Day 2 :
Keynote Forum
Rashidul Haque
Emory University School of Medicine, USA
Keynote: MicroRNA and the ocular renin-angiotensin system
Time : 9:30-10:15
Biography:
Rashidul Haque has been involved in several research projects including the role of circadian clocks in the retinal function and the potential role of microRNA in the regulation of renin angiotensin system in the retina. He has characterized a couple of microRNA molecules and investigated their role in diabetic retinopathy
and other ocular diseases.
Abstract:
Angiotensin (Ang) II, the most physiologically active component of RAS, mediates its effect through two G-protein coupled receptors, Ang II type-1 or type-2 (AT1R and AT2R), having different signal transduction mechanisms. Most of the known cardiovascular effects of Ang II are mediated by AT1R. Pro-renin has long been considered as an inactive precursor of renin, without any biological function of its own. However, pro-renin binding to a receptor called (pro)renin receptor (PRR) has been recently reported to exert biological effects in the retina. It is also known now that pro-renin is highly elevated in ocular fluid of diabetic patients with proliferative retinopathy, which all suggest that pro-renin 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 pro-renin 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 hyperglycemia-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.
Keynote Forum
Satya Prakash Singh
R.I.O, India
Keynote: Retropupillary fixation of iris claw lenses – Savior in difficult situations
Time : 10:15-11:00
Biography:
Satya Prakash Singh has completed his postgraduate studies from MLN Medical College, Allahabad, India. Currently, he is the Director and Professor of Department of Ophthalmology, RIO Allahabad, India and Principal of MLN Medical College, Allahabad. His name is endorsed in the prestigious Limca book of records 2002 for performing maximum number of surgeries in a day. He has also been awarded Best Eye Surgeon in state. He was also Editor-In-Chief of journal SPOSI 2013-2014. He has 118 research papers in national and international journals.
Abstract:
The ideal intraocular lens in cases of aphakia without capsular support is still debated. Choices include anterior chamber lenses, iris sutured lenses, scleral fixated lenses and iris-claw lenses, with the latter now being used more commonly. Iris claw lenses have undergone development in all aspects. The retro-pupillary approach for iris-claw intraocular lens (RPICIOL) implantation has recently gained popularity. The technique of fixation is time tested and addition of vaulting has improved its outcomes. They have now become the choice in compromised posterior capsule in different situations e.g., aphakia, dislocated intraocular lens, penetrating keratoplasty, traumatic mydriasis even coloboma iris. Iris claw intraocular lens implantation is clinically safe and effective primary or secondary procedure in cases with deficient posterior capsule or inadequate capsular support with minimal complication rate.
- Cataract and Refractive Surgery | Ophthalmology Research and Novel Approaches| Pediatric Ophthalmology
Location: Osaka, Japan
Chair
Avinoam Ophir
Wolfson Medical Center, Israel
Co-Chair
Rashidul Haque
Emory University School of Medicine, USA
Session Introduction
Basant Kumar Singh
MLN Medical College, India
Title: Management of pre-existing and surgically induced astigmatism by various incisions in cataract patients
Time : 11:15-11:45
Biography:
Basant Kumar Singh has completed his postgraduate studies from MLN Medical College, Allahabad, India. Currently, he is the Senior Consultant, Department of Ophthalmology, RIO, Allahabad, India and is also pursuing PhD in Ophthalmology in MLN Medical College, Allahabad. He has written chapters in various books and has attended and presented papers in various national and international conferences.
Abstract:
Cataract surgery has evolved tremendously in all these years and the expectations of the patients are increasing by the day. The goal of cataract surgery is to achieve a desirable refractive outcome with minimal surgically induced astigmatism (SIA) after cataract surgery. Several methods have been employed for this purpose including changing the size and site of the incision, using corneal or limbal relaxing incisions, applying opposite clear corneal incision (OCCI) on the steep axis and implantation of toric IOLs. Early visual rehabilitation and targeting of emmetropia is the main objectives of modern cataract surgery. Limbal relaxing incisions (LRIs) have been advocated as an effective method for reducing 0.5-4.0 diopters (D) of astigmatism. Because of their placement at the limbus, LRIs have the potential advantage of preserving the optical qualities of the cornea, inducing less postoperative glare, minimizing discomfort, reducing overcorrections and allowing quicker recovery of vision. The clear corneal incision (CCI) has a small flattening effect on corneal curvature, adding an identical penetrating CCI opposite the first one can enhance the flattening effect. The paired opposite CCIs (OCCIs) are placed on the steepest meridian axis to flatten it. In this study, we have evaluated and compared the efficacy of various incisions on the steep axis of the cornea during cataract surgery in order to reduce pre-existing corneal astigmatism with minimal surgically induced astigmatism after cataract surgery. Applying these incisions on the steep axis can cause flattening and decrease corneal astigmatism which is effective and have low cost.
