3^rd Global Pediatric Ophthalmology Congress March 22-23, 2018 Park Inn by Radisson Hotel, London, UK

Biography:

Didar S Anwar has completed Pediatrics and Strabismus Fellowship training at Wilmer Eye Institute-Johns Hopkins Hospital. He is now Director of Neega Eye Center in Erbil, Iraq. He was speakers at many national and international ophthalmology meetings. He has also many peer-reviewed publications in international
journals.

Abstract:

Aim: To report the outcome of the first 10 cases of 360 degree prolene suture trabeculotomy at Neega Eye Center.
Methods: Ten eyes underwent 360 degrees prolene suture trabeculotomy by one surgeon (DA). Mean age was six months. Mean postoperative follow-up was one year. Preoperative mean intra-ocular pressure was 35 mm Hg.  Tonopen Avia was used to measure the intraocular pressure. Surgical Technique: Conjunctival peritomy is  performed. The sclera is then cauterized. Four by four millimeter flap is fashioned. Then another two by two millimeter flap is also performed. Schlemm’s canal is reached and 5-0 prolene suture is inserted and pushed 360 degree until the prolene suture come out from the other end. The prolene suture is then pulled to open the trabecular meshwork 360 degree and this way decrease the outflow resistance and decrease the intraocular pressure. Results: Postoperative mean intraocular pressure was 18 mm Hg. The corneal edema cleared in all eyes. Three eyes underwent further surgery because target intraocular pressure was not achieved. Hyphema was observed in all ten eyes but cleared eventually at one week postoperative visit. Conclusions: 360 degree prolene suture trabeculotomy seems to be effective technique for congenital glaucoma surgery.

Biography:

Yizhi Liu’s research focuses on ocular stem cells’ self-renewal, differentiation and senescence, and the role of extracellular matrix and engineered biomaterials that surround both normal and degenerated cells in cornea, lens and retina. Dr. Liu has published or co-authored more than 80 peer reviewed manuscripts in top journals including Nature, New England Journal of Medicine, Science, BMJ and PNAS. He is recognized as one of the pioneer ophthalmologists in China who perform phacoemulsification and intraocular lens implantation. He has carried out approximately 200, 000 surgical operations for cataract patients. He is serving as the Co-Editorin- Chief of Molecular Vision, Associate Editor-in-Chief of Current Molecular Medicine. He has received grants from the National Basic Research Program of China, the Chinese Ministry of Health Key Clinical Program, the Chinese National Natural Science Foundation and the Natural Science Foundation’s Key Program in Guangdong.

Abstract:

The repair and regeneration of tissues using endogenous stem cells represents an ultimate goal in regenerative medicine. However, tissue or organ regeneration using endogenous stem cells in human has not been demonstrated. Currently, the only treatment for cataracts, the leading cause of blindness worldwide, is to extract the cataractous lens and implant an artificial intraocular lens. This procedure poses significant risks of complications for young patients. Here we isolate lens epithelial stem/ progenitor cells (LECs) in mammals and show that Pax6 and Bmi-1 are required for LEC renewal. We designed a surgical method of cataract removal that preserves endogenous LECs and achieved functional lens regeneration in rabbits and macaques, as well as in human infants with cataract. Compared with the traditional procedure, we move the anterior capsulorhexis from the center to the periphery, reducing the diameter to 1-1.5mm, preserving the capsule, sub-capsular cells, and the physiological barrier between the anterior and the posterior segment. For infants and young children, this procedure reduces post-operative inflammation and the incidence of postoperative complications such as iris adhesion and secondary ocular hypertension while protecting the local milieu required for lens regeneration. Our approach conceptually differs from current practice, as it maximally preserves endogenous LECs and their natural environment, and regenerates lenses with visual function. Our findings demonstrate a novel treatment strategy for cataract and provide a new paradigm for tissue regeneration using endogenous stem cells.

Biography:

Federico Iacono has been working in Ophthalmic department of Santobono Hospital of Naples; his main interest has always been the strabismus surgery, its strategies and techniques. During his hospital career, he has performed many strabismus operations, has worked with the most expert Italian surgeons of strabismus and every year he has attended national and international congresses to keep up to date with new surgical techniques.

