times over a period of eight months. First, three injections were given one month apart, followed by two more injections three months apart. The tumor shrunk to one third of its original size after the first bevacizumab injection. Reduction in the size of the tumor continued thereafter along with regression of the tumor vasculature and a decrease in leakage. Three months after the fourth injection (at eight months), the tumor had regressed to an almost indiscernible size.

Case 2: A 52-year-old Caucasian woman with a known history of biliary tract carcinoma presented with metastatic tumor in the left iris. At presentation, her intraocular pressure was elevated to 34 mmHg in her left eye with a decrease in her visual acuity to 20/50 level. The tumor was occupying nasal half of the iris with 160 degrees closure of the angle. Several foci of small tumoral masses were scattered on the iris and in the anterior chamber angle. Her intraocular pressure remained high despite full medical therapy with dorzolamide, timolol, brimonidine and oral acetozolamide. Due to the vascularized nature of the tumor, three repeated injections of bevacizumab (1.25 mg/50 ml) one month apart was done. Three repeated injections of bevacizumab resulted in shrinkage of the tumoral mass and disappearance of the scattered tumoral cell clumps from the iris and the angle. Complete tumor regression was obtained at the end of the third bevacizumab injection. Patient’s vision improved to 20/20 and intraocular pressure remained within normal limits only with topical dorzolamide/timolol. Gonioscopy showed nasal part of the anterior chamber angle was remained close by peripheral anterior synechiae.

Conclusion: Treatment methods used for the treatment of metastatic iris tumors have serious systemic and local side effects and the effect of systemic chemoteraphy on ocular compartment is also limited. Anti-vascular endothelial growth factor (anti-VEGF) treatment with intravitreal bevacizumab can restore sight and achieve intraocular pressure control in metastatic iris tumors and can prevent enucleation of these eyes. In conclusion, the case presented herein demonstrates that intravitreal bevacizumab can be an option for local treatment of iris metastases. Intravitreal anti-VEGFs successfully regulate these vascular metastatic tumors and provide a successful and cost effective alternative to conventional treatment methods.

Biography

Safwan Al Bayati has completed his M.B.CH.B from Baghdad Medical Col­lege, IRAQ. then has completed Board in ophthalmology (F.I.C.M.S.OPHTH) 4 years study Ophthalmology, Iraqi commission for medical specialization. the he finished FRCS Fellowship of Royal College of Physicians and Sur­geons of GLASGOW- UK. He has worked as Director of Ophthalmic Depart­ment and Specialist Ophthalmologist, Phaco- Refractive- Retina Surgeon at N.M.C. Specialty Hospital, Dubai, UAE. Then he has worked as a Consultant Ophthalmologist ,Phaco-Refractive- Retina Surgeon at Imperial Healthcare Institute, DHCC, Dubai, UAE. Currently he is the Founder, Medical Director and Consultant Ophthalmologist, Phaco- Refractive- Retina Surgeon at New Vision Eye Center, DHCC, Dubai, UAE.

Abstract

Evaluating a cataract patient’s astigmatic error isn’t just about the shape of the front of the eye anymore. Failure to include posterior corneal curvature in the pre-surgical calculations can bring unwanted refractive surprises for both doctor and patient. Most devices to assess corneal curvature, such as keratometers and corneal topographers, measure the anterior surface curvature to calculate the cornea’s total refractive power and its total astigmatism. In these calculations, the posterior corneal curvature and the anterior curvature are assumed to have a constant ratio. Ignoring posterior corneal astigmatism may yield incorrect estimation of total corneal astigmatism. Selecting toric intra-ocular lenses based on anterior corneal measurements could lead to overcorrection in eyes that have with the rule astigmatism and under correction in eyes that have against the rule astigmatism. It is now shown that the posterior corneal surface acts as a negative lens and as a result the total corneal power is overestimated in eyes with the rule anterior astigmatism and underestimated in eyes with against the rule when only the anterior corneal surface is taken in account. The Barrett Toric Calculator is a one step formula that shows great promise for calculating IOL toricity and recommended alignment. Preliminary data look excellent. Surgeons using an intra-operative aberrometer are able also to measure the corneal power including the front and back surface prior to lens insertion to best determine the optimal amount of astigmatism that should be corrected. in conclusion considering the effect of posterior corneal power in the toric IOL calculation reduce the Post-op surprise

Biography

Agnieszka Boszczyk prepares for defending her PhD in Physics at Wroclaw University of Science and Technology. She earned a BSc Degree in Tech­nical Physics and an MSc Degree in Optometry. She is a Member of SPIE Student Chapters and SPIE Women in Optics. She is also a Manager of a grant Preludium 11 entitled, “Examination and numerical analysis of corneal deformation dynamics during intraocular pressure measurement with air-puff tonometer” founded by the National Science Center Polish.

Abstract

The value of intraocular pressure (IOP) is one of the most important parameter in diagnosis of glaucoma. IOP values are determined based on the response of the cornea to a deflection force. Like other biological tissues, the cornea exhibits distinct viscoelastic properties. However, type of this viscoelasticity is still not clear. Presumably, model of the corneal viscoelasticity and its specific parameters differ for individual cornea. Moreover, these values influence results of tonometric measurements. Interaction between the IOP and the biomechanical properties of anterior segment of the eye determines geometry of the cornea. Thus, there is a close relationship between biomechanical, geometrical and optical properties of the cornea, which has a direct impact on the quality of vision. Information about corneal biomechanical properties may be extracted in vivo from a dynamic deformation of the cornea, which occurs during air-puff measurement of IOP. Thanks to the Scheimpflug technology, non-contact Corvis ST tonometer allows to register sequences of images, which depict deforming horizontal corneal profiles with a speed over 4000 frames per second. The whole measurement takes 32 miliseconds and gives a sequence of 140 images. The study will present physical phenomena occuring during intraocular pressure measurements with air-puff tonometer Corvis ST, which includes: corneal indentations, corneal vibrations, retractions and rotations of the entire eyeball. These phenomena will be described and parameterized. The proposed parameters can potentially be used to describe the particular biomechanical properties of anterior segment of the eye. Understanding of processes of the corneal deformation and more detailed, quantitative description of these processes can be very useful in more advanced ophthalmic diagnostics.