advances in Ophthalmology - Suffolk LOC€¦ · Advances in Ophthalmology Ramy Bassily Consultant...

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5/4/18 1 Advances in Ophthalmology Ramy Bassily Consultant Ophthalmic Surgeon Dry Eyes ". . . a multifactorial disease of the ocular surface characterized by a loss of homeostasis of the tear film, and accompanied by ocular symptoms, in which tear film instability and hyperosmolarity, ocular surface inflammation and damage, and neurosensory abnormalities play etiological roles.DEWS II definition of dry eyes 7-16% of all adults over 48 1 1. Ophthalmic Epidemiol, 13 (2006), pp. 263-274 2. Arch Ophthalmol. 2000 Sep; 118(9):1264-8 3. Oc Surf. 2016; 14(2):144-167 £820,930 per year for every 1000 dry eye patients 2 Makes people miserable 3 Dry Eyes ". . . a multifactorial disease of the ocular surface characterized by a loss of homeostasis of the tear film, and accompanied by ocular symptoms, in which tear film instability and hyperosmolarity, ocular surface inflammation and damage, and neurosensory abnormalities play etiological roles.DEWS II definition of dry eyes Measurable markers for diagnosis and treatment - Osmolarity - MMPs Investigative Ophthalmology & Visual Science May 2008, Vol.49, 5851 The Dry Eye Questionnaire 5 (DEQ-5): Use of a 5-Item Habitual Symptom Score to Discriminate Between Groups With Varying Self-Assessed Severity Improved diagnosis Dry Eyes ". . . a multifactorial disease of the ocular surface characterized by a loss of homeostasis of the tear film, and accompanied by ocular symptoms, in which tear film instability and hyperosmolarity, ocular surface inflammation and damage, and neurosensory abnormalities play etiological roles.DEWS II definition of dry eyes Inflammation Breaking the Vicious cycle Omega 3 Reduce inflammation Increase tear production (up to 30%) Improve epithelial regeneration All studies used EPA +1500mg DHA +500mg Med Sci Mont 2014; 20: 1583–1589 Immunomodulating Drugs TRPV1 receptor antagonist (SYL1001) Cyclosporine A Tacrolimus Tumor necrosis factor α-stimulated gene/protein-6 (TSG-6) Interleukin-1 receptor antagonist (IL-1Ra) Anti tumor necrosis factor-α therapy (TNF- α) Anti Interleukin-17 (IL-17) therapy Neuropeptides Lymphocyte function-associated antigen 1 (LFA-1) antagonist Lifitegrast 5%

Transcript of advances in Ophthalmology - Suffolk LOC€¦ · Advances in Ophthalmology Ramy Bassily Consultant...

Page 1: advances in Ophthalmology - Suffolk LOC€¦ · Advances in Ophthalmology Ramy Bassily Consultant Ophthalmic Surgeon Dry Eyes ... Glaucoma High IOP Drops-Poor compliance-Ocular surface

5/4/18

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Advances in Ophthalmology

Ramy Bassily

Consultant Ophthalmic Surgeon

Dry Eyes". . . a multifactorial disease of the ocular surface characterized by a loss of homeostasis of the tear film, and accompanied by ocular symptoms, in which tear film instability and hyperosmolarity, ocular surface inflammation and damage, and neurosensory abnormalities play etiological roles.”

DEWS II definition of dry eyes

7-16% of all adults over 481

1. Ophthalmic Epidemiol, 13 (2006), pp. 263-2742. Arch Ophthalmol. 2000 Sep; 118(9):1264-83. Oc Surf. 2016; 14(2):144-167

£820,930 per year for every 1000 dry eye patients2

Makes people miserable3

Dry Eyes". . . a multifactorial disease of the ocular surface characterized by a loss of homeostasis of the tear film, and accompanied by ocular symptoms, in which tear film instability and hyperosmolarity, ocular surface inflammation and damage, and neurosensory abnormalities play etiological roles.”

DEWS II definition of dry eyesMeasurable markers for diagnosis and treatment

- Osmolarity- MMPs

Investigative Ophthalmology & Visual Science May 2008, Vol.49, 5851

The Dry Eye Questionnaire 5 (DEQ-5): Use of a 5-Item Habitual Symptom Score to Discriminate Between Groups With Varying Self-Assessed Severity

Improved diagnosis

Dry Eyes". . . a multifactorial disease of the ocular surface characterized by a loss of homeostasis of the tear film, and accompanied by ocular symptoms, in which tear film instability and hyperosmolarity, ocular surface inflammation and damage, and neurosensory abnormalities play etiological roles.”

DEWS II definition of dry eyes

Inflammation

Breaking the Vicious cycleOmega 3

Reduce inflammationIncrease tear production (up to 30%)Improve epithelial regeneration

All studies used EPA +1500mgDHA +500mg

Med Sci Mont 2014; 20: 1583–1589

Immunomodulating Drugs

• TRPV1 receptor antagonist (SYL1001)• Cyclosporine A• Tacrolimus• Tumor necrosis factor α-stimulated

gene/protein-6 (TSG-6)• Interleukin-1 receptor antagonist (IL-1Ra)• Anti tumor necrosis factor-α therapy (TNF- α)• Anti Interleukin-17 (IL-17) therapy• Neuropeptides• Lymphocyte function-associated antigen 1

(LFA-1) antagonist• Lifitegrast 5%

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Dry Eyes". . . a multifactorial disease of the ocular surface characterized by a loss of homeostasis of the tear film, and accompanied by ocular symptoms, in which tear film instability and hyperosmolarity, ocular surface inflammation and damage, and neurosensory abnormalities play etiological roles.”

DEWS II definition of dry eyes

Nociceptors

Nasal neurostimulation Autologous serum /Fingerpick autologous blood

Corneal Transplants

Keratoconus

Corneal dystrophy Scars

Fuchs dystrophy

Corneal Transplants

Emergency Full Thickness Transplant for perforation from Herpes Simplex Keratitis

Corneal Transplants

DALKDeep Anterior Lamellar Keratoplasty

Reduce rejection ratesQuicker recovery

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Corneal Transplants With Femtolaser

Endothelial Corneal Transplants

• x20 fold reduction in rejection rates

• Recovery in 6 weeks (Vs 12 months)

DMEKDescment’s membrane Endothelial Keratoplasty

Endothelial Corneal TransplantsDMEKDescment’s membrane Endothelial Keratoplasty

• x20 fold reduction in rejection rates

• Recovery in 6 weeks (Vs 12 months)

Corneal transplants - the future

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Collagen cross linking• Developed 1997• In clinical use Italy 2005• NICE approved 2013• FDA approved 2016

85% success rate at stopping progression

Eye. 2015,29:1504

Started in Ipswich Aug 2017- 21 procedures

Femtosecond laserUltrashort pulse - Once 10-15 secs = No

collateral damage Intacs Radial keratectomies

Cataracts

IOL manipulation

Glaucoma

High IOP

Drops- Poor compliance- Ocular surface toxicity- Poor response Selective laser trabeculoplasty

+/-

>20% continue to progress

TrabeculectomyCystic leaking bleb Blebitis

Minimally invasive glaucoma surgeryMIGS

I-stent

Trabeculome

Hydrus stent

Cypass

Xen implant