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EUROPEAN SOCIETY OF OPHTHALMOLOGY10-13 JUNE 2017 | BARCELONA, SPAIN

SEE YOU INBARCELONAwww.soe2017.org


Congress of the EuropeanSociety of Ophthalmology(SOE) 201569 June, 2015, Vienna, Austria

Scientific Programme Committee

Stefan Seregard, Sweden, Chairman and EducationThomas Fenech, Malta, Programme Co-ordination and Wet LabsNikolaos Bechrakis, Austria, Oncology and PathologySusanne Binder, Austria, RetinaJan-Tjeerd de Faber, The Netherlands, Paediatrics and StrabismusShlomo Dotan, Israel, Neuro-ophthalmologyIsabelle Hamilton-Bower, United Kingdom, Allied HealthChristoph Hintschich, Germany, OculoplasticsGraham Holder, United Kingdom, ElectrophysiologyFriedrich Kruse, Germany, Cornea and External EyeJanet Marsden, United Kingdom, Allied HealthCarlos Pavsio, United Kingdom, UveitisMarie-Jos Tassignon, Belgium, Cataract and RefractiveCarlo Enrico Traverso, Italy, Glaucoma

Congress Committee

Stefan Seregard, Sweden, PresidentThomas Fenech, Malta, Secretary GeneralJan-Tjeerd de Faber, The Netherlands, TreasurerSusanne Binder, Austria, Local Organiser

Abstracts

| BARCELONA, SPAIN

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Congress of the European Society of Ophthalmology (SOE) 201569 June, 2015, Vienna, Austria

Contents

Author Index

Free Paper Presentations

Rapid Fire Presentations

Electronic Poster Presentations

FP01 Retina 1: Surgical 0001-0010FP02 Paediatric Ophthalmology and Strasbismus and Refractive Surgery 0011-0020FP03 Cataract and Electrophysiology 0021-0030FP04 Retina 2: Experimental 0031-0040FP05 Glaucoma 0041-0050FP06 Oculoplastics and Oncology & Pathology 0051-0060FP07 Neuro-ophthalmology and Uveitis 0061-0070FP08 Cornea and External Eye 0071-0080FP09 Education and Ocular Surface 0081-0090FP10 Retina 3: Medical 0091-0100

EP Cataract 0150-0213

EP Contact Lenses 0216-0223

EP Cornea 0226-0293

EP Education 0296-0316

EP Electrophysiology 0319-0323

EP External Eye 0326-0342

EP Glaucoma 0345-0434

EP Neuro-ophthalmology 0437-0487

EP Ocular Surface 0490-0525

EP Oculoplastics 0527-0577EP Oncology and Pathology 0580-0621

EP Paediatric Ophthalmology and Strabismus 0624-0689

EP Refractive Surgery 0692-0722

EP Retina 0725-0957

EP Uveitis 0959-1003

RF01 Glaucoma and Retina 0101-0114

RF02 Cataract, Contact Lenses, Cornea, External Eye, Ocular Surface, Refractive Surgery 0115-0128

RF03 Education, Oculoplastics, Neuro-ophthalmology, Oncology & Pathology, Paediatric Ophthalmology and Strabismus, Uveitis 0129-0142

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FREE PAPER PRESENTATIONS

7Congress of the European Society of Ophthalmology (SOE) 69 June, 2015, Vienna, Austria - Abstract E-Book

FP-RET-0001

Ocriplasmin for Vitreomacular traction: our experienceNeves P., Brito R., Bacalhau C., Ornelas M., Santos M., Martins D.Setbal Hospital Center, Setbal, Portugal

Purpose: Ocriplasmin is a truncated plasmin derivative, with vitreolytic enzy-matic activity. Following the MIVI-TRUST study, it was approved as a thera-peutic option for focal (< 1500m) VMT (Vitreomacular Traction), when ac-companied by visual symptoms and/or a macular hole < 400m. In this paper, we present our experience with ocriplasmin and present a novel approach to evaluate the area of adhesion of VMTs.Methods: During 2014, we selected 8 patients with focal VMTs or macular hole, with a decrease in visual acuity and metamorphopsia. Before the injec-tion, all visual acuities were assessed, visual disturbances were examined and an OCT (Optical Coherence Tomography) was performed, in which we mea-sured the diameter and area of adherence (en face mode), as well as the aver-age macular thickness. We administered 125g of Ocriplasmin in an operating theatre, via pars plana. Each patient was daily re-examined over the following 7 days, and weekly thereafter. Results: Our sample had 8 patients (9 eyes) with an average age of 70.8 years. 4 eyes were pseudophakic, 5 were phakic and 1 had an epiretinal membrane. One patient had a macular hole with a diameter of 263m. Average VMT di-ameter was 471m and the average area was 0.36 mm2. We report a complete VMT resolution in 4 patients (44%) and one partial release (11%). Average time until release was 20.8 days, and one case only resolved after 56 days. The area of adhesion was 2 times greater in the group with no resolution than in the group with successful release of traction. VA improved by 2/10 on the first month after VMT release. We report no serious adverse events. We had one case of self-limited subretinal fluid accumulation happening after the in-jection.Conclusions: Our study achieved a better success rate when compared with the original MIVI-TRUST study. As many authors have reported, a better selection of patients was crucial for a better outcome. We report no serious adverse events.

