bluuebunny/crossref_metadata_2025 huggingface dataset:
EBO‐EGS exam in glaucoma; our first experience in 2015?
Authors: Sunaric Megevand G.
Published: September 2015

The main goal of the EBO is to harmonize education and training in general ophthalmology within Europe and the main tool is the comprehensive EBO Diploma examination, organized annually since 1995, awarding successful candidates the title of the Fellow of the European Board of Ophthalmology (FEBO). More recently the EBO has established a Subspecialty European Board of Ophthalmology Diploma Examination with the goal to increase standards of knowledge and care in various subspecialties. The EBO is realising this goal by close collaboration with different European ophthalmological subspecialty societies who are actively taking part in the organization and realization of the EBO Subspecialty Examinations allowing an official and standardized evaluation and awarding of knowledge in various specialties.

The first of these subspecialty examinations to be introduced is in the field of glaucoma and is developed in close collaboration with the European Glaucoma Society (EGS). The goals, the organisation and requirements to sit the subspecialty exam as well as the first experience with the FEBO‐Glaucoma exam and Diploma will be presented.
Drug induced glaucoma: old and new drugs
Authors: Lambrecht P.
Published: September 2015

Some drugs have the ability to cause ocular hypertension and glaucoma as a consequence. This lecture discusses the old and new drugs that have the ability to cause an ocular hypertension side effect and classifies them according to the mechanism of action.
Early‐onset Behr syndrome due to compound heterozygous mutations in OPA1
Authors: Bonneau D. , Lenaers G. , Procaccio V. , Amati‐Bonneau P. , Reynier P.
Published: September 2015

Behr syndrome is an early‐onset and severe syndromic optic atrophy which is probably heterogeneous. Recently, a heterozygous mutation in OPA1 was reported in an adult‐onset Behr‐like syndrome. Heterozygous mutations in OPA1 are the main causes of autosomal dominant optic atrophy (DOA). As many as 20% of patients with DOA exhibit extra‐ocular signs including deafness, external ophthalmoplegia, ataxia, peripheral neuropathy and, myopathy. Aside from these autosomal dominant forms, only few syndromic cases have so far been linked to compound heterozygous OPA1 mutations suggestive of either recessive or semi‐dominant inheritance. However, the clinical spectrum of these emerging double‐mutant OPA1‐related disorders remains to be characterized. We report on four children affected with Behr syndrome associated with compound heterozygous OPA1 mutations. These children were similarly affected with an early‐onset neurological syndrome associating a severe optic atrophy (4/4), cerebellar ataxia (4/4), peripheral neuropathy (4/4), digestive involvement (2/4) and deafness (1/4). This report confirms the importance of searching an OPA1 compound heterozygosity in paediatric cases of syndromic optic neuropathy.
The changes of the retinal layers in diabetic patiens with retinopathy
Authors: Vujosevic S. , Bini S. , Berton M. , Midena G. , Martini F. , Midena E.
Published: September 2015

Purpose

Retinal neurodegeneration and inflammation are considered early events in diabetic retinopathy(DR). Herein are described changes, in retinal glial and neuronal cells, with spectral domain(SD‐OCT) in patients with non proliferative DR.

Methods

130 subjects were evaluated:88 diabetics with DR and 42 normals.All subjects underwent full ophthalmologic examination and SD‐OCT. After automatic retinal segmentation in 5 layers, the thickness of each layer was calculated and compared. Intraretinal hyperreflective spots(HRS) were evaluated on linear scans.

Results

A significant increase in inner nuclear (INL) and outer plexiform(p < 0.01) and decrease in retinal nerve fiber layer (RNFL) thickness (p < 0.01) was found in DR eyes (without DME) vs controls.HRS number was significantly higher in diabetics with DR with or without DME vs controls,(p < 0.05). HRS number increased with progressing DR.

Conclusion

Selective thinning of inner retina in the macula, suggesting an early neuronal loss(accompanied by Muller cells activation with increased INL thickness) in DR is reported. HRS increase and migration to outer retina, may represent a surrogate of microglial activation.SD‐OCT may be useful in detecting intraretinal changes in DR.
New development in clinical ultrasound
Authors: Schmetterer L.
Published: September 2015

Since more than 40 years ultrasound is used as a clinical tool in diagnostics. In the early years mainly used in cardiology it has now become standard in many fields including ophthalmology. In the eye the technique has been used to visualize all tissues and to quantify blood velocities in retrobulbar vessels. In the recent years the technique saw many innovations that have so far only partially transferred to the eye: Four‐dimensional scanners yield three‐dimensional volumetric images. In addition, new approaches came up allowing for quantitative measurement of tissue biomechanical properties. Transversal resolution has been improved using high‐frequency imaging. Finally therapeutic applications include drug delivery that may also be applicable to the eye.
New perspectives in dry eye treatment
Authors: Barabino S.
Published: September 2015

