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20, 21 and 22 June, 2019 - Phoenicia Hotel, Beirut

THE 27th ANNUAL MEETING OF THE

LEBANESE OPHTHALMOLOGICAL SOCIETY

Under the High Patronage of His ExcellencyThe President of the Lebanese Republic

GENERAL MICHEL AOUN

20 CMECredits

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Table of Contents

Word of Welcome 4

Committees 5

Faculty List 7

Scientific Program 8

Biographies 14

Abstracts 38

Acknowledgments 62

Notes 64

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Salah El Ladki, MD President of LOS President of the Congress

On behalf of the Lebanese Ophthalmological Society (LOS), it is a great pleasure and privilege to welcome you to our 27th annual meeting, which will be held at the Phoenicia hotel in Beirut on the 20th, 21st and 22nd of June, 2019.

The meeting will address major topics and discuss the updates and new trends in ophthalmology, thus contributing to the promotion of clinical practice and improvement in the quality of care.

Distinguished physicians and experts will join us to share their knowledge and experience. The congress program is broad and will cover various ophthalmic subspecialties, such as uveitis, glaucoma, retina, orbit, eyelid and cosmetic surgery, cornea, cataract and refractive surgery.

I would like to thank our distinguished guest speakers, who have taken the trouble of travelling long distances to share their experiences with us. We are honored to have them visit Beirut, the ever charming capital and glittering pearl of the Middle East.

Sincere thanks go to our LOS team, to the executive board, and to our scientific committee members, who did their best to make this event a success.

I would like to take this opportunity to also thank and express my deepest appreciation to our partners the participating companies that have always contributed by their continuous support in the making of this event.

Last but not least, special thanks to the team of our organizing company, Trust and Traders, who as usual, did all their best for the success of the meeting.

Finally, I welcome you once more and hope we will enjoy together a productive and a memorable event.

Word of Welcome

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Organizing Committee

Salah El-LadkiPresident

Nada S Jabbur Vice-President

Mohamad S El Hajj Secretary

Mohamad HouriMember

Omar C Fakhoury Member

Ousama JebaiMember

Carole G CherfanMember

Georges AzarMember

Hassan BassamTreasurer

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Scientific Committee

Salah El-LadkiPresident

Karim TomeyChair

Georges AzarMember

Rola HamamMember

Hala El RamiMember

Riad BejjaniMember

Nicolas GhaziMember

Shadi AwwadMember

Maher SalehMember

Alain SaadMember

Riad MaaloufMember

Alexandre AssiMember

Ramzi AlameddineMember

Nada S Jabbur Vice-President

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Faculty List

Alain Gaudric - Guest of Honor France Sofia Androudi GreeceSamuel Arba Mosquera GermanyFrancesco Bernardini ItalyBahram Bodaghi FranceUday Devgan USAAlain Ducasse FranceMichel Eid Farah BrazilOlivier Galatoire FranceDavid Kang South KoreaMoncef Khairallah Tunisia Albert Khouri USAFelipe Medeiros USAMohamad Moghazy Aly Mahgoub EgyptSamir Mulki JordanMarc Muraine FranceTammy Osaki BrazilBarbara Parolini ItalyAmmar Safar UAEMohamed Shafik EgyptScott Smith USAGiovanni Staurenghi Italy Khalid Tabbara KSA

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Thursday June 20th, 2019

12:00-12:50 Registration

12:50-13:00 Introduction to the Workshops Karim Tomey

13:00-14:45 EYELID & ORBIT WORKSHOPModerators Riad Maalouf, Lama Khatib, Vicky Massoud

13:00-13:15 External versus endonasal DCR Alain Ducasse13:15-13:30 Management of the anophthalmic socket Olivier Galatoire 13:30-13:45 Aesthetic procedures: small details that make the difference Tammy Osaki13:45-14:00 Exenteration: Indications and techniques Alain Ducasse 14:00-14:15 Management of facial paralysis Olivier Galatoire14:15-14:40 Interactive case presentations Oculoplastics Team14:40-14:45 Discussion / Q & A

Moderator Mahmoud Jaroudi

14:45-15:30 Uveitis treatment beyond the conventional: Will anti-TNF advance our treatment paradigms? Sofia Androudi

15:30-16:00 Coffee Break

16:00-17:40 UVEITIS WORKSHOPModerators Hala El Rami, Issam Hemade, Souha Allam

16:00-16:20 Differential diagnosis of noninfectious posterior uveitis Khalid Tabbara16:20-16:40 Approach to the treatment of non-infectious uveitis Khalid Tabbara16:40-17:00 Infectious uveitis not to be missed Moncef Khairallah17:00-17:20 Approach to the main uveitis complications Bahram Bodaghi17:20-17:40 Discussion / Q & A

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Friday June 21st, 2019

07:30-08:25 Registration

08:25-08:30 Word of Welcome Salah El-Ladki, President LOS

08:30-10:15 UVEITISModerators Rola Hamam, Mounir Kassir, Georges El Mollayess

08:30-08:45 Diagnosis and Management of “Presumed” Ocular Tuberculosis Khalid Tabbara08:45-09:00 Anterior viral uveitis: clinical presentation, diagnosis and management Bahram Bodaghi09:00-09:15 Infectious Posterior Uveitis in the Immunocompromised Host Khalid Tabbara09:15-09:30 Diagnosis and treatment of scleritis Moncef Khairallah09:30-09:45 Updates in the treatment of Behçet disease Bahram Bodaghi09:45-10:00 White dot syndromes: Overview and management Moncef Khairallah10:00-10:15 Discussion / Q & A

10:15-10:45 Coffee Break

10:45-12:15 EYELID & ORBIT Moderators Ramzi Alameddine, Lama Jurdi, Ama Sadaka

10:45-11:05 Noninvasive rejuvenation of the lower eyelid Francesco Bernardini11:05-11:25 Lower eyelid blepharoplasty: the eyelid lift Francesco Bernardini11:25-11:45 Minimally invasive procedures for the aesthetic patient Tammy Osaki11:45-12:05 Endoscopic lifting and fat grafting for midfacial rejuvenation Francesco Bernardini12:05-12:15 Discussion / Q & A

12:15-14:00 Lunch

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14:00-14:30 Opening Ceremony

Program

Word of Welcome by the Master of Ceremonies Dr. Nada Jabbur

Address by the president of the Lebanese Ophthalmological Society Dr. Salah El-Ladki

Address by the Guest of Honor Pr. Alain Gaudric

Address by the President of the Jordanian Society of Ophthalmology Pr. Samir Mulki

Address by the President ofthe Syrian Society of Ophthalmology Dr. Anas Aljord

Address by the President of the Lebanese Order of Physicians

Address by the President Of The Lebanese Republic H.E General Michel Aoun

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14:30-16:10 RETINA (I)Moderators Ziad Bashshur, Mohamad Khalife, Alexandre Schakal

14:30-14:45 Macular pigment: How to measure it and why it is important Giovanni Staurenghi14:45-15:00 Therapeutical regimens in wet AMD Michel Eid Farah15:00-15:15 Auto-fluorescence imaging in clinical practice Giovanni Staurenghi15:15-15:30 Challenging AMD case discussions Michel Eid Farah15:30-15:45 OCT Angiography Giovanni Staurenghi15:45-16:00 Atypical forms of Central Serous Chorioretinopathy Alain Gaudric16:00-16:10 Discussion / Q & A

16:10-16:40 Coffee Break

16:40-18:25 RETINA (II)Moderators Alexandre Assi, Nicola Ghazi, Maher Saleh

16:40-16:55 Imaging the posterior pole in high myopia Alain Gaudric16:55-17:15 Myopic traction maculopathy: New staging system and guidelines for treatment Barbara Parolini17:15-17:30 Advances in chromovitrectomy for macular surgery Michel Eid Farah17:30-17:45 Lamellar macular hole and pseudo-macular hole: A new classification Alain Gaudric17:45-18:00 Vitrectomy in diabetic retinopathy Michel Eid Farah18:00-18:15 Ten years’ experience with autologous choroidal/retinal transplantation for exudative and atrophic maculopathies Barbara Parolini18:15-18:25 Discussion / Q & A

Moderator Charbel Fahed

18:25-19:00 Proactive dosing for effective patient management: What do the latest data show? Giovanni Staurenghi, Ammar Safar

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Saturday June 22nd, 2019

07:45- 8:30 Registration

08:30-10:00 GLAUCOMA (I)Moderators Baha’ Noureddine, Georges Azar, Pierre Mardelli

