European_Society_of_Ophthalmology_Europe.pdf

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European
Society
of
Ophthalmology
8–11
June
2013
Copenhagen,
Denmark
www.soe2013.org
SOE2013
Abstract
E-Book
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PETER
RIGAUD

European Society
of Ophthalmology
Congress of the European
Society of Ophthalmology
(SOE) 2013
8–11 June, 2013, Copenhagen, Denmark
Abstracts
Scientific Programme Commit tee
Stefan Seregard, Sweden, Chairman and Education
Fridbert Jonasson, Iceland, Programme Co-ordination
Susanne Binder, Austria, Retina
Jan-Tjeerd de Faber, The Netherlands, Paediatrics and Strabismus
Shlomo Dotan, Israel, Neuro-ophthalmology
Thomas Fenech, Malta, Wet Labs
Isabelle Hamilton-Bower, United Kingdom, Allied Health
Christoph Hintschich, Germany, Oculoplastics
Graham Holder, United Kingdom, Electrophysiology
Friedrich Kruse, Germany, Cornea and External Eye
Janet Marsden, United Kingdom, Allied Health
Carlos Pavésio, United Kingdom, Uveitis
Jan Ulrik Prause, Denmark, Oncology and Pathology
Marie-José Tassignon, Belgium, Cataract and Refractive
Carlo Enrico Traverso, Italy, Glaucoma
Congress Commit tee
Stefan Seregard, Sweden, President
Thomas Fenech, Malta, Secretary General
Jan-Tjeerd de Faber, The Netherlands, Treasurer
Fridbert Jonasson, Iceland, Programme Co-ordination
Gabriel van Rij, The Netherlands, Immediate Past President
Jan Ulrik Prause, Denmark, Local Organiser

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Congress of the European
Society of Ophthalmology
(SOE) 2013
8–11 June, 2013, Copenhagen, Denmark
Contents
Author Index
Free Paper Presentations
Rapid Fire Presentations
Electronic Poster Presentations
FP01 Oculoplastics, Oncology and Pathology 001-010
FP02 Cataract and Refractive Surgery 011-020
FP03 Uveitis, Paediatric Ophthalmology and Strabismus 021-030
FP04 Retina I 031-040
FP05 Glaucoma 041-050
FP06 Retina II 051-060
FP07 Contact Lenses, Cornea, External Eye, Ocular Surface,
Refractive Surgery 061-070
FP08 Education, Electrophysiology and Neuro-ophthalmology 071-078
FP09 Cornea 079-088
FP10 Retina III 089-098
EP Cataract 141-189
EP Contact Lenses 190-192
EP Cornea 193-263b
EP Education 264-279
EP Electrophysiology 280-281
EP External Eye 282-301
EP Glaucoma 302-387b
EP Neuro-Ophthalmology 388-438
EP Ocular Surface 439-460b
EP Oculoplastics 461-494
EP Oncology and Pathology 496-539
EP Paediatric Ophthalmology and Strabismus 540-593
EP Refractive Surgery 594-613
EP Retina I 614-683
EP Retina II 684-752
EP Retina III 753-821
EP Uveitis 822-825
RF Cataract, Cornea, External Eye, Ocular Surface, Oculoplastics,
Oncology, Pathology and Refractive Surgery 099-112
RF Electrophysiology, Glaucoma, Neuro-ophthalmology,
Paediatric Ophthalmology and Strabismus, Uveitis 113-126
RF Retina 127-140
5
7
10
13
16
19
23
25
27
30
45
58
58
78
82
83
88
113
127
134
142
155
169
174
193
212
233
34
37
41
247
Abstract No. Page

FREE PAPER PRESENTATIONS
5
Congress of the European Society of Ophthalmology (SOE) 8–11 June, 2013, Copenhagen, Denmark - Abstract Book
FP01: OCULOPLASTICS, ONCOLOGY AND PATHOLOGY
FP-OPL-001
The “bucket-handle” lash line transposition: a novel
technique for correction of intractable trichiasis
Roos, J.C., Pharoah, D.S., Beigi, B.
Norfolk & Norwich University Hospital, Ocular Adnexal Unit, Dept of
Ophthalmology, Norwich, United Kingdom
Purpose: To describe the preliminary results of a new surgical technique to
treat intractable trichiasis.
Methods: Eight patients with intractable trichiasis were treated by a single
surgeon at one centre. Following a deep lower-lid split through the grey line,
a “bucket-handle” transposition of the lash line was performed. Subsequent
healing of the lid margin was by secondary intention. Photographic images
were obtained prior to surgery and at subsequent review appointments for
comparison. Video is also available of the surgical technique.
Results: Eight patients (3 Males and 5 Females ranging in age from 46 to 80)
have been followed for at least 5 months. The cosmetic and functional out-
come was very satisfactory in all 8 patients. There was no recurrence of trichi-
asis in this limited follow up time, nor any other post-operative complications.
Conclusion: To the best of our knowledge the “bucket-handle” lash line trans-
position described here has not been previously reported and appears suitable
for cases of intractable trichiasis.
This new procedure offers a number of advantages over current treatment op-
tions in that it is permanent, non-destructive, preserves lashes and does not
lead to shortening of the lid margin. This procedure provides a safe and effec-
tive alternative to other techniques such as rotation of terminal tarsus (Tarbut
type) procedures.
FP-OPL-002
Assessment of tear meniscus with optical coherence
tomography in thyroid-associated ophtalmopathy
Sizmaz S.1
, Altan-Yaycioglu R.2
, Bakiner O.S.3
, Bozkirli E.3
,
Coban-Karatas M.2
, Ulas B.2
1
Cukurova University, School of Medicine, Department of
Ophthalmology, Adana, Turkey, 2
Baskent University, School of
Medicine, Department of Ophthalmology, Adana, Turkey, 3
Baskent
University, School of Medicine, Department of Endocrinology, Adana,
Turkey
Purpose: To evaluate the tear ilm meniscus with optical coherence tomogra-
phy (OCT) in patients with Graves’ disease (GD).
Methods: Patients with GD without clinical features of thyroid-associated
ophthalmopathy (TAO) (Group 1, n=35), patients with signs of TAO (Group
2, n=31), and healthy participants (Group 3, n=31) were enrolled. Palpebral
issure width, Schirmer test, tear break-up time (TBUT) test, and tear ilm
meniscus height and area obtained with Fourier-domain OCT were analyzed.
Results: Tear break-up time test scores were 8 seconds (2 - 25) in Group 1,
8 seconds (2 - 15) in Group 2 (p=0.38); and10 seconds (5 - 17) in Group 3
(p=0.000 Group 1 vs 3, and 0.000 for Group 2 vs 3). Tear ilm meniscus height
did not signiicantly differ between Groups 1 and 2 (257.5 µ (86 - 962) and
258 µ (99-1340) respectively, p=0.98). In Group 3 tear ilm meniscus height
was 316 µ (122 - 720) (p=0.005 Group 1 vs 3, and 0.004 for Group 2 vs 3).
Tear ilm meniscus area did not signiicantly differ between Groups 1 and
2 (0.025 mm2
(0.004 - 0.250) and 0.024 mm2
(0.003 - 0.316) respectively,
p=0.85). In Group 3 tear ilm meniscus area was 0.048 mm2
(0.006 - 0.75)
(p=0.000 Group 1 vs 3, and 0.000 for Group 2 vs 3).
Conclusion: Tear function is signiicantly disturbed in GD. Optical coherence
tomography is an effective way to assess the tearing function also in patients
with GD.
FP-OPL-003
Abstract has been withdrawn.
FP-OPL-004
Clinical functional and cosmetic results in post-
enucleation surgical reconstruction
Gushchina M., Egorova E., Kondratenko T.
The S. Fyodorov Eye Microsurgery Federal State Institution, Moscow,
Russian Federation
Purpose: The aim was to improve the clinical functional and cosmetic results
after enucleation.
Methods: There were 196 patients with different ophthalmic pathology. We
used orbital implant (OI) “Bionic” for post-enucleation reconstruction. It was
made of a mixture of oligomeric compositions by method of photo-polym-
erization. This technology excludes the formation of free radicals on the im-
plant’s surface. The material is biocompatible, nontoxic, approved for using in
ophthalmosurgery. The “Bionic” OI provides the axis of rotation, a biological
ixation of the rectus extra-ocular muscles, ingrowth of the ibrovascular tis-
sue into the implant’s surface. There was used the formula for calculation of
the OI size (OIS):
OIS = Size of fellow eye - 3
Results: All patients were observed in the follow up from 6 months to 7 years
with out any post-operative complications. Clinical functional results of post-
enucleation reconstruction with “Bionic” OI were:
- high motility of the orbital implant (136o
±4o
),
- large amplitude motility of the artiicial eye (75%±3%).
We used the software “STATISTICS 6.0” for statistical evaluation of cosmetic
results and achieved the following cosmetic results:
- symmetry of exophthalmometric indexes between the cosmetic ocular pros-
thesis and the pair eye (95%),
- symmetry of opening of eyelids (95%),
Conclusions: The method of postenucleation reconstruction with OI “Bionic”
and using of the formula for the calculation of SOI were clinically safe, func-
tional effective, and cosmetically acceptable.
FP-ONC-005
Periocular sebaceous gland carcinoma: prognostic
signiicance of nuclear survivin (BIRC5), androgen
receptor, Ki-67 and p63
Mulay, K.1
, White, V.2
, Shah, S.1
, Honavar, S.1
1
L.V.Prasad Eye Institute, Hyderabad, India, 2
Vancouver General
Hospital, Vancouver, Canada
Purpose: To determine the expression of survivin, androgen receptor (AR),
Ki-67 and p63 in periocular sebaceous gland carcinoma and correlate their
expression with clinical outcomes.
Methods: 56 cases of periocular sebaceous gland carcinoma with a minimum
follow up of 1-year were retrieved from the archives. Patient iles were as-
sessed for clinical outcomes. Immunostaining for survivin, androgen recep-
tor, Ki-67 and p63 was performed on all cases. All tumours were assigned a
nuclear survivin score (NS-Score) and androgen receptor score (AR-Score)