Dry eye syndrome is a chronic disease that affects tens of millions of people worldwide, representing one of the most common ocular pathologies. The traditional approach to treat dry eye focuses on tear replacement with artificial tears or on conserving the patients’ tears through occlusion of the tear drainage system, but these therapies can be considered palliative in that they do not address the pathogenic process that underlines the disease. This presentation will discuss the recent major advances in managing dry eye patients, including a new algorithm of therapy and new technologies that can help in monitoring the effect of treatments, and the results of studies with new molecules‐ ocular surface modulators‐ aimed at restore the tear film‐ocular surface epithelia equilibrium.
Alterations of stabilization of the eyes under dynamic conditions
Authors: Kaeser P.F.
Published: September 2015

Dynamic stabilization of the eyes depends mainly on vestibulo‐ocular reflex (VOR). VOR is initiated by the labyrinth of the inner ear and is modulated by the cerebellum. During head motion, the VOR stabilizes the retinal image by producing an opposite synchronized eye movement. If the retinal image is not steady enough on the retina, visual acuity will drop. The cerebellum integrates eye velocity, retinal slip, motor feedback and vestibular afferences to modulate the VOR. Therefore, inadequate VOR generation or modulation will result in visual loss under dynamic conditions. At the end of the session, participants should be able to identify VOR dysfunction and organize proper investigations accordingly.
Innate immunity in age‐related retinal degeneration
Authors: Luhmann U.
Published: September 2015

Purpose

Ageing is a major risk factor for the development of multifactorial ocular conditions like glaucoma, diabetic retinopathy and age‐related macular degeneration. We aim to understand how its influence on the innate immune system may contribute to increased morbidity of retinal degenerations with age.

Methods

Changes in expression of cytokines, chemokines and complement genes in response to ageing, laser‐injury or light were determined in young (2–4 months) and aged (18–24 months) wildtype, chemokine (Ccl2−/−) and complement regulator (CD59a−/−) deficient mice and correlated with myeloid cell populations and histology of the retina and the RPE‐choroid.

Results

Ageing promotes pro‐inflammatory Ccl2‐Ccr2 signalling and up‐regulation of complement genes in particular in the choroid. Genetic ablation of Ccl2 attenuates these age‐related inflammatory changes and is associated with reduced recruitment of pro‐inflammatory myeloid cells and a reduced CNV response. Deficiency of CD59a enhances complement activation but not pathology.

Conclusion

Age‐related innate immune activation by Ccl2 or by complement can promote ocular pathology, and may represent common mechanisms for enhanced pathology in age‐related inflammatory diseases.
Genetic modification possibilities in treating corneal diseases
Authors: Moore T. , Courtney D. , Atkinson S. , Maurizi E. , Allen E. , McLean I. , Leslie Pedrioli D. , Moore J. , Nesbit A.
Published: September 2015

Treatment of genetic eye disease poses significant medical and surgical challenges. Two gene based therapies were assessed using an in‐vivo firefly luciferase bioluminescence mouse model to target corneal epithelium. Short interfering RNA (siRNA) targeting selectively only the mutant allele was assessed for efficacy, through its ability to downregulate corneal epithelial luminescence in vivo using live animal imaging. This innovative animal model provides clear advantages enabling assessment of topical, subconjunctival and intrastromal delivery. Potent and sustained in vivo gene silencing >50% for up to 7 days was observed after intrastromal injection of siRNA and various topical formulations are further being assessed.

siRNA therapy provides transient effect, however, Type II Clustered Regularly Interspaced Short Palindromic Repeats (CRISPR)/CRISPR‐associated nuclease 9 (Cas9) holds great promise to provide ‘one off’ permanent gene editing. Gene‐specific cleavage of the mutant allele was detected through this method. DNA repair resulted in frameshift mutations predicted to result in mutant allele knockout. This offers exciting potential for translation into clinical treatment of corneal genetic diseases.
Down under the sclera: Deep sclerectomy
Authors: Clement C.
Published: September 2015

Deep Sclerectomy is an ab externo glaucoma filtration technique that aims to lower intra‐ocular pressure without the need for a penetrating incision into the eye. The potential benefits are significant intra‐ocular pressure reduction with a different complication profile to that of trabeculectomy. Deep Sclerectomy is not used by many glaucoma services world wide due to factors including restricted training, fear of intra‐operative complications, a perceived steep learning curve and a perception that deep sclerectomy is ineffective or less effective than trabeculectomy. This presentation aims to address these issues by presenting data on the efficacy and complication profile of deep sclerectomy along with strategies to learn a safe and effective technique in a short period of time.
Future and perspectives
Authors: Tuulonen A.
Published: September 2015

The primary mission of the European Glaucoma Society (EGS) is to promote well being of glaucoma patients, i.e. to develop and constantly improve sustainable glaucoma care in Europe by identifying and applying the best methods on a country wise basis to deliver good quality care at a sustainable cost.

Current Map: Where are we now?

What are the most important challenges in every‐day practice

Where Do We Want to Go: Outcome and Quality of Care with Relation to Patients’ Well Being

What are the outcomes we should identify and agree

How to formally assess the quality of outcomes

Road map for improved care: How are we going to get there?

Good practices and policies

Practical tools to improve care

The role of the EGS Committees as ‘Enablers’ – How to Pave the Way to Better Care?