Abstract:

Aim: To report the outcomes in a patient who underwent surgical corrections of bilateral MR paralysis. Methods: This was a case report. Preoperative and postoperative follow-up of a patient with bilateral MR paralysis were assessed. Surgery was performed in the Pediatric Hospital of Naples, Ophthalmic department. Results: Patient M M was born with 2.3 kg at term, with growth retardation in the first year of life, affected by arthrogryposis. At the first ophthalmic examination in our center, at the age of 3 year old, she showed complete bilateral adduction restriction and limitation of elevation (LE greater than RE) with large angle exotropia and head rotated right-side or left-side according to fixation, RE dominants. Refraction performed by instillation by ciclo-pentolato three times, showed hyperopia w.n.l. Any pathologies in anterior chamber and fundus were excluded. Follow-up was performed during time with complete orthoptic evaluation. Preoperatively VA was 6/10 in both eyes. Krimsky test showed an exodeviation, with an angle greater than 85 PD. M M underwent surgery at age 4. In both eyes the following surgical approach was performed: LR 10 mm. recession + MR 6.5 mm. resection with insertion forwarded at 1 mm. from limbus. Postoperatively, one year after surgery, adduction deficit was still present, bilateral down-shoot was reported, with abduction limitation. Cover test showed: at distance an angle of 15 PD with 4 PD L/R hypertropia (RE fixating) and 10 PD with 4 PD R/L hypertropia (LE fixating); at near an angle of 20 PD with 10 PD L/R hypertropia (RE fixating) and 15 PD with 8 PD R/L hypertropia (LE fixating). Conclusion: Overall the surgical procedure performed has shown an improvement of preoperative clinical deviation, nevertheless a Jensen technique may be another option, as first surgery, in such cases. A video is available to show the case before and after surgery treatment.

Biography:

Hanife Tuba Akcam has completed her MD at Kırıkkale University and  Residency at Gazi University School of Medicine. She is an Assistant Professor at Duzce University Medical School. She has published various papers in reputed journals. Also, she has a lot of project about pediatric eye disorders.

Abstract:

Cataract which means clouding in eye lens may result in a wide variety of visual outcomes from blurry vision to blindness. Moreover, if cataract has congenital roots, it may turn out to be a huge power affecting the course of whole life in patients as visual development will be deeply affected. Therefore, it is important whether timely and appropriate treatment is performed. Congenital cataract occur about 3 in 10000 live births. Besides, cataracts coupled with genetic abnormalities are much rarer. In this presentation, we aimed to draw attention to syndromic cataracts by reporting a rare instance of congenital cataract with Hallermann-Streiff syndrome (HSS). One-month-old full-term female infant has been referred to our clinic since the cataract etiology cannot be determined. Examination showed bilateral congenital cataract, microphthalmia and microcornea. Patient’s medical history was normal except parents were relatives. We didn’t find any abnormalities that can shed light on etiology of cataract in the systemic investigation including TORCH panel. When we re-evaluate the patient in detail, we noticed bird-like face, dental abnormalities, hypotrichosis, skin atrophy and short stature. In the light of these findings, the patient was diagnosed with HSS. HSS diagnosis was confirmed by chromosome analysis which showed gene defect in sixth chromosome (6q21-q23.2). Bilateral limbal lensectomy was performed for the cataract treatment. In conclusion, HSS is a rare condition that possesses a typical facial appearance. True diagnosis of congenital cataracts with unclear etiology must be made by thoroughly evaluating the cases and recording any atypical phenotypic finding.

Biography:

Abstract:

Aim: To assess the clinical outcomes in children, having cataract surgery with posterior capsulorhexis and intraocular lens (IOL) implantation using two techniques: standard surgical steps, in-the-bag IOL with anterior vitrectomy and optic capture of IOL and eliminate the need for vitrectomy. Methods: The study included 43 children (54 eyes) between two and six years old. Patients were randomized in two groups. Group 1 (phaco-aspiration was accompanied by posterior capsulorhexis followed by an anterior vitrectomy and in-the-bag IOL implantation). Group 2 (phaco-aspiration was accompanied by posterior capsulorhexis and optic capture 3-piece IOL implantation without anterior vitrectomy). Intraoperative complications were documented. All patients had at least 21 months of follow-up (mean 42±13 months [range 21 to 59 months]).
Results: In Group 1 (20 children (32 eyes) 2 eyes developed visual axis obscuration (VAO). Significant VAO was detected three months postoperatively and pars plana membranectomy was performed 4-6 months postoperatively. In Group 2 (23 children (22 eyes) the IOL could not be captured in five eyes (22.7%), no complications occurred in these eyes. Conclusion: This study found the incidence of complications was comparable between two methods of congenital cataract surgery. Optic capture of IOL is an alternative to the standard approach for pediatric cataract surgery and it eliminates anterior
vitrectomy as a routine step during surgery.