6
based on the intensity and percentage expression. The expression of Ki-67
& p63, NS-Score and AR-score were correlated with the clinical outcomes.
Results: All tumors (100%) expressed survivin in the nucleus of cells. In ad-
dition, 10 cases also expressed survivin in the cytoplasm. Androgen receptor
was expressed in the nucleus in 53 tumors (94.6%). p63 was expressed in all
tumors (range 82-99%). Ki-67 activity ranged from 7-72%. 29 (51.8%) tu-
mors had a high NS-Score. 23 (41.0%) tumors had a high AR-Score. Tumors
with high NS-Score had a signiicantly higher Ki-67 activity (p< 0.005), high
AR-Score and a high recurrence rate (p< 0.0001). Tumors with a high AR-
Score had a signiicantly high recurrence (p< 0.001).
Conclusions: Nuclear expression of survivin and androgen receptor has a
signiicant prognostic impact in periocular sebaceous gland carcinoma. They
might serve as a prognostic biomarkers in patients after surgical treatment.
Expression of androgen receptors also suggests a possible role for hormonal
therapy in these patients.
FP-ONC-006
Update on retinoblastoma chemotherapy treatment and
outcome in Sweden during the last decade
Bartuma K.1
, Pal N.2
, Kosek S.3
, Holm S.2
, All-Ericsson C.1
1
St Erik Eye Hospital and Karolinska Institutet, Department of
Vitreoretinal Diseases, Stockholm, Sweden, 2
Karolinska Institutet,
Department of Paediatrics, Astrid Lindgren Children’s Hospital,
Stockholm, Sweden, 3
University of Uppsala, Uppsala, Sweden
Purpose: Retinoblastoma is the most common eye cancer in children, affect-
ing 1 of 15000. The survival of retinoblastoma has improved signiicantly,
with approximately 98% of patients surviving. The exceptional outcome has
mainly been attributed to novel chemotherapeutical regimens. The aim of this
study is to report the outcome following chemotherapy treatment for patients
with retinoblastoma in Sweden during the last 10 years.
Methods: Medical records on all retinoblastoma cases, treated with at least
two cycles of chemotherapy in Sweden between 2001 and 2011 were re-
trieved. Data on demographics, presenting clinical sign, tumor group, treat-
ment, tumor progression and outcome were extracted.
Results: 24 consecutively treated cases (46 eyes) of retinoblastoma were in-
cluded with a median follow up of 4.5 years. 38% had an affected irst grade
relative. Tumor group at presentation staged by IIRC included: A (14%), B
(57%), C (0%), D (19%) and E (10%). All patients received 4-9 cycles of
vincristine, etoposide, carboplatin (VEC). Most A/B tumors responded well to
VEC initially, while advanced tumors responded worse. Recurrent, progres-
sive and new tumor growth was treated with focal therapy. Further, 6 patients
received 2-4 additional cycles of vincristine, ifosfamide, doxorubicin (IVAd)
treatment. All tumors initially responded to the IVAd regimen. Side effects
included infections associated with neutropenia (54%), nausea (42%), failure
to thrive (19%) and anemia (15%). The failure rate (eyes undergoing external
beam radiation or enucleation) was 28%. Enucleated eyes were group E (7), D
(4) and B (1). The mortality rate was 0%.
Conclusions: Chemotherapy has greatly improved the outcome of retinoblas-
toma and in this cohort, 83% of the tumors initially responded well to VEC
treatment. Long-term control was good for group A/B, but not group D/E. The
IVAd protocol was effective in tumors with VEC resistance and sIde effects
were acceptable.
FP-ONC-007
Successful treatment of macular retinoblastoma with
intraarterial (IA) chemotherapy
Hadjistilianou, D.1
, Coriolani, G.2
, De Francesco, S.3
1
University of Siena, Ophthalmology, Siena, Italy, 2
University of Siena,
Pediatrics, Siena, Italy, 3
University of Siena, Opthalmology /Oncology
Unit, Siena, Italy
Purpose: To report our experience in intaarterial chemotherapy( IA) for mac-
ular retinoblastoma, in order to obtain tumor control while preserving as much
as possible useful vision.
Methods: We report about 7 patients with “ naive” unilateral retinoblastoma
involving the macula, out of the patients population scheduled for IA as the
primary treatment. Follow-up ranges from a minimum of 4 months and 14
days to a maximum of 2 years, 4 months and 14 days.
Results: each patient underwent to an entire treatment cycle of three IA pro-
cedures, receiving 3-5 mg of Melphalan per eye per treatment. IA procedure
was well tolerated in all 7 patients. All treated patients are alive and free of
metastatic disease. Nobody has been enucleated. All the eyes achieved oph-
thalmoscopic remission of the tumor foci, showing types I to III regression.
Conclusions: IA chemotherapy is also effective for the macular retino-
blastoma, when performed by neuroendovascular interventionists skilled in
the angiographic diagnosis and treatment of intracranial vascular diseases.
Furthermore, Melphalan superselectively delivered in the ophthalmic artery
may allow many eyes that are currently being enucleated to be salvaged, with
a very low rate of complications from local and systemic toxicity.
FP-ONC-008
Role of neonatal blue light phototherapy and different
extrinsic and intrinsic factors in the development of
benign pigmented uveal lesions: a twin study
Tóth-Molnár E.1
, Facskó A.1
, Oláh J.2
, Kemény L.2
, Széll M.3
, Csoma Z.2
1
University of Szeged, Department of Ophthalmology, Szeged,
Hungary, 2
University of Szeged, Department of Dermatology and
Allergology, Szeged, Hungary, 3
University of Szeged, Department of
Medical Genetics, Szeged, Hungary
Purpose: The aim of the present study was to investigate various factors which
may inluence the prevalence of benign pigmented uveal lesions (BPUL). The
role of constitutional and environmental factors, anamnestic neonatal blue
light phototherapy (NBLP), and cutaneous melanocytic nevi were examined.
To search for possible gene-environmental interactions involved in the appear-
ance of pigmented lesions, the MC1R variants and the I439V polymorphism
of HAL were determined.
Methods: One hundred and forty-two monozygotic and dizygotic pairs of
twins and 3 sets of triplets of white origin, aged 1-34 years were enrolled
in this study. The prevalence of BPUL was surveyed during ophthalmologi-
cal examinations. Whole body skin examination was performed to determine
melanocytic skin lesions. A standardized questionnaire was used to assess data
relating to constitutional factors, sun exposure, sunbathing habits, and other
variables. Information regarding NBLP derived from the original neonatal
medical charts. The effect of the gene polymorphisms on the numbers of pig-
mented skin lesions and the presence of BPUL was assessed.
Results: Anamnestic NBLP was associated with a signiicantly higher preva-
lence of both uveal and cutaneous melanocytic lesions. Signiicant association
was found between the presence of cutaneous atypical nevi and BPUL. The
frequency of sunbathing, a history of severe painful sunburns during child-
hood and eye color were also signiicantly related to the density of BPUL.
Neither the univariate nor the multivariate analysis revealed any effects of the
studied polymorphisms on the skin and uveal pigmented lesions.

7
Conclusions: According to our indings, NBLP can be a risk factor for me-
lanocytic nevus development both in the uvea and the skin. The presence of
cutaneous atypical nevi could also be a strong inluencing factor. Further stud-
ies are needed to establish the potential long-term adverse effects of neonatal
blue light phototherapy.
FP-ONC-009
Prognostic implications of GEP class 2 in clinical
practice: a single center experience with 275 cases
Augsburger J.J., Corrêa Z.M.
University of Cincinnati, Ophthalmology, Cincinnati, United States
Purpose: Several reports from the developer of the gene expression proile
(GEP) test of uveal melanomas currently licensed for commercial use in the
USA have suggested that patients with a GEP Class 2 tumor have almost no
chance of long-term survival. We analyzed our series of patients to determine
if our experience mirrored or differed from the published results.
Methods: Retrospective analysis of tumor size and GEP class in 273 primary
posterior uveal melanomas evaluated by FNAB prior to or at the time of intra-
ocular tumor treatment and actuarial assessment of cumulative probability of
death from metastasis.
Results: The mean largest basal diameter of our tumors was 11.8 mm and
their mean thickness was 5.6 mm. 103 patients (37.3%) had a tumor ≤ 10 mm
in largest linear tumor dimension (LTD) while 123 (45.1%) had a tumor > 10
but ≤ 15 mm in LTD and only 47 (17.2%) had a tumor > 15 mm in LTD. 193
of the tumors (70.7%) were categorized as GEP class 1 while only 77 (28.2%)
were categorized as class 2. Three-year melanoma-speciic cumulative actu-
arial mortality in patients with a class 2 tumor was 32.8%; in contrast, 3-year
mortality in the class 2 cases in the reported validation series for this assay
was 44.3%.
Conclusions: Our patients with a GEP class 2 tumor did not have as unfavor-
able life expectancy as that reported by the validation study of this assay. This
observation suggests that GEP class 2 is not as predictably linked to short-term
development of metastasis as indicated by the developer of this assay, tumor
size smaller than medium to large is associated with a longer metastasis-free
latent interval, or both.
FP-ONC-010
Factors associated with insuficiently cellular yield
for cytopathological diagnosis in FNAB of intraocular
tumors
Corrêa Z.M., Augsburger J.J.
University of Cincinnati, Ophthalmology, Cincinnati, United States
Purpose: To identify tumor characteristics and procedural factors associated
with insuficiently cellular specimens for cytopathologic diagnosis of
intraocular tumors evaluated by ine-needle aspiration biopsy (FNAB).
Methods: Retrospective analysis of 522 cases of intraocular tumors evalu-
ated by ine needle aspiration biopsy (FNAB) prior to or at the time of initial
intraocular tumor treatment during the years 1982 through 2008. The principal
outcome evaluated in this study was an insuficiently cellular specimen for
cytopathologic classiication.
Results: An insuficient aspirate for cytopathologic diagnosis/classiication
occurred in 105 of the 522 cases (20.1%). Factors associated with an insufi-
cient cellular yield included tumor size (smaller size unfavorable, P < 0.0001),
indication for biopsy (diagnostic uncertainty unfavorable, P < 0.0001), and
number of tumor sites sampled (single site sampled unfavorable, P < 0.02).
Conclusions: This retrospective study identiied several factors that strongly
inluence the cellular yield of FNAB of intraocular tumors. Authors of reports
of FNAB of intraocular tumors should be encouraged to report the frequency
distributions of these variables in their results.
FP02: CATARACT AND REFRACTIVE SURGERY
FP-REF-011
Eficacy, safety and refractive predictability after
femtosecond lenticule extraction for moderate and high
myopia: ReLEx lex vs. ReLEx smile
Vestergaard A.H.1
, Sjølie A.K.1
, Grauslund J.1
, Ivarsen A.2
, Hjortdal J.2
1
Odense University Hospital, Ophthalmology, Odense C, Denmark,
2
Aarhus Sygehus, Aarhus University Hospital, Ophthalmology, Aarhus,
Denmark
Purpose: ReLEx lex (lex) and ReLEx smile (smile) are two relative new
corneal refractive procedures, where a stromal lenticule is cut by a femtosec-
ond laser and manually extracted. The purpose of this study was to compare
eficacy, safety and predictability.
Methods: A prospective study of 29 patients treated with lex in one eye, and
smile in the other at the Department of Ophthalmology, Aarhus University
Hospital. Preoperative spherical equivalent refraction averaged -7.50 D (range
-6.00 to -9.75 D) with a maximal astigmatism of -1.75 D in both groups. A
VisuMax®
femtosecond laser (Carl Zeiss-Meditec, Jena, Germany) was used.
Lenticule diameters were the same in both eyes and ranged from 6.00 to 6.50
mm. Flap thickness was 110 to 120 µm, and lap/cap diameter ranged from 7.3
to 8.0 mm. Clinical examinations were performed preoperatively and at day 1,
1 week, 1 month, 3 months, and 6 months after surgery.
Results: For eyes with emmetropia as target, 92 % of both lex and smile
eyes had uncorrected distance visual acuity (UDVA) ≥ 0.50 (Snellen) at day 1.
After 6 months, all eyes had UDVA ≥0.50, and 58 % of lex eyes and 62 % of
smile eyes had UDVA ≥ 1.00 (p=1.00). Mean corrected distance visual acuity
(CDVA) had improved 1 to 2 ETDRS letters for both techniques (p=0.85).
Also, one eye in each group had lost 1 line of CDVA, and 5 lex eyes and 6
smile eyes (p=1.00) had gained 1 line of CDVA 6 months after surgery. The
rest were unchanged. The achieved refraction after 6 months was -0.03 ± 0.32
D from the attempted refraction for lex eyes, and -0.13 ± 0.36 D for smile
eyes (p=0.235). Ninety percent of both lex and smile eyes were within ± 0.50
D of the intended correction, and 100% of lex eyes and 97% of smile eyes
were within ±1.00 D (p=1.00).
Conclusions: Both ReLEx lex and ReLEx smile are promising all-in-one
femtosecond laser refractive procedures.

