9th Global Ophthalmology Summit March 15 - 16, 2017 London, UK

Biography:

Carlos Vergés is currently Professor of Ophthalmology and Director of Area Oftalmologica Avanzada, Universidad Politécnica de Cataluña, where he performs his clinical and research activity, collaborating with the Laboratory of Physical Optics, Facultad  de Óptica y Optometría de Tarrasa. Now it focuses its interest in Dry eye disease, in the search of new treatments, developing a new therapeutic method of improvement of the physiological state of the ocular surface and the eyelids, based on the application of intense ultra-regulated pulsed light.

Abstract:

Lipid deficiency occurs in 76.7% of dry eye patients with a prevalence of meibomian gland dysfunction (MGD) in the
majority of eyes. The treatments of MGD have been shown only short-term symptom relief. This suggests that we need
more treatment options, one of which is intense pulsed light therapy (IPL). IPL treatment applies Xenon flash lamp to emitting
wavelengths of light ranging from 400 to 1200 nm. The initial application of IPL for dry eye patients began in 2002 and from
that, different authors have used this technology reporting good results. In our case, we have improved the IPL with a new
system called Intense Ultra-Regulated Pulsed Light (IURPL, Thermaeye ®) which generate short pulses with low energy. The
aim of his study is to explore the safety and efficacy of intense ultra-regulated pulsed light (IURPL) in MGD eyes.
Methods & Methodology: This is a prospective and open label study. 184 eyes of 92 MGD patients were recruited and received
4 consecutive IURPL treatments on day 1, day 7, day 21, and day 45, with a follow up of 6 months. Symptoms were evaluated
with OSDI score. Best corrected visual acuity, IOP, conjunctival injection, upper and lower tear meniscus height, TBUT, corneal
staining, lid margin and meibomian gland assessments, and meibography were also recorded.
Results: Significant improvements were observed in single and total ocular surface symptom scores, TBUT, and conjunctival
injection at all the visits after the initial IURPL treatment (P<0.03). Compared to baseline, the signs of eyelid margin, meibomian
gland secretion quality, and expressibility were significantly improved at every visit during 6 months after treatments. There
was no regional and systemic threat observed in any patient.
Conclusion: Intense ultra-regulated pulsed light (IURPL) therapy is a safe and efficient treatment in relieving symptoms and
signs of MGD eyes.

Biography:

Mouna Al Saad is a Consultant Ophthalmologist and an Assistant Professor in the Department of Ophthalmology at the University of Jordan. Her topics of interests
are Vitreoretinal Surgery, Corneal Graft and Modern Cataract Surgery. She is a member of the Jordanian Ophthalmic Society and fellow of the Royal College of Physicians and Surgeons of Glasgow, UK. She has already worked as a Researcher, Teaching Assistant and a General Ophthalmologist in the University of Jordan, and Jordan University Hospital, Jordan. She has done her Medical degree from the University of Jordan, School of Medicine, Jordan. She has done her Residency in Ophthalmology from the Jordan University Hospital, University of Jordan.

Abstract:

Objectives: The objectives of this study are to measure the macular choroidal thickness in diabetics without diabetic retinopathy and
to compare it with non-diabetics, and to correlate that with age and refractive error.
Method: This is a retrospective, observational and case series study. EDI-OCT images were obtained in diabetics without apparent
diabetic retinopathy with a spectral domain OCT. The sub-foveal choroidal thickness was measured from the outer boarder of the
retinal pigment epithelium to the inner scleral boarder. Statistical analysis was performed to evaluate CT and to correlate it with age,
refractive error in eyes without diabetic retinopathy.
Results: We studied 65 eyes of 38 patients (30 eyes were of diabetic patients) aged between 26 and 79 years. There were 17 males and
21 females in which 30 eyes were of 21 diabetic patients and 35 eyes were of 19 non-diabetic patients. It was observed that, the mean
CT had no significant difference between patients with diabetes mellitus and non- diabetic subjects (256±108 um vs. 265±105 um),
p=0.51.
Conclusion: Patients with diabetes mellitus had a slightly but statistically insignificant, thicker sub-foveal choroid than non-diabetic
patients

Biography:

Abstract:

Diabetic retinopathy is a risk factor for increased cardiovascular death. Our purpose was to find a significant difference in levels
of endothelial progenitor cells (EPCs) in the peripheral blood of patients at different stages of diabetic retinopathy. In this
prospective study, colony forming units of endothelial progenitor cells (CFU-EPCs) in peripheral blood were counted. Forty subjects
were enrolled (10 healthy [41±8 y], 10 type 2 diabetes mellitus (T2DM) [64±12 y] without retinopathy, 10 T2DM patients [62±26
y] with non-proliferative retinopathy (NPDR), 10 T2DM patients [66±9 y] with proliferative retinopathy (PDR)). The study was
approved by the ethics committee of the hospital and every subject signed a consent form before enrollment. Growing CFU-EPCs
was according to the Hill's EPCs protocol. Blood was drawn early in the morning and was processed within one hour. Mononuclear
cells were separated and cultured on fibronectin-coated plates with EndoCult medium (Stemcell Technologies, Vancouver, Canada)
for 5 days. CFU-EPCs were counted on day 5 (an average of 8 wells). It was observed that healthy subjects had 36±8 CFU-EPCs,
patients without retinopathy had 13±12 CFU-EPCs (p<0.01), patients with NPDR had 22±26 CFU-EPCs (p=NS), and 2±2 CFUEPCs in patients with PDR (p<0.01). A significant difference was found between patients with PDR and with NPDR (p<0.05). It was also observed that, CFU-EPCs were inhibited in T2DM patients with DPR. Levels of CFU-EPCs can be used as a surrogate biologic
marker to determine the severity of diabetic retinopathy and for cumulative vascular risk.

Biography:

Tarun Sharma is a Consultant Ophthalmic Surgeon at Worcestershire Acute NHS Trust since 2007. He has done his Ophthalmology training from Midland Eye Centre, Oxford Eye Hospital and Moorfields Eye Hospital in UK. He has special interest in routine and complex cataract surgery. He has also delivered lectures
at Royal College meetings and abroad (Europe, USA and Asia) on the subjects of glaucoma management and modern glaucoma surgery, as well as on cataract surgery in patients with glaucoma. He has launched the Worcestershire Glaucoma Support Group, which provides education and support to patients with glaucoma
enabling them to achieve better outcomes. He has won many awards in Ophthalmology for best patient education and teaching initiative. He has also worked with the Department of Health UK and Mckinsey USA to help in the development of national policies for UK eye care.

Abstract:

The level of patient education given is substandard and the current patient education systems are ineffective. The main reasons are
outdated materials, inappropriate timing and manner of rushed presentation. Most people need to review information three to
five times before retention. Worcestershire glaucoma team pioneered patient education through support meeting and digital patient
education. Worcestershire Glaucoma Support Group was set up in 2009 to provide education and support to patients with glaucoma
to improve compliance and adherence with treatment. We organize 2-3 patients/public free meeting every year. We have an average
of 135 attendees. Such meetings provide patient-to-patient interaction and networking. We decided to make such support online by developing a website providing educational videos regarding various treatment options. Patients have an option to watch these videos as and when they want, in the company of their family (who were unable to attend hospital appointment). This can be done in the
comfort of their living room. It gives them an option toreview/replay the video as much time as needed. We also developed up to date
downloadable information leaflets for our patient. These educational videos are regularly used in glaucoma unit for informed consent
purposes. We have more than 4500 visitors to our website in 12 months. Visitors have downloaded more than 22,000 pages from our
website. Our online feedback score is 4.9/5. Support group’s initiatives led to significant fund raising which allowed ophthalmology department to purchase equipment worth £250,000. Digital patient education is way forward for consent and service deliver purposes while enhancing the patient experience and quality of service.

Biography:

Chairman Of The Department Of Ophthalmology Of Federal University Of Uberlandia-UFU. Associate Professor At UFU. Director And President Of Uberlandia Eye Hospital– HOLHOS. Vice Presidente Of Brazilian Retina And Vitreous Society- BRAVS.

Abstract:

One sentence objective: Optic disc pit associated with serous retinal detachment is a rare condition and there is no "gold standard" to treatthis disease. We are discussing few cases that were treated with PPV and gas.
Overview: In 1882, Wiethe described abnormalities in both optic discs in a 62-year-old woman. This most likely was the first report of Optic Disk Pits, OPD. Both men and women are equally affected by OPD and 10 to 15% are bilateral. Most are non-familial and there are few reports with an autosomal dominant pattern of inheritance. 70% occur on the temporal side of the disc, 20% centrally and 10% inferiorly, superiorly and nasally. Most are gray in color, although they varied from yellow to black. OPD’s can be very small to large in size. Normally, a gray fibroglial membrane appears to overlie the pit in many cases. Cavities in the Optic Nerve Head appear as tilted discs, peripapillary staphyloma, morning glory disc anomaly, colobomas and congenital ODP. Associated retinal changes may occur. If the ODP is located centrally, it is less likely to be associated with retinal changes. An ODP along the rim of the optic disc are usually seen in association with peripapillary chorioretinal atrophy, RPE changes or SRD. There’s a Posterior Vitreous Detachment in 50% of the cases of Serous Retinal Detachment, SRD, patients. The prevalent theory is that the associated sub-retinal and probably intraretinal fluid derives from liquefied vitreous that passes through the opening created by the ODP. Serous Retinal Detachment, SRD, most frequently occurs in early adulthood but can varied from six to 90 years of age. It has been discussed that the fluid from the vitreous enters through the ODP and actually travels between the inner and outer layers of the retina, which produces a retinal schisis (1-3). OCT, Optical Coherence Tomography, has shown inner retinal schisis preceding outer-layer detachment (4-6). SRD are generally low (less than 1.0 mm in height). The elevated retina often
contains cystic regions within the inner nuclear layer. Occasionally, the cystic areas ruptured outward, producing a Lamellar Macular Hole, but, with intact ILM, Internal Limiting Membrane (4-6).
Purpose: The purpose of our paper is show the surgical treatment of ODP associated with SRD using PPV and gas. There is no "gold
standard" to treat these patients and laser, gas or association has been reported. In the literature, the best option is PPV and gas, but few cases are reported and there is no evidence that the surgical treatment is the best option for these patients.
Methods: Four patients were diagnosed with ODP and serous retinal detachment, between November 2013 and October 2015. The patients were examined with indirect ophthalmoscopy, fundus photography and to confirm the diagnosis spectral domain OCT was done. The patients had done, before our examination, refraction and the BCVA was recorded. The patients were treated with pars plana vitrectomy, posterior hyaloid detachment, internal limiting membrane peeling, fluid air exchange, laser in the temporal side of the disc, and C3F8. All patients were oriented to maintained face down position for at least four days and were followed with OCT postoperative and refraction, at least three months after the surgery.
Results: All patients improved their vision. The patients remained with residual amount of fluid in the macula area during the follow-up but it was remarkable less than before surgery. The first patient (BEC, 16 years old) had vision of 20/800 and after six month the vision improved to 20/80 with some fluid in the macula, after almost two year. Another doctor submitted her to gas and laser, two months before surgery, without improvement. The second patient (EJS, 39 YO) improved his vision from 20/100 to 20/50. He had foveoschisis in the macula area with lamellar macular hole that improved to discreet schisis and resolution of the lamellar macular hole. The third patient (JAS, 42 YO) had 20/80 BCVA with foveoschisis that improved to 20/60 with only small cystic lesions in the macula. The fourth patient (CAS, 54 YO) had BCVA of 20/400 and improved to 20/60. The patient had SRD and foveoschisis that improved after 5 months, but some fluid and schisis still remains in the macula area.
Conclusions: The most widely accepted treatment for patients with ODP and SRD is a surgical approach involving PPV with or without ILM peeling, with or without endolaser photocoagulation and gas endotamponade (7-10). All patients treated in our reported cases had improved their vision, SRD or schisis associated. The limitation of this paper is the small number of patients and no control group.

Biography:

Tarun Sharma is a Consultant Ophthalmic Surgeon at Worcestershire Acute NHS Trust since 2007. He has done his Ophthalmology training from Midland Eye Centre, Oxford Eye Hospital and Moorfields Eye Hospital in UK. He has special interest in routine and complex cataract surgery. He has also delivered lectures
at Royal College meetings and abroad (Europe, USA and Asia) on the subjects of glaucoma management and modern glaucoma surgery, as well as on cataract surgery in patients with glaucoma. He has launched the Worcestershire Glaucoma Support Group, which provides education and support to patients with glaucoma enabling them to achieve better outcomes. He has won many awards in Ophthalmology for best patient education and teaching initiative. He has also worked with the Department of Health UK and Mckinsey USA to help in the development of national policies for UK eye care.

Abstract:

Aim: To compare the safety and efficacy profile after combined micro-incision cataract surgery (MICS) and micro-invasive glaucoma surgery (MIGS) with the ab interno trabeculectomy (Trabectome®) versus iStent® inject devices in patients with open-angle glaucoma (OAG) and cataract.
Method: This retrospective comparison study included 60 eyes which were treated with combined MICS and ab interno trabeculectomy (group I, Trabectome®) (30 eyes) and iStent® inject devices (group II, GTS 400) in 30 eyes. Primary outcome measures included intraocular pressure (IOP) and glaucoma medication after 6 weeks, 3, 6 and 12 months follow-up. Secondary outcome measures were number of postoperative interventions, complications and best-corrected visual acuity (BCVA).
Results: Mean preoperative IOP decreased from 23.3±3.7 mmHg in group I and 22.8±4.1 mmHg in group II to 14.8±3.6 mmHg
for trabectome and 16.8±2.3 mmHg for iStent inject, respectively at 12 months after surgery. When percentage drop was assessed,
group 1 (trabectome) had 37.17% drop in IOP, while group II had 22.93% drop in IOP. No vision-threatening complications such
as choroidal effusion, choroidal hemorrhage, or infection occurred. In each group, 2 eyes developed cystoid macular edema which
responded to topical treatment. In each group trabeculectomy had to be performed in one eye due to insufficient IOP lowering effect.
Conclusions: Ab interno trabeculectomy and iStent® inject were both effective in lowering IOP with a favorable and comparable
safety profile in a comparative study over a 12-months follow-up in OAG. Trabectome appears to have a greater percent drop in
IOP than iStent in this study. However, longer follow-up of these patients will be necessary to determine long-term outcomes and to
evaluate significant differences.