Innovation, Education, Communication

Implementation

Next steps

How to develop, lead and measure a sustainable glaucoma unit

How to measure well‐being of glaucoma patients
Is there something like a “Healthy Contact Lens”?
Authors: Knop E. , Knop N.
Published: September 2015

Contact lenses (CL) are popular. Soft CL are in the vast majority in spite of severe inherent risk factors. On the other hand, design, materials & properties of scleral CL have greatly improved and they are used as therapeutic devices. This leads to the question whether there is something like a “healthy” CL.

CL history is reviewed with changes in designs, materials & properties over the last century together with the implications of the term “healthy” CL.

Scleral lenses that cover the complete ocular surface (OS) with a rigid spherical material are almost lost in favor of CL from soft materials. Even though the adaptation to soft CL is short & wearing is easy they are still not a toy. Apart from the ability to correct refraction they cannot improve the health of the OS in terms of anatomy & physiology. Careless use can have severe risks to OS health as detailed in a vast body of literature. In particular for children and teenagers it is made easy to view soft CL as must‐have life style devices and they come into the focus of a advertisements.

For principal reasons, a “healthy” CL is almost a contradiction in terms. However, scleral lenses that cover the complete OS, have a therapeutic potential in many OS disease conditions.
The eye screen design in Czech Centre for Phenogenomics and selected models for eye diseases
Authors: Antosova B. , Smolikova J. , Zilova L. , Lachova J. , Bendova M. , Machon O. , Kozmik Z.
Published: September 2015

The eye screen will be part of emerging Czech Centre for Phenogenomics (CCP) in proximity to Prague. The purpose of our eye screen will be the detection of various eye abnormalities in eye morphology and eye physiology. We would like to examine retina structure abnormalities using optical coherence tomography, or anterior segment abnormalities using Scheimpflug imaging. In addition, we plan to perform functional analysis of the visual system using virtual optomotor system. Finally, retinal function will be tested by electroretinography.

Based on our previous work, we have expertise especially in the field of transcriptional regulation of eye development. Specifically, our interest is transcriptional regulation of Pax6 that is crucial for eye development in various species. Pax6 haploinsufficiency is characterized by aniridia in human and by small eye phenotype in mouse. Therefore, here we describe our results using transgenic mouse models to reveal requirement of upstream regulators of Pax6 for lens induction.
Photopsia, floaters, cataract – a systematic approach to correct diagnosis
Authors: Tall M.
Published: September 2015

It is a well‐known fact that more common disease occur more often, but less common ones should not be forgotten about. Photopsia, floaters and cataract – are some of the most common symptoms in patients ophthalmologist see daily. These symptoms are not always worrying, although in reality they can withhold nearly any ocular disease. Uveal melanoma (UM) is one of the rear possibly deadly disease that often lurks behind innocent symptoms. As it is known that earlier treatment of the UM can enhance survival it is essential to recognize the disease at first glance and refer patient quickly to specialized clinic. There are some nuances in the usual symptoms that should ring the alarm bell of every careful eye care professional and prompt a thorough ophthalmic examination.
DALK: Intraoperative pitfalls and how to manage them
Authors: Dua H.S.
Published: September 2015

Deep anterior lamellar keratoplasty (DALK) has two major advantages over conventional keratoplasty – it completely eliminates failure due to rejection and leaves behind a stronger eye. The steep learning curve associated with the technique deters or frustrates surgeons. This part of the course will highlight the intra‐operative pitfalls and how to avoid, anticipate and avoid them using the Big Bubble (BB) technique.

Key steps that will be dealt with are (a) Centration and Trephination. (b) Air injection and identification of the different types of BB (Types 1, 2 and mixed). (c) Lamellar dissection of the anterior stroma and puncturing the bubble without damaging the posterior lamella (Dua's layer + Descemets membrane (DM) or DM alone) (d) Excising the deep residual stroma and extending the dissection if an adequate size bubble is not achieved. (e) Confirmation of type of BB after removing all anterior stroma. (f) Precautions to take to avoid tear or burst (g) How to deal with a tear and aqueous leak (h) What to do if a BB is not achieved. (i) What to do if unsure whether a BB is present or not. (j) Peeling donor DM and suturing the donor graft. All tips will be demonstrated with videos of actual surgical events.
DALK: Post operative management
Authors: Said D.
Published: September 2015

Success of DALK, like that of any other operation depends on good surgical technique, appropriate post‐operative examination, treatment, early detection of any problems and adequate management thereof.

In the immediate post operative period eye pressure check is important especially if air is left in the anterior chamber. High pressure can cause Urrets‐Zavalia syndrome if not treated.

Topical steroids, antibiotics, mydriatic and hypotensive medication if needed, are the mainstay postoperatively. Steroids can be tapered and discontinued earlier than for PK as there is no risk of endothelial rejection.

In the early postoperative days, special attention should be paid to the sutures, epithelial defects, signs of inflammation and infection. A loose suture needs to be removed and replaced as soon as possible as it carried a high risk of infection and vascularization. The latter can be a precursor of stromal rejection. Epithelial rejection does occur and behaves exactly like in PK with an advancing epithelial line that stains with fluorescein.

