Day 1 :
Keynote Forum
Victor V Sevastyanov
Volga State University of Technology, Russia
Keynote: A novel method for treating inoperable congenital and age-related cataracts
Time : 9:30-10:15
Biography:
Victor V Sevastyanov is the Head of the Center for Speech Pathology and Neuro-Rehabilitation of Neurosensory and Motor Disorders and Professor of the Department of Radio-Technical and Biomedical Systems at Volga State University of Technology. He holds an MD degree from I.M. Sechenov First Moscow State Medical University and MSc degree in Radio Engineering from Ryazan State Radio Engineering University. He conducts research into the issues of the optic nerve regeneration and investigates the processes of neuro-restoration of the optic and auditory nerves. His research interests also include electro-stimulation of neuromuscular tissues with multi-channel portable electrical stimulators, prevention of oxygen deficiency and hypokinesia in astronauts during long-term space flights. He holds 10 international patents.
Abstract:
A novel method for treating inoperable cataracts has been proposed based on using a solution of dimephosphon whose active ingredient is dimethyloxobutylphosphonyl dimethylate. The medication has anti-oxidative and anti-inflammatory properties and stabilizes cell membrane functions. It increases blood flow and metabolism within the lens and improves protective functions of the eye. Treatment with dimephosphon was provided to 43 patients; five of them were children aged 2-3 years who received a 2% dimephosphon solution (eye drops) to treat bilateral congenital cataracts, 1 drop 4 times a day. One patient was diagnosed with Weyers-Fulling syndrome accompanied by bilateral polymorphic cataract and microphthalmos. Cataract surgery in such children is ineffective. Other children with bilateral congenital cataracts also had bilateral microphthalmos. The patients were denied surgery because of its low efficiency. Among the patients there were also elderly people (age 85 years and over) with cataracts who were treated with a 5% dimephosphon solution (eye drops), 1 drop 4 times a day. The initial change in blood flow in the vessels of limbal vascular plexus occurred 10 minutes after the drops were administered and lasted for up to 2-2.5 hours. The change in blood flow was recorded by a thermal imager. The first effects were observed 6 months after the beginning of treatment; a weak light response appeared. Parents continued giving medication to children for over 1.5-2 years. One child had reverse cataract growth, the other had partial cataracts. Similarly, vision of elderly patients improved, e.g., a 98-year-old female patient could watch television 6 months after the treatment started. The latest advancements in nanotechnology allow the use of medications that will improve quality of life for patients for whom cataract surgery is contraindicated.
Keynote Forum
Avinoam Ophir
Wolfson Medical Center, Israel
Keynote: A durable therapy for diabetic macular edema: All we need is to choose the right imaging approach
Time : 13:30-14:15
Biography:
Avinoam Ophir completed his medical studies and Residency in Hadassah Medical Center in Israel. During his Retina fellowship in Bascom Palmer Eye Institute, he together with another young doctor, Mark Blumenkranz, introduced the antimetabolites, primarily 5-FU, to the ophthalmology world, in order to treat non-malignant proliferating cells, especially in the prevention of postoperative scarring. Due to 5-FU efficacy in trabeculectomy, Dr. Ophir moved to specialize also in glaucoma. He explained the mechanism of MMC on bleb toxicity and how to prevent it, and also introduced the "mini-trabeculectomy" approach without radial incisions. Meanwhile he and his team found that Zn-Desferal in the cat substantially inhibited reperfusion injury following CRAO. He was appointed as chairman in the department of Ophthalmology in Hadera in 1993, associated with the Technion School of Medicine. For the last 4 years he works at the retina unit in Wolfson MC.
Abstract:
Statement of the problem: Intravitreal anti-VEGF medications and steroids, and often laser photocoagulation, are routinely used in the major studies for treating diabetic macular edema (DME), including focal type, diffuse (DDME), epiretinal membrane (ERM) -associated and even ischemic-related. However, lucentis treatment, for example, failed in more than 50% of eyes. On the other hand, there are DDME eyes that respond well to grid laser prior to administration of any medication. And, there are many so called "non-tractional" DDME eyes, with neither vitreofoveal traction nor ERM that respond well to pars plana vitrectomy (PPV) after repeat failures of the alternative treatments. If we had known the distinctiveness of these DDME eyes, we could probably treat them rightly by either Early PPV or grid laser, avoiding intravitreal medications.
Methodology: Using full-field 3D SD-OCT (Topcon-1000) that scans point by point continuously, rather than by separate lines, and thus provides 3D data and 3600 video clips; and following search at extramacular sites, I present our published pathogeneses of DDME.
Conclusions & significance: By using full-field 3D-OCT imaging, we present the pathogeneses of diffuse DME. A proper durable treatment would be aimed towards the pathogenesis: PPV or observation in tractional DDME and laser photocoagulation in non-tractional DME, both in focal and diffuse types. The outcome of the hundreds of DME treatment studies is now clearer.