Faisal A. Almobarak
King Saud University, Saudi Arabia
Title: Incidence, management and visual outcomes of haemorrhagic Descemet membrane detachment in canaloplasty and phacocanaloplasty
Time : 11:45-12:15
Biography:
Faisal A Almobarak is an Assistant Professor and Consultant at King Saud University, Saudi Arabia. He is the Chief of the Glaucoma and Cataract Division and the Director of the Glaucoma and Cataract Fellowship program in the Department of Ophthalmology. His research interest is in designing new surgical methods for treating glaucoma and currently holds a patent on Schlemm’s canal tube. He has published several peer-reviewed articles and has won awards and honors for posters research papers. He is actively participating in several international meetings and involved in surgical and diagnostic glaucoma courses and workshops as a Supervisor and Instructor.
Abstract:
Objective & Purpose: To report the incidence and management of hemorrhagic descemet membrane detachment (HDMD) in canaloplasty and phacocanaloplasty.
Materials & Methods: This study included 105 eyes of 92 patients with uncontrolled open angle glaucoma who underwent canaloplasty and phacocanaloplasty between 2010 and 2014. Eyes that developed either HDMD or non-HDMD were identified. The main outcome measures were the development of HDMD and non-HDMD best corrected visual acuity, recovery time after descemet membrane detachment (DMD), intra-ocular pressure (IOP) and number of anti-glaucoma medications. Each eye was managed according to the time of development, type and extent of DMD.
Results: Ten eyes (9.5%) developed DMD- four eyes underwent canaloplasty (3.8%) and six eyes underwent phacocanaloplasty (5.7%). Three of 10 eyes developed non-HDMD while seven of 10 developed HDMD, the majority of HDMD cases occurred in combination with phacocanaloplasty (five of seven). The non-HDMD eyes resolved completely within 2 weeks without intervention. One eye with HDMD was observed for 2 weeks, before a 15% sulphur hexafluoride (SF6) intra-cameral injection was given. The patient developed a dense corneal stain that was resolving slowly over 30 months. One eye with HDMD underwent YAG laser membranotomy, 2 weeks after being identified, which regained corneal transparency 1 month after treatment, while the remaining five eyes underwent immediate surgical drainage and regained corneal transparency 1day post-procedure.
Suneeta Yadav
Central University of Jharkhand, India
Title: Hyperglycemia changes expression of photoreceptors in the eye
Time : 12:15-12:45
Biography:
Suneeta Yadav has completed her PhD from Banaras Hindu University, India and has worked on interaction of photoperiod and temporal phase relation of circadian neural oscillations in the reproductive regulation of Japanese quail. Her area of research was photobiology, reproductive endocrinology and chronobiology. Presently, she is Assistant Professor of Central University of Jharkhand, India. She is also engaged in research on Zebrafish for the study of diabetic retinopathy, neuropathy, nephropathy and hormonal disorders. She has 5 publications in different reputed, peer-reviewed journals and 13 abstracts published in different conferences and symposia with 13 oral/poster/invited presentations accordingly.
