Day 2 :
Keynote Forum
Luciana Elsa Acosta Guemes
Centre of Medical Education and Clinical Investigation, Argentina
Keynote:
Biography:
Luciana Elsa Acosta Guemes has completed her Ophthalmology at the University of Buenos Aires (UBA). She is a certified Ophthalmologist in Argentina with a Master’s degree in Ophthalmology. She was trained in Argentina, USA and India and received a Postgraduate Diploma in Glaucoma at University of Buenos Aires. Currently, she is an Assistant Professor and a Cataract and Refractive Surgeon at CEMIC for the last 12 years. She is mainly focused in medical training programs and surgical activities, and is a regular assistant at international ophthalmology congresses.
Abstract:
Keynote Forum
Elsahn A
University of Nottingham, UK
Keynote: Early events of Pseudomonas aeruginosa microbial keratitis: An electron microscopic study
Biography:
Dr Elsahn is a fully trained, practicing ophthalmic surgeon. He graduated with honours from Egypt’s prestigious Alexandria University, and completed an academic Ophthalmology residency. He then completed a cornea and refractive surgery fellowship at the renowned Wills Eye Institute in the United States of America. On returning to Egypt, Dr Elsahn completed a Master degree in laser eye surgery and customized corneal ablation, graduating with honours. In 2009, after attaining after attaining Fellowship of the Royal College of Surgeons in Ophthalmology, Dr Elsahn relocated to the United Kingdom, where he started a second cornea and refractive surgery fellowship in University Hospitals Southampton NHS Foundation Trust.
Abstract:
Purpose: To study the behavior of Pseudomonas aeruginosa bacteria inside the corneal stroma after corneal infection in human microbial keratitis.
Methods: Human whole donor corneas obtained from the eye bank were used in this project. Bacterial suspensions of wild type and mCherry expressing P. aeruginosa PAO-1L were prepared to a concentration of 107 cfu/ml. Fifty microliters of bacterial suspension was injected into the middle of the corneal stroma from the endothelial using a 25G hypodermic needle. The corneas were then incubated in medium for 24 hours, after which they were either examined live under a Laser Confocal Fluorescence Microscopy (CFLM) or fixed and processed for Transmission Electron Microscopy (TEM).
Results: After 24 hours of infection, P. aeruginosa bacteria were found to internalize into Corneal Stromal Keratocytes (CSK). Using TEM, PAO-1L bacteria were found clustered inside CSK with much fewer bacteria scattered in the stroma outside cells. With CFLM live imaging, mCherry-expressing PAO-1L bacteria were seen inside CSK, also with much fewer extracellular bacteria.
Conclusion: We have established ex vivo models of bacterial keratitis and demonstrated that Pseudomonas aeruginosa internalize early into stromal keratocytes, possibly to avoid contact with resident immune cells.
- Ophthalmic Findings | Photodynamic Therapy | Idiopathic Intracranial Hypertension
Session Introduction
Fatima Iqbal
The University of Faisalabad, Pakistan
Title: Mirror on the wall, can optometrist really save a life, or just the sight?
Biography:
Fatima Iqbal has her expertise in cornea, low vision and pediatric care. She is working as full time Faculty at School of Optometry, The University of Faisalabad and private practice at Abdullah Memorial Hospital. She is also Global Ambassador of TFOS (Tear Film and Ocular Surface Society). Her interest in cornea and her study also unveiled role of accommodation on described ocular structures.
Abstract:
Background: Eyes are the windows to one’s soul. Through these windows optometrists can peep into the souls of their patients. We can tell them what they know what they do not, not only about their eyes but the systemic health also. Sometimes an ophthalmic finding may be the earliest manifestation of a systemic disorder or may precede the classical clinical signs and symptoms. Eye care doctors, by identifying such findings, may not only save the vision and eye but also the lives of their patients.
Aim: To present a series of cases with ophthalmic findings associated with systemic disorders.
