Day 2 :
University of Missouri School of Medicine, USA
Keynote: Three techniques to adjust IOP immediately following Femtosecond Laser-Assisted (FLACS) & Micro Incision Cataract Surgery (MICS) to avoid IOP spikes
Time : 09:30-10:05
- Photorefractive ablation of the cornea with cross-linking effect
Pirogov National Medical-Surgical Center, Russia
Igor Kornilovskiy is professor of the Department of Ophthalmology of Institute of Postgraduate Medical Education; consultant and laser refractive surgery of the Center of Ophthalmology of Pirogov National Medical-Surgical Center; Doctor of Medical Sciences, Professor, Academician of the Laser Academy of Sciences of Russia.In1974, Dr I.M. Kornilovsky had graduated from the Faculty of Medicine of Krasnoyarsk State Medical University, then, completed the one-year internship training in ophthalmology at the same university. While working as a healthcare practitioner specializing as an ophthalmologist, in 1979 he had defended the M.D. thesis on the topic: “Experimental and clinical development of the test and method to evaluate the functional state of blood vessels in the eye”, and was awarded the M.D. degree. In 1981, Dr I.M. Kornilovsky had moved to Moscow where he worked for many years at the Federal IRTC “Eye Microsurgery” complex named after S.N. Fedorov. In1995, while working at the IRTC, he had defended the doctorate thesis on the topic: “Eximer-laser for treating corneal pathology” and was awarded the degree of doctor of medical sciences. In 1997 Dr I.M. Kornilovsky was elected the acting member (academician) of the Russian laser academy of sciences. The scientific interests of Professor Igor Kornilovskiy cover a wide range of research related to new technologies of laser refractive surgery of the cornea with photo protection and cross-linking; refractogenesis; accommodation; etiology and pathogenesis of myopia; aberrations of the eye optical system; restorative correction of vision based on spectacle, contact, laser and surgical correction; laser therapeutic and optic-reconstructive surgery on different pathology of the cornea. Igor Kornilovskiy is the author of 350 scientific papers on different issues of ophthalmology, over 35 inventions, patents and innovation proposals.
Purpose: To evaluate the effect of a cross-linking under photorefractive ablation of the cornea saturated with riboflavin
Methods: Several studies on corneal collagen cross-linking (CXL) and secondary radiation induced by excimer laser ablation were reviewed. TransPRK, LASIK and FemtoLASIK were performed on 402 eyes with myopia and myopic astigmatism. Photorefractive ablation was performed after corneal stroma saturation with 0.25% isotonic riboflavin. Follow-up varied from 1 month to 4 years. The effects of CXL were assessed by spectral-domain OCT and corneal densitometry
Results: CXL induced by photorefractive ablation with riboflavin is realized through the series of consecutive reactions of riboflavin activation. Activation of riboflavin with the secondary radiation induced by corneal ablation is considered as a trigger. Broad spectrum of the secondary radiation covers all four peaks of maximum riboflavin absorption at 223, 268, 374, and 445 nm. Cross-linking effect amplifies due to the secondary interaction of riboflavin with peroxyl radicals of the oxidative stress and aseptic inflammation in the stroma in response to photorefractive keratectomy. Corneal densitometry and anterior segment OCT demonstrate that CXL increases optical density of the residual stroma and enhances the absorption of external UV photons. This improves or compensates impaired mechanical and photo protective functions of the ablated cornea. Thin membrane-like Structure on the ablation surface as well as higher optical density of the corneal stroma adjacent to the ablation zone are revealed after TransPRK with riboflavin. In addition to the higher optical density of the corneal stroma, demarcation line of various intensity (which resolves later) is revealed after LASIK and FemtoLASIK.
Conclusions: The effect of crosslinking in photorefractive ablation with riboflavin was realized through the formation of a membrane-like structure on the ablation surface and was accompanied by an increase in the optical density in the layers of the stroma adjacent to the ablation zone
Key words: cross-linking, secondary excimer laser radiation, photorefractive ablation, riboflavin.
- Diagnostic and Imaging Tools in Ophthalmology | Biomaterials in Ophthalmology | Cataract and Refractive Surgery | Ocular Pharmacology
ENAIM Medical and Refractive Centres, Israel,
ENAIM Medical and Refractive Centres, Israel
Dr. David Israeli is a Head of the corneal disease and corneal transplantation unit at Carmel hospital, Haifa, Israel. Director of cornea and refractive surgery at Enaim medical center, Haifa and northern region, Israel. Co-founder of Maayan medical centre, Haifa, Israel. Doctor at general surgery department. Dushanbe, USSR.
Total or partial Aniridia often occurs as a result of penetrating ocular trauma. This condition may cause symptoms including glare, light sensitivity, reduced vision, and asymmetric appearance was Morcher iris reconstruction lens and Human optics in our presentation treatment options artificial iris implant.