8
FP-REF-012
Vision ICL V4c versus conventional ICL (a year of
experience)
Dvali M.L.1,2
, Sirbiladze B.2
, Tsintsadze N.2
1
Tbilisi Medical UniversityState Medical University, Eye Diseases,
Tbilisi, Georgia, 2
Eye Clinic ‘Akhali Mzera’, Tbilisi, Georgia
Purpose: To share the pilot results and assess the potential visual beneits
of New Vision Implantable Collamer Lens (ICL V4c, STAAR Surgical Co)
implantation to correct moderate to high myopia, as well as to compare them
with the results of conventional ICL implantation.
Methods: This prospective case series comprised 31 eyes (16 patients) that
underwent ICL V4c implantation (3 spherical and 28 toric ICL cases) with
myopic refractive errors of -6.5 to -16.0 diopters (D). The patients underwent
ICL implantation and routine pre and postoperative examinations before and 1
week, 1 month, 3 months after the surgery. The control group included 46 eyes
of 23 patients with conventional ICL surgery (among them 7 spherical and
39 toric ICL cases). The safety, eficacy, predictability, stability, and adverse
events of the surgery were assessed.
Results: No signs of pigment dispersion or hemorrhage as well as less inlam-
mation in eyes that received the V4c surgery. As for the visual performance,
there was no statistically signiicant difference between the main and control
groups. No vision-threatening complications occurred during the observation
period. The ICL group had lower aberration values of entire ocular and corneal
HOAs in comparison of pre-op. HOAs changed for the entire ocular trefoil-y,
spherical aberration and corneal trefoil-y.
Conclusions: Implantation of ICLs is safe and effective and provides predict-
able and stable refractive results in the treatment of moderate to high myopia.
The good control of IOP, eliminating the need for iridectomies, which can
lead to signiicant changes in the aqueous dynamics after surgery, hypema,
suggesting its viability as a best surgical option for the treatment of such eyes.
Moreover, it does not request the learning curve from the surgeon experienced
in the implantation of previous model of ICL.
FP-CAT-013
Intra-ocular mirror telescope for phakic and
pseudophakic AMD eyes
Lipshitz, I.
Optolight Vision Technology, Hetzlia Pituach, Israel
Purpose: To evaluate the visual improvement after implanting an intra-ocu-
lar mirror telescopic lens in pseudophakic age-related macular degeneration
(ARMD) eyes.
Methods: A specially designed mirror telescopic lens was implanted over an
existing IOL in 8 pseudophakic ARMD patients. The visual acuity compared
to the pre-op distance and near vision was evaluated.
Results: All 8 eyes showed an improvement of visual functions for distance
and for near. The range of distance improvement was between 2.0 and 3.5
ETDRS lines (average 2.7 lines) and for near between 3.0 and 4.0 lines (aver-
age 3.2 ETDRS lines).
Conclusions: The implanted mirror telescope can be used to improve visual
acuity for selected cases of pseudophakic ARMD eyes.
FP-CAT-014
Reasons for not implanting premium IOLs according to
total corneal aberrations
Arce, C.G.
Federal University of Sao Paulo, Ocular Bioengineering and Refractive
Surgery Sectors, Campinas, Brazil
Purpose: To establish the relation among individual corneal HOAs and IOL
optics to explain when Premium IOLs should not be implanted.
Methods: Dual Scheimplug and Placido anterior segment analyzer was used
to assess the total corneal high order aberrations (HOAs).
Results: Aspheric IOLs with negative spherical aberration (SA) should not be
implanted in eyes with negative total corneal SAlike keratoconus and after hy-
peropic corneal surgery but seem better for eyes with normal prolate aspheric
corneas or with myopic surgery because their positive total corneal SA. Toric
IOL calculation using only anterior surface cylinder may fail when eyes have
large vertical or horizontal total corneal coma, when this coma is oblique to
the astigmatic axis or when there is large kappa distance. Visual complaints
seem to be enhanced when diffractive IOLs are implanted in eyes with large
total corneal trefoil and quatrefoil.
Conclusions: Matching HOAs from the cornea and from IOLs will help to
avoid postoperative visual complaints. Preoperative 3rd and 4th order total
corneal HOAs may be used to determine best patient for toric and/or multifo-
cal Premium IOLs.
If larger coma (>±0.50 µm), trefoil (>±0.40 µm), quatrefoil (>±0.30 µm) and/
or 5th order (>±0.20 µm) multifocal Premium IOLs should probably not be
implanted.
FP-CAT-015
Predicting the post-operative intraocular lens position
using continuous intra-operative optical coherence
tomography measurements
Hirnschall N.1
, Amir-Asgari S.1
, Maedel S.1
, Findl O.1,2
1
VIROS - Vienna Institute for Research in Ocular Surgery, a Karl
Landsteiner Institute, Hanusch Hospital, Ophthalmology, Vienna,
Austria, 2
Moorfields Eye Hospital NHS Foundation Trust, London,
United Kingdom
Purpose: Aim of this study was to assess, if measuring the position of the lens
capsule intra-operatively with a continuous intra-operative optical coherence
tomography (OCT) device could be useful to improve the prediction of the
IOL position.
Methods: This prospective study included patients who were scheduled for
cataract surgery. Aprototype operating microscope with an integrated continu-
ous OCT device (Visante attached to OPMI VISU 200, Carl Zeiss Meditec
AG, Germany) was used to measure the anterior and posterior lens capsule
position at different time points during cataract surgery.
In all cases a capsular tension ring (CTR) was used to tauten the lens cap-
sule. Partial coherence interferometry (AC-Master, Carl Zeiss Meditec AG,
Germany) was used to measure anterior chamber depth (ACD) immediately
before, and 1 hour and 3 months post-operatively. Partial least squares re-
gression (PLSR) was used to assess the inluence of different pre- and intra-
operatively measured parameters.
Results: In total, 70 eyes of 70 patients were included. Mean axial eye length
was 23.6mm (range: 20.6mm to 30.8mm), mean used IOL power was 22.2D
(range: 6.0D to 31.5D). PLSR showed that the anterior lens capsule measured
after removing the crystalline lens and after implanting a CTR was a signii-
cantly better predictor for the post-operative ACD compared to pre-operative
ACD measurements.

9
Conclusions: The main problem of IOL power calculation, the prediction of
the IOL position after surgery, could possibly be reduced by using intra-oper-
ative lens capsule measurements instead of pre-operative ACD measurements.
FP-CAT-016
Non-invasive laser-based cataract treatment
Kessel, L.
Copenhagen University Hospital Glostrup, Department of
Ophthalmology, Glostrup, Denmark
Purpose: Cataract remains the leading cause of blindness world-wide in spite
of an effective treatment. At present cataract cannot be prevented and the only
cure is invasive surgery. There are too few eye surgeons world-wide and the
treatment is too technically demanding and too costly to be available to a large
part of the worlds population. The aim of the research project is to develop a
non-invasive treatment of cataract based photochemically reversing the post-
translational protein modiications responsible for cataract formation.
Methods: Human organ donor lenses with physiological lens ageing were
treated using different laser modalities. The optical effects of the laser treat-
ment was evaluated by measuring the light transmission and scattering proper-
ties of the lenses before and after treatment.
Results: The transmission of light increased signiicantly after laser treatment
whereas little effect was seen on the scattering properties. There was, how-
ever, very little light scattering by the donor lenses before treatment and hence
it is not surprising that no effect could be demonstrated. The improvement
in transmission was most notable in the short wavelenght region where the
age-related decline in transmission is most pronounced. Optical effects cor-
responding to 10-25 years of lens rejuvenation was achieved. Older and more
densely coloured lenses responded better to treatment than younger lenses.
Conclusions: The age-related deterioration in optical quality of the human
lens can be reversed by non-invasive laser treatment. The long term effects of
the treatment are unknown due to the short time period human donor lenses
can be kept in the laboratory. More research and technical reinement is need-
ed before the method can be tested clinically.
FP-CAT-017
Using dynamic Purkinje meter measurements to
evaluate capsular bag stability in special cases
Maedel S.1
, Hirnschall N.1
, Weber M.1
, Tabernero J.2
, Artal P.2
, Findl O.1
1
Vienna Institute for Research in Ocular Surgery, Hanusch Hospital
Vienna, Vienna, Austria, 2
Laboratorio de Óptica, Universidad Murcia,
Murcia, Spain
Purpose: To evaluate capsular bag stability in eyes with versus without im-
plantation of a capsular tension ring (CTR) during cataract surgery, and eyes
with pseudoexfoliation syndrome (PXF) using a novel dynamic Purkinje me-
ter system.
Methods: In this prospective randomized study cataract patients with and
without PXF were included. Cataract surgery was performed as standard, but
in non PXF eyes half of the patients received a CTR in a randomized fash-
ion. Dynamic Purkinje meter measurements were performed pre-operatively,
1 hour, 1 week and 3 months post-operatively. The novel dynamic Purkinje
meter system allows to evaluate crystalline lens and IOL oscillation or “wob-
bling” immediately after change direction of gaze by video recording of sac-
cadic eye movements. Wobbling can be quantiied by terms of oscillation
amplitude (pixels) or mean stationary time (msec), representing the time the
oscillating lens/IOL needs to return to its original centered position. Higher
oscillation amplitudes and larger stationary time indicate larger degrees of
lens/IOL wobbling.
Results: In total, 50 eyes of 30 patients will be included and presented at
the meeting. Recently, clinical feasibility of the dynamic Purkinje meter was
shown to be good, and a measurable wobble effect was detected in all patients.
Preliminary results for the clinical comparison concerning wobbling of eyes
with and without capsular tension ring and with PXF will be presented.
Conclusions: This novel device may be useful to assess the effect of a CTR in
early post-operative IOL performance during the phase of capsule bag shrink-
age. Another aim of this study is to assess whether pre-operative crystalline
lens wobbling can be used to detect eyes at risk for intraoperative capsular
complication, zonulolysis and postoperative pseudophakodonesis.
FP-CAT-018
Capsule ring dynamics in pseudophakic “BIL” pediatric
eyes
Bobrova N.1
, Tassignon M.-J.2
, Romanova T.1
, Kovaltchuk A.1
,
Levytskyy I.1
1
SI ‘Filatovs Institute of Eye Diseases and Tissue Therapy’, Pediatric
Department, Odessa, Ukraine, 2
University Hospital Antwerp,
Department of Ophthalmology, Antwerp, Belgium
Aim: The aim of the study was to analyze capsular ring dynamics in pseudo-
phakic “BIL” pediatric eyes as a long term postoperative observation (12 - 24
mo.).
Material and Methods: “BIL” implantation was performed in 19 children
(19 eyes), age 2.5 - 18 yr (average 8±3,7 yr) with various types of congenital
and traumatic cataracts, following the twin capsulorhexis (d-5,0 mm)method,
irrigation-aspiration of lens material and IOL “BIL” implantation on capsu-
lorhexis ixation. Capsular ring investigation was performed in 11 eyes after
12 mo. and in 14 eyes after 24 mo. using biomicroscopy and UltraSound (US)
examination in 4 meridians on “Aviso” device (Quantel Medical, France).
Results: Stable IOL ixation and optic axis transparency were obtained in all
pseudophakic “BIL” eyes in all periods. In 12 mo. period no epithelial cells
proliferation between capsules was found by biomicroscopy. Correct “BIL”
positioning was determined by US test - it was strictly centered relative to the
pupil. Capsular ring thickness at 12 mo. observation term ranged from 0.1 to
0.2 mm on average.
At 24 mo. postop revealed ibrosis of twin capsulorhexis edge with a white rim
up to 0.1-0.15 mm width densely embracing the IOL. No LEC proliferation
was visualized biomicroscopically in the visual axis but only into the capsular
bag . US examination estimate capsular ring thickness increased to 0.4 - 0.8
mm on average (in one case it reached 0.9 - 1.1 mm).
Conclusions: Dynamic observations of pediatric pseudophakic “BIL” eyes
showed capsular ring thickening from 0.1-0.2 at 12 mo. postoperatively to 0.4-
0.8 at 24 mo. postoperatively which did not impact on the visual axis transpar-
ency. No changes in IOP were noted.