08:30-08:45 OCT and visual fields: How to understand, interpret and combine them for managing glaucoma Felipe Medeiros08:45-09:00 Recent developments in glaucoma medical treatment Albert Khouri09:00-09:15 Neovascular glaucoma Scott Smith09:15-09:30 Artificial Intelligence in Ophthalmology: Will Robots replace us? Felipe Medeiros09:30-09:45 Teleglaucoma: the new frontier in remote structural and functional testing Albert Khouri09:45-10:00 Discussion / Q & A

10:00-10:30 Coffee Break

10:30-12:15 ANTERIOR SEGMENT (I)Moderators Shady Awwad, David Fahd, Samer Mneimneh

10:30-10:44 Transepithelial photorefractive keratectomy Sam Arba Mosquera10:44-10:58 Corneal biomechanics of laser vision correction surgeries as measured with the Corvis ST David Kang10:58-11:12 Principles of astigmatism correction using excimer lasers Sam Arba Mosquera11:12-11:26 What is after CXL? A promising protocol to provide best vision for our keratoconus patients Mohamed Shafik Shaheen11:26-11:40 Modern results of SMILE and comparison with excimer lasers David Kang11:40-12:00 Will SMILE replace LASIK? The quest of visual quality Mohamed Shafik12:00-12:15 Discussion / Q & A

Moderator Antoine Assaf

12:15-12:55 Treatment response in nAMD

Mohamad Moghazy Aly Mahgoub

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12:55-14:00 Lunch

14:00-15:55 Glaucoma (II)Moderators Ziad Khoueir, Nabil Torbey, Yahya Shahine

14:00-14:20 Glaucoma following vitreo-retinal surgery Scott Smith14:20-14:40 The evoling paradigm in precision glaucoma surgery: MIGS or Myths? Albert Khouri14:40-15:50 Case discussion Glaucoma Guests15:50-15:55 Discussion / Q & A 15:55-16:20 Coffee Break

16:20-16:35 Best Resident Poster Presentation Karim Tomey

16:35-18:45 Anterior Segment (II)Moderators Hassan Chahine, Randa Haddad, Dany El Alam

16:35-16:55 Anterior segment OCT: indications in corneal pathology Marc Muraine16:55-17:07 Future of IOL calculations Uday Devgan17:07-17:20 Novelties and new developments in laser vision correction Sam Arba Mosquera17:20-17:40 Corneal neovascularization: diagnosis and management Marc Muraine17:40-18:05 Challenging cataract cases Uday Devgan18:05-18:30 Challenging cornea surgery cases Marc Muraine18:30-18:45 Discussion / Q & A / Adjournment

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BIOGRAPHIES

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Alain Gaudric

Alain Gaudric is an Emeritus Professor of Ophthalmology at University of Paris 7-Denis Diderot, and Lariboisière Hospital, where he was Chair of the Ophthalmology Dept. from 1993 to 2010. Dr Gaudric has received the prize of the Retinal Research Foundation for his Jules Gonin lecture, the Paul Henkind Award and Lecture of the Macula Society and the EURETINA lecture. Dr Gaudric’s clinical and research interests focus on retinal diseases. He is known for his works on choroidal ischemia, macular hole pathogenesis and surgery, the posterior pole of high myopia, and on OCT interpretation in macular diseases. He has published more than 220 articles in peer-reviewed international journals, as well as 15 book chapters and edited 3 books. He serves as Associate Editor of the American Journal of Ophthalmology and as Editorial Board Member of Ocular Surgery Laser and Imaging, and of Ophthalmologica. Dr Gaudric has been an invited speaker at numerous national and international conferences on a wide range of medical and surgical topics.

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Sofia Androudi

Associate Professor, At Regional General University Hospital of Larissa Ophthalmology Clinic Mezourlo, Larissa, Greece

Education-Professional Experience

Medical degree: From the University of Thessaloniki, Greece.

Residency in Ophthalmology:1. Ophthalmology Clinic, 401 General Military Hospital, Athens, Greece September 1995- April 19972. Ophthalmology Clinic, Aristotle University of Thessaloniki, Greece, April 1999- March 2002 (completed)

Fellowship in ocular immunology: Massachusetts Eye and Ear Infirmary, BostonShe got several awards from committee membershipsShe is a revewier in several JournalsAnd has 103 Publications in peer-reviewed journals (PUBMED)

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Samuel Arba-Mosquera

Samuel Arba-Mosquera received his PhD in sciences of vision from the University of Valladolid in 2007 to 2012 and physics from the University of Santiago de Compostela in 1993 to 1998. He works as an optical/visual researcher at SCHWIND eye-tech-solutions (Germany), with 20 years of experience in R&D in optics and vision and expertise in development of algorithms for refractive surgery.

More than 100 published papers in peer-reviewed journals in the field of refractive-surgery, 12 contributions in books, and 30 international patent applications (5 granted), as well as his activities as reviewer for 25 journals on refractive surgery support his expertise.

In the Academia, he contributes in Refractive, Lens and Corneal Surgery to Miguel Hernandez University, Ulster University, and University of Santiago de Compostela.

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Francesco Pietro Bernardini

Francesco Pietro Bernardini completed his two-year fellowship training in Cincinnati (1998-2000). Dr Bernardini established his Private Practice “Oculoplastica Bernardini” based in Genova with satellites in Roma, Milano and Torino. He has published more than 50 scientific papers and is part of the editorial board of OPRS. Dr Bernardini is also international member of the ASOPRS and full member of the ESOPRS and member of the Orbital Society.

Dr Bernardini has been an international invited speaker at many meetings and has organized many international meetings himself, including the 2011 ESOPRS Lake of Como meeting on behalf of the European Society of Ophthalmic Plastic Surgery Society.

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Bahram Bodaghi

Bahram Bodaghi, MD, PHD, FEBO is Professor of Ophthalmology & Visual Sciences at Sorbonne University in Paris, France.

He coordinates the Teaching Hospital Department of Vision and Handicaps (ViewMaintain) and serves as Vice President of the French Society of Ophthalmology. He chairs the national University Council of Ophthalmology since 2013 and is actively involved in undergraduate and postgraduate teaching programs at the University of Paris. He has been elected President of the International Ocular Inflammation Society since 2015.

Dr. Bodaghi was trained as a resident at the University of Ren� Descartes, in Paris. At the end of his residency, he started his experience in basic research in the Viral Immunology Unit, at the Pasteur Institute. During his PhD training, he focused on the pathophysiology of viral infections, especially CMV retinitis and reported on chemokine sequestration by viral chemoreceptors as a novel viral escape strategy.

He performed medical uveitis fellowship at the Piti�-Salp�tri�re Hospital in Paris. B.

Bodaghi is a member of numerous national and international organizations.He served as Secretary General of the European Association for Vision and Eye Research (EVER) from 2008-12 and member of the ARVO annual program committee (2013-15). He was an International Board member of the BCSC (Intraocular Inflammation and Uveitis section) for the American Academy of Ophthalmology from 2005-11.

Dr. Bodaghi has published more than 260 papers in peer-reviewed journals and 25 textbook chapters. He serves on the editorial boards of several prestigious journals and is a member of major vision research and clinical ophthalmology societies. He has given more than 130 invited lectures around the world and organized the 2014 International Conference on Behçet’s Disease in Paris.

Dr. Bodaghi was the first ophthalmologist to win the Oudin Award of the French Society of Immunology. He also obtained the Senior Achievement award of the American Academy of Ophthalmology and the International Uveitis Study Group Prize. During the last decade, he mainly focused his efforts on the understanding of infectious agents associated with different forms of intraocular inflammation but also new therapeutic strategies in autoimmune uveitis.

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Uday Devgan

Uday Devgan is passionate about teaching ocular surgery to the next generation of ophthalmologists. He is full clinical Professor at the Jules Stein Eye Institute at the UCLA School of Medicine and Chief of Ophthalmology at Olive View-UCLA Medical Center, where he has taught surgery for two decades.

Dr. Devgan is also in private practice, specializing in cataract and refractive surgery, at Devgan Eye Surgery in Los Angeles and at Specialty Surgical Center in Beverly Hills. He has been named one of the top key ophthalmology opinion leaders in the USA and he has taught ocular surgery in more than 50 countries

Most recently he has started a revolutionary bio-mathematical company, helped develop an innovative truly accommodating lens implant, and authors the most successful cataract surgery teaching site www.CataractCoach.com.