Astigmatism is a major problem, strategies for management include, selective suture removal, glasses, contact lenses, arcuate incisions, laser refractive surgery and toric intraocular implants.
Ocular Autonomic Regulation
Authors: Rocha De Sousa A. , Barbosa‐Breda J.
Published: September 2015

The autonomic ocular regulation is described with focus on sympathetic and parasympathetic enervation. This is emphasized by the role of the alfa and b adrenergic system and by the muscarinic enervation mainly in the aqueous inflow and outflow systems and in ocular blood flow. Also the role of the non‐adrenergic, non‐cholinergic system in those pathways is described and discussed. Finally the neuro‐humoral regulation, involving the cilliary epithelium role in the ocular regulation of ocular blood flow and aqueous humor kinetic.
Retinal vasculitis
Authors: Bodaghi B.
Published: September 2015

Retinal vasculitis is a sight‐threatening inflammatory or infectious condition, requiring an accurate clinical examination followed by an extensive but oriented work‐up and an efficient therapy. The place of retinal vasculitis in the IUSG or SUN classifications remain indistinct as it may be associated to an intermediate, posterior or panuveitis. It is important to determine the level of vitreous haze and the type of involved vessel. Complications such as macular edema, retinal ischemia and neovessels must be excluded promptly. The main associated conditions are sarcoidosis, Behçet's disease, birdshot choroidopathy, SLE, IRVAN, Susac syndrome, tuberculosis, syphilis, toxoplasmosis, acute retinal necrosis and CMV retinitis. Imaging techniques such as fluorescein and ICG angiography together with OCT are irreplaceable to determine the basic characteristics of the disease and potential complications. Treatment must be adapted to the severity of the disease and relies on systemic or local corticosteroids associated with conventional immunosuppressors or biologic agents. In patients with an associated infection, specific antibiotics or antivirals are necessary. Laser photocoagulation and vitrectomy may be selectively performed.
Diabetic retinopathy – pathophysiology
Authors: Marques‐Neves C.
Published: September 2015

Diabetic retinopathy (DR) is a common complication of diabetes and is a leading cause of visual impairment and blindness in many countries. This visual impairment results from long‐term accumulated damage to the small blood vessels in the retina. It takes several years before any clinical symptoms of retinopathy appear in diabetic patients. The definition of diabetic retinopathy is based on observation of vascular changes. The first recognizable vascular abnormalities are microaneurysms and small hemorrhages, followed by signs of vascular leakage, such as hard exudates and larger hemorrhages, vascular dropout, and neovascularizations. A number of hyperglycemia‐induced metabolic stresses have been implicated in the pathophysiology of DR. The microvasculature of the retina responds to hyperglycemia through a number of biochemical changes, including the activation of protein kinase C, increased advanced glycation end‐products formation, polyol pathway and oxidative stress. However, it has been long known that the neuroretina is affected at an early stage by diabetes‐induced metabolic changes. DR is now recognized as a neurovascular complication or sensory neuropathy resulting from disruption of the neurovascular unit.
Viral retinopathies: a spectrum of disease from East to West
Authors: Bodaghi B.
Published: September 2015

Viral retinopathies remain an absolute emergency among all other infectious entities. They may occur in immunocompromised or immunocompetent patients at any age. Most of the cases are associated with herpes viruses and happen to be necrotizing. Acute retinal necrosis has been initially described in Japan with important clinical characteristics. Molecular tools are of utmost importance in order to confirm the viral type. VZV seems more aggressive than HSV1 or 2. CMV retinitis occurs more frequently in immunocompromised patients. More recently, the nonnecrotizing type of viral retinopathy has been reported, masquerading as different autoimmune entities. Furthermore, other types of nonherpetic viral retinitis may be encountered in different geographical areas. Treatment is always challenging. Despite a few reports on the use of oral antivirals, most of the patients require intravenous therapy and intravitreal injections. Treatment is always long in order to prevent a relapse, especially in the second eye. Laser photocoagulation has not demonstrated its efficacy but may be proposed in selected cases. Primary vitrectomy should not be proposed in all patients as it may increase the risk of retinal detachment. Visual prognosis is guarded.
Silicone oil use in trauma
Authors: Weinberger D.
Published: September 2015

The use of Silicone oil and PFCL tamponades following vitrectomy in Penetrating ocular trauma and perforating injuries are highly advantageous due to their chemical‐physical properties which enables them to displace aqueous humor from the retinal surface and maintain the adhesion between retina and retinal pigment epithelium. There are different types of silicone oils to which their dynamics depends on the interaction between buoyancy, interfacial surface tension, and viscosity. Therefore, depending on the type of oil, a short‐ to long‐term tamponade would be provided to the retina. It has been shown that silicone oils and PFCL were successfully used to minimize the risk of postoperative bleeding, maintain the retina attached, and avoid phthisis in cases of hypotony following severely traumatized eyes. However, as in any vitreoretinal surgery, complications may occur such as re‐detachment and PVR under the oil, increased IOP and damage to the cornea and AC. Herein, we will discuss the use of different type of silicone oils and PFCL's their advantages and disadvantages in the use of ocular trauma surgeries.
Recent advances in drug delivery to the retina
Authors: Davis B.
Published: September 2015