Cases: Two real life cases of multisystem disorders with initial ocular presentation are discussed. Case-1: was a 16 years old girl with complaint of transient visual blur. Comprehensive ocular examination raised the suspicion of underlying hematopoietic disorder. Multispecialty workup confirmed the diagnosis of chronic myeloid leukemia. Case-2 was a 23 year, only eyed female. She had received a cryotherapy and anti-VEGF for a presumed Coats disease OD ending up in phthisis bulbi. Optometric exam suggested multisystem cancer disorder. Investigations further confirmed the diagnosis of Von-Hipple Lindau disease.
Results & Discussion: Optometrists can identify potentially dangerous systemic disorders before the development of specific systemic symptoms/signs.
Conclusion: The earlier detection and timely referral to the appropriate specialties, thus, improve the prognosis, life expectancy and help avoiding complications associated with late diagnosis. Also enhancing scope of practice of optometrists and finding professional identity.
Mohammed E Mahdy
Zagazig University, Egypt
Title: The sensitivity of optic nerve CT scan combined with OCT in diagnosis of Idiopathic intracranial hypertension
Biography:
Mohammed Mahdy was born in Egypt 1982, He accomplished his education basic and postgraduate in Egypt, and he is a graduate from Zagazig University that was established in 1974, He finished his master degree in neuropsychiatry 2010, and MD in neurology 2016, He is working as neurology Lecturer in faculty of medicine, Zagazig University, and a member of the American Academy of Neurology, and now He works as a neurology consultant in Saudi airlines medical services.
Abstract:
Introduction: Idiopathic Intracranial Hypertension (IIH), also referred to as benign intracranial hypertension, is a disorder generally affecting overweight women of childbearing age. Idiopathic intracranial hypertension has often been considered a diagnosis of exclusion, especially if no cranial neuropathies or papilloedema have been detected. Measurement of the Optic Nerve Sheath Diameter (ONSD) using CT scan can provide a solution for this situation, as it has been used as a non-invasive method of ICP monitoring since the mid-1990s. Another rapid non-invasive method for evaluation of patients with IIH is Optical Coherence Tomography (OCT). Spectral-domain OCT provides reliable thickness and volume measurements of the optic nerve head and retina and can reliably demonstrate structural changes due to papilloedema. This study included 40 patients (aged ≥18 years) presented with headache and fulfilled modified Dandy criteria for IIH.
Method: We collected and analyzed data on the following variables: ONSD in the middle third of the intraorbital path (the point where the ophthalmic artery crosses the optic nerve served as an anatomical landmark); Our patients underwent spectral domain OCT (SD-OCT) scanning dual beam Spectralis laser tracking tomography Spectralis®, using a commercially available device (3D OCT-1000; Topcon Corp., Tokyo, Japan). The scanning protocol involved the acquisition of a 6×6 mm cube scan of the Optic Nerve Head (ONH) and macula with a scan density of 512×128 pixels.
Results: Our study included 40 female patients with clinico-radiological diagnosis of IIH with their age range from 22 to 42 years, their main complaints were visual complaints as blurred vision and transient visual obscurations in 16 patients (40%), and headache in 15 patients (37.5%), while 9 patients (22.5%) had both complaints (table 1). None of our patients developed side effects or allergic reaction with the used contrast agent in orbital CT with contrast. The ONSD was nearly in the same range in both eyes (4-10 mm for right and 4-11 mm for left) when measured by CT with contrast at the crossing point of ophthalmic artery (table2). More than 82% (33) of patients diagnosed by OCT to have papilloedema while in 17% (7) of patients not (table 3). There was a statistical significant relation between the ONSD by OCT in both right and left sides with the diagnosis of IIH (P =0.003 for right, P= 0.001 for left) while there was no significant relation between PTC and patient's age (P= 0.921) (table 4). The estimated statistical cutoff value of ONSD was 5.5 mm with sensitivity of 84.4% and a specificity to diagnose optic nerve thickening by 100% in the left side and 85.7% in the right side (table 5, 6)
Conclusion: The addition of OCT to ONSD by CT+C can increase its diagnostic ability for the cases with IIH, which may reduce the need for invasive diagnostic techniques like LP.