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Alain Ducasse

• Professor of ophthalmology since 1985 • Head of department of ophthalmology of Reims CHU 1985 to 2016 • Head of Head and neck department for 6 years • President of the French Society of ophthalmology in 2005• Past president of the SOPREF (French Society of oculoplastic surgery)• French member of the board of ESOPRS during 8 years• Mustarde lecture of ESOPRS in Marseille in 2010 • Retired since September 2017

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Michel Eid Farah

Michel Eid Farah did a retina-vitreous fellowship at the Bascom Palmer Eye Institute, USA. He is Professor of Ophthalmology at the Federal University of S�o Paulo, President of the Vision Institute, Brazil, a philanthropic organization, President of the Brazilian and the Pan-American Retina-Vitreous Society. Michel is Involved in the Prevention of Blindness, Teaching, and Scientific Boards. He has served as President of several national and international meetings and presented the AJO Lecture at AAO. Michel was the Principal Investigator in over 40 clinical trials evaluating new drugs, devices, surgical innovations and delivery systems. He has been a peer reviewer and a member of the editorial board of several scientific journals. He is the author of 10 books and 151 chapters and has 282 peer-reviewed articles. His H index is 42.

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Olivier Galatoire

Dr. Olivier Galatoire, French ophthalmologist, is specialized in oculoplastic surgery. He is particularly interested in eyelid and orbit surgery. He has published more than 30 articles, 10 book chapters and coordinated two books on eyelid disorders. After studying medicine at the Faculty of Bordeaux, he did his internship and his fellowship in the Hospitals of Paris. He then joined the Ophthalmology and Orbito-Palpebral Reconstructive Plastic Surgery Department of the A. de Rothschild Ophthalmological Foundation in 2002. He has been in charge of this specialized department since 2009. Dr. GALATOIRE is a member of the French Society of Ophthalmology, the European Society of Oculoplastic Surgery (ESOPRS), and also of the French Society of Oculoplastic Surgery (SOPREF) of which he was general secretary for 4 years.

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David Kang

David Kang is the founder and clinical director at Eyereum EYE Clinic and CEO of Eyereum Healthcare in Korea. He also serves as out-patient clinical associate professor at Ulsan University, Asan Medical Center and as out-patient assistant clinical professor at Severance Hospital, Yonsei University School of Medicine in Seoul Korea.

His primary passion is corneal wavefront-guided ablation for amelioration of aberrations for keratoconus, corneal ectasia, and central islands. Kang has received three Best Academic Achievement Awards from the Korean Ophthalmological Society and Best Paper Award from ASCRS in 2018 And he has been named to one of the ‘The Power List 50’ by The Ophthalmologist in 2017. He has rights to six patents

Since then he has patented new methods of deepithelization of the cornea prior to refractive surface ablation, removing phakic IOLs, and removing lenticules during SMILE.

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Moncef Khairallah

Professor Khairallah is Professor of Ophthalmology at the University of Monastir, Tunisia, and Chairman of the Department of Ophthalmology, Fattouma Bourguiba University Hospital, Monastir. Much of his research focusses on ocular inflammatory and retinal disease. He has more than 170 publications in peer-reviewed journals and has authored 6 books in addition to over 70 book chapters. He has given presentations in more than 120 meetings globally. He is reviewing editor and editorial board member for the Ocular Immunology and Inflammation journal, serves as an editorial board member of 3 other international ophthalmology journals, and regularly reviews manuscripts for various other major journals. He is a member of Club Jules Gonin, Vice-President of the Society for Ophthalmo-Immunoinfectiology in Europe, member of the International Uveitis Study Group, member of the Vision Loss Expert Group of the Global Burden of Disease Study, and member of the Thea Foundation, among others. He was an Executive Board member of the International Ocular Inflammation Society from 2011-2015. Among Professor Khairallah’s awards and honors are: 2005 Achievement Award, American Academy of Ophthalmology, 2009 Research Medal from the Mediterranean Society of Ophthalmology, 2013 Besrour Prize for Clinical Research (Faculty of Medicine of Montreal, Canada), 2015 Award from the International Ocular Inflammation Society, 2016 Gold Medal from the Moroccan Society of Ophthalmology, and 2018 Gold Medal from the Tunisian Society of Ophthalmology.

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Albert Khouri

Albert S Khouri, MD is the Director of Glaucoma and Ophthalmology Residency at Rutgers New Jersey Medical School. He earned his medical degree and residency in Ophthalmology at the American University of Beirut. In the US, he completed a residency in Ophthalmology at the New Jersey Medical School and a Fellowship in Glaucoma at the University of Louisville. He is the Director of the Glaucoma Research Laboratory at Rutgers with a focus on Tele-Ophthalmology and Glaucoma Clinical Trials.

Dr. Khouri has received 21 grants in support of his research, and has authored 72 peer-reviewed manuscripts, 15 book chapters, and 180 scientific abstracts.

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Felipe Medeiros

Felipe A. Medeiros, M.D., Ph.D. is Distinguished Professor of Ophthalmology and the Joseph Wadsworth Endowed Chair at Duke University. He is also Vice-Chair of Technology and the Director of the Clinical Research Unit, where he leads clinical research efforts in the Department of Ophthalmology.Dr. Medeiros’ research has been focused on the development of innovative methods and technologies for early diagnosis, prediction and detection of glaucoma progression. He has published over 300 peer-reviewed scientific articles and 6 books in ophthalmology. His work has been cited over 15,000 times. Dr. Medeiros has been the recipient of over 40 international awards, including the prestigious Cogan Award from the Association for Research in Vision and Ophthalmology (ARVO), the World Glaucoma Association Research Award, the American Academy of Ophthalmology (AAO) Senior Achievement Award, among others. Most recently, he received the Moacyr Alvaro Gold Medal, the most prestigious award in Ophthalmology in Latin America.Dr. Medeiros serves as the Chair of the American Glaucoma Society (AGS) Program Committee and he is also Member of the Program Committee of the prestigious Glaucoma Research Society. Dr. Medeiros has acted as Editorial Board Member for several journals, including the Journal of Glaucoma and the ARVO journal TVST. He has trained numerous students, fellows and postdocs from many parts of the world.

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Mohamad Moghazy Aly Mahgoub

• Professor Of Ophthalmology Ain-Shams University, Cairo, Egypt • Fellowship of the Royal College Of Surgeons Of Edinburgh in 2003 • Ph.D. in Ophthalmology Ain-Shams University in 2004 • Fellow of Oakland and Wayne State universities, Michigan USA• Is an active member of the American Society Of Retina Specialists, The American academy of ophthalmology, and the European society of retina specialists and the European vitreoretinal society• Major interests include vitreoretinal surgery, medical retina and Uveitis• He has many publications in the field of medical and surgical retina

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Marc Muraine

Medical Studies (Faculty of Medicine of Bordeaux II) 1981 - 1987 Medical Residency: 1988-1993 National Service 1991-1992 Master of Biological and Medical Sciences – 1993 (University of Toulouse France)Master 2 Human Pathophysiology (1994) Faculty of Sciences of ToulouseDiploma of Medical Doctor on April 21, 1994 (University of Rouen)Fellowship in the department of Professor Brasseur (May 1994 to October 1996), Rouen University Hospital, FranceDiploma of Philosophy Doctor October 11, 2002 in Rouen, FranceProfessor of Universities (Rouen University Hospital) since September 2004Head of the department of ophthalmology of Rouen University Hospital since March 2008Medical Director of the tissue bank of Normandy (Rouen University Hospital) since 1994National President of the Banque Française des Yeux (National French Eye Bank) since April 2012

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Tammy H. Osaki

Tammy H. Osaki, M.D., Ph.D is Affiliate Professor and Chief of the Division of Oculoplastics at Federal University of Sao Paulo, Brazil

Part of her PhD was conducted at Harvard Medical School/ MEEI, USA, where she completed her research fellowship. Dr. Osaki is an active clinician and researcher. She has published several scientific articles and book chapters and is the senior editor of the textbook Eyelid and Periorbital Rejuvenation. She is the recipient of relevant awards including: ASOPRS Merrill Reeh Award, Pan-American Association of Ophthalmology Gillingham Award, WOC Travel Award, AAO Best Poster Award. She has lectured in several national and international conferences, including US, Japan, China, Portugal, Argentina and Brazil.