Drug delivery to the retina is presently one of the greatest challenges in ophthalmology due to the inherent limitations of ocular barriers. This therapeutic impediment affects many promising treatments including; anti‐VEGFs, which have revolutionised the management of age‐related macular degeneration, and have increasing indications for use as sight‐saving therapies in diabetes and retinal vascular disease. However, large molecular weight anti‐VEGF therapies such as ranibizumab and bevacizumab currently require invasive intravitreal (IVT) injections to bypass ocular barriers, and thus carry a risk of significant side effects. Despite this, the success of anti‐VEGF therapies has led to a dramatic increase in the number of IVT procedures, placing a high burden on healthcare resources. For these reasons, the development of non‐invasive ocular drug delivery systems has received considerable interest in recent years. This talk outlines the current understanding of anatomical barriers to ocular drug delivery and recent developments in overcoming these barriers for delivery of large drug cargo to posterior ocular tissues. Particular focus will be paid to the role of nanotechnology and annexin A5, which we recently reported to enhance the delivery of topically applied bevacizumab to the rabbit retina.
B27‐associated uveitis, Fuchs uveitis
Authors: Willermain F.
Published: September 2015

B27‐associated uveitis is a very frequent form of non infectious intraocular inflammation which account for approximately 50% of acute anterior uveitis. Its main clinical features, natural history and association with seronegative arthritis are well known. Fuchs uveitis is another frequent cause of anterior and intermediate uveitis. Its natural history is well characterised as well as its association with intraocular production of anti‐rubella antibodies. Both diseases are thus often considered as easy diagnosis. However, several aspects of those diseases remain challenging and debated. In this interactive course, based on clinical cases, we will insist on those difficult aspects as well as on the more recent issues discussed in the literature.
Tear proteomics in health and disease
Authors: Beuerman R.
Published: September 2015

Purpose

To evaluate the tear proteins in normal and diseased eyes to determine how the tear proteins reflect the health of the ocular surface. The tear proteome in normal and in specific pathological conditions has been determined using mass spectrometry.

Methods

Tears were collected by either fire polished micropipettes of 1–10 μl or Schirmer's Type I tear test, and prepared for mass spectrometry on a AB Sciex 5600.

Results

The normal tear proteome has been found to contain more than 1300 proteins. Proteomic studies have been particularly successful in revealing key molecules associated with inflammatory diseases such as dry eye, Meibomium gland disease (MGD) and pterygium. In these studies S100 proteins were found to be upregulated, In MGD, levels of S100A8 and S100A9 were correlated to disease severity and levels of S100A8 protein were significantly correlated to sensations of grittiness, whereas S100A8 and S100A9 were correlated to symptoms of redness and transient blurring.

Conclusions

In each disease, the changing levels of disease associated inflammatory markers were found to be unique. Generally, more than one proteomic signal was useful for characterizing the disease state. Proteomic biomarkers must undergo thorough clinical trials for validation, but in the future could augment lengthy and often inconclusive clinical observations.
Estrogen as an antioxdant in the lens
Authors: Zetterberg M.
Published: September 2015

Female gender is a known risk factor for age‐related cataract, although the explanation for this is still largely unknown. We have demonstrated that physiologic concentrations of 17b‐estradiol (E2) protect cultured human lens epithelial cells (HLECs) from oxidative stress induced by H2O2, as evident by decreased production of reactive oxygen species (ROS) and a stabilization of the mitochondrial membrane potential. Total superoxide dismutase (SOD) activity was increased by these concentrations of E2 but no change in gene or protein expression of SOD was seen. In cataract patients and controls, a significant correlation between higher age and decreasing serum levels of E2 was found but no correlation between serum levels of E2 and SOD was demonstrated. Men exhibited higher E2 levels compared to postmenopausal women. To conclude, estrogen seems to exert antioxidative effects on human lens cells, possibly by affecting SOD activity, which may explain the difference in risk of cataract between genders. The finding that men have higher levels of E2 than postmenopausal women further supports the hypothesis that it is the decline in estrogen at menopause that causes the higher risk of cataract in women.
Infectious uveitis
Authors: Pleyer U.
Published: September 2015

The differential diagnosis of infectious uveitis is broad and an essential step in any initial work‐up. Underlying organisms include all types of infectious agents. The more common infectious causes of uveitis include viruses, T. gondii, T. pallidum, Mycobacterium tuberculosis that will be covered in this course. Based on clinical features further diagnostic tools will be discussed and critically reviewed. In particular newer evolving techniques in the investigations will be included, e.g. intraocular fluid evaluation for polymerase chain testing for the genome and antibody synthesis against the causative organisms.
DALK versus PK for keratokonus
Authors: Borderie V.
Published: September 2015