10
FP-CAT-019
Modiied CTR for hereditary and acquired zonular
pathology associated with cataract
Malyugin B.1
, Golovin A.2
1
S. Fyodorov Eye Microsurgery Federal State Institution, Moscow,
Russian Federation, 2
S.Fyodorov Eye Microsurgery Complex, Cataract
and Implant Surgery, Moscow, Russian Federation
Purpose: To investigate the safety, visual outcomes, and IOL position after
phacoemulsiication assisted with scleral suturing of the modiied CTR and
intracapsular IOL implantation.
Methods: 12 patients with Marfan’s syndrome (mean age 12.6+/-8.5 years)
leading to natural lens subluxation. The extent of zonular defect varied from
110 to 270 degrees (mean 112 degrees) according to UBM.
Results: 12 patients with Marfan’s syndrome (mean age 12.6+/-8.5 years)
leading to natural lens subluxation. The extent of zonular defect varied from
110 to 270 degrees (mean 112 degrees) according to UBM.
Conclusions: 12 patients with Marfan’s syndrome (mean age 12.6+/-8.5
years) leading to natural lens subluxation. The extent of zonular defect varied
from 110 to 270 degrees (mean 112 degrees) according to UBM.
FP-CAT-020
Eradicating postcataract endophthalmitis in a Colorado
ophthalmology department
Schelonka L.1
, Sabell P.2
1
Kaiser Permanente, Ophthalmology, Lakewood, United States, 2
Kaiser
Permanente, Infectious Diseases, Denver, United States
Purpose: To describe the rate of postcataract endophthalmitis in Kaiser
Permanente’s Colorado region, with interventions to reduce the rate.
Methods: Interventional case series. An electronic medical record was que-
ried to ascertain all postcataract endophthalmitis cases from 1998 through
August, 2012. From 2002 through 2005 (intervention 1) steps to reduce the
rate included povidone-iodine 5% sterilization of the ocular surface, add-
ing vancomycin 10mg/500mL to the irrigating solution, suturing imperfect
wounds, eliminating lash sterilization, using only single-dose medications,
and for most surgeons, using gatiloxacin 0.3% preoperative, perioperative,
and postoperative drops. Starting in 2006 (intervention 2), surgeons pressur-
ized the eye and hydrated the incisions with the vancomycin irrigating solu-
tion, instead of plain BSS. The local rate of endophthalmitis was compared to
national rates.
Results: From 1998 through 2001 (baseline), there were 13 cases after
8,392 operations (rate 1.55/1000). During intervention period 1, there were
5 cases after 12,407 operations (rate 0.40/1000), dropping 74% from baseline
(p=0.006). From 2006 through August 2012, there have been no cases of post-
cataract endophthalmitis after 31,014 operations.
Conclusions: Povidone-iodine sterilization, vancomycin 10mg/500mL irri-
gation, and gatiloxacin 0.3% preoperative, perioperative, and postoperative
drops were associated with a signiicant drop in postcataract endophthalmitis
below the US Medicare rate (p=0.009), equaling the Swedish national rate.
Pressuring the eye and hydrating the incisions with vancomycin/BSS from
the irrigating bottle eliminated postcatarct endophthalmitis. Vancomycin
10mg/500mL in the irrigating solution appears to be a safe, effective method
to reduce postcataract endophthalmitis. Surgeons who use antibiotics in the
irrigating solution should consider pressurizing the eye and hydrating the inci-
sions with the antibiotic irrigating solution, instead of plain BSS.
FP03: UVEITIS, PAEDIATRIC OPHTHALMOLOGY AND
STRABISMUS
FP-UVE-021
Optical coherence tomographic features of
inlammatory choroidal neovascular membranes and
inlammatory lesions secondary to multifocal choroiditis
and punctate inner choroidopathy
Amer R.1
, Priel E.2
, Kramer M.3
1
Hadassah University Hospital, Department of Ophthalmology,
Jerusalem, Israel, 2
Mor Institute for Medical Diagnosis, Bnei Barak,
Israel, 3
Rabin Medical Center, Department of Ophthalmology, Petah
Tikva, Israel
Purpose: To describe the spectral-domain optical coherence tomography (SD-
OCT) features of inlammatory choroidal neovascular membranes (iCNV) and
to compare them to those of the acute inlammatory lesions in multifocal cho-
roiditis (MFC) and punctate inner choroidopathy (PIC).
Methods: Observational case series. SD-OCT features of 10 eyes (10 pa-
tients) with iCNV were reviewed and compared to SD-OCT features of 8 eyes
(6 patients) with the acute lesions of chorioretinitis. Each patient underwent
a comprehensive eye examination, fundus photography, and luorescein angi-
ography (FA) on the initial visit. The patients underwent SD-OCT scanning at
baseline and at follow-up visits.
Results: Inlammatory CNV and the inlammatory lesions were more com-
monly encountered in females than males. Median age was 30 years in the
2 groups. More than half of the iCNV (54.5%) were juxtafoveal in location,
27.3% were subfoveal and 16.7% were extrafoveal. Whereas the majority of
the inlammatory lesions were extrafoveal in location (63.6%), 27.3% were
subfoveal and 9.1% were peripapillary in location.
All iCNV were heterogenous in contour and content and showed associated
luid exudation. They consisted of subRPE part and a retinal or subretinal
component. Inlammatory lesions were homogenous, not associated with luid
exudation and all showed choroidal hyperrelectivity. Most showed a subRPE
part and subretinal or retinal component. Inlammatory CNV were signiicant-
ly bigger in dimensions.
Conclusions: The acute lesions of chorioretinitis can be dificult to distin-
guish from iCNV based on clinical examination and FA. However, the inlam-
matory lesions can demonstrate characteristic SD-OCT indings not seen with
iCNV. These SD-OCT indings may help to differentiate these two entities that
typically require different treatments.
FP-UVE-022
The effects of intravitreal bevacizumab in infectious and
non-infectious uveitic macular oedema
Al-Dhibi H.1
, Hamade I.2
, Al-Halafi A.3
, Barry M.3
, Bou Chacra C.2
,
Tabbara K.2
1
KKESH, Vitreoretinal & Uveitis, Riyadh, Saudi Arabia, 2
The Eye Center
and the Eye Foundation for Research in Ophthalmology, Riyadh, Saudi
Arabia, 3
KKESH, Riyadh, Saudi Arabia
Purpose: To assess the effects of bevacizumab for the treatment of infectious
and non-infectious uveitis with macular oedema (ME).
Methods: Retrospective interventional case series. A chart review was per-
formed of patients who were diagnosed with uveitic ME and received intra-
vitreal bevacizumab injection at two referral centers in Riyadh, Saudi Arabia.
Eyes received 1.25 mg of bevacizumab.
Visual acuity and macular thickness (using optical coherence tomography)

11
were analyzed at baseline and at 1 and 3 months following bevacizumab in-
jection.
Results: The mean age of patients was 41±16 years with a mean follow-up of
4±1 months. Ten patients had idiopathic intermediate uveitis, 9 patients had
Behcet’s disease, 10 patients had idiopathic panuveitis, and twelve patients
had presumed ocular tuberculosis uveitis. Post intravitreal bevacizumab in-
jection the mean LogMar visual acuity improved from 0.8±0.8 at baseline,
to 0.4±0.5 at 1 month and 0.3±0.5 at 3 months (P < 0.002, at 3 months). The
mean macular thickness was 430±132 µm at baseline. Following intravitreal
injection macular thickness improved to 286±93 µm at 1 month and to 265±88
µm at 3 months follow-up (P < 0.001, at 3 months).
Conclusions: Bevacizumab was effective in the management of ME follow-
ing infectious and non-infectious uveitis. Intravitreal bevacizumab induced
remission of ME with infectious uveitis, and had no immunosuppressive effect
against infectious agents.
FP-UVE-023
Comparative eficacy of biologic therapies for paediatric
uveitis
Katargina L., Denisova E., Starikova A., Lubimova N., Veklich Y.,
Osipova N.
Helmholtz Research Institute of Eye Diseases, Pediatric Department,
Moscow, Russian Federation
Purpose: To investigate eficacy of biologics in treatment of paediatric uve-
itis.
Methods: 110 children with uveitis associated with rheumatic diseases (RD)
(108 with juvenile idiopathic arthritis, 2 with Behcet’s disease) were treated
with biologics in standard doses.
Inliximab was given in 52 (mean follow-up period - 11.3 month);Adalimumab
- in 57 (mean - 17.3 month);Abatacept - in 25 (mean - 12.9 month); Rituximab
- in 4 (1-3 courses of treatment); Tocilizumab - 1 (follow-up - 25 month). 26
patients received sequentially from 2 to 5 biologics. Biologics were usually
combined with Methotrexate, its combination with Cyclosporin or low-dose
steroids. Topical treatment was also used.
Results: In Inliximab group remission of uveitis was achieved in 31%, de-
crease in the degree of inlammation and/or frequency of relapses - in 14.3%
patients. In Adalimumab group - in 43.1% and 41.2%, in Abatacept - in
33.4% and 33.3% respectively. Correlation between uveitis severity and re-
sponse to the treatment was established. In 30.4% of cases with initial re-
sponse to TNF-α blockers exacerbation of uveitis was seen after 1 year of
treatment. Adalimumab application led to steady remission in both children
with Behcet’s uveitis. During Rituximab treatment steady remission of uveitis
was achieved in 1 child. Exacerbation of uveitis was in the patient treated with
Tocilizumab. Surgical interventions (55 operations, 38 eyes, 30 patients) were
uncomplicated in 91% of cases. Ocular adverse effects were not observed,
systemic - occurred in 11.8% of patients resulting in discontinuance of biolog-
ics in 6.4%.
Conclusions: Biologics were effective in 44.3-84.4% children with RD re-
lated uveitis depending on the drug and disease severity. Nowadays the most
effective drug is Adalimumab. Secondary resistance to biologics remains a
serious problem. Further investigations are required to deine indications for
different biologics in pediatric uveitis and criteria for successful outcome pre-
diction.
FP-UVE-024
Eficacy of systemic treatment in childhood uveitis
Sandfeld L.1,2
, Nielsen S.3
1
Glostrup Hospital, Eye Dept., Copenhagen, Denmark, 2
Rigshospitalet,
Eye Clinic, Copenhagen, Denmark, 3
Rigshospitalet, Juliane Marie
Centret, Paediatric Clinic, Copenhagen, Denmark
Purpose: To evaluate the eficacy of systemic treatment in childhood uveitis.
Methods: A retrospective evaluation of childhood uveitis patients in a uveitis
clinic. Children aged < 18 y at time of diagnosing uveitis, seen in the eye clinic
from 1.1.2007 to 31.12.2012 were included. Eficacy of systemic treatment
and side effects were registered. Clinical Remission (CR) was deined as no
uveitis during medical treatment for ≥ 1 year.
Results: 73 children were identiied with uveitis; 52 cases were related to
JIA, 19 cases were idiopathic, 1 patient had sarcoidosis, and 1 had glomeru-
lonephritis. Mean age at uveitis debut was 7y 4m (1y - 17y), and mean age
at systemic disease debut was 4y 6m (6m - 13y). In 4 cases, data was not
obtainable regarding previous medication. 12 patients used local and systemic
steroids during attacks of uveitis as only necessary treatment. Methotrexate
(MTX) induced CR in 32 of 48 patients, adalimumab caused CR in 18 of 23
ptt, inliximab caused CR in 6 of 9 ptt, and eternacept caused CR in 9 of 17
ptt. A combination of MTX + adalimumab gave CR in 7 of 18 ptt, MTX + inf-
liximab gave CR in 21 of 26 ptt, and MTX + eternacept gave CR in 6 of 7 ptt.
Severe side effects were noted for inliximab (anaphylaxis: 4 cases) and for
MTX (nausea and increasing liver enzymes: 7 cases).
In 25 of 69 ptt, three or more different treatment regimes were necessary to
obtain suficient disease control.
Response to treatment was not related to sex, race, age, or HLA-B27-, RF- or
ANA-status.
Conclusions: Treatment of childhood uveitis is complex, based on subtype
and severity, systemic disease and side effects. Intensive monitoring is needed
to avoid systemic and ocular complications. Biologic agents increase the pos-
sibility of suficient disease control considerably.
FP-PED-025
Deep periocular infantile capillary haemangiomas
responding to topical timolol maleate 0.5% monotherapy
Xue, K., Hildebrand, G.D.
King Edward VII Hospital, Prince Charles Eye Unit, Windsor, United
Kingdom
Purpose: Periocular infantile capillary haemangiomas (IH) can cause visual
impairment as well as facial disigurement. Oral propranolol is increasingly
used as irst-line therapy for IH. While propanolol is usually well tolerated by
infants, adverse reactions could occur in around 7% of cases. A growing body
of evidence suggests that the topical β-blocker, timolol maleate, is also effec-
tive in the treatment of supericial IH but with fewer adverse effects. Almost
all published reports so far have focused on topical timolol treatment of super-
icial IH. We presents two infants with deep periocular IH treated with topical
timolol alone.
Methods: A retrospective review of two infants with deep periocular capillary
haemangiomas. Case 1 was a 7-week-old with a deep IH involving the whole
left upper lid, causing lid closure, astigmatism and amblyopia. Case 2 was a
6-month-old with a 15 x 20 mm medial right lower lid IH, causing limitation
of adduction in depression of the right eye. Both were treated with topical
timolol maleate 0.5% gel 3 drops applied twice daily to the skin.
Results: In both cases, topical timolol treatment led to near complete involu-
tion of the deep capillary haemangiomas with functional recovery of vision
and satisfactory cosmesis. Case 1 received 1 year of topical timolol treatment
and achieved equal visual acuity of 6/7.5 in each eye. No evidence of recur-