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Barbara Parolini

• Dr. Barbara Parolini, born in Italy on April 17th, 1968 • Postodoctoral fellowship: 1994-1995 UCSF (San Francisco, USA); 1997- 1998 UMDNJ at UMDNJ (Newark, USA) • Head of VitreoRetinal Unit, at Eyecare Clinic, in Brescia, Italy• 10000 cases of complex cases of vitreoretinal pathologies, cataract, submacular surgery• 36 peer-reviewed papers and 4 Book Chapters• Tutor of the Bremen VitreoRetinal School and the Thessaloniky VitreoRetinal School• Invited as Speaker and Moderator and for live surgery to national and international meetings• Reviewer for multiple peer-reviewed journals • VicePresident of European Vitreoretinal Society

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Ammar Safar

Dr. Ammar Safar is American Board Certified in Ophthalmology and is a highly experienced consultant in Vitreoretinal diseases and surgery. Dr. Ammar is the Medical Director of Moorfields Eye Hospitals in the UAE & GCAA Approved Specialist Aeromedical Medical Examiner . He is based in Moorfields Eye Hospital Dubai

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Mohamed Shafik

• Professor of Ophthalmology, University of Alexandria, Egypt • Master degree of Ophthalmology (University of Alex) and Doctorate degree in Ophthalmology (University of Complutense Madrid, Spain), Fellow of Instituto Ramon Castroviejo, Madrid• Founder member of many Refractive Societies in Egypt and Middle East• Board member of the Egyptian Society of Ocular Implants and Refractive Surgery (ESOIRS), the Egyptian Society of Cataract and Refractive Surgery (EgSCRS) & the Egyptian Refractive Club (ERC)• Winner of many honors and awards from the Egyptian and regional Societies of Refractive Surgery• Author of more than 60 Regional and International Published Original Articles and Book Chapters in the Field of Refractive Surgery• International Global Advisory Board Member of Cataract and Refractive Surgery Today Europe (CRSTE)

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Scott D. Smith, MD, MPH

• Professor of Ophthalmology, Cleveland Clinic Lerner College of Medicine, Cleveland, USA • Chair, Eye Institute, Cleveland Clinic Abu Dhabi, UAE; 2012-present • Edward S. Harkness Associate Professor of Clinical Ophthalmology, Columbia University, New York, USA; 2008-2011• Assistant Professor of Ophthalmology, Cole Eye Institute, Cleveland, USA; 2000-2008• Associate Director of Research and Consultant Glaucoma Specialist, King Khaled Eye Specialist Hospital, Riyadh KSA; 1996-2000• Medical School: Yale University, New Haven, USA• Master of Public Health: Johns Hopkins University Bloomberg School of Epidemiology and Public Health, Baltimore, USA• Ophthalmology residency: Massachusetts Eye & Ear Infirmary, Harvard Medical School, Boston, USA• Glaucoma fellowship: Wilmer Eye Institute, Johns Hopkins University, Baltimore, USA

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Giovanni Staurenghi

Professional Experience 1999 Clinical Fellow at the Department of Ophthalmology San Paolo - Hospital, Milan 1987-1991 Resident in Ophthalmology at Clinica Oculistica I, Milan State University at the Department of Ophthalmology San Paolo Hospital, Milan 1990-1999 Staff Member Department of Ophthalmology San Paolo Hospital, Milan 1991-1993 Research Fellow at Schepens Eye Research Institute – Harvard Medical School 1998-2001Assistant Professor of Ophthalmology University of Milan School of Ophthalmology 1999-2004 Associate Professor of Ophthalmology University of Brescia 1999-2004 Staff Member Department of Ophthalmology Spedali Civili, Brescia2004 Associate Professor of Ophthalmology University of Milan 2005 Chairman of University Eye Clinic Ospedale Sacco Milan 2005 Director Second Residency School of Ophthalmology University of Milan 2007 Professorship 2010 Full Professor of Ophthalmology University of Milan 2013 Director Residency Program University of Milan

Research and Clinical Training 1984-1986 Undergraduate Research and Clinical Training at Internal Medicine Institute Pavia State University (New beta-blockers in cardiology) 1987 National Institutes of Health (USA) Sarasota FL Clinical Vision Research Course 1986-1991 Researcher at Department of Ophthalmology San Paolo Hospital, Milan:- age-related macular degeneration - retinitis pigmentosa 1989-1990 Bilateral project with the Italian Research Council in the field of Retinitis Pigmentosa and other degenerative retinal pigment epithelium cell diseases 1991-1993 Research fellow Schepens Eye Research Institute – Harvard Medical School - Lipofuscin and Age-Related Macular Degeneration (in vitro and in vivo studies) - Scanning Laser Ophthalmoscope: Infrared and Indocyanine Green Angiography

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1993-1996 Project sponsored by European Community (BIOMED) on the Indocyanine Green Angiography and the possibility of early detection of choroidal neovascular membrane 1999-2001 Project sponsored by Iridex corp. on the Transpupillary Thermo Therapy in Age-Related Macular Degeneration 1999-2000 Co-investigator VIT study (Verteporfin in Italy) sponsored by Novartis Ophthalmics 1999-2001 Project sponsored by Iridex corp. on the use of 810 nm micropulse laser for the treatment of Feeder Vessels in Age-Related Macular Degeneration 2001-2018 Principal Investigator for more than 70 RCT (All clinical trials are conducted following GCP rules)

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Khalid F. Tabbara

Khalid F. Tabbara is former Chairman of the Saudi Scientific Board of Ophthalmology at the Saudi Commission for Health Specialties, former Adjunct Professor, Wilmer Institute, Johns Hopkins University, Baltimore, MD, Clinical Professor of Department of Ophthalmology, College of Medicine, King Saud University, Executive Director at The Eye Center and The Eye Foundation for Research in Ophthalmology, Riyadh, Saudi Arabia. Dr. Tabbara received the Life Achievement Award from the American Academy of Ophthalmology in Las Vegas, Nevada (2015), the Ben Goldfeller Service Award (2017) from the American Board of Ophthalmology (ABO) for participating as Examiner in 20 or more oral examinations, and the Award in Teaching and Training in Ophthalmology from the Saudi Ophthalmological Society (SOS) during the Third Red Sea Ophthalmology Symposium (2017). Dr. Tabbara is currently active in residents’ training, continuing medical education, clinical and research in ophthalmology, and has published more than 400 publications and 21 books in ophthalmology.

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ABSTRACTS

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EYELID & ORBIT WORKSHOP

External versus endonasal DCR

Alain DucasseThe DCR is the treatment of choice for the stenosis of the vertical lacrimal pathway. But there are two main possibilities: an external or an endonasal approach. Nowadays these two DCRs have the same results and the same indications, except in case of horizontal stenosis associated, where an external approach must be preferred or in case of nasal disease, as a polyposis, where an endonasal approach is better. The advantages of the endonasal DCR are no scar, rapidity and possibility of treatment of the both sides at the same time. But there are also some disadvantages: material and its cost, need of general anesthesia and learning of practice.

Management of the anophthalmic socket

Olivier Galatoire

Aesthetic procedures: small details that make the difference

Tammy OsakiIn this talk, in addition to tips to maximize the results in surgical and non-surgical aesthetic procedures, relevant aspects in contemporary beauty concept, facial aging, patient selection, preoperative evaluation and post-operative care will be addressed.

Exenteration: Indications and techniques

Alain Ducasse The exenteration remains the last possibility in some diseases. The main indications are above all certain orbital tumors, which are impossible to remove totally, or which have invaded the orbit from the eyelids, like epidermoid or basal cell carcinomas or for the conjunctiva as melanomas. Rarely it is realized for a serious infectious disease, like a mucormycosis. The technique is always the same and quite easy: resection of the whole orbital content. Complications are rare. Actually the main problem is the reconstruction, which can be performed by several possibilities and the psychological aspects.

Thursday June 20th, 2019

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Management of facial paralysis

Olivier Galatoire

Uveitis treatment beyond the conventional: Will anti-TNF advance our treatment paradigms?

Sofia AndroudiUveitis is a term applied to a wide range of conditions that are characterized by intra-ocular inflammation. Non-biologic and biologic immuno-modulatory agents have been evaluated for the treatment of non-infectious uveitis. How will Anti-TNF advance the treatment paradigms?What do the guidelines and evidence-based say on the management of non-infectious uveitis? What is the target and what is the priority to treatment goals for uveitis?