- Ophthalmology Disorders|Glaucoma| Clinical and Surgical Ophthalmology
Location: Osaka, Japan
Chair
Avinoam Ophir
Wolfson Medical Center, Israel
Co-Chair
Leyla Ali Aljasim
King Khaled Eye Specialist Hospital, Riyadh
Session Introduction
Avinoam Ophir
Wolfson Medical Center, Israel
Title: Extracentral presentation of epiretinal membrane as tractional posterior hyaloid in diabetic macular edema
Time : 10:15-10:45
Biography:
Avinoam Ophir has completed his Medical studies and Residency in Hadassah Medical Center in Israel. During his Retina Fellowship in Bascom Palmer Eye Institute, he together with Mark Blumenkranz introduced the antimetabolites, primarily 5-FU to the ophthalmology world, in order to treat non-malignant proliferating cells, especially in the prevention of postoperative scarring.He was appointed as the Chairman in the Department of Ophthalmology in Hadera in 1993, associated with the Technion School of Medicine. For the last 4 years he works at the Retina Unit in Wolfson MC.
Abstract:
Statement of the Problem: There is still controversy whether the central epiretinal membrane (ERM) in diffuse diabetic macular edema (DME) is tractional.
Methodology: Summary of the known data regarding the association between central ERM and the incompletely detached posterior vitreous (PVD) in diffuse DME in the central field, as detected by spectral-domain optical coherence tomography (SD-OCT; Topcon 1000) in b-scan figures and video clips were studied and presentation of extra-central association between these two membranes. In this retrospective study, findings were analyzed in one eye of consecutive patients. Excluded were eyes that had undergone vitreoretinal intervention or that had either complete PVD or complete vitreous attachment.
Results: Of the 44 eyes with diffuse DME and ERM, incomplete PVD was apparent in 23 (52.2%) eyes. Unified ERM/posterior hyaloid membrane or EVi membrane was apparent in 20 (87.0%) of the 23 eyes. Two major OCT presentations (n=23) were encountered: Incomplete vitreopapillary detachment (n=11; 48%) while the ERM is attached to the macula and posterior vitreous detachment from the macula associated with vitreopapillary adhesion (n=10; 43%), in four different manifestations. In the remaining two eyes, there was no detectable association between the ERM and the posterior hyaloid. In some other eyes without central unification of the two membranes, they were detected as one unified membrane at extra-central sites, beyond the vascular arcades.
Conclusions & Significance: In eyes with central ERM associated with diffuse DME, the findings suggest that the ERM is actually the posterior hyaloid membrane associated with or without vitreoschisis. This explains the tangential forces implemented on the ERM by the incomplete PVD, in a centrifugal direction. These findings may have clinical importance in the context of treating diffuse DME associated with central ERM.
Gail M Ormsby
Avondale College of Higher Education, Australia
Title: Addressing barriers to eye health care through a collaborative integrated approach at the district level of the public health system: A case study from Takeo Province, Cambodia
Time : 10:45-11:15
Biography:
Gail M Ormsby has completed her PhD from the University of Melbourne, Centre for Eye Research, Australia. She has worked in international humanitarian programs for more than 25 years. Her recent experience was focused in Pakistan, Cambodia and Vietnam. She is interested in addressing issues of quality and the barriers associated with accessing eye health care to decrease the impact of avoidable blindness.
Abstract:
Growing evidence shows that a range of barriers hinder the uptake of eye health care services particularly in low and middle income countries. These barriers must be addressed to ensure that vulnerable population groups are more likely to access health services. In Cambodia, several studies (knowledge, attitude and practice study, n=599; follow-up of patients who had been screened in the community, n=354; study of patient perspectives about acquiring spectacles, n=62 and a rapid assessment of avoidable blindness (RAAB), n=4,650) were conducted in Takeo Province. The identified barriers were sub-divided into three main categories: (1) Patient oriented barriers (knowledge, attitudes, practices, beliefs, disability, education, age, gender, fate and cost, (2) Service delivery barriers (service provider knowledge, attitudes, practices, communication, types of services, appropriateness, accessibility, affordability, location, policies, quality and the lack of health system integrated eye health care services) and (3) Socio-environmental barriers (poverty, work load, work-place conditions, geographical terrain and distance). The establishment of a vision center managed by two ophthalmic nurses, at the Kiri-Vong District Referral Hospital, resulted in a significant increase in individuals accessing primary eye care and refraction services. Between May 2010 to October 2012, 7,858 consultations were conducted and 2,802 refractions were performed. This presentation reports on the implementation of the Australian funded avoidable blindness initiative project and how data/evidence were used to target health promotion messages throughout the province, improve health system stakeholder training, communication linkages, delivery of services and referral systems. The integration of eye health care services at the district level of the health system was expedient.
Leyla Ali Aljasim
King Khaled Eye Specialist Hospital, Riyadh
Title: Long term outcome of selective LASER Trabeculoplasty (SLT)
Time : 11:30-12:00
Biography:
Leyla Ali Aljasim has completed her MBChB at Baghdad University, Baghdad, Iraq in 1990. She has also received Fellowship of the Royal College of Surgeon, Glasgow. She is the Consultant Ophthalmologist, Member of Glaucoma Division at King Khaled Eye Specialist Hospital since 2011 and an active participant in glaucoma research. She has presented in 22 international conferences, participated in 9 publications and conducted 7 training programs in ophthalmology.