12
rence was seen after cessation of treatment for 5 months at the last follow-up.
Case 2 was treated for 11 months and achieved visual acuity of 6/9 in each
eye with full range of extraocular movements. No adverse reaction was seen.
Conclusions: These cases represent novel examples of the usage of topical
timolol maleate 0.5% gel in the treatment of deep periocular capillary hae-
mangiomas and suggest that topical timolol may be a viable alternative when
systemic propranolol treatment is contraindicated.
FP-PED-026
Comparative study of transcanalicular laser DCR with
external DCR in children 6 to 15 years of age with
congenital dacryocystitis
Bansal Y.1
, Rastogi A.1
, Moharana R.1
, Kamlesh K.1
, Sachdeva M.1
,
Kapoor M.2
1
Guru Nanak Eye Centre New Delhi, Ophthalmology, Delhi, India,
2
Guru Nanak Eye Centre New Delhi, Ophthalmology, New Delhi, India
Purpose: To compare transcanalicular laser DCR with external DCR.
Methods: Our study was a randomised controlled trial consisting of 20 pa-
tients with congenital dacryocystitis divided in two groups. 10 of them un-
derwent transcanalicular laser DCR and the other 10 underwent external
DCR. Nasal intubation was performed in both methods. Follow up period of
6 months was taken in which success was assessed on basis of syringing and
luorescein dye disappearance test. Post operative complications were also
compared.
Results: At the end of 6 months follow up period, success of both methods
was 90%.Absence of scar mark, reduced intra and post operative bleeding was
seen in patients who underwent transcanalicular laser DCR. There was how-
ever an increased incidence of post operative edema with the above method.
Conclusions: Transcanalicular laser DCR is as effective as externalDCR with
advantages of an incision less surgery, absence of a scar mark, reduced bleed-
ing as well as preservation of medial canthal structures and lacrimal sac pump
mechanism.
FP-PED-027
Aetiology and management of ectopia lentis in
paediatric age group
Chaudhary, M.A.
Nishtar Medical Institution, Ophthalmology, Multan, Pakistan
Purpose: To study the aetiology, complications and visual outcome of ectopia
lentis (EL) in paediatric age group.
Methods: This study was conducted at King Edward Medical University
Lahore, Pakistan. Thirty cases presented with subluxation were selected after
excluding the secondary subluxation. Patients were selected having best cor-
rected visual acuity (BCVA) 6/36 or less, pupil block glaucoma, cataract or
clear subluxated lenses bisecting the pupil. Treatment options used were opti-
cal correction, within the bag limbal lensectomy and anterior vitrectomy (AV)
with aphakic correction and in the bag irrigation/aspiration (I/A) with poste-
rior chamber intraocular lens (PCIOL) implantation with or without capsular
tension ring (CTR) followed by amblyopia treatment.
Results: Marfan’s syndrome was noted in 14(46.7%) eyes, Weill Marchesani
syndrome in 4(13.3%) eyes, homocystinuria in 2(6.7%) eyes, hereditary EL in
4(13.3%) eyes and simple EL in 6(20%) of eyes. Within the bag lensectomy
was performed on 20(66.7%) eyes, optical correction was given in 4(13.3%)
eyes. In the bag I/A with PCIOL implantation with or without CTR was done
in 6(20%) eyes. Preoperative BCVA, HM-6/60 was seen in 14 (46.7%) eyes,
6/36-6/24 in 10 (33.3%) eyes and 6/18-6/12 in 6 (20%) eyes. After six months,
BCVA was 6/6-6/9 in 6(20%) eyes, 6/12-6/18 in 16 (53.3%) eyes, 6/24-6/36 in
4(13.3%) eyes and 6/60-HM in 4(13.3%) eyes.26 (86.7%) eyes showed post
operative BCVA improvement from 2-6 lines on Snellen’s visual acuity chart.
Conclusions: Lensectomy with aphakic correction is a safe and effective
technique for the management of Ectopia Lentis in paediatric age group.In
the bag I/A with PCIOL implantation with or without CTR is an emerging
technique for Ectopia Lentis in paediatric age group.
Keywords: Ectopia lentis, Subluxation of lens, Aphakia, Lensectomy,
Capsular tension ring.
FP-PED-028
Higher order aberrations in amblyopic children and its
role in idiopathic and refractory amblyopia
Santos A.D., Rosa R., Ferreira J., Cunha J.P., Paixão A., Brito C.,
Toscano A.
Centro Hospitalar de Lisboa Central, Ophthalmology, Lisboa, Portugal
Purpose: Some studies have hypothesized that an unfavourable higher or-
der aberrometric proile could be an amblyogenic mechanism, responsible for
some cases of amblyopia refractory to conventional treatment or cases of “id-
iopathic” amblyopia. The objectives of this study are:
1) to compare the aberrometric proile in amblyopic children with that of chil-
dren with normal visual development,
2) to compare the aberrometic proile in corrected amblyopic eyes and refrac-
tory amblyopic eyes with the aberrometry of healthy eyes.
Methods: Cross-sectional study comparing two groups of amblyopic chil-
dren - CA group (22 eyes of 11 children with unilateral successfully treated
amblyopia) and RA group (24 eyes of 13 children with unilateral refractory
amblyopia) - with a control group - C group (28 eyes of 14 children with nor-
mal visual development). Comparisons between the amblyopic and healthy
eyes were also made within the CA and RA groups. Higher order aberrations
were evaluated using OPD-Scan III (NIDEK).
Results: The analysis of the higher-order aberrations with greater impact on
visual quality did not reveal statistically signiicant differences between RA
and C groups, nor did the comparison of amblyopic and healthy eyes within
the CA and RA groups. A statistically signiicant difference was observed be-
tween CA and C groups in 5th order vertical coma, which was higher in C
group.
Conclusions: Contrary to lower order aberrations (myopia, hyperopia and
primary astigmatism), higher order aberrations do not seem to be involved in
the etiopathogenesis of amblyopia. It is also unlikely that these are the cause
of most cases of “idiopathic” or refractory amblyopia.
FP-PED-029
Are we appropriately treating orbital cellulitis in
children? A review of diagnosis and antibiotic treatment
options in a large district general hospital
Bull A.1
, Maino A.2
1
University of Manchester, Manchester, United Kingdom, 2
Stepping
Hill Hospital, Ophthalmology, Stockport, United Kingdom
Purpose: Each year 20-30 children present to our centre with orbital celluli-
tis. Following a multi-disciplinary consultation, guidelines were formulated in
2010 aiming to standardise diagnosis and management. Main features were: 1)
introduction of diagnostic criteria for scanning, 2)Oral antibiotics (ciproloxa-
cin and clindamycin) as irst line treatment to minimise delay. We analysed
clinical compliance with the guidelines.
Methods: All children referred to the paediatric ward between September
2010 and June 2012 were included. Patients aged 17 or those with other causes
of periorbital swelling were excluded. We deined time to treatment (TT) as

13
the interval between diagnosis (as found in the notes) and the irst dose of
antibiotic.
Results: 40 children were included in the audit (22 males). Average age was
6yrs. 32(80%) were referred by their general practitioner, 6 by the emergency
department and 2 by other hospitals. 94% of children presented with preced-
ing upper respiratory tract symptoms, 12% had pyrexia at presentation and
6%(n=2) were vomiting at admission. On ocular examination 17% of children
had reduced visual acuity, 6% had diplopia or proptosis. 30% met the criteria
for an orbital CT scan, but only 15% had it. Out of the 33 eligible patients,
only 9 received oral antibiotics. 22 patients were started on intravenous anti-
biotics (IV) against guidance. Average TT for the oral antibiotic group was
signiicantly lower than the IV group (115 mins vs 198 mins, range 15-180 vs
60-300, p=0.013, t-Student).
Conclusions: Main cause for omitting CT scan was lack of discussion with
the consultant. Despite oral ciproloxacin and clindamycin having equal bio-
availability to IV preparations, clinicians still favoured IV therapy, delaying
treatment. This could be due to the dificulties in gaining IV access and the
logistics of running two infusions through the same IV line. Results of this au-
dit have been presented locally and we are re-auditing our practice in 3 years.
FP-PED-030
Brain functional and structural changes in congenital
ibrosis of the extraocular muscles (CFEOM):
a combined resting-state fMRI and DTI study
Jiao Y.1
, Miao W.2
, Man F
.3
, He H.4
1
Beijing Tongren Hospital, Capital Medical University, Beijing
Ophthalmology and Visual Science Key Lab, Beijing, China, 2
State Key
Laboratory of Management and Control for Complex Systems, Beijing,
China, 3
Beijing Tongren Hospital, Capital Medical University, Beijing
Ophthalmology and Visual Science Key Lab, Beijing Tongren Imaging
Centre, Beijing, China, 4
Institute of Automation, Chinese Academy of
Sciences, Beijing, China
Purpose: Molecular genetic studies have already demonstrated that the
CFEOM are primarily caused by developmental defects of the oculomotor
(CN3), trochlear (CN4) nuclei. Neuroimaging studies show hypoplastic CN3,
CN4, CN6 and abnormalities of target extraocular muscles. The present study
aims to investigate abnormal function in the areas of the brain that control eye
movements of CFEOM, using resting-state fMRI and DTI.
Methods: Two patients and six age and gender matched controls were scanned
using a 3T GE Signa Hdxt MRI. Amplitude of low-frequency luctuations
(ALFF), Regional Homogeneity (ReHo) and posterior cingulate cortex (PCC)
based correlation were then calculated. DTI were processed using FSL’s TBSS
toolbox. Statistical analyses were then performed using Two-sample t-test of
SPM.
Results: Compared to controls, the patients’ Superior Frontal Gyrus shown
ALFF increase (P< 0.001 uncorrected for all results) and in correlation with
PCC, occipital pole shown ReHo decrease, Lateral Occipital Cortex shown
decrease in correlation with PCC and Lingual Cortex shown increase in cor-
relation with PCC. TBSS successfully ind out FA decrease in middle brain.
Conclusions: The present study suggests that CFEOM can result in functional
and structural changes in visual cortex and areas controlling eye movement, as
revealed by ALFF, ReHo, PCC based correlation and TBSS. FA changes in the
area which containing oculomotor nucleus may best explained by increased
extracellular bulk water, indicating the loss of the myelin sheath due to lack
of stimuli. We have not yet found clear relation between structural changes
revealed by DTI and functional changes revealed by resting-state fMRI.
FP04: RETINA I
FP-RET-031a
Long-term outcomes after cataract surgery in patients
(pts) with chronic diabetic macular oedema (DME)
treated with ILUVIEN implant releasing 0.2 µg/day
luocinolone acetonide (FAc)
Augustin, A.J., the FAME Study Group
Städtisches Klinikum Karlsruhe, Augenklinik, Karlsruhe, Germany
Purpose: Steroid treatment can increase likelihood of cataract development,
and cataract surgery can impact visual acuity and result in complications.
Eficacy and safety outcomes after cataract surgery were assessed as part of
the Fluocinolone Acetonide for Diabetic Macular Edema (FAME) trial to de-
termine the impact of ILUVIEN on these outcomes.
Methods: The FAME study consisted of 2 randomized, prospective, multi-
center, double-masked, sham-controlled, parallel-group phase 3 trials enroll-
ing 956 pts with DME despite ≥1 prior macular laser treatment. Pts received
ILUVIEN (0.2 µg/d FAc; n=376), 0.5 µg/d FAc (n=395), or sham control
(n=185). All pts were eligible for rescue laser therapy 6 weeks after random-
ization at masked investigator discretion, and retreatment with randomized
therapy after 12 mos by meeting prespeciied retreatment criteria. Prespeciied
subgroups, including the duration of DME at baseline (< or ≥ median),
were analyzed to determine which pts may achieve the greatest beneit from
ILUVIEN.
Results: Among phakic ILUVIEN-treated pts, 80% of the full population
and 85% of the chronic DME population underwent cataract surgery during
FAME. Among ILUVIEN-treated pts who underwent cataract surgery, 43.4%
experienced ≥15-letter improvement in BCVA at mo 36. Among ILUVIEN-
treated pts with chronic DME, mean BCVA increased 20.6 and 23.7 letters at
1 mo and 12 mos postcataract surgery, respectively, vs 6.3 and 13.9 letters for
control pts with chronic DME. During the 12-mo postcataract surgery period,
there was no evidence of exacerbation of luorescein leakage, increased reti-
nopathy, or reduction in wound healing with ILUVIEN.
Conclusions: In pts receiving ILUVIEN, neither diabetic retinopathy nor
DME were exacerbated following cataract extraction. There was no indica-
tion of an increase in common safety concerns after cataract surgery with
ILUVIEN present, and results suggest a positive functional outcome for
ILUVIEN-treated pts undergoing cataract surgery.
FP-RET-031b
Diabetic retinopathy in newly diagnosed diabetic
subjects in Skåne, Sweden, during 2008-2012.
Baseline indings
Gustavsson, C.1,2
, Dorkhan, M.3
, Waerme, M.1
, Romberg, M.1
,
Groop, L.3
1
Department of Clinical Sciences in Malmö, Ophthalmology, Malmö,
Sweden, 2
Lund University, Malmö, Sweden, 3
Department of Clinical
Sciences in Malmö, Diabetes and Endocrinology, Malmö, Sweden
Purpose: Diabetes treatment, ophthalmological intervention possibilities and
population demographics in Sweden change continuously, which is why new
epidemiological data on diabetic retinopathy (DR) is continuously warranted.
The regional program All New Diabetics in Skåne (ANDIS) involving all
hospitals and primary care centers in Skåne is collecting data from all newly
diagnosed diabetics. The purpose of ANDISec is to assess the prevalence and
incidence of DR associated to individual risk factors in 2000 subjects from
the cohort.