Biography:

Abstract:

Monitoring the outcomes of surgical interventions to correct strabismus was found to be limited in literature. The first step to improve quality of care given to patients is imperative to have a full discussion with patients/family about outcomes, long term and short term, of surgery. Reasons identified for the limited monitoring of outcomes where the different etiology of strabismus, age groups variability, and wide variations of outcome measures definitions. In this review we did a retrospective audit, using a modified goal determined audit tool suggested by Ehrenberg et.al in 2014. The audit was done at King Fahad Medical City, a tertiary care center for pediatrics and neuro-science in Saudi Arabia. Outcomes of surgeries done over a five year period, with minimum follow up of six months, and up to three years post-surgery. The risk factors for poor surgical outcomes were identified using a Pareto chart, a process used most frequently used in quality studies to identify causes of failure. Quality improvement processes like the goal determined outcome tool, and the Pareto chart are simple to use and helpful for monitoring outcomes in a variable etiology surgical outcomes.

Biography:

Abstract:

Aim: Anteriorization procedure of the inferior oblique muscle in its hyperfunction. Materials & Methods: 18 patients admitted to the Department of Vision Protection of children of the National Centre of Ophthalmology named after acad. Zarifa Aliyeva with the diagnosis of inferior oblique muscle hyperfunction were under observation. For investigation of refraction, we used the method of sciascopy and autorefractometry at the height of cycloplegia (pediatric autorefractometer “Plusoptix A-09”, auto-refractometer “Tomey”). Result & Discussion: In postoperative in all patients, the functions of the inferior oblique muscle was rehabilitated. There were no any negative results after the surgery. This changes the inferior oblique from an elevator to more of a depressor.

Biography:

Teuta Haveri completed her MD diploma in 1999 and Specialization Diploma in Ophthalmology in 2006 from Faculty of Medicine University of Tirana. She is currently working as Ophthalmologist Surgeon at Eye Clinic, American Hospital of Tirana, Albania.

Abstract:

Statement of the Problem: Keratoconus is a degenerative disease of the cornea, starting generally at 14-25 years old, and causing progressive thinning of the cornea, leading to a conical shape and causing distortion of vision. Extreme advancement of the keratoconus can cause corneal perforation. At the last 20 years the incidence and prevalence of keratoconus has increased and also the number of keratoconus in children has increased. Lately, the number of patients in pediatric age, presenting high values of astigmatismus (4 and 5 diopters) has considerably increased. It is also not rare to examine children with evidenced progressive keratoconus. Trying to understand if the latest are only sporadic cases or is a real change in cornea profile between generations that could predict a keratokonic future generation; we collect data from patient of different ages and make a comparison statistical study. Methodology & Theoretical Orientation: A total number of 701 eyes are examined, patient that undergone three dimensional corneal topography (Oculus Pentacam HR). Parameters recorded were: Corneal pachymetry: central and thinnest point, main perpendicular corneal radius (K1/K2) and maximal value Kmax, corneal astigmatismus and values of posterior face of the cornea. Patients are divided in three main groups: 1st group 1 (<14 years old) 215 eyes/2nd group 2 (14-40 years) 397 eyes/3rd group 3(>40 years) 81 eyes. Findings: Corneal thickness 2nd group presents the lowest values (524.24±45.57) than 1st (545±45.57) and 3rd (549.42±43.89). The difference is statistically significant between the 1st and 2nd age group (p≤0.001) and between 1st and 3rd (p=0.02). Central corneal thickness is higher in 1st age group (549.42±43.89) than 2nd (524.24±51.48), difference statistically significant (p≤0.001). 3rd group measurements (533.87±69.49) are lower than 1st, a difference significant (p=0.06). The difference in measurements between the 2nd and the 3rd group (p=0.63). Corneal radius K1: The patient younger than 14 year old presents lowest values (49.64±51.45 D) than 3rd (51.75±51.19) and 2nd group (56.67±71.94. Corneal radius K2: 1st group has lower values (45.04±3.49), than 3rd (49.07±42.06) and 2nd group (50.23±49.60), however differences between the groups are not statistically significant (p=0.71; p=0.28). Furthermore the second age group records just slightly higher values than the third group, difference that is not statistically significant (p=0.960). Maximal radius Kmax is higher in 2nd group (51.56±49.74) compared 1st and 3rd, that have similar measurements (46.03±4.69; 46.65±5.20), however, there are not statistically significant (p=0.19; p=0.52). Corneal astigmatismus is higher in the patients under 14 years old (2.60±4.54) compared with 3rd (0.47±3.38) and 2nd (0.95±2.44), differences that are statistically significant (p=0.003; p≤0.001). The maximal value of cornea’s posterior face is lower in the young patients (under 14 years old) (59.10±179.92) than in 3rd group (99.34±211.61), and the 2nd (186.93±253.70). Conclusion & Significance: Keratoconus early signs are high values in corneal radius and posterior face of the cornea, accompanied with lower values of corneal thickness and also high and asymmetric astigmatisms. In this statistical study, we found that 1st group of patients (up to 14 years old) present high values of corneal astigmatisms but, low values of corneal radius and posterior face of the cornea and high values of corneal thickness. So there is an increasing in corneal astigmatisms but not predicting a future keratokonic generation.