Abstract:
Zebrafish (Danio rerio) is a good research model to study visual system in vertebrates. In the visual system of Zebrafish, retina is most important part for photoinduction as it has photoreceptor cells called cone cell having photoreceptor protein molecules called opsins, photo-sensitive proteins. A few reports on retinopathy are available on Zebrafish but reports on change of photoreceptors in response to hyperglycemia were rare. To investigate the effect of hyperglycemia on the expression of opsins in the eye of the Zebrafish, adults were divided into two groups: Experimental and control. The experimental group was induced for diabetic condition or hyperglycemia frequently or alternately immersing them in glucose solution and water. Another group i.e., control received normal water and not provided with glucose. At the termination of study i.e., after 30 days of first day treatment, animals of both the groups were sacrificed and blood (for glucose level and stress hormone level), brain (for study of neurons and neuropathy in different areas), kidney (for nephropathy) and eye (for retinopathy and to measure expression of photoreceptors-opsins) were removed. Blood glucose level was measured using glucometer in both the groups and it was observed that glucose level in experimental animals were higher as compare to control. For visual histopathology, eyes were fixed, paraffinized, sectioned, deparaffinized and stained. When histological sections were photographed, visual deteriorations were detected. For immunohistochemistry, deparaffinized sections were rinsed in phosphate buffer saline (PBS) and primary as well secondary antibodies were applied on section to measure immune-reactivity of opsin and its expression. It was observed after photography of immuno-stained sections that immune-reactivity of opsins in experimental or diabetic group was higher as compare to control. These findings suggest that diabetes affects visual system and causes retinopathy. Neuropathy, nephropathy, endocrine disorders and stress study still needs to be studied.
Vinod Kumar Singh
R.I.O, India
Title: Controversy in management: IVTA in phakic eyes
Time : 13:45-14:15
Biography:
Vinod Kumar Singh has completed his postgraduate studies with a Gold Medal from MLB Medical College Jhansi, further he did Vitreo-Retinal Fellowship from Aravind Eye Hospital Madurai, followed by Senior Resident in MLN Medical College Allahabad. Currently, he is a Lecturer at the Department of Ophthalmology, RIO, India. He has attended and presented papers in various national and international conferences.
Abstract:
Purpose: To determine incidence of progression of cataract and interval to cataract surgery in phakic patients receiving intravitreal triamcinolone acetonide (4 mg) injection.
Methods: IVTA was given in 100 phakic eyes of 98 patients for various pathologies causing macular edema. Patients with follow up for 1 year retrospectively included. Lens status, best-corrected visual acuity, intraocular pressure recorded at each follow up. We also noted duration to cataract surgery. Cataract progression analyzed by lens scores using LOCS III.
Results: The mean follow-up time was 15 months. At the last follow-up, out of 21 clear lens cases lens opacity increased in 19 cases of which 7 posterior sub-capsular cataracts, 5 nuclear sclerosis grade I, 5 had lens changes, 2 operated at 6 months. Out of 39 lens changes, 33 had progression in lens opacity of which include 21 PSC, 11 NS I, 3 NS II, 1 case remained the same and 1 developed mature cataract. 83% received single injection of which 46.98% underwent surgery at a mean of 14 months. 15% received 2 injections, of them 46.66% operated at 16 months. 2 received 3 injections both underwent surgery at mean of 24 months. 48% underwent surgery at duration of 15 months.
Conclusions: Cataract formation became visually significant in t half of eyes and required surgery by one year after injection. Most of these cases known to have worsening of macular edema with cataract surgery, alternative treatment modalities may be a better option for reducing macular edema in phakic eyes.
Satya Prakash Singh
R.I.O, India
Title: Phacoemulsification in different degree of Subluxated Lens : Tips & Tricks
Time : 14:15-14:45
Biography:
Satya Prakash Singh has completed his postgraduate studies from MLN Medical College, Allahabad, India. Currently, he is the Director and Professor of Department of Ophthalmology, RIO Allahabad, India and Principal of MLN Medical College, Allahabad. His name is endorsed in the prestigious Limca book of records 2002 for performing maximum number of surgeries in a day. He has also been awarded Best Eye Surgeon in state. He was also Editor-In-Chief of journal SPOSI 2013-2014. He has 118 research papers in national and international journals.