UVEITIS WORKSHOP

Differential diagnosis of noninfectious posterior uveitis

Khalid TabbaraThe main objective is to study the causes of posterior uveitis and the systemic approach to arrive at an accurate diagnosis. The diagnosis of posterior uveitis can be established, in most cases, on the basis of clinical findings. The diagnosis is based on the history, ocular manifestations, associated system disease, and laboratory findings. Our series of patients with posterior uveitis were caused by the following: viral infections (AIDS, CMV, Herpes simplex, Herpes Zoster), bacterial infections (Tuberculosis, Syphilis, Nocardia), parasitic infections (Toxoplasma, Toxocara, Onchocerca), fungal infections (Candida, Histoplasma, Cryptococcus,), autoimmune diseases (Vogt-Koyanagi-Harada syndrome, Behcet’s disease, Birdshot retinopathy), diseases of unknown etiology (Sarcoidosis, Geographic choroidopathy, Acute posterior multifocal placoid pigment epitheliopathy (APMPPE). Posterior uveitis is a common cause of ocular morbidity and visual loss is associated with a number of systemic diseases. An early diagnosis based on clinical signs and symptoms and laboratory work-up with prompt treatment may help in the prevention of visual loss.

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Approach to the treatment of non-infectious uveitis

Khalid TabbaraOur therapeutic strategy for immune-mediated uveitis is evolving and new therapeutic modalities are emerging. New biologics have contributed to the successful control of autoimmune insults preventing loss of vision. Anti-vascular endothelial growth factors are safe and effective for the control of cystoid macular edema in non-infectious uveitis. TNF-α plays a major role in the propagation of the inflammatory process in patients with uveitis. The level of TNF-α in certain patients with uveitis is found to be elevated in the serum and in the intraocular fluids. Recent TNF-α blockers have been used to modify or modulate the inflammatory process in patients with immune-mediated diseases such as rheumatoid arthritis, psoriasis, Crohn’s disease, and juvenile idiopathic arthritis. Anti-TNF-α inhibitors have been recently approved by the FDA for the treatment of non-infectious uveitis. Anti-TNF-α inhibitors such as infliximab, adalimumab, golimumab, and certolizumab pegol have been shown to be safe and effective therapy for vision-threatening non-infectious inflammatory ocular disorders. Systemic and Intravitreal injection of adalimumab is safe and effective in patients with non-infectious immune-mediated uveitis. Anti-TNF-α inhibitors serve as steroid sparing agents.

Infectious uveitis not to be missed

Moncef KhairallahIn any patient with uveitis, an infectious cause should always be excluded first before administration of corticosteroids and immunosuppressive drugs. Early diagnosis of any specific infectious uveitic entity is essential for prompt initiation of appropriate therapy to prevent visual morbidity and, in some instances, systemic complications. Clinicians should be aware of the wide clinical spectrum of classic infectious uveitis including herpesviruses, toxoplasmosis, toxocariasis, tuberculosis, syphilis, and bartonellosis. Diagnosis can be confirmed by laboratory testing applied to blood or intraocular fluid samples. Numerous other infectious agents also may cause uveitis. Among them, specific arthropod vector-borne diseases have recently emerged as potential causes of uveitis, mainly in developing countries. Diagnosis of any emerging infection is primarily based on specific epidemiological data, systemic symptoms, and typical ocular features. It can be supported by laboratory testing, especially detection of specific serum antibodies.

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Approach to the main uveitis complications

Bahram BodaghiUveitis remains one of the major preventable causes of blindness in young patients. Complications are important to consider and their incidence may be dramatically reduced with a rapid diagnostic management followed by an efficient therapeutic strategy. Cataract and glaucoma are the best examples to consider. The use of topical corticosteroids may be significantly reduced in most of the cases with a direct effect on the occurrence of cataract and especially glaucoma. Efficient tools and medications are currently available in order to fully control intraocular inflammation. Anterior uveitis in children and posterior uveitis including white dot syndromes in adults have particularly benefited from this progress.

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Friday June 21st, 2019

UVEITIS

Diagnosis and Management of “Presumed” Ocular Tuberculosis

Khalid TabbaraOcular Tuberculosis is a common cause of ocular morbidity and loss of vision. The main objective of this presentation is to describe the clinical manifestations of ocular tuberculosis and management. Patients with anterior and posterior segment mycobacterial ocular infections will be elucidated including conjunctival granuloma, nodular scleritis, sclerokeratitis, granulomatous uveitis, retinal vasculitis, chorioretinitis, optic papillitis, and multifocal choroiditis. Extrapulmonary tuberculosis requires a high index of suspicion. The clinical diagnosis is confirmed by the clinical findings, skin testing, and Quantiferon blood tests. Patients with ocular tuberculosis require multidrug therapy to prevent resistance. Recognition of clinical signs is crucial in rendering therapy and preventing ocular complications. The anti-tuberculous drugs include isoniazid, rifamycin, pyrazinamide, ethambutol, streptomycin. Other anti-tuberculous alternate drugs include ciprofloxacin, rifabutin, clarithromycin, and linezolid. The incidence of resistant strains of Mycobacterium tuberculosis is increasing. Treatment with anti-tuberculous drugs helps in the prevention of ocular structural damage and loss of vision. Delay in diagnosis and therapy may eventuate in blindness.

Anterior viral uveitis: clinical presentation, diagnosis and management

Bahram BodaghiViral infection is the second etiology of anterior uveitis. In addition to the classical form of HSV and VZV infections, other entities have been recently described. The use of molecular techniques applied to ocular fluids has been the main diagnostic tool to determine CMV and rubella virus associated with Posner Schlossman syndrome and Fuchs uveitis, respectively. The clinical presentation is important to consider with the characteristics of keratic precipitates, the mild anterior chamber reaction and the level of ocular hypertension. Therapeutic options depend on the type of viral infection and may range from topical gancyclovir to oral valacyclovir, intravenous acyclovir and even abstention.

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Infectious Posterior Uveitis in the Immunocompromised Host

Khalid TabbaraIn immunocompromised patients, the most common cause of posterior uveitis is infectious in nature. The main objective of this study was to determine the causes of infectious uveitis in HIV negative immunocompromised patients and to outline the methods for prophylaxis and prevention. Patients underwent complete ophthalmologic examination. Systemic diseases and medications were recorded. Laboratory investigations and ocular fluids were obtained whenever indicated. A total of 18 patients were included (10 males and 8 females) with an age range of 9-72 years (mean age: 36 years). Five patients had viral posterior uveitis, five had fungal uveitis, three had toxoplasmosis, three had tuberculosis, and two had Streptococcal infections. Causes of fungal posterior uveitis included Candida, Aspergillus, Amesia, Fusarium, and Mucor. Infectious uveitis is more common in immunocompromised hosts than in immunocompetent patients. In the management of infectious posterior uveitis, immunosuppressive regimens may be modified. Vaccination and antimicrobial prophylaxis are given for prevention of infectious uveitis prior to immunosuppression.

Diagnosis and treatment of scleritis

Moncef KhairallahScleritis is defined as a painful inflammation of the sclera that can be broadly categorized according to anatomic location (ie, anterior or posterior) and whether the process is nonnecrotizing or necrotizing. Anterior scleritis is more common than posterior scleritis. Scleritis can present as isolated condition or as part of a systemic inflammatory or rarely infectious disorder. This ocular condition can result in vision loss and therefore requires early diagnosis and treatment. A thorough diagnostic work-up is crucial in the exclusion of underlying disorders. Necrotizing scleritis is usually associated both with poor visual prognosis and severe systemic morbidity. Nearly two-thirds of patients with non-infectious scleritis require systemic glucocorticoid therapy, and one fourth needs an immunomodulatory therapy, as well.

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Updates in the treatment of Behçet disease

Bahram BodaghiBehçet’s uveitis is one of the most sight-threatening types of intraocular inflammation. During the last 20 years, the visual prognosis has dramatically improved. Based on prospective controlled studies, it has been shown that immunosuppressors must be initially added to corticosteroids in all patients with posterior segment involvement. The EULAR recommendations for the management of ocular disease have been recently updated but a few challenging situations still need to be addressed. Biologic agents may be proposed in severe forms resisting to conventional immunosuppressors. In all cases, treatment must be continued for at least 2 years and discontinuation needs to be cautiously discussed in each patient in order to avoid blindness.