Abstract:
Statement of Problem: SLT plays a major role in treating glaucoma patients, with increasing use as first line of management, for eyes with uncontrolled intraocular pressure (IOP) with maximal tolerated medical treatment when surgery is avoided, or as replacement to medical glaucoma. SLT effectiveness in reducing IOP is well known, though, its long-lasting effect is controversial.
Methods: Reporting our SLT long term results, retrospective review of patients underwent SLT 2011-2012 carried out in January 2017. SLT was considered successful when resulted in clinically significant IOP reduction (mostly IOP reduction ≥3 mmHg or ≥15%) or reduction of glaucoma medication ≥1, with stable condition without the need for further medical or surgical intervention. When further intervention carried out SLT was considered failure. Repeating SLT once more during follow up period was not considered as failure. Patients included are adult, with open angle glaucoma or angle closure glaucoma with patent peripheral iridotomies and open angle ≥180.
Results: 191 eyes underwent 360°-180° SLT (80% had 360°), with 79 mean number of shots and 0.5 mj/shot (mean). Baseline IOP was 19.5±5.9 mmHg on 2.5±1.2 glaucoma medications. Success rate was 75.4%, with reduction of IOP of 4.2±6 mmHg and 1.08±1.1 reduction of medications. Success rate had significant correlation with baseline IOP, number of medication and extension of treatment. During follow up period of 49±14 months, 13% (n=19) had SLT repeated one more time, at mean of 31.4 months (4-46) and 11% (n=16) needed intervention for uncontrolled glaucoma (medical or surgical) at 35 (25-54) months.
Conclusions: SLT has a good and sustained IOP reduction in Saudi population. Low rate of failure noted following initial success and occurred after 2 years of follow up repeating SLT was successful, independent of time interval.
Jerrygibsyn Anurika Ekeh
Nigeria
Title: Ocular Morbidity in rural communities in Nigeria
Time : 12:00-12:30
Biography:
Jerrygibsyn Ekeh is an Optometrist, graduated from Abia State University, Uturu, Abia State, Nigeria. He has his expertise on primary eye health care, his evaluation model based on responsive analysis creates new pathways for improving eye health and his desire to improve eye care lead him to various outreach in rural eastern Nigeria. He is a holder of Doctor of Optometry degree.
Abstract:
Approximately, 80% of blindness is avoidable. Poverty and ignorance has been reported as factors responsible for many cases. There is a poor uptake of orthodox eye health services and an increase in the consultation of traditional healers in the developing countries. Age, level of education, occupation, cost and accessibility to those traditional healers has been reported as predictors of this behavior. The absence of eye care services at the rural areas has necessitated the use of free eye screening/treatment as tools for educating and offering eye care to these rural dwellers. Various patterns of eye diseases have been described in different regions and localities within and outside Nigeria. The study aims to determine the pattern and prevalence of ocular disorder in some rural areas of Imo state in Nigeria where primary eye care facilities are scare with a view in making recommendations to the health authorities for proper planning of eye care services. This was a retrospective review of data generated from self-selected patients during free eye screening organized in each of the 3 senatorial zones of Imo State in Nigeria. A total of 1973 subjects participated in the outreach. There were 1111 (56.3%) females and 862 (43.7%) males giving a ratio of 1.3:1. The most common causes of ocular morbidity were refractive error (31.6%), glaucoma (23.5%), presbyopia (17%) and cataract (12.5%). Refractive errors, glaucoma and cataract were significantly associated with age and sex while presbyopia was only positively associated with age. Considering the causes of ocular morbidity noted in this study, there is an urgent need to establish primary eye care services in those remote and rural areas in order to achieve the vision 2020 goal of eliminating avoidable blindness.
Leyla Ali Aljasim
King Khaled Eye Specialist Hospital, Riyadh
Title: The effect of Endoscopic Cyclophotocoagulation combined with Phacoemulsification in PXFG compared to POAG
Time : 14:15-14:45
Biography:
Leyla Ali Aljasim has completed her MBChB at Baghdad University, Baghdad, Iraq in 1990. She has also received Fellowship of the Royal College of Surgeon, Glasgow. She is the Consultant Ophthalmologist, Member of Glaucoma Division at King Khaled Eye Specialist Hospital since 2011 and an active participant in glaucoma research. She has presented in 22 international conferences, participated in 9 publications and conducted 7 training programs in ophthalmology.
Abstract:
Statement of the Problem: ECP is simple, relatively safe procedure that can be combined with phaco with good results in OAG but there are no much of publication regarding the result of ECP in PXFG, some cases of PXFG included in study groups of ECP treatment with inconsistent results. In PXFG it is difficult to achieve coagulation of ciliary processes with ECP; processes are small and covered by exfoliation, causing poor response.
Method: Retrospective Cohort study; review PXFG & POAG underwent phaco+ECP for significant cataract with controlled or uncontrolled glaucoma, with≥6month follow up Eyes were virgin & laser naïve.
Conclusion: ECP has favorable effect in PXFG compared to POAG.