14
Methods: 2028 subjects, 1180 men (58.2%) and 848 women (41.8%) from
the ANDIS cohort went through routine fundus photography screening for
DR during 2008-2012. Information on patient characteristics, diabetes type
and ethnicity was collected from the ANDIS database. The International
Classiication of Diabetic Retinopathy was used for DR grading.
Results: Median age was 61 (17-91) years. The distribution of diabetes was
2.1% type 1, 84.5% type 2, 5.5% LADA, 0.1% MODY and 1.0% secondary
diabetes. 65.8% of subjects originated from Sweden. At diagnosis 86.6% of
subjects had no, 8.7% mild, 4,2% moderate, 0.4% severe and 0.1% prolifera-
tive DR. DR prevalence was highest in type 2-diabetes (13%) but also evident
in other types (7-9.5%). Men and immigrants were at higher risk of having
DR at diagnosis (OR 1.4, p=0.005 and 1.3, p=0.018, respectively). 406 (20%)
subjects attended a second visit. The incidence of new DR was 52 per 1000
person-years. Progress was evident in over 50% of subjects.
Conclusions: The prevalence of DR at diagnosis was surprisingly low, re-
lecting early diabetes diagnosis as well as DR screening. ANDISec envis-
ages future assessment of individual medical, social and genetic risk factors
and aims to follow the entire cohort in ive-year intervals, to tailor individual
screening and treatment intervals.
FP-RET-032
OCT measurement of outer retinal thickness in diabetic
macular oedema
Wong I.Y.H.1
, Yeung I.2
1
The University of Hong Kong, Ophthalmology, Hong Kong, Hong
Kong, 2
University of Hong Kong, Ophthalmology, Hong Kong, China
Purpose: To investigate the correlation of outer retinal thickness (distance
between the retinal pigment epithelium and the external limiting membrane)
and visual acuity in patients with diabetic macular oedema.
Method: Eyes with conditions other than DME, and conditions that would
render media unclear for OCT scans were excluded. Each subject was as-
sessed by a Snellen visual acuity chart, and OCT scan using the Heidelberg
Spectralis (Heidelberg, Germany). The scanned images were then analyzed
with the software provided by Heidelberg (Heidelberg Explorer). The hyper-
relective lines in the outer retina were identiied, and the distance between the
external limiting membrane (ELM) and the retinal pigment epithelium (RPE)
was measured using the built-in caliber. Those with disruption of the ELM at
the fovea were excluded from further analysis. A P value < 0.05 was consid-
ered statistically signiicant.
Results: A total of 108 eyes of 108 subjects were recruited, but 30 (27.8%)
were excluded due to disruption of the ELM, resulting in 78 eyes for analysis.
The mean age was 58.1±11.5 years. 51 of them were male (47.2%). Mean
refractive error was -1.3±2.5 dioptres. The mean Snellen VA was 0.51±0.18.
Mean total retinal thickness (TRT) at fovea was 398.0±74.3mm. Mean outer
retinal thickness (ORT) at fovea was 115.7±35.6mm. When both the TRT and
ORT were compared against VA, both had P< 0.001. When TRT was cor-
related with VA, r was 0.34. When ORT was correlated with VA, r was 0.65.
Conclusion: This was the irst study to use the distance between the ELM
and the RPE to correlate with VA in subjects with DME. There was good cor-
relation between VA and outer retinal thickness (ELM to RPE). Our results
were comparable to published series using total retinal thickness. It serves as
a novel marker when assessing patients with DME.
FP-RET-033
Dynamics of retinal oxygen extraction during
hyperglycemia
Klefter O.N.1,2
, Larsen M.1,2
1
Glostrup University Hospital, Department of Ophthalmology, Glostrup,
Denmark, 2
University of Copenhagen, Copenhagen, Denmark
Purpose: To study changes in retinal oxygen extraction during hyperglycemia
in healthy volunteers.
Methods: Fifteen eyes of 15 healthy volunteers were examined after an over-
night fast and following pupil dilation to a diameter of more than 7 mm with
1% tropicamide and 10% phenylephrine hydrochloride. Retinal snapshot ox-
imetry (Retinal Oximeter T1, Oxymap, Iceland) was performed at baseline
and every 30 minutes for 3 hours after an oral glucose load (75 g). Three
oximetry images centred on the optic disc were captured at each time point.
The largest supero- and inferotemporal arterial and venous segment were
identiied at a distance of 0.5 to 1.0 disc diameter from the optic disc margin.
Using proprietary software (Oxymap Analyzer v 2.3.2) oxygen saturations
were measured and results were averaged across the three images at each time
point. Retinal oxygen extraction was approximated by the arterio-venous (a-
v) oxygen saturation difference. Mixed model analysis with post-hoc Dunnett
comparisons were used to characterise changes in blood glucose and oxygen
extraction over time.
Results: Blood glucose increased from 4.4 ± 0.2 mmol/l to 7.7 ± 0.3 mmol/l
after 30 minutes (p < 0.0001) and reached its peak value of 8.0 ± 0.4 mmol/l
after 60 minutes. This was followed by a slow decline and blood glucose
reached near-baseline values at 150 minutes.
The a-v oxygen saturation difference was stable for the irst 60 minutes but
increased from the fasting level of 33.6 ± 1.3 % to a nadir of 35.4 ± 1.4 % at
90 minutes (p < 0.05). It remained signiicantly increased at 120 minutes but
was reduced to 34.5 ± 1.5% at 180 minutes (p = 0.43).
Conclusions: A transient increase in retinal oxygen extraction was found dur-
ing hyperglycaemia in healthy volunteers. The change in oxygen extraction
occurred 30-60 minutes after the blood glucose peak. This time lag may be
necessary for the retina to redirect its metabolic pathways which could also
have been conditioned by the preceding overnight fast.
FP-RET-034
Six hours post intravitreal bevacizumab (Avastin)
visual acuity: a predictor of its therapeutic response in
macular oedema
Anuradha A., Singh S., Sheokand M., Sahoo M.K., Khanduja S.,
Nada M.
Pt.B D Sharma PGIMS, Ophthalmology, Rohtak, India
Purpose: To evaluate visual improvement after 6hrs of a single/subsequent in-
travitreal injection of bevacizumab for the management of macular oedema in
CNVM, RVO (ischemic&nonischemic) & DR and correlation of early visual
improvement with the visual acuity and decrease in central macular thickness
(CMT) after 4 weeks.
Methods: 100 patients of macular oedema due to CNVM, RVO&DR having
BCVA≤20/40 were included. Total 191 shots (1.25mg) were given.
Ophthalmic evaluation was performed prior to injection and at 6hrs and 4(±1)
wks following each shot. Main outcome measures were changes in visual acu-
ity and CMT. Visual improvement considered signiicant if ≥1line.
Results: 36CNVM,35nonischemic RVO, 9ischemic RVO, 20 patients of DR
were included.In CNVM group,preinjection CMT was 344.362±85.924µ
& decreased to 298.219±90.904µ(p< 0.05)at 4wks.The logMARBCVA im-
proved from 0.907±0.533 preinjection to 0.749 ±0.425&0.699±0.420 at
6hr&4wks respectively(p< 0.05).In nonischemic RVO group, preinjection