White dot syndromes: Overview and management

Moncef KhairallahWhite dot syndromes (WDS) are a group of rare inflammatory eye disorders of unknown etiology characterized by multiple whitish-yellow inflammatory lesions located at the level of the outer retina, retinal pigment epithelium, and choroid. They mainly include multiple evanescent white dot syndrome (MEWDS), acute posterior multifocal placoid pigment epitheliopathy (APMPPE), serpiginous choroiditis, multifocal choroiditis, punctate inner choroidopathy, and birdshot chorioretinopathy. Proper clinical and multimodal imaging approach to exclude a masquerade syndrome and to differentiate between WDS entities is essential for appropriate management and for visual outcome.

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EYELID & ORBIT

Noninvasive rejuvenation of the lower eyelid

Francesco BernardiniTreating the lower eyelids with fillers allows immediate effect, short recovery time the results are as good as surgery in well-selected patients. The G-point lift technique consists of using the different rheological features of the fillers to achieve the desired results and minimize the complications.

Lower eyelid blepharoplasty: the eyelid lift

Francesco BernardiniLower eyelid blepharoplasty consists of the correction of volume defects, liddefects and lower lid laxity defects at the same time. Using the ‘eyelid lift’ the three components of eyelid aging can be corrected at the same time without need of adjunctive procedures.

Minimally invasive procedures for the aesthetic patient

Tammy OsakiMinimally invasive procedures, such as botox, fillers, laser will be addressed in this talk. These procedures can be indicated isolately or associated with blepharoplasties. Focus will be on indications, contraindications and how to obtain the best results and avoid complications for each procedure.

Endoscopic lifting and fat grafting for midfacial rejuvenation

Francesco BernardiniEndoscopic lifting using the MIVEL technique allows to address vertical descent of the superior, inferior and lateral complexes of the periocular aesthetic unit by a complete release, under endoscopic visualization, and adequate fixation.

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RETINA (I)

Macular pigment: How to measure it and why it is important

Giovanni StaurenghiMacular pigment (MP) is a blue-absorbing pigment. Visualization is obtained mainly with blue auto-fluorescence and appears as dark spot in the fovea due to the absorption by yellow pigment of the blue light. There are a series of techniques to measure.Psychophysical with an Heterochromatic flicker photometry: it is accomplished by viewing a small circular stimulus that alternates between a test wavelength that is absorbed by the MP (typically--blue, 460 nm) and a reference wavelength that is not absorbed (typically-green, 540 nm). Flicker observed by the subject is reduced to a null point by adjusting the intensity of the former while viewing the stimulus centrally, and then peripherally (Bone et al. Arch Biochem Biopys 2004 Oct 15; 430; 2:137-42).Resonance Raman Spectroscopy. Light from an argon laser was used to resonantly excite the electronic absorption of the carotenoid pigments, and scattered light was collected and analyzed by a Raman spectrometer. (Bernstein et al IOVS 1998; 39:2003-2011).Reflection-based imaging which uses a narrow-band blue-wavelength excitation of the macular pigment absorption in combination with spectrally selective blue-wavelength readout of the reflection signals received by the instrument’s CCD detector array (Sharifzadeh et al. Journal of Biomedical Optics November 201; 18; 11, 116001).Single-pass two wavelength auto-fluorescence. It takes advantage of the auto-fluorescence of lipofuscin, which is normally present in the human retinal pigment epithelium. Stimulating the fluorescence with two wavelengths, one well absorbed by macular pigment (BAF) and the other minimally absorbed by macular pigment (GAF) (Delori. Archives of Biochemistry and Biophysics 430 (2004) 156–162).There are a series of pathologies where macular pigment can be important such as macular telangiectasia (Helb et al. Retina 2008 Jun; 28(6):808-16), to evaluate drug toxicity such as Tamoxifen (Preziosa et al. in press) or neurological disorders such as Alzheimer and Multiple Sclerosis (Staurenghi et al in press).

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Therapeutical regimens in wet AMD

Michel Eid FarahThere are two different strategies in the treatment of wet AMD: Individualized versus fixed dosing of anti-VEGF agents. With fixed dosing we may over- or under-treat patients. Over treatment may result in increasing the number of infections and adverse events, and also result in more geographic atrophy. Under-treatment could lead to irreversible loss of visual acuity for not controlling the wet disease. The goal is to reduce the number of injections and visits, without compromising the results.

Auto-fluorescence imaging in clinical practice

Giovanni StaurenghiAuto-fluorescence imaging is obtained using blue, green or near-infrared light to excite the fundus fluorophores. With blue or green excitation the main fluorophore visualized is lipofuscin accumulated in the RPE cells or bisretinoids outside the RPE cells. The difference between these two wavelengths is the fact that the blue light is absorbed by the macular pigment giving a dark spot in the image in the fovea area. This could be a problem if we are interested in visualizing the extension of geographic atrophy in the fovea but could be an advantage for differential diagnosis when we want to detect the macular pigment such as in DD of lamellar hole and pseudo-hole or macular telangiectasia or for other neurological diseases.Near-infrared auto-fluorescence visualizes melanin in the RPE and in the choroid. So young subjects exhibit more auto-fluorescence than the older ones using this technique, whereas the case is the opposite if blue or green auto-fluorescence is used.

Challenging AMD case discussions

Michel Eid FarahSeveral clinical cases with discussions on the specific differential diagnosis, kinds of treatments and prognosis, including associated lesions or variations such as pigment epithelium detachments, retinal angiomatous proliferation, idiopathic polypoidal vasculopathy, as well as propaedeutic findings in angiography and optical coherence tomography.

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OCT Angiography

Giovanni StaurenghiIn the last two years OCT angiography has enriched the diagnostic tools for retinal diseases.This approach allows visualization of retinal and choroidal vessels without dye injection. The goal of the meeting is to learn more about this new diagnostic tool.In particular we will first go deep to the heart of the technologies. In fact a series of different approaches are used to obtain OCT angiography by different companies or University laboratories.Then we explore the possibility of imaging in different retinal pathologies showing the limitations and advantages of this new technique.Different types of choroidal neovascularization will be compared with fluorescein angiography and indocyanine green angiography. Types 1, 2 and 3 and inflammatory choroidal neovascularization will be shown.We will also discuss the possibility to use OCT angiography to differentiate different types of macular atrophy, particularly important in the era of new clinical trials for macular atrophy in age-related macular degeneration.The possibilities to visualize retinal capillaries could be very useful in diabetic retinopathy. The high contrast between vessel and the surrounding areas should allow identification and automatic measurement of non-perfused retina. Finally we will discuss the use of OCT angiography into drug development and clinical trials. In particular opportunities and pitfalls.

Atypical forms of Central Serous Chorio Retinopathy

Alain GaudricCentral Serous Chorioretinopathy (CRSC) is a polymorphous disease that can take very different forms. Acute CSCR is characterized by multiple leaking points, yellow spots or fibrin deposition in the subretinal space, bullous inferior exudative retinal detachment, and it occurs in women or in the elderly. Chronic CSCR shows additional atypical signs compared to acute CSCR: various retinal pigment epithelium changes, including gravitating atrophic tracks, necklace pigment clumps, focal or diffuse depigmentation, flat irregular pigment epithelium detachment (PED) containing or not type 1 choroidal new vessels, cystoid maculopathy, and choroidal excavation. In these atypical forms, the diagnosis of CSCR is based on the presence of at least one of the following findings: subretinal leaking point, idiopathic PED, thickened choroid and dilated choroidal veins.

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RETINA (II)

Imaging the posterior pole in high myopia

Alain Gaudric

Myopic traction maculopathy: New staging system and guidelines for treatment

Barbara ParoliniMyopic traction maculopathy (MTM) is a spectrum of diseases that represents a severe cause of visual impairment in a large percentage of highly myopic eyes. At the moment there is no uniform and complete classification nor clear guidelines for treatment. The talk summarises the studies undertaken by the authors to reach the proposal of the new MTM Italian Staging System (MISS). As well the prognosis and guidelines for management are customised for each stage of MTM in the MISS based Management Table (MISS MAN table). The MISS MAN table guides in selecting when to perform a buckle, when a vitrectomy, when combined surgery or just observation.