Advanced keratoconus usually leads to keratoplasty in young adult patients who have a long life expectancy. Repeat keratoplasty is known to be associated with shorter graft survival compared with primary graft and increased risk of glaucoma that may result in progressive loss of vision. For these reasons, keratoplasty in keratoconus should aim not only to provide patients with good vision but also to permit long‐term survival of the graft. Recent studies have raised controversies regarding survival of penetrating and deep anterior lamellar keratoplasties. In two large series of keratoplasties, graft survival was higher in PK than in DALK eyes. Conversely, a meta‐analysis recently showed that DALK is associated with lower risk of rejection and lower risk of failure compared with PK. These findings make sense if we consider the absence of endothelial rejection and the high survival rate of the corneal endothelium observed in DALK eyes. DALK and PK appear to give similar visual recovery at least in the short and mid‐term. It is not yet possible to determine which technique is associated with the highest chance of maintaining good vision in the long term. This issue depends not only on maintenance of graft transparency but also on corneal biomechanics. Progressive thinning of the peripheral inferior recipient cornea may result in severe irregular astigmatism after keratoplasty for keratoconus. This issue should be further addressed.
Cases
Authors: Audo I.
Published: September 2015

Case reports will be presented.
Cases
Authors: Leroy B.P.
Published: September 2015

Case reports will be presented.
New and old drug delivery systems
Authors: Wilson C.
Published: September 2015

Effective, prolonged and safe drug delivery to the eye in the treatment of ocular disease is a complex issue for clinical management. The approach to date has largely been adaptive: taking existing potent molecules which are active in reducing VEGF action and repurposing in new vehicles. From the point of view of a device, such materials may not be ideally druggable, the period of treatment too short or the true target involve more than one receptor. The dispersion of the dosage form is also an issue. Outside the eye, the drug may be lost by dilution and vascular/lymphatic clearance and inside, formulation debris at the back of the eye is a risk factor and may alter vision. The next generation of systems must address these concerns and utilize every tool at our disposal to improve efficacy. This includes the selection of better molecules, the use of modeling to better predict the disposition in the aged eye and perhaps the adoption of surgical procedures to increase drug flux more reliably. Up to now, we have relied on a singular approach – the drug‐ to solve the problem and now we realize that drug, vehicle and procedure must be integrated.
Establishing new OCT parameters: Is race‐specific phenotyping necessary?
Authors: Chauhan B.
Published: September 2015

Establishing phenotypes of the normal optic nerve head via normative databases is vitally important for clinicians. Attributing likelihoods for glaucoma based on single OCT examinations helps clinicians triage and assign resources for further or more intensive testing. It is recognized that significant race‐specific differences in optic nerve head parameters exist, however, it their utility has not improved diagnostics. One reason could be that these databases have thus far used only conventional parameters that do not exploit measurements now possible to characterize neuroretinal rim parameters that are anatomically and geometrically accurate, or the deep optic nerve head. This presentation will review the literature on race‐specific databases, postulate reasons for their inability to yield better diagnostics and present new alternative race‐specific OCT data that may enhance clinical glaucoma practice.
OCT angiography in CNV quantitative follow up
Authors: Lumbroso B.
Published: September 2015

Optical coherence tomography (OCT) angiography is a novel imaging modality that uses intrinsic flow contrast and does not require any dye injection. It is a less invasive alternative to fluorescein angiography that is 3 dimensional. It is used to image and measure retinal, choroidal and optic disc circulations. Quantitative applications are possible. The angiograms are visualized as cross sections and en face views of separate retinal and choroidal layers. SSADA technology is used in this study.
Coming full circle: Canal surgery with/without implants
Authors: Grieshaber M.
Published: September 2015

Canaloplasty, one of the latest ab externo, non‐penetrating procedures in glaucoma, reduces intraocular pressure by targeting the pathologically high resistance to aqueous outflow and restoring the natural outflow system. After (circumferential) viscodilation of Schlemm's canal, a polypropylene suture is looped through the canal and tightened to distend the trabecular meshwork; alternatively a new device, the Stegmann Canal Expander is implanted. The main advantage of canaloplasty over fistulating trabeculectomy is the independence of a filtering bleb. Furthermore, there is no need for antimetabolites and needling procedures. Canaloplasty as a stand‐alone procedure or combined cataract extraction is proven to be safe and efficient. Technically, the surgeon must understand and respect the microanatomy of the outflow system and the mechanics of the procedure itself. This presentation guides the surgeon through standard canaloplasty and the implantation of the Stegmann Canal Expander, highlights tips and pitfalls, and presents new clinical data.
Big Bubble DALK: The ladder to success, step by step
Authors: Katamish T.
Published: September 2015