Biography:

Nagendra Prasad is an experienced Ophthalmologist based in Patna, where he practices at Buddha Eye and Lasik Laser Centre, which is a centre of excellence for phaco, retina, glaucoma and diabetic eye care. His areas of specialization include Cataract (MICS), LASIK, Glaucoma and treatment of retinal disorders. He is currently Secretary of the Patna Ophthalmic Club, and also a life member of several regional and national ophthalmological associations. He has done his MBBS and MD in Ophthalmology, and also completed fellowship in vitreo-retinal surgery. After completing his MBBS and subsequent Residency training, he worked as Medical Officer in State health services from February 1991 to June 1992, after which he pursued his MD in Ophthalmology from All India Institute of Medical Sciences (AIIMS), New Delhi. He was then Senior Resident in Department of Ophthalmology at the Regional Institute of Ophthalmology, Indira Gandhi Institute of Medical Sciences, Patna, from September 1995 to August 1998. He then moved into the area of training at the same institute for over eight years, first as Assistant Professor, and subsequently as Associate Professor and Officer-in-Charge, up to December 2006.

Abstract:

Background: Amblyopia is one of the most common disorders of decreased vision in children, the approximate prevalence is 2-4% and one third of it is due to anisometropia. If not treated in time lead to permanent subnormal vision throughout life, it is totally preventable disease. The recommended treatment is full correction of refractive error after cycloplegia with spectacles and occlusion therapy. Classical method of occlusion therapy is complete full time patching with eye pad, but sometimes it has fewer acceptances to stick to the treatment for both parents and child owing to odd looks. Another form of occlusion is partial occlusion for few hours a day has been tried with varying results. Aim: In this prospective randomised trial, full time complete occlusion when child awake on spectacles have been done and result was analysed. Method: 40 child of anisometropic amblyopia between the ages of 3 to 10 years has been enrolled into study and divided into two groups; group A-20 patients with complete occlusion with eye patch and group B-20 patients with spectacle patching. Inclusion criteria age was 3-10 years, anisohypermetropia within 3-9 diopters with amblyopia and first time attending the clinic. Exclusion criteria-age beyond 3-9 years, previously treated amblyopia occlusion has been given in the ratio of 1:7 i.e. the better eye has been occluded for seven days and amblyopic eye for one that monthly follow up has been done for six months. Result: It has been analysed at the end of six months. All patients showed some improvement at the end of three months and few patients are still under occlusion. Final result will be analysed after two months.

Biography:

Norma Helen Medina has her expertise in Public Health Ophthalmology and Epidemiology of eye diseases. She coordinated activities to assess the ocular health practices, within the neonatal units of the State of São Paulo. She and her team trained more than 800 pediatricians to perform red reflex examination and prevention of blindness in children. Implemented the trachoma control program in São Paulo state and give advisory services to the States and Ministry of Health of Brazil, and Portuguese speaking countries. She collaborated in the elaboration of school eye health manuals and training materials. Her division is responsible to train health personnel to perform primary eye care, prevention of eye disabilities in leprosy and trachoma elimination.