Advances in chromovitrectomy for macular surgery

Michel Eid FarahThe latest results from our research investigations about the use of classic and new surgical staining agents, toxicity profile and possible dye-light interactions. The pre-retinal tissues are usually thin and transparent, so, there may be some difficulties in the process of their identification during the surgery, making this step not always easy. This issue justifies the study of substances with no toxicity, that stain and enhance the contrast, making membrane removal easier and the procedure safer. Triamcinolone is excellent for the vitreous, trypan blue, is very good for epiretinal membrane and brilliant blue is the gold standard, for ILM.

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Lamellar macular hole and pseudo-macular hole: A new classification

Alain GaudricThe distinction between Lamellar Macular Holes (LMH) and Macular Pseudoholes (MPH) has been confused and controversial for a long time. A careful analysis of SD-OCT B-scans and en face images has allowed an international group of specialists to propose a new definition and classification. LMH definition is based on 3 major criteria including irregular foveal contour, foveal cavitation and the apparent loss of foveal tissue, and 3 minor diagnostic criteria including premacular proliferation, a foveal bump and the disruption of the ellipsoid line. MPH definition is based on 3 major criteria including foveal-sparing epiretinal membrane, thickened retina and the presence of a verticalized or steepened foveal profile, and 2 minor criteria including microcystoid spaces in the inner nuclear layer and a near normal central foveal thickness.

Vitrectomy in diabetic retinopathy

Michel Eid FarahAlthough macular edema is the major cause of decreased vision in diabetic retinopathy, there are more severe cases in which neovascularization occurs with different degrees of fibrosis, that progress to partial posterior vitreous detachment, epiretinal membrane, tractional retinal detachment and vitreous hemorrhage. There are many situations in which surgery is required. A classical indication is persistent vitreous hemorrhage, another indication for vitrectomy is tractional retinal detachment involving mainly the macular and the peripapillary regions. Modern techniques can be associated.

Ten years’ experience with autologous choroidal/retinal transplantation for exudative and atrophic maculopathies

Barbara ParoliniRPE and choroid transplantation can be proposed as a retina rescue treatment for exudative and atrophic maculopathies. The talk will present the collection of 10 years’ data for RPE choroidal transplant and 3 years’ data for RPE, choroid and retina transplant, focusing of the results obtained in 88 eyes with at least 2 years follow up. Visual change, complications and technique variants will be discussed.

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Proactive dosing for effective patient management: What do the latest data show?

Ammar SafarThe mechanism of action of Aflibercept will be explained and the differences from the other Anti VEGFs, a summary of ALTAIR study results and a summary of PLANET study results will be presented.

Giovanni Staurenghi

Highlighting the importance of proactive regimen with anti VEGFs.Real life cases of w AMD patients will be presented showing the different types of wAMD and the different responses with different Anti VEGFs and different regimens.

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GLAUCOMA (I)

OCT and visual fields: How to understand, interpret and combine them for managing glaucoma

Felipe MedeirosStructural and functional assessment are at the core of glaucoma management. This presentation will review the evidence on the use of standard automated perimetry and optical coherence tomography for detecting glaucoma progression. Specifically, the presentation will review the importance of these methods, the sources of disagreement, the required frequency of testing in clinical practice and the existing algorithms for evaluation of change over time. The presentation will also describe approaches for combining SAP and OCT for improving detection of progression.

Recent developments in glaucoma medical treatment

Albert KhouriIn 2018, two new topical medications were made available for the treatment of glaucoma. Netasurdil a Rho Kinase inhibitor, and Latanoprostene Bunod a nitric oxide donating agent both lower intraocular pressure through novel mechanisms of action. The presentation will focus on mechanisms of action, efficacy, adverse effects, and the advantages and challenges of incorporating these novel agents in modern glaucoma therapy.

Neovascular glaucoma

Scott SmithNeovascular glaucoma is a serious, sight-threatening complication of diseases causing retinal and/or anterior segment ischemia. Intraocular pressure (IOP) elevation is often severe and acute in onset, and generally requires surgical intervention on an urgent basis. Appropriate management of patients affected by this condition also requires the identification and treatment of the underlying cause. Careful and thorough ophthalmic examination provides the necessary information to guide further systemic evaluation when the cause is not immediately evident. Concurrent management of the underlying disease and reduction of IOP is important to achieve optimal clinical outcomes. The appropriate use of pre-operative intraocular anti-VEGF therapy can improve surgical outcomes by reducing iris neovascularization and postoperative hemorrhage. Due to the inflammatory nature of this form of glaucoma, glaucoma implant surgery can offer improved long-term outcomes for control of IOP in comparison to trabeculectomy.

Saturday June 22nd, 2019

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Artificial Intelligence in Ophthalmology: Will Robots replace us?

Felipe Medeiros There has been an enormous recent interest in artificial intelligence (AI) and its potential uses to improve medical care. This presentation will give an overview of recent applications of AI in ophthalmology and in particular glaucoma. It will describe a new approach for AI-based assessment of fundus photographs to improve screening for glaucoma. In addition, other applications of AI in glaucoma will be discussed, such as improving evaluation of OCT and detection of visual field progression.

Teleglaucoma: the new frontier in remote structural and functional testing

Albert KhouriTeleglaucoma has potential applications in remote screening and consultation for glaucoma and other vision threatening diseases. Modern advances in digital imaging and OCT allow the integration of these technologies during teleglaucoma. Software enhancements can improve the detection of glaucomatous signs. Artificial intelligence and robotics can also be included in telemedicine to improve efficiency and accuracy.

ANTERIOR SEGMENT (I)

Transepithelial photorefractive keratectomy

Sam Arba MosqueraThe talk will cover different aspects of transepithelial approaches for laser vision correction. This includes the definition of transepithelial PRK, a brief historic review of the development of transepithelial PRK techniques, the introduction of TransPRK by SCHWIND eye-tech-solutions, and current status of the different transepithelial approaches as of June 2019. The review further includes the description of TransPRK, along with its wide indication range, and covers aspects such as the sequence of treatment, the (relative) importance and use of epithelial thickness measurements, the importance of smoothness of the residual stromal bed, the optical zone selection, and the centration.

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Corneal biomechanics of laser vision correction surgeries as measured with the Corvis ST

David KangPURPOSETo evaluate the changes in biomechanically corrected intraocular pressure (IOP) and new dynamic corneal response parameters measured by a dynamic Scheimpflug analyzer before and after transepithelial photorefractive keratectomy (PRK) and femtosecond laser-assisted laser in situ keratomileusis (LASIK).SETTINGYonsei University College of Medicine and Eyereum Eye Clinic, Seoul, South Korea.DESIGNRetrospective case series.METHODSMedical records of patients having transepithelial PRK or femtosecond-assisted LASIK were examined. The primary outcome variables were biomechanically corrected IOP and dynamic corneal response parameters, including deformation amplitude ratio 2.0 mm, stiffness parameter at first applanation, Ambrósio relational thickness through the horizontal meridian, and integrated inverse radius before the procedure and 6 months postoperatively.RESULTSOf the 129 patients (129 eyes) in the study, 65 had transepithelial PRK and 64 had femtosecond-assisted LASIK. No significant differences in biomechanically corrected IOP were noted before and after surgery. The deformation amplitude ratio 2.0 mm and integrated inverse radius increased, whereas the stiffness parameter at first applanation and the Ambrósio relational thickness through the horizontal meridian decreased after surgery (P < .001). The changes in deformation amplitude ratio 2.0 mm and integrated inverse radius were smaller in transepithelial PRK than femtosecond-assisted LASIK (P < .001). Using analysis of covariance, with refractive error change or corneal thickness change as a covariate, the changes in deformation amplitude ratio 2.0 mm and integrated inverse radius were smaller in transepithelial PRK than femtosecond-assisted LASIK (P < .001).CONCLUSIONSThe dynamic Scheimpflug analyzer showed stable biomechanically corrected IOP measurement before and after surgery. The changes in dynamic corneal response parameters were smaller with transepithelial PRK than with femtosecond-assisted LASIK, indicating less of a biomechanical effect with transepithelial PRK.

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Principles of astigmatism correction using excimer lasers

Sam Arba MosqueraThe talk comprehensively describes the key aspects for an efficient astigmatic correction in laser vision correction procedures with special emphasis on the following aspects: brief history of LVC, transferring measurements into ablations, evolution of the beam characteristics of the laser systems, evolution of the optical zone selections and centration, evolution of the eye-tracking technologies including eye-registration techniques, and the potential advantage of customization. The review covers essential parameters for the successful correction of astigmatism including: treatment technique, OZs, TZs, coupling effects, centration, spot size and repetition rates, eye-tracking, eye registration, treatment customization, and vector planning. A succinct report on recent published findings on the laser correction of high astigmatism will also be provided.