Deep anterior lamellar keratoplasty (DALK) has too many techniques to achieve, one of them and most reproducible is the big bubble technique. The steep learning curve known to this operation some times considered a barrier for many surgeons to try and master. However in my presentation I will try to go through the operation step by step giving my own personal tips and tricks for executing the perfect big bubble DALK. Special emphasis will be put on the following important steps: (1) Trephine adjustment and partial thickness trephination of the recipient cornea. (2) Technique of air injection and big bubble formation, which is considered the key step of this technique. (3) Safe opening of big bubble roof. (4) Cruciate incision and cutting of the reaming stroma after lamellar dissection of superficial corneal layers. (5) Descemet's membrane staining and stripping from donor cornea. Moreover, I will put a focus on the new anatomical pre‐ Descemet's layer (Dua's layer), describing and demonstrating by many video clips the different types (type 1, type 2 and mixed type) of big bubbles based on this new anatomical layer. The aim of my presentation is to allow the participants to perform big bubble DALK in a safe and reproducible way with very high percentage of success in obtaining the big bubble.
Angiography reveals novel features of the retinal vasculature in mice
Authors: Ruberte J.
Published: September 2015

Here, we present a comprehensive characterization of the mouse retinal vasculature by SLO‐OCT fluorescein angiography. Using this clinical imaging technique, we report previously unrecognized variations in C57BL/6J vascular anatomy. All layers of the mouse retinal vasculature could be readily visualized during fluorescein angiography by SLO‐OCT. Blood vessel density was increased in the deep vascular plexus (DVP) compared with the superficial vascular plexus (SVP). When we examined different regions of the SVP and DVP, no differences in capillary density were observed between the inferior and superior hemispheres, or between different regions of the SVP. However, a small, but significant increase in capillary density was detected in the temporal hemisphere of the DVP compared with the nasal hemisphere of the DVP. Arteriolar and venular typologies were established and structural differences were observed between venular types. Unexpectedly, the hyaloid artery was found to persist in 15% of C57BL/6 mice, forming anastomoses with peripheral retinal capillaries.
Inflammation, wound healing and tear proteomics in glaucoma
Authors: Uusitalo H.
Published: September 2015

Wound healing is a complex process involved in ocular surgery, trauma and pathogenesis of several eye diseases. Due to the delicate and sensitive structures of the eye wound healing is playing a essential role in ophthalmology. In glaucoma surgery well controlled wound healing process is as important for the creation of a functioning passage to aqueous humor out of the eye. The state of the ocular tissues is of great importance for the success of ocular surgeries. Chronic topical glaucoma medication is an important risk for the ocular surface disease. It is also a risk for the failure in glaucoma surgery. The mechanism of failing glaucoma surgery is related to the presence inflammatory cells, accumulation of extracellular matrix proteins in the conjunctiva and the site of surgery, activation of matrix metalloproteinases and their tissue inhibitors and accumulation oxidized lipids in the conjunctiva and around the site of operation and glaucoma shunts. Tear fluid proteome is a novel technique to get detailed information about the processes of the anterior surfaces of the eye and could easily be performed. It has also proven to be a promising technique for detecting biomarkers for ocular surface disease, ocular inflammation and predicting thus the success of glaucoma surgery.
Physiology of retinal oxygenation
Authors: Stefansson E.
Published: September 2015

The retina receives O2 from retinal and choroidal circulations. Both vascular beds can now be imaged with noninvasive spectrophotometric oximetry in human subjects. This allows study of normal O2 metabolism and physiology and clinical research in retinal disease. Normal physiology: Technical and biological variability in retinal O2 saturation is low compared to most clinical parameters. Test‐retest studies show standard deviations of about 1% and in a healthy population the standard deviation is only 5–11% of the mean, low compared for example to IOP measurements. Retinal O2 saturation is relatively stable with age and shows only a minor reduction over decades of life. Retinal oximetry reliably detects retinal O2 saturation consumption due to changes in illumination. Retinal and choroidal oximetry data agree well with invasive studies in animals and human subjects. Ischemic retinopathies: Abnormal O2 saturation has been documented in diabetic retinopathy, retinal vein and artery occlusions and neovascular AMD. This agrees well with invasive PO2 studies and presence of Hypoxia‐Inducible‐Factor in these diseases. Atrophic retinopathies: Retinal atrophy in glaucoma and retinitis pigmentosa reduces O2 consumption and this is detected by retinal oximetry. Retinal oximetry may be a good method to quantify progressive retinal atrophy.
Information technology in ophthalmology. www.retinarisk.com
Authors: Stefansson E.
Published: September 2015

A huge amount of epidemiological data has been accumulated in ophthalmology as in other fields of medicine. The use of these data in health care tends to be simplistic and makes too little use of information technology and mathematics. We have used published reports on risk factors for progression of diabetic retinopathy, DR, to create an algorithm that predicts an individual's risk of sight threatening DR. The prediction is based on the type and duration of diabetes mellitus, blood glucose and pressure, DR stage and gender; see www.retinarisk.com. It predicts 80% of the risk as seen as the area‐under‐curve on ROC plots. The software provides individual predictions based on these risk factors. It educates the patient about DR risk and allows estimation of the effect of improving risk factors such as blood glucose. It has motivational and educational value. Current norm in DR screening is annual examination (every other year for eyes without DR). Individualized risk assessment allows individualized determination of the frequency of eye screening. High risk eyes are screened more frequently and low risk eyes less frequently. This improves safety for the high risk eyes and saves on resources for the low risk eyes. When compared with annual screening this provides cost savings of about 50%.
Biomaterials for ocular surface reconstruction and lamellar keratoplasty
Authors: Fuchsluger T.
Published: September 2015