Abstract:

In State of São Paulo, Brazil the prevalence trachoma in the last school survey was 3.8%. The World Health Organization (WHO) has set the global elimination of trachoma, aiming a prevalence of trachomatous inflammation-follicular (TF) in children aged 1–9 years of < 5%, by 2020. Two strategies are used to verify the elimination: a trachoma census, in the municipalities with <2.000 children 1 and 9 years of age, and household survey using a random sample targeting the poorest census tracks, with the mean per capita income below ¼ of the Brazilian minimum wage, in the larger cities. Trachoma cases diagnosed are notified, treated and re-examined twice, in six-month intervals. The interim results of the progress towards elimination is: trachoma censuses were conducted in 68 municipalities, and prevalence survey conducted in Itapevi and Francisco Morato, municipalities of São Paulo metropolitan area, with a population of 223,408 and 168,234 respectively. In these a two stage cluster sample frame was used to select a sample of 2,400 children in each; the ocular examination with a 2.5X glass, according to WHO criteria. Among children 1 and 9 years of age, trachoma prevalence was 1.5% (79/5393). In the 1 to 9 age group, the prevalence was 1.2% among boys, and 1.7% among girls (χ2=1.73; p=0.19). The prevalence was in Francisco Morato (1.3%) and in Itapevi (1.0%). In trachoma censuses the examined children were 42,276 and a prevalence of TF (475-1.1%). The São Paulo state trachoma elimination plan is being implemented; currently three surveys are being conducted, with the objective to assess the extension and distribution of trachoma, in order to implement the control activities for the elimination as a public health problem. After the elimination, epidemiological surveillance for TF prevalence should be conducted in high risk communities.

Biography:

Fernando O Avellis is a Pediatric Ophthalmologist, focused his expertise in finding new measurable parameters useful in order to improve screening, early diagnosis and rehabilitation of childhood visual performance alterations. Particular emphasis is placed on new digital technologies, in particular those designed to achieve applications in low vision. One of fields of his research activity regards the identification of anatomical macular aspects typical of eyes affected by visual impairment at optic coherence tomography with the intent of using for future development of rehabilitation tools. He tries to create these models along with more than 10 years of experience spent in research, evaluation, teaching and administration in Pediatric Ophthalmology Service of University Hospital of Parma, Italy.

Abstract:

Statement of the Problem: Finding new parameters could be important for earlier diagnosis and follow-up of amblyopia, a visual condition that actually seems to have not much objectively measurable prognostic factors. There's a relationship between fixation eccentricity and visual acuity (VA). In recent studies amblyopic eyes compared to normal shown an increase in central choroidal thicknesses measured by optical coherence tomography (OCT). We evaluated through OCT how foveal choroidal thicknesses (CT) correlates with strabismic amblyopia. Methodology: 15 patients (mean age 5.4±1.9) including seven cases with strabismic amblyopia and eight controls with nonstrabismic amblyopia were recruited. Amblyopic eye CT was measured in nine points of the foveal region within a fixed topographic map: in center-fovea (CF) and in four cardinal points respectively at 1.5 mm and at 3 mm from CF. Thicknesses in topographic map was matched within two groups and maximum CT was reported. Three eccentricity patterns based on the distance from CF and maximum CT site were identified: first was in CF, second at 1.5 mm and third at 3 mm from CF. To each amblyopic eye a specific eccentricity pattern was attributed and compared between two groups. Subsequently, affected group eccentricity patterns were matched with the strabismic deviation degree. Finally, amblyopic eyes VA were correlated with the corresponding central CT for both groups. No statistically significant difference between groups was found in 9 CT topographic points. Instead maximum CT eccentricity differed statistically between two groups (p<0.05). No correlation between degree of eccentricity and strabismic deviation was found. Furthermore, there was a weak negative correlation between center-foveal CT and depth of amblyopia as VA in controls. Conclusions: These results suggest correlations between CT and amblyopia degree and probably between eccentricity of maximum foveal CT and VA. Our data encourage looking into analyzed parameters as possible prognostic indicators for antiamblyopic rehabilitation.