Abstract:
The success of cataract surgery in subluxated lens depends upon the ability to implant an endocapsular supporting device and in the bag IOL. Our various modifications in endocapsular ring implantation and fixation minimizes the stress on capsulozonular
complex leading to well expanded, stable and centered capsular bag allowing safe and successful phacoemulsification and implantation of IOL in the capsular bag. A forcep was used for introduction of the CTR/Cionni ring through the main incision and a second instrument sinskey hook, which is introduced through a side port incision was used for guiding the remaining trailing part of CTR/Cionni ring. It prevents inadvertent escape of endo-capsular ring out of the bag in the sulcus, avoids any stress on the anterior capsule margin thereby preventing tear and extension of rhexis margin and it changed vector
force from vertically antero-posterior to horizontally along capsular bag thereby reducing stress on existing intact zonules, preventing posterior dislocation of capsular bag CTR complex into the vitreous cavity. For scleral fixation of cionni ring, we bent the straight needles of double armed 10-0 polypropylene suture and 26-gauge needle. Advantage of using bent curved 26-gauge needle rather than straight needle is that it keeps the direction of the needle tip upwards during passing through the scleral bed into anterior chamber so that the chances of piercing and damaging capsular bag is very unlikely. Secondly, feeding
of the bent curved 10-0 needle into bent curved 26-gauge needle becomes much easier compared to straight needles.
Motazz A Alarfaj
Imam Abdulrahman Bin Faisal University, Saudi Arabia
Title: Traumatic Subhyaloid Macular Hemorrhage with complete resolution following Neodymium-Doped Yttrium Aluminium Garnet Laser
Time : 14:45-15:15
Biography:
Motazz A Alarfaj has completed his MBBS from Imam Abdulrahman Bin Faisal University and is presently a Medical Intern at King Fahd University Hospital, Al- Khobar, Saudi Arabia.
Abstract:
purpose: To report a case of traumatic subhyaloid macular hemorrhage with severe sudden vision loss treated successfully with neodymium-doped yttrium aluminum garnet laser (Nd:YAG laser).
Observations: A 16-year-old male was afflicted by a traumatic injury to his left eye, hit by a stone that caused subhyaloid macular hemorrhage. Nd:YAG laser was performed to open the hyaloid membrane and allow the blood to diffuse to the vitreous cavity and get absorbed. The patient demonstrated complete recovery as his visual acuity went from counting fingers to 20/20 within 20 days. No complications were reported due to the treatment.
Conclusions: As far as we are aware, there have been no reported cases of subhyaloid macular hemorrhage treated with Nd:YAG laser where the etiology was trauma and showed full rapid recovery with no sequela.
Faisal A. Almobarak
King Saud University, Saudi Arabia
Title: Glaucomatous Optic Nerve Head Assessment in residency program using Discus software
Biography:
Faisal A Almobarak is an Assistant Professor and Consultant at King Saud University, Saudi Arabia. He is the Chief of the Glaucoma and Cataract Division and the Director of the Glaucoma and Cataract Fellowship program in the Department of Ophthalmology. His research interest is in designing new surgical methods for treating glaucoma and currently holds a patent on Schlemm’s canal tube. He has published several peer-reviewed articles and has won awards and honors for posters research papers. He is actively participating in several international meetings and involved in surgical and diagnostic glaucoma courses and workshops as a Supervisor and Instructor.
Abstract:
Objective & Purpose: To validate DISCUS software and establish reference data for the performance and reproducibility of residents evaluating optic nerve head damage.
Materials & Methods: 54 residents tested themselves 3 times using the freely available online discus software displaying 100-disc photographs: 80 non-stereo-photographs of VF negative optic nerves and 20 of VF positive glaucomatous discs. 26 photographs were repeated (2 glaucomatous and 20 healthy) to test the reproducibility of answers. At the end of the test, online submission and analysis of results is done where, each resident will repeat the test other day and will finally submit the file to the residency office where new identification numbers will be created. Online feedback was given to each resident. Interclass correlation, Bland-Altman test, average of diagnostic performance and ROC curves were calculated.
Results: The mean response latency was 4.91 seconds with no difference in the response between all residents (p=0.28, Wilcoxon test). The interclass correlation showed high degree of reliability of the 3 tests (0.76). The Bland-Altman test showed good agreement and reproducibility of 3 tests among all residents with more convergence in senior residents and only two repeated tests were more than one standard deviation but within two standard deviations. Senior residents had better performance that junior residents where the AUROC was 0.68, 0.68, 0.69 and 0.71 for the first, second, third and fourth year residents respectively (p=0.04, Kruskal-Wallis test). There was no correlation between the performance and the response latency (ρ=- 0.03, p=0.89). There was a moderate correlation with experts, 0.59 (±0.1), for all level, but fourth years residents had the highest correlation among others [r=0.64 (±0.08)] which was significantly different when compared to junior residents (p=0.02).