This presentation present strategies to engineer a biomatrix through nanofibers. Different characteristics of the fibers and the matri, f.ex. biocompatibility, degradability, wetability are displayed. Future possibilities of use in ocular surface reconstruction are discussed.
Genetic variants in the TNFA are associated with Korean Dry Eye Disease
Authors: Yang S. , Na K.S. , Mok J.W. , Ju H.J. , Joo C.K.
Published: September 2015

Purpose

To determine whether variations altering the function or expression of TNFA, contribute to the pathogenesis of dry eye disease.

Methods

Genomic DNA was extracted from blood samples of unrelated dry eye disease patients (non‐Sjogren's syndrome patients (n = 200) and Sjogren's syndrome patients (n = 100). Polymerase chain reaction and direct sequencing were used to screen variations in promoter region of TNFA gene. One hundred fifty control individuals without corneal disease were selected from the general population.

Results

We investigated 6 SNPs of TNFA; −1196 C>T, −1031 T>C, −863 C>A, −857C>T, −308 G>A (rs1800629) and −238 A>G (rs361525) in promoter. Among them, −1196 C>T, −857 C>T, rs1800629 and rs361525 were different between patient groups and control groups. The *A allele frequency of rs361525 in dry eye patients (2.6%) and Sjogrens’ patients (2.5%) were decreased compared with control subjects (5.1%). The *A allele frequency of rs1800629 was lower in Sjogrens’ patients (2.5%) than in the controls (4.8%). In −1196C>T variation, *T allele of both patient groups was decreased compared with control subjects. Whereas, the *T Allele frequency of −857 C>T was higher in the Sjogrens’ patients (30.0%) than in the controls (16.8%). The genotype distributions of all polymorphisms of TNFA among the control subjects and the affected individuals were in Hardy‐Weinberg equilibrium.

Conclusions

Our results suggested that the genetic variations of TNFA gene seem to be associated with dry eye predisposition in a Korean.
Back to the future: The return of angle surgery
Authors: Sharkawi E.
Published: September 2015

Micro invasive glaucoma surgery (MIGS) claims extremely high safety profiles and is a rapidly expanding field. In this session we will examine the efficacy and safety of ab interno angle surgery, and outline surgical tips and methods to maximize trabecular outflow in open angle glaucomas. We will also explore how angle surgery may improve results in angle closure eyes, over phacoemulsification alone. MIGS healthcare costs are not insignificant and efficacy can be limited. We will therefore examine cost effectiveness and quality of life issues that are paramount in moving this field forward. MIGS will be compared to more invasive glaucoma surgical approaches and real world indications discussed.
Long‐term cultivation of corneal stem cells – possible applications from benchside to bedside
Authors: Petrovski G.
Published: September 2015

Long‐term cultures of corneal stem cells can be developed for future tissue engineering and clinical applications. Cornea limbal and stromal tissue explants can be cultivated and expanded for longer periods of time (months) under special conditions and without the use of scaffolds. Viable 3D cell outgrowth from the explants can be achieved within 4 weeks time. The outgrowing limbal epithelial stem cells (LESCs) revealed a unique fingerprint of markers specific for stemness, proliferation, limbal epithelial cells and differentiated cornea epithelial cells. Morphological and immunostaining analysis concluded that long‐term culturing can form stratified 3D tissue layers with a clear extracellular matrix deposition and organization of collagen, which was similar to that formed by corneal stromal stem cells (CSSCs). Overall, modelling 3D long‐term structures of corneal stem cells can be used for generating highly pluripotent, long‐standing 3D cultures from limbal and stromal stem cells, which can be used for further research purposes and clinical transplantation.
Potential retinal causes: when and how to investigate
Authors: Leroy B.P.
Published: September 2015

Purpose

To describe the retinal conditions that need to be excluded when non‐organic visual loss is suspected, and the investigations required to either confirm or exclude them.

Methods

A case presentation format will be used to illustrate those conditions which can be discovered using psychophysical and electrophysiological tests as well as special imaging including blue and near‐infrared autofluorescence and reflectance imaging and spectral‐domain optical coherence tomography, in patients in whom a non‐organic origin for visual loss is initially suspected.

Results

Inherited retinal diseases such as Stargardt macular dystrophy, X‐linked retinoschisis and cone dystrophy as well as Batten disease in their early stages all need to be excluded when visual loss is thought to be non‐organic. In addition, several acquired retinal conditions such as acute acular neuroretinopathy need to be taken into account. Visual field testing, ISCEV‐standard full‐field flash electroretinography, pattern electroretinography and visual evoked potentials and specialised imaging techniques contribute significantly to making the correct diagnosis.

Conclusions

Visual loss in a list of organic conditions may mimic non‐organic visual loss. Functional testing as well as specialised imaging techniques are essential in differentiating true organic from non‐organic visual loss.