What is after CXL? A promising protocol to provide best vision for our keratoconus patients

Mohamed Shafik ShaheenVisual rehabilitation of keratoconus eyes is still controversial with many protocols described in the literature. Corneal collagen cross linking offers a great tool to halt the progression of the disease and to stop visual deterioration.Yet, CXL doesn’t result in improvement of the UCVA nor any refractive treatment. In this topic, I discuss an attractive protocol for visual to target Emmetropia/ addressing HOA treatment in crosslinked keratoconic eyes.The protocol is published in peer-reviewed journals and offers a ten years’ experience in this field.

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Modern results of SMILE and comparison with excimer lasers

David KangPURPOSETo evaluate the changes in corneal higher-order aberrations (HOAs) after corneal wavefront-guided transepithelial photorefractive keratectomy (PRK) and small-incision lenticule extraction (SMILE).SETTINGYonsei University College of Medicine and Eyereum Eye Clinic, South Korea.DESIGNRetrospective case series.METHODSMedical records of patients having either corneal wavefront-guided transepithelial PRK or small-incision lenticule extraction were examined. The root-mean-square total HOAs, 3rd-order coma aberration, and 4th-order spherical aberration were measured preoperatively and 6 months postoperatively. Independent t tests and analysis of covariance were used to compare changes in corneal HOAs between the 2 groups.RESULTSThe study comprised 77 eyes having corneal wavefront-guided transepithelial PRK and 81 eyes having small-incision lenticule extraction. The total HOAs and spherical aberration increased after transepithelial PRK (all P < .001), whereas coma aberration was stable after transepithelial PRK. The total HOAs, spherical aberration, and coma aberration increased after small-incision lenticule extraction (P < .001 for total HOAs, spherical aberration; P = .004 for coma). At 6 months postoperatively, total HOAs and spherical aberration were significantly larger in the transepithelial PRK group than in the small-incision lenticule extraction group. Coma aberration was larger in the small-incision lenticule extraction group than in the transepithelial PRK group. Spherical aberration induction was significantly smaller in the small-incision lenticule extraction group than in the transepithelial PRK group (P < .001), and coma aberration induction was larger in the small-incision lenticule extraction group than in the transepithelial PRK group (P = .011).CONCLUSIONSSmall-incision lenticule extraction demonstrated that the induction of total HOAs was comparable to corneal wavefront-guided transepithelial PRK, accompanied by smaller spherical aberration induction and larger coma aberration induction. During small-incision lenticule extraction, surgeons should aim to obtain optimum centration for smaller induction of corneal HOAs.

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Will SMILE replace LASIK? The quest of visual quality

Mohamed ShafikSMILE surgery is gaining a lot of popularity as a new modality in the field of refractive surgery. It has its powerful marketing tool as an attractive flapless procedure that might replace LASIK; the gold standard of refractive surgery.In this topic I analyze the comparison between SMILE and LASIK focusing on the visual quality provided by both of them.This comparison is based on personal experience and publications and the analysis of more than 100 peer-reviewed articles.The lecture will offer and interesting argument about the unfinished debate: Will SMILE replace LASIK?

Treatment response in nAMD

Mohamad Moghazy Aly MahgoubHow to evaluate treatment response to Anti-VEGF therapy in the treatment of nAMD and the treatment options available in resistant cases. What is the role of switching between anti VEGF drugs in non-responsive or resistant cases.

GLAUCOMA (II)

Glaucoma following vitreo-retinal surgery

Scott SmithPatients who undergo vitreoretinal surgery are at risk for intraocular pressure (IOP) elevation for a wide range of reasons. Acute post-vitrectomy IOP elevation may occur as a consequence of intraoperative interventions, including infusion of silicone oil or intraocular gas. Other causes of post-operative IOP elevation include hemorrhage or inflammation that can lead to obstruction of aqueous outflow. Late-onset elevation of IOP after vitrectomy has also been reported and has been hypothesized to occur as a result of oxidative damage to the trabecular meshwork related to alterations of oxygen tension within the eye after surgery. Careful consideration of the timing of IOP elevation after surgery and details of the clinical examination are essential in identifying the mechanism glaucoma, and in selecting appropriate therapy targeting the underlying cause.

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The evoling paradigm in precision glaucoma surgery: MIGS or Myths?

Albert KhouriMicro-incisional glaucoma surgeries have become increasingly popular and include devices and techniques that aim to lower IOP with varying efficacy in conjunction with cataract surgery or as stand-alone procedures. MIGS have ushered a new era of precision glaucoma surgery with an improved safety profile for patients with mild to refractory glaucoma. The presentation will highlight the changing paradigms in glaucoma surgery, as well as the limitations in efficacy, advantages and complications of various commonly utilized MIGS.

ANTERIOR SEGMENT (II)

Anterior segment OCT: indications in corneal pathology

Marc MuraineOptical Coherence Tomography (OCT) is a non-invasive imaging technique originally developed for retinal analysis. Since then, its use has extended to the examination of other structures of the eye and in particular of the cornea. OCT is able to measure the thickness of the cornea at any point and for some devices to measure the thickness of the corneal epithelium that would have a role in the detection of keratoconus. OCT is a diagnostic help for epithelial and stromal dystrophies and will guide therapeutic excimer laser. OCT is also extremely helpful in preoperative keratoplasty and in their postoperative follow-up. OCT helps to understand the recurrent keratoconus mechanism several years after penetrating keratoplasty. It allows to detect a possible detachment of the Descemet’s membrane and to correct it.In stromal pathologies, OCT is able to measure corneal thickness in every point and thus may guide the realization of a deep lamellar keratoplasty with more security. OCT is also of great help in analyzing the proper positioning of intracorneal rings in patients with keratoconus. Finally OCT is also essential when performing endothelial grafts, either during surgery by facilitating the adequate positioning of the graft, or postoperatively since it allows detecting every detachment of Descemet’s membrane. The last advance of OCT is represented by angio-OCT whose development is possible in the cornea even if it is extremely recent. It will be of great help in monitoring patients with severe corneal neovascularization.

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Future of IOL calculations

Uday DevganMethods of IOL power calculation will continue to evolve and static formulae, such as SRK/T, Hoffer, and Holladay 1, will eventually become outdated. This is why the future of IOL calculations will be using methods incorporating artificial intelligence (AI), neural networks, and big data. These machine learning methods will be able to incorporate new factors and will become more accurate. Already, using AI, we can achieve more than 90% of patients within 0.5 diopters of target which is a huge improvement compared to just a few years ago.

Novelties and new developments in laser vision correction

Sam Arba Mosquera This talk covers the continuous evolution of technologies competing in the laser vision correction space. It moves from ablative technologies, to SMILE, CXL, non-invasive approaches (PiXL, RIS, microwave), additive technologies, to myopia control technologies, LACS, presybopic corrections, diagnosis, and medicinal drugs. The talk shall provide a brief overview of the main market drivers for innovation, and which techniques are gaining momentum and can be “soon” ready to enter the clinical work.

Corneal neovascularization: diagnosis and management

Marc MuraineThe appearance of neovessels on the cornea has multiple causes and may be dramatic for vision in case of significant residual opacity because prognosis of corneal transplants is very severe. Treatment of corneal neovessels is particularly difficult but must be oriented according to the etiology. It is indeed necessary to refute any single treatment because several mechanisms can be involved in the genesis of these neovessels. Three questions must be asked in each situation: Are they superficial or deep? Are they recent or old? what is the mechanism behind neovessels: are they secondary to corneal hypoxia, corneal inflammation, corneal infection, trophic disorder or limbal stem cell deficiency ?Different therapeutic options that may be more or less effective may be proposed: local corticosteroids, photocoagulation, ocular surface reconstruction with limbal transplant, and more recently VEGF inhibitory molecules such as Bevacizumab, scleral lenses or surgical removal of neovessels bed.

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Challenging cataract cases

Uday DevganCataract surgery is the among most commonly performed surgery worldwide but not all cases are the same. There are many challenging situations which must be approached differently in order to achieve surgical success and great vision for patients. These cases include Posterior Polar Cataracts, Traumatic Zonular Loss, Dense White Cataracts, Small Pupils, and even iatrogenic capsule rupture. We will show videos how to manage all of these challenging cases and more.

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Acknowledgments

s.a.r.l

Your ophthalmic Partner

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