Conclusion: Senior residents had better performance and less variability on repeated tests compared to junior residents and had the highest correlation with experts. Discus allows a rapid and efficient assessment of resident’s performance of different levels in disc damage, which can help improving training defects whenever present.
Abraham Nai
National University of Pharmacy, Ukraine
Title: Open angle glaucoma: Causes of open angle glaucoma and prevention
Biography:
Abraham Nai is currently pursuing Masters from the National University of Pharmacy. He has participated in a research work on tattoos and their side effects on cells of the human body. Currently he is working with Professor Filiptsopva Olga Volodymyrivna on tissue culture.
Abstract:
Glaucoma has been one of the world’s greatest challenges in medicine. Glaucoma is a group of eye related diseases which causes damage to the optic nerve and in the long run affecting vision or causing vision loss. Open angle glaucoma is damage to the optic nerve, usually caused by high intraocular pressure. Open angle glaucoma falls under the types of glaucoma. There are typically no early warning signs or painful symptoms of open angle glaucoma. It develops slowly and sometimes without noticeable sight loss for many years. Open angle glaucoma is the most common form of eye diseases. It is known to cover about
90% of eye related diseases in respect to glaucoma. The risk of being affected is high with African, American or Latino. People with diabetes and cardiovascular diseases stand a high risk too. The drainage angle formed by the cornea and iris remains open, but the trabecular mesh work is partially blocked. This causes pressure in the eye to gradually increase. This pressure gradually damages the optic nerve. Main aim is to create awareness or enlighten people about open angle glaucoma. It is recommended that individuals or persons before age 40 should check for open angle glaucoma (OAG) every two to four years, age 40 to 54 every one to three years, 55 to 64 every one to two years and after age 65 every six to 12 months, even though in cases of high risk, it is recommended much more frequently. With this analysis, we can deduce that risk of OAG increase with age. A regular program of moderate exercise will benefit your overall health and studies have shown that moderate exercise such as walking or jogging three or more times every week can have an intraocular pressure lowering effect. Spinach and other green leafy vegetables or supplements rich in antioxidants can also help with OAG due to presence of vitamins C, E, A and zinc which is good for protecting vision. Treatment of OAG may differ from on patient to the other in selective laser trabeculoplasty (SLT), drainage implant surgery and non-penetrating surgery in severe cases.
Gail M Ormsby
Avondale College of Higher Education, Australia
Title: The challenge of improving program outcome and impact to enhance the delivery of equitable people-centered services
Time : 16:15-16:30
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:
Eye health care delivery in low-resource countries is complex, set within a host of multi-faceted considerations including: The need for universal health coverage, changing causes of vision loss and epidemiological patterns, under-resourced services, challenges of financing, cost recovery and patient insurance for eye care services, limited integrated health systems, limited governance and accountability, and varying approaches to service delivery with adequate financial support. To address avoidable blindness, cataract surgery is the most commonly performed sight-restoring intervention. However, uncorrected
refractive error continues to be a significant debilitating condition which places unnecessary burden and loss of productivity upon people and requires improved intervention strategies for low-resource settings. A challenge is how to improve the efficiency, effectiveness and impact of program strategies. Additionally, the consideration of patient-centered indicators such as timely health seeking behavior, equitable services, vision quality and quality of life need further study. The Cambodian 2009 Knowledge Attitude and Practice survey showed that only 19% of people with self-reported impairments (including vision) reported being able to travel to the eye hospital on their own, whereas nearly twice as many people with no reported impairment (36%) stated they could travel alone. A follow-up study in 2013, of patients who had received refraction services, revealed that some patients reported concerns about the quality/durability/cost of spectacles. The challenge is to acquire and apply available evidence to enhance the delivery of integrated eye health services within the public health system. This presentation discusses the relevance of outcome measures including effectiveness, equity and quality.