15
CMT was 446.482 ±137.248µ & decreased to 287.258±61.955µ(p< 0.5)
at 4wks.The logMARBCVA improved from0.774±0.497 preinjection to
0.482±0.271&0.438±0.253 at 6hrs&4wks(p< 0.05).In ischemic RVO, prein-
jection CMT was 626.666±215.719µ & decreased to 368.9444±113.684µ(p<
0.05) at4wks.The logMARBCVA improved from1.402±0.640 preinjection
to1.101±0.494&1.047±0.462 at6hrs&4wks(p< 0.05). In DR group, preinjec-
tion CMT was 425.875±89.872& decreased to 326.136±87.795µ(p< 0.05)
at4wks.The logMARBCVA improved from 0.611±0.279 preinjection to
0.456±0.293&0.447±0.278 at 6hrs&4wks(p< 0.05).
Conclusions: Visual improvement was achieved with intravitreal injection of
bevacizumab in patients with macular edema as early as in6hrs. Out of 191
shots given, 58.63% showed therapeutic response at 6hrs and all of them either
maintained or showed further increased response at4wks. Out of remaining
41.37% shots only 8.86% had responded at 4wks. Improvement in outcome
measures were obtained in the following order:nonischemicRVO>CNVM>is
chemicRVO>DR.
FP-RET-035
The progression of diabetic retinopathy in type 2 of
diabetes mellitus and its treatment with statins
Pavlyuchenko, K.1
, Oleynyk, T.2
, Korobova, A.2
1
Donetsk National Medical University, Donetsk, Ukraine, 2
Donetsk
National Medical University, Ophthalmology Department, Donetsk,
Ukraine
Purpose: The purpose of the study was to evaluate the progression of diabetic
retinopathy (DR) in patients with type 2 of diabetes after phacoemulsiication
of cataract and simvastatin treatment.
Methods: The design of our study was a prospective observational. For 3
years we have observed 82 patients (91 eyes) with type 2 of diabetes with
the absence and the initial stages of DR after phacoemulsiication of cata-
ract. The patients were divided into two groups: the study group (42 patients,
47eyes) received 40 mg of simvastatin for 3 years, in the control group (40
patients, 44 eyes) received only oral antidiabetic therapy. The average dura-
tion of diabetes in the study group was 5.22±0.47 years and 5.02±0.49 years in
the control group (p=0.71). The study group included 59.58% of eyes without
DR, 21.28% of eyes were with mild non-proliferative DR (NPDR), 19.15% of
eyes were with moderate NPDR. The control group included 61.36% of eyes
with no DR, 18.18% of eyes had the mild NPDR, 20.45% of eyes had moder-
ate NPDR. The data were analyzed with the program STATISTICA 6.0 for
Windows. We used Mann-Whitney test and Fisher’s exact test.
Results: After 3 years of observation 40.43% of eyes with no DR remained in
the study group, that was signiicantly higher than in the control group 22.73%
(p=0.033). In the study group more eyes remained with mild NPDR - 29.79%
in comparison with the control group - 15.91% (p=0.056). Moderate NPDR
developed in 23.40% of eyes in the study group, which was signiicantly lower
than in the control group - 43.18% (p=0.022). Severe nonproliferative and
proliferative DR developed in 6.38% of eyes in the study group, which was
signiicantly lower as compared to 18.18% in the control group (p=0.039).
Conclusions: Simvastatin treatment of the patients with type 2 of diabetes
reduces the diabetic retinopathy incidence from 72.73% to 53.19% in all cases
(p=0.026).
FP-RET-036
Combination of ranibizumab and navigated retinal
photocoagulation in diabetic macular oedema,
compared to ranibizumab mono-therapy: twelve month
results
Kernt M., Langer J., Ulbig M., Haritoglou C., Kampik A., Neubauer A.S.
LMU, Ophthalmology, Munich, Germany
Purpose: The purpose of this study is to evaluate the impact of navigated
retinal photocoagulation on the number of intravitreal anti-VEGF injections
necessary to maintain visual gain in patients with diabetic macular oedema
(DME), compared to anti-VEGF mono-therapy.
Methods: A consecutive series of 76 eyes with DME were included and
randomized into 3 groups: 1. Ranibizumab monotherapy (n=27; using an ob-
servation and retreatment paradigm for anti-VEGF therapy that is compliant
with the European Public Assessment Report (EPAR, European Medicines
Agency) for ranibizumab),
2. Three consecutive monthly ranibizumab injections followed by navigated
laser therapy, then application of the observation and retreatment paradigm as
in group “1” (n=15),
3. Monthly ranibizumab injection until central retinal thickness (CRT) was
reduced to 450µm (Spectralis OCT) then navigated laser therapy followed
by the application of the observation and retreatment paradigm as in group
“1” (n=34). Subjects were followed monthly (best corrected Visual acuity
(BCVA), CRT) for 12month, to assess the number of anti-VEGF injections
required to maintain stable clinical improvement.
Results: After 12 month BCVA increased and in all three investigated groups
signiicantly (group 1: 6.3 ±6.77; group 2: 7.1 ±8.22; group 3: 7.4 ±7.53 let-
ters). To achieve these results, after an upload of three consecutive monthly
applied ranibizumab injections, ranibizumab mono-therapy group (group 1)
needed 5.2 ± 3.2 injections. In contrast, group 2 and 3 nedded signiicantly less
ranibizumab injections (0.5 ± 0.8 and 0.8 ± 1.1, p< 0.001).
Conclusions: In this study, additional navigated laser therapy applied after
3 initial anti-VEGF injections in DME patients was effective in preserving
visual gains, comparable to anti-VEGF mono-therapy. In addition, navigated
macular laser reduced the number of injections needed signiicantly.
FP-RET-037
FP-RET-038
Predictive value of the area of peripheral retinal non-
perfusion on treatment response in branch and central
retinal vein occlusion
Sadda S.R.1
, Tan C.2
, Singer M.3
1
University of Southern California, Ophthalmology, Los Angeles,
United States, 2
Tan Tock Seng Hospital, Ophthalmology, Singapore,
Singapore, 3
Medical Center Ophthalmology, San Antonio, United
States
Purpose: To evaluate the extent of retinal non-perfusion in patients with
branch or central retinal vein occlusion (RVO) and to determine the effect of
the size of the ischemic area on the response to treatment, duration of treat-
ment effect, and requirement for re-treatment.
Methods: 32 patients with RVO were recruited at the Medical Center
Ophthalmology Associates (San Antonio, Texas) for this study. Patients were
treated with intravitreal anti-VEGF injections and the dexamethasone intra-

16
vitreal implant. At presentation and each follow-up clinic visit, patients un-
derwent 200-degree wideield luorescein angiography (FA) and color fun-
dus photography using the Optos 200Tx, and spectral domain OCT using the
Cirrus OCT. The FA images were centered on the fovea, and then steered to
visualize the retinal periphery. The areas of ischemia were manually graded in
a masked fashion and the severity of ischemia was expressed as a percentage
of the total area of retina visible.
Results: The mean extent of retinal ischemia was 14.8% (range, 0% to 68%,
SD ± 17.3), with 17 patients (53%) having ischemia of 10% or less, while
the remaining 15 (47%) had areas of ischemia >10%. At study entry when
macular oedema was present, the mean central subield thickness on OCT was
signiicantly thicker in those with total areas of ischemia >10% compared to
those 10% (520.8 µm vs. 424.5 µm, p=0.029). Similarly, the decrease in OCT
thickness in response to treatment was greater for those with ischemia >10%
(-296.1 µm vs. - 165.3µm, p=0.019). The time to recurrence of macular oe-
dema was slightly longer for those with ischemia >10% (4.3 vs. 3.4 months),
but this was not statistically signiicant.
Conclusions: Patients with RVO demonstrate considerable variability in the
extent of peripheral retinal non-perfusion. The area of non-perfusion at base-
line appears to affect the severity of retinal thickening and the magnitude of
reduction in retinal thickness on OCT with treatment.
FP-RET-039
Three intravitreal bevacizumab versus two intravitreal
triamcinolone injections in recent onset central retinal
vein occlusion; a randomized clinical trial
Ramezani A.1
, Esfandiari H.1
, Entezari M.1
, Moradian S.1
, Soheilian M.1
,
Dehsarvi B.2
, Yaseri M.3
, Nikkhah H.1
1
Shahid Beheshti University of Medical Sciences, Ophthalmology,
Tehran, Islamic Republic of Iran, 2
Ophthalmologist, Sari, Islamic
Republic of Iran, 3
Shahid Beheshti University of Medical Sciences,
Tehran, Islamic Republic of Iran
Purpose: To compare three intravitreal injections of bevacizumab (IVB)
versus two intravitreal injections of triamcinolone (IVT) in the treatment of
macular oedema in acute central retinal vein occlusion (CRVO).
Methods: In a randomized clinical trial, 86 eyes with recent onset (less than
12 weeks) CRVO were included. Participants were randomly assigned to two
treatment groups: IVB group (43 eyes), patients who received 3 monthly in-
jections of 1.25 mg of IVB, and IVT group (43 eyes), patients who received 2
injections of 2 mg IVT two months apart. Main Outcome Measure was change
in best-corrected visual acuity (BCVA) at 6 months. Secondary outcome mea-
sures were central macular thickness (CMT) and intraocular pressure (IOP)
changes.
Results: Mean BCVA improved signiicantly up to 6 months in both groups
from 0.87±0.49 to 0.41±0.35 logMAR in the IVB group and from 0.81±0.45
to 0.62±0.48 logMAR in the IVT group (P< 0.001 for both). However, be-
tween-group differences reach to a signiicant level at months 4 (P=0.003) and
6 (P< 0.001) in favor of the IVB group. In terms of CMT reduction, similarly,
both groups showed a signiicant decrease at the months 3 and 6 and the dif-
ferences between the groups were statistically signiicant (P=0.002) at inal
visit again in favor of the IVB group. Dividing the cases into ischemic and
non-ischemic types, more difference was noted in the ischemic cases regard-
ing BCVA improvement and CMT reduction in favor of the IVB group. Mean
IOP rise was signiicantly higher in the IVT group at all visits.
Conclusions: Both 3 times monthly IVB injections and 2 times IVT injec-
tions could be effective for improving BCVA and CMT in recent onset CRVO.
However, considering the better visual and anatomic outcomes after IVB in-
jections and the potential complications of IVT injections, we would recom-
mend prescheduled repeated IVB injections for such cases.
FP-RET-040
Anti-vascular endothelial growth factor therapy in
patients with retinal vein occlusion: 5 years of clinical
experience
Rezar S., Sacu S., Eibenberger K., Blum R., Georgopoulos M.,
Bühl W., Schmidt-Erfurth U., Macula Study Group Vienna
Medical University of Vienna, Department of Ophthalmology and
Optometry, Vienna, Austria
Purpose: To determine long-term effects of intraocular antagonism of vascu-
lar endothelial growth factor (VEGF) in patients with macular edema second-
ary to retinal vein occlusion.
Methods: From case series concerning macula edema secondary to branch
retinal vein occlusion (BRVO) 54 patients were treated with either intravitreal
ranibizumab (IVR, n=25) or bevacizumab (IVB, n=29). After a mean of 5
years 28 of these patients were included into this cross-sectional study. Main
outcome measures were mean change in best-corrected visual acuity (BCVA)
from initial treatment, change in central retinal thickness (CRT) and retinal
sensitivity (CRS).
Results: Mean time between onset of RVO and initial treatment was 188±141
days in the IVB group (n=14, 48%) and 51±31 days In IVR group (n=14,
56%). 28 of the original 54 patients were successfully recruited to the study.
The mean follow-up was 6±1.0 years in the IVB group and 4±0.8 in the
IVR group. In the IVB group, the average visual acuity increased by 6 let-
ters, however this was not statistically signiicant (p=0.3). CRS improved by
3.1dB (p=0.01) and CRT decreased by 162 µm (p=0.02). In the IVR group,
visual acuity and CRS increased signiicantly (27 letters; 4.6dB) (p< 0.001)
and the CRT decreased 229µm (p< 0.001). A mean of 9±5.4 injections were
performed in the IVB group and 6±5.6 injections in IVR group. 6 patients in
the IVB group and 4 patients in IVR group received additional sector laser
photocoagulation due to retinal ischemia.
Conclusions: Our indings show that the inhibition of vascular endothelial
growth factor provides a substantial long-term beneit in patients with macular
edema secondary to branch retinal vein occlusion. Early treatment with anti-
VEGF agents showed better visual recovery in our patients.