We present the surgical management and clinical course of 2 patients with traumatic total Aniridia and 1 patient with partial Aniridia. No patient exhibited complications in the postoperative course conclusions. In patients with total and partial Aniridia the artificial iris implants allows functionally and aesthetically satisfactory reconstruction of the anterior segment.
Hadassah-Hebrew University Medical Center, Israel
Shlomo Dotan is working as the director of the Neuro-Ophthalmology Service at the Hebrew University-Hadassah Medical Center in Jerusalem for more than two decades. He is part of the Editorial Board of the esteemed journal - Neuro-Ophthalmology. His major research project in the past was The Optic Neuritis Treatment Trial Study and The International Optic Nerve Trauma Study which were published in The New England Journal of Medicine and several ophthalmological journals. He is currently involved in several scientific projects investigating therapeutic aspects in MS, NMO and NAION. He is member of the Israel Medical Association, Israel Ophthalmological Society, North American Neuro-Ophthalmology Society, American Academy of Ophthalmology, European Neuro-Ophthalmology Society, and the European Ophthalmological Society. He has been giving lectures worldwide on various ophthalmological and neuro-ophthalmological topics and has published articles in several prestigious medical journals. He has been part of many esteemed conferences held in Europe, including Israel
The presentation will elaborate on five neuro-ophthalmologic disorders, part of a much longer list, which can potentially cause death or blindness if not diagnosed and treated correctly: (i) Aneurysmal third nerve palsy- the aneurysm is not the most common compressive lesion causing third nerve palsy, but it has the highest mortality if untreated; (ii) Giant Cell Arteritis- is an idiopathic inflammatory vasculitis affecting small to medium size arteries, which can cause blindness, but also cerebral infarction and cardiac ischemia; (iii) Myasthenia Gravis- is an autoimmune disease of the neuromuscular junction, which has both an ocular and generalized form. Myasthenic crisis is a neurologic emergency, which could cause paralysis of the muscles of breathing; (iv) Pituitary apoplexy results from hemorrhagic infarction of the pituitary gland, and causes acute endocrine and neurologic symptoms and; (v) Pseudotumor cerebri or idiopathic intracranial hypertension is a condition of unknown cause that produces elevated intracranial pressure and papilledema primarily in young obese females, and in about 25% of cases might cause visual dysfunction.
Ayman Abd Elhamid Shouman is a Professor of Ophthalmology in the Research Institute of Ophthalmology in Cairo-Egypt. He has built his experience over 27 years of practice between Egypt, Germany, Saudi Arabia, Sultanate of Oman and United Arab Emirates. He is an expert cataract and vitreoretinal surgeon with expertise in uveitis and ROP management. He has a lot of published articles over a wide range of ophthalmological subjects with a vast experience in teaching and continuous medical education activities through his career. He is a visiting Consultant in the Spanish centre for eyes in Dubai.
The diabetic patient has increased incidence of cataract affection. He has a lot of factors that we have to consider before doing him cataract extraction procedure like evaluation of eye surface abnormalities, astigmatism, general condition and most notable his diabetic retinopathy staging and how to manage before proceeding with the cataract removal. This is a review of the different factors to consider and how to manage them accordingly.
Moorfields Eye Hospital, UAE
Sandra Fiorentini is a consultant ophthalmologist with over 15 years of experience as ophthalmic surgeon. She started the ophthalmology residence in Brazil and completed it in Portugal where she became an European board certified consultant. She continued her education doing 2 fellowships: in Corneal and external eye diseases and refractive surgery and she also completed a PhD in anterior segment. Due to her international career working in Dublin -Ireland in Royal Victoria Eye and Ear Hospital, in the private clinic specialized in refractive surgeries called OPTILASE Eye Clinic and also in 2 different hospitals in London- UK for the latest years, Dr Fiorentini is currently registered in 5 countries (UK, Ireland, Brazil, Portugal and UAE) and member of a range of professional bodies:
· Irish College of Ophthalmology
· European Society of Cataract and Refractive Surgeons
· Brazilian Council of Ophthalmology
· American Society of Cataract and Refractive Surgery
At this moment, Dr Fiorentini is working as an ophthalmologist specialist at Moorfields Eye Hospital Dubai.
The tear film can be considered the first refractive layer of the eye; however, its importance has been not receiving the proper attention, especially before cataract and refractive surgeries. The accuracy of regular pre surgical investigations like keratometry and aberrometry can be hugely affected by the quality of the tear film. In addition, dry eye and other corneal and conjunctival problems can easily compromise the final refractive result even after a prestine uncomplicated surgery. In this presentation, I’ll bring evidence based data to convince the importance of the ocular surface proper assessment and management timely, including diagnosis tools and updated treatment of ocular surface most common diseases.