17
FP05: GLAUCOMA
FP-GLA-041
FP-GLA-042
The effect of child delivery process on the intraocular
pressure in healthy women
Geffen N., Meshi A., Armarnik S., Kaneti H., Assia E.I., Segev F
.
Meir Medical Center, Kfar Saba, Affiliated with Tel Aviv University,
Ophthalmology, Kfar Saba, Israel
Purpose: To investigate the effect of vaginal child delivery on the intraocular
pressure (IOP) in healthy women.
Methods: Open, prospective, non-randomized clinical trial, enrolling healthy
pregnant women candidates for vaginal delivery. Medical, ophthalmic and ob-
stetric histories were obtained at enrollment and biomicroscopic examination
was performed. Heart rate (HR), blood pressure (BP) and IOP were measured
at enrollment, during the 1st
(latent and active phases), 2nd
and 3rd
stages of the
delivery and at 24, 48 hours postpartum. The average of 3 IOP measurements
(variance< 5%) was calculated. Labor position and drugs were documented.
Results: Thirty healthy Caucasian women were recruited. Average age was
31.5 years (range 19-41). Mean gestational age was 39.2 weeks. The mean
number of pregnancies and deliveries was 2.2 and 1.4, respectively. Four
women had dropped-out from the study due to an unplanned conversion to
cesarean section. Fourteen women required induction of labor with oxytocin.
All received epidural anesthesia. Twenty six women were in supine position,
3 in left decubitus and 1 in right decubitus position. The mean IOP (±SD)
measured on admission, during the latent and active phases of the 1st
stage
and during the 2nd
and 3rd
stages of the delivery, 24 and 48 hours post-delivery
were 11.8±3.6 mmHg, 11.9±3.3 mmHg, 11.8±2.9 mmHg, 12.1±3.1 mmHg,
12.2±4.0 mmHg, 11.9±2.4 mmHg and 13.2±2.3 mmHg, respectively (P >
0.05). Mean HR and BP remained stable during all stages of delivery.
Conclusions: To the best of our knowledge this is the irst time that the impact
of the modern labor on the IOP was investigated. IOP changes documented
during vaginal delivery under an epidural anesthesia were within the physi-
ologic diurnal variation range. IOP changes during labor probably have no
clinical signiicance in healthy women and should not serve as an indication
for changes in the planned management of labor.
FP-GLA-043
FP-GLA-044
Primary open-open angle glaucoma as compared to
exfoliation glaucoma at the time of diagnosis in Finland
Kivelä T., Tarkkanen A.
Helsinki University Central Hospital, Department of Ophthalmology,
Helsinki, Finland
Purpose: To compare ocular indings in eyes with primary open-angle glauco-
ma (POAG) and exfoliation glaucoma (EG) at the time of diagnosis in Finland
based on identical national diagnostic criteria for glaucoma.
Methods: We obtained the medical certiicates of 505 consecutive, unselected
patients with open-angle glaucoma iled for reimbursement of cost-free medi-
cation by the Finnish National Social Insurance Institute (FSII). The certii-
cates had been written by hospital- or private practice-based ophthalmologists.
The criteria for glaucoma had been set and enforced by the FSII. Of the 505
patients, 329 patients had POAG and 176 had EG. The main outcome mea-
sures were best corrected visual acuity (BCVA), intraocular pressure (IOP),
cup/disc (C/D) ratio of the optic nerve head, and glaucomatous changes of
the visual ields (VF). The mean values for the left and right eye were used
in the analysis.
Results: The two groups were comparable as regards gender with 67% of
females. The EG patients were older (median, 75 vs. 69 years, P=0.0001),
had a lower median BCVA (0.76 vs. 0.84 on Snellen scale; P=0.0012) and
a higher IOP (27 vs. 24 mmHg; P=0.0001), but a lower C/D ratio (0.55 vs.
0.60; P=0.0011) and a lower VF category indicating a better preserved ield
(P=0.016) as compared to POAG patients. In the VF categories 0 and 1 (nor-
mal ields or Bjerrum’s scotoma, respectively), there were 15% and 60% of
POAG eyes as compared to 45% and 36% of EG eyes, respectively.
Conclusions: Our study conirmed the well known higher age, higher IOP and
poorer BCVA at the time of diagnosis in EG patients as compared to POAG
patients. Unexpectedly, in spite of their higher age and higher IOP, optic neu-
ropathy was less advanced in EG patients as judged both by their C/D ratios
and VF indices. This suggests that a previously unrealized potential may exist
for preserving vision by immediate and effective life-long antiglaucomatous
therapy in newly diagnosed EG.
FP-GLA-045
Patient behaviour when prescribed non-affordable
glaucoma medication in the Medical Service Unit of the
National Research Center, Cairo, Egypt
Saeed Ibrahim, A.
National Research Center, Medical Research Division, Ophthalmology
Department, Cairo, Egypt
Purpose:
(1) Identify cost-reducing strategies, including cost related non-adherence
(CRN), employed by primary open-angle glaucoma (POAG) patients,
(2) explore impact of better doctor-patient interaction (DPI) on CRN; and (3)
pinpoint best DPI methods that minimized CRN.
Methods: Cross-sectional study was enrolled on consecutive adult patients
attending the eye clinic of the medical service unit of the National Research
Center, Cairo, Egypt, diagnosed with POAG and on outpatient topical anti-
glaucoma treatment in the irst 8 months of 2012. Data were collected via an
interviewer-administered questionnaire. The impact of factors such as educa-
tion, insurance, drug cost to income ratio and physician trust were tested using
multivariate logistic regression.
Results: Data gathered from 280 patients of mean age 50.7 ± 10.8 years,
showed that 75% of patients employed at least 1 method of CRN (termed
CRN+). Of those, up to 70% postpone buying prescriptions, 64% skip their
doses, and 28% ignore buying it altogether.

18
We found signiicant relationships between lower CRN scores and better
insurance coverage (p=0.002), higher education (p=0.002), lower values of
“drug cost to monthly income” ratios (p=0.003), lower number of prescribed
drugs (p=0.003), and better DPI regarding drug costs (p = 0.004).
Only 58% of CRN+ patients reported having DPI, (termed CRN+[DPI]). In
CRN+[DPI], the most common methods were doctors showing sympathy
towards patients’ drug costs (72%), ensuring patients’ affordability of drugs
(65%), and changed one to a cheaper alternative (62%). And in those who
reported not having DPI, the most cited cause was “being embarrassed” to ask
about drug costs (80%).
Conclusions: Future strategies should focus on improving DPI to lower CRN.
Ensuring patient education on drug costs, showing strong emotional support,
and reducing polypharmacy can signiicantly lower CRN. Encouraging pa-
tients to ask for cheaper alternatives can also help.
FP-GLA-046
Inluence of dispensary at glaucoma progression
Vitovska O.P.1
, Zbitneva S.2
, Deryapa I.2
, Obuhova N.2
1
O.O.Bogomolets National Medical University, Ophthalmological
Department, Kiev, Ukraine, 2
P.L. Shupik National Medical Academy
of Postgraduated Education, Ophthalmological Department, Kiev,
Ukraine
Purpose: To determine the inluence of regular medical check-up on the vi-
sual functions of glaucoma patients.
Methods: 150 glaucoma patients with the beginning stage have been under
the investigation. We have determined the visits frequency, IOP control fre-
quency, compliance. We have evaluated visual acuity, IOP, visual ield and
NFI evolution in % to the data year before.
Results: We have classiied the quality of monitoring like low, middle and
high. High quality means not less than 4 visits per year, not less than one
IOP control per 2 months, neuroprotective treatment two times per year, high
compliance. Middle one - 2-3 visits per year, IOP control ones per 3 months,
neuroprotective treatment once per year, bad compliance. Low quality means
- one visit per year, IOP control - once per 6 months, incompliance. We have
marked that low monitoring quality leads to decrease of VA on 7,9%, increase
of IOP on 5,9%, narrowing of VF on 9,5%. These patients have demonstrated
the worsening of glaucoma disease in 59%.
From the other hand, in the group with high monitoring quality we have
marked IOP decreasing on 25%, VF improvement on 10,5%, stabilization of
NFI, improving of VA on 8,7%, stabilization of glaucoma in 98%.
Conclusions: Limitations of glaucoma regular medical check-up quality leads
to the progression of disease already at the beginning stage of disease.
FP-GLA-047
Leukosapphire drainage in refractory glaucoma:
a comparative study
Volik S.1
, Khade A.1
, Sakhnov S.2
, Volik E.3
1
Kuban State Medical University, Pathophysiology, Krasnodar,
Russian Federation, 2
Kuban State Medical University, Ophthalmology,
Krasnodar, Russian Federation, 3
Hospital of Veterans of Wars, Eye
Surgery, Krasnodar, Russian Federation
Purpose: To evaluate the eficacy of use of the leukosapphire drainage (LED)
(glaucoma iltration device, that consists of tube 2,4 mm long with broadening
on one of the ends, and its inner diameter 0,3 mm) in maintenance of stable
hypotensive effect in treatment of refractory glaucoma
Methods: A total of 72 eyes of 64 patients with refractory glaucoma consecu-
tively included in this study were divided in two groups. Case group included
41 eye of 39 patients who had undergone deep sclerectomy with LED implan-
tation in modiication (the body of the tube was ixed under supericial sclera
lap, which was inserted into suprachoroidal space) and posterior sclerectomy.
In the control group, 31 eyes (25 patient) with deep penetrating sclerectomy
and deep posterior sclerectomy were randomly selected for comparison with
the case group.
Results: Postoperative IOP was at the level of 16-18 mm Hg in 36 eyes
(87,8%) of 34 patients in the case group. In 3 eyes (7,3%) of 3 patients IOP
was 19-24 mmHg, decompensation of IOP ( >25 mm Hg) was recorded in
2 eyes (4,9%) of 2 patients1. In control group postoperative IOP was 16-18
mm Hg in 12 eyes (38,7%) of 10 patients, 19-24 mm Hg in 6 eyes (19,4%)
of 5 patients. Decompensation of IOP was registered in 13 eyes ( 41,9%) of
ten patients.
Conclusions: Use of LED in glaucoma iltering surgery allows to achieve a
long-run hypotensive effect due to constant low of aqueous humor, which
also prevents scar formation. The additional outlow tract into supraciliary
and suprachoroidal spaces also contributes to prolonged maintenance of hy-
potensive effect.
FP-GLA-048
Topical eye treatment with BDNF rescues pattern
electroretinogram and retinal ganglion cells in DBA/2J
murine model of glaucoma
Domenici L.1,2
, Falsini B.3
, Origlia N.1
, Cerri E.1
, Barloscio D.1
,
Sansò M.4
, Giovannini L.4
1
National Research Council of Italy (C.N.R), Institute of Neuroscience,
Pisa, Italy, 2
University of L
’Aquila, L
’Aquila, Italy, 3
Università Cattolica
del Sacro Cuore, Institute of Ophthalmology, Rome, Italy, 4
University
of Pisa, Department of Translational Research on New Technologies in
Medicine and Surgery, Pisa, Italy
Purpose: The present study is focused on new approach using topical eye
treatment with BDNF to protect retinal ganglion cells (RGCs) in glaucoma.
Methods: We used the DBA/2J mouse model of glaucoma (JAX Mice strain).
In these mice we measured the intraocular pressure (IOP) at different postnatal
ages. RGCs function was evaluated by means of the pattern electroretinogram
(PERG) evoked by alternating gratings of different spatial frequencies in an-
aesthetized mice; visual evoked cortical potentials (VEPs) were also recorded.
Cell density of RGCs was assessed by immunostaining using speciic anti-
bodies recognizing markers of RGCs (Brn3 and y-synuclein) and confocal
microscopy analysis in lat mounted retinas; Brn3 is POU domain-containing
transcription factor and y-synuclein is member of small unfolded proteins.
Highgly puriied human recombinant BDNF was topically applied on ocu-
lar surface at the level of conjunctival fornix (concentrations: 1-15 µg/µl in
physiological solution). Retinal BDNF level was measured by ELISA in tissue
homogenates.
Results: A single drop eye application of BDNF induced signiicant increase
of BDNF level in the retina of normal mice treated eyes (C57BL/6J; n=5)
compared to vehicle treated control eyes (n=5). Repeated topical eye applica-
tion (one BDNF drop every 48 h for two weeks starting from 7 months of age)
was able to prevent the reduction of PERG and VEP amplitudes in DBA/2J
mice characterized by elevated IOP (n=8 eyes); in addition topical eye BDNF
treatment restored RGCs expressing Brn3 in 7 month DBA/2J mice (n =8
eyes).
Conclusions: Repeated topical eye treatment with BDNF rescues visual func-
tion and diminishes the vulnerability of RGCs to ocular hypertension in a
murine model of glaucoma.

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