- Internuclear Ophthalmoplegia | Ophthalmology Management | Ophthalmic Genetics | Cornea and anterior segment | Cataract and Refractive Surgery
Pirogov National Medical-Surgical Center, Russia
ENAIM Medical and Refractive Centres, Israel
Enaim Medical Refractive centre is an international model for excellence, Innovation and leadership in the field of Refractive, Cataract and corneal surgery, unique combination of experienced and responsible ophthalmic privet practice, with academic achievements, has created successful business development. The financial results keep growing, the budget of marketing is devaluating and that enable ENAIM to grow and extend its involvement in collateral medical businesses.
The purpose of this lecture is to present our vision: “who is the wise man – the one who sees the future”.
IMC Healthcare- UAE
Edna Joyce Santos is an accomplished and dedicated ophthalmologist for the past 28 years. She has pioneered the establishment of the Southern Tagalog Society of Ophthalmology and served as President from 1996 to 1998. She was also the Past President of the Philippine Medical Women’s Association, Lucena-Quezon Chapter for four years. She had shown remarkable competence and professionalism as Head of the Department of Ophthalmology in different hospitals in her country and in the United Arab Emirates. She has been in the UAE for the past 18 years and presently she is the Head of the Department of Ophthalmology in International Medical Center in Ras Al Khaimah. She was the first one to do research on the Prevalence of Diabetic Retinopathy in the UAE together with Dr. Fatima Al Maskeri and Dr. Mohammed Saddiq of the Faculty of Medicine, Health and Sciences. She is also a published author, and her books are available in Amazon, entitled “Are You Crazy?” and she co-authored a book with Jack Canfield of Chicken Soup for the Soul entitled “Success Mastery”. She will soon publish two more books entitled “Dearly Beloved” and the biography of world famous life coach, Wolfgang Christoph, entitled “Sohni, The Human Will Against The Force of Destiny”. She is a member of the National Association of Expert Writers and Speakers in the United States. She holds several positions, namely, Lead Corporate Activist for YGB Hybrid Cryptocurrency, Official Mandate for the UAE, Middle East and Africa for Wefsech Ocean Nexus Solutions which deals with aquaculture farming based in Malaysia and the Netherlands, Board Advisor of the Board of Directors of Laurel Resources, LLC based in Atlanta, Georgia, USA, Consultant for Eneq, ELV and Engrid Digital Solutions based in Dubai, UAE, Member of the Board of Directors of Sheema Africa Safaris, Ltd. based in Kampala, Uganda, and Official Mandate for UAE, Middle East, Africa and Asia for Saccadio Suites based in Trondheim, Norway. She is also International Reviewer for articles and researches in ophthalmology for the Journal of Ocular Therapeutics and Pharmacology as well as other international ophthalmic journals.
Statement of the Problem: A lot of countries around the world are still underserved by ophthalmologists. The expense of setting up an ophthalmology clinic is so high that majority of the population do not have access to ophthalmic services and investigations. In fact, instead of expanding. most medical centers prefer to forego opening satellite clinics that could have increased practice efficiency and revenue.
The purpose of this study is to show that there is a new online platform, called Saccadio Suites, that bridges the gap between the lack of ophthalmologists in distant locations and the availability of management systems that not only provide access to affordable ophthalmic tests and investigations but also could connect more patients to the clinic than ever before.
Methodology & Theoretical Orientation: In order to give a clear picture of a patient’s eye condition, a powerful blend of structural and functional devices were used such as the Saccadio Web and Saccadio Haploscope, collectively known as the Saccadio Suites.
Discussion will center on the different devices in the Saccadio Web (structural tests) and the Saccadio Haploscope (functional tests). Each device will be briefly described and an overview given.
Conclusion: The Saccadio Suites help in the prevention of blindness by bridging the gap between the lack of ophthalmologists and ophthalmic services in remote areas. It increased the clinic’s efficiency by making very fast, accurate and comprehensive eye examination. The remote teleophthalmologist gets the report online, makes an immediate interpretation and decides on the treatment.
Recommendations: Most of the ophthalmic devices in the market today provide only structural tests but not the functional tests included in the Saccadio Haploscope. It is, therefore, highly recommended that clinics and medical centers avail of Saccadio Suites which are integrated with artificial intelligence that can be automated to facilitate diagnosis and management of eye diseases.
Dubai Health Authority, UAE
Fellow of the Royal college of physicians and surgeons of Glasgow (FRCP – Glasgow). Hold a Doctorate degree in Public Health and Epidemiology, Master degree in Clinical Epidemiology (MSc), Master degree in Public Health (MPH), all from The Netherlands Universities with broad experience driving Research and Development (R&D) strategies and operations.
Background: The prevalence of sight loss increases with age, and the Dubai population is ageing. In addition there is a growing incidence in key underlying causes of sight loss such as obesity and diabetes. This means, that without action, the number of people with sight problems in the Dubai is likely to increase dramatically over the next 25 years.
Purpose: The purpose of the eye health needs assessment is:
- To build a picture of current eye health services, i.e. a baseline.
- To gather information in order to plan and change services for the betterment of eye health.
Method: In order to carry out eye health assessment we applied qualitative (focus groups with 20 ophthalmology experts) and quantitative methodology (Analyzing hospital, population health related surveys. Prevalence or incidence estimates based on research from national and international documents. It is intended to help stakeholders discuss the scale of the issue locally.
- A number of studies have shown that that rate of reported cataracts is around 2% on average. If these estimated prevalence rates (2%) are applied to the population of Dubai(without adjustment), there may have been 47,716 people with cataract across Dubai in 2015 of which: 33,145 would be males and 14,571 females.
- It was estimated around 9,144 residents in Dubai aged 40 years or more in 2015 had glaucoma (of which 8,149 were OAG and 995 were ACG).
- It was estimated there would be approximately 12,128 (95%confidence interval 9,639-15,001) Adults aged 18+ years in 2015 suffering from diabetic retinopathy at some stage.
- Age-related macular degeneration (AMD) seem to be a rare condition in Dubai and patients and AMD are not often seen at private health care sectors, as it is most common among the older white population.
ENAIM Medical and Refractive Centres, Israel
Nadav Levinger is ophthalmology resident in his second year of training at the Department of Ophthalmology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel. From the beginning of the residency his major fields of research were medical retina, cataract and refractive surgery. He is hoping to bring a comprehensive look to the field of ophthalmology. Among others, Dr. N. Levinger teaches the medical and nursing students of the Hebrew University.
Purpose: To evaluate for association among socio-economic status (SES), baseline visual acuity, clinical parameters, and treatment outcome in neovascular age-related macular degeneration (nvAMD).
Methods: Retrospective single center cohort study. Patients' residential addresses were extracted from medical records. SES was determined for each patient based on the 2008 Israeli census, and classified into four different groups. Clinical and demographic parameters were extracted from patient charts. The relationship between the SES cluster and clinical parameters was then evaluated.
Results: A weak correlation was found between baseline visual acuity (VA) of the first eye diagnosed with nvAMD and SES (R=-0.13, p=0.049; n=233). No correlation was found between the SES and baseline VA of the second eye (R=-0.05, p=0.95). SES was not associated with the number of anti-VEGF injections of the first (p=0.943) or second eye (p=0.704). No association was found between the SES and the VA outcome of the first or second eye after 1 year of therapy (p=0.421, p=0.900 respectively). Central subfield thickness (CST) at presentation as measured by OCT was associated with SES ( r= -0.31 p= 0.001).
Conclusion: The lack of association between SES and visual outcome in nvAMD suggests that there are no Social disparities in ophthalmologic care in our study population
- Video Presentation
Jarstad is an Associate Professor and Director of Cataract & Refractive Surgery at University of Missouri. He is a graduate of Brigham Young University (B.S.), University of Washington Medical School (Seattle WA) and completed an Internship and Residency at the Mayo Clinic in Rochester MN in ophthalmology. He was a medical student research fellow at the N.I.H. Bethesda MD. Dr. Jarstad is past president of the Washington State Academy of Eye Physicians and Surgeons, a member of the American Society of Cataract and Lasik surgeons, and was elected to the Royal Society of Medicine - United Kingdom in 2006. Dr. Jarstad is the author of one book and more than 90 publications and presentations in the eye surgery literature. He is the inventor of the Jarstad Refractive Cataract Surgery Marker, the first injectable foldable lens inserter (Chiron Passport) and an FDA phase I, II and III clinical investigator for medications and phaco machines used in eye surgery. Along with family members, he has participated in 41 short term medical missions to Egypt, Zimbabwe, Angola, Madagascar and Nigeria Africa, the Philippines, Vietnam, Cambodia, Indonesia and North Korea.
The surgical management of Phacodonesis, Duplication of the anterior lens capsule, small eyelid fissures, removal of an unusual foreign body to avoid causing a traumatic cataract and “emergency” cataract surgery in a monocular law student with chronic uveitis and microphthalmos using edited surgical videos.
1. The Forgetful Patient with pseudophacodonesis and a surprise!
2. The Second Opinion on a colleague’s cataract procedure that was “unsuccessful.”
3. The “almost” Femtofailure
4. A “thorny” issue
5. The law school student “emergency”