FP-RET-0002

Vitrectomy as primary treatment for rhegmatogenous retinal detachmentThaler A.1, Kotnik T.2, Lumi X.11Eye Hospital, University Medical Centre Ljubljana, Ljubljana, Slovenia, 2Celje General Hospital, Department of Ophthalmology, Celje, Slovenia

Purpose: To review the clinical features, functional and anatomical outcomes and complications of rhegmatogenous retinal detachment (RRD) managed by pars plana vitrectomy.Method: A retrospective noncomparative analysis of patients with RRD who had a vitrectomy from September 2011 to September 2013. The surgical pro-cedures were performed by a single surgeon. All patients underwent a vitrec-tomy with complete fluid-air exchange, gas or silicone oil tamponade, and laser retinopexy. The patients completed at least 6 months of follow-up. Results: A total of 139 eyes of 139 patients were included: 71 (51.1%) were phakic, 65 (46.8%) were pseudophakic and 3 (2.1%) were aphakic. Mean time from the onset of symptoms to hospital admission was 31.4 days (range 1 day - 2 years). Mean BCVA at presentation was logMAR 0.60 (Snellen 0.25; range

hand movements to 1.0). Mean axial length of the operated eye was 24.65 mm (of which 16.9% < 23 mm; 36.9% 23 - 25 mm; 46.1% > 25 mm). 31 patients (22.5%) had proliferative vitreoretinopathy grade C or more at presentation. Primary intervention resulted in anatomical success in 137 patients (98.6%). A redetachment developed in 2 eyes (1.4%). Postoperative BCVA improved significantly to logMAR 0.35 (Snellen 0.44; range hand movements to 1.0) (p < 0.001). Visual acuity of logMAR 0.30 (Snellen 0.5) or better was achieved in 46.5% of cases. Mean postoperative IOP was 15.5 and did not differ signifi-cantly from mean preoperative value of 14.7 (p = 0.264).Conclusion: Primary pars plana vitrectomy offers potential advantages in the treatment of rhegmatogenous retinal detachment, including accurate diagnosis of breaks, high reattachment rate with a single surgery, and no postoperative axial length changes. The main concern remains late diagnosis of RRD and consecutively a late treatment with poor visual outcomes.

FP-RET-0003

The intraoperative OCT in the clinical routine of peeling surgeryLeisser C.1, Hackl C.1, Hirnschall N.1, Luft N.2, Doeller B.2, Draschl P.1, Rigal K.1, Findl O.11Hanusch Krankenhaus Wien, Vienna Institute for Research in Ocular Surgery, Vienna, Austria, 2Vienna Institute for Research in Ocular Surgery (VIROS), a Karl Landsteiner Institute, Vienna, Austria

Purpose: The intraoperative microscope integrated OCT (iOCT) enables im-mediate visualization of pathologies of the retinal layers during peeling sur-gery. Even iatrogenic changes, such as traction induced subfoveal hyporeflec-tive zones can be shown properly with the iOCT.Method: A prospective study including 20 subjects with epiretinal mem-branes, scheduled for 23G-ppV and membrane peeling. iOCT scans with an intraoperative microscope integrated OCT were acquired before and after peeling and compared to routine pre- and postoperative OCT scans. Results: The authors will give examples which additional information with the iOCT can improve the surgery, such as assessment of remnants of epireti-nal membranes, finding a location for grasping the epiretinal membrane, titrat-ing the extend of the peeling and by monitoring iatrogenic retinal traction during peeling, visualizing intraoperative subfoveal hyporeflective zones and intraretinal pathologies such as cysts. Epiretinal membranes could be visual-ized in all examined cases by the iOCT, whereas the inner limiting membrane could not be shown. An intraoperative, traction induced subfoveal hyporeflec-tive zone could be shown in 30% of cases by the iOCT. Conclusion: The iOCT has the potential to improve peeling surgery, by visu-alization of intraocular structures and the effects of iatrogenic, peeling associ-ated tractional forces.

FP-RET-0004

Internal limiting peeling with the inverted flap technique: a new paradigm in the macular hole surgeryMenezes C., Carvalho R., Lemos J., Serino J., Gonalves R., Bruna V., Tenedrio P.Hospital Pedro Hispano, Ophthalmology, Matosinhos, Portugal

Purpose: To evaluate the efficacy and safety of the internal limiting membrane peeling (ILM) with the technique of inverted flaps in macular hole surgery.Method: Retrospective analysis of cases of patients with complete macular hole who underwent vitrectomy and ILM peeling with inverted flap technique,

FREE PAPER PRESENTATIONSFP01: Retina 1: Surgical


Congress of the European Society of Ophthalmology (SOE) 69 June, 2015, Vienna, Austria - Abstract E-Book8

between January 2013 and May 2014, with a minimum follow-up of 3 months. All eyes underwent gas tamponade with SF6, with face down positioning for 3 days. Myopic macular holes were excluded.We evaluated the following parameters: best corrected visual acuity (BCVA), hole closure documented by OCT and complications.We compared preoperative and postoperative values, for the average time of follow-up.The Wilcoxon test was used for comparing BCVA (p < 0.05).Results: 18 eyes of 18 patients with a mean age of 63.6 14.9 years, with equal sex distribution, were studied. The etiology of macular holes was as follows: 78.1% idiopathic, 11,1% post-vitrectomy and 11,1% post-traumatic. Its average minimum diameter was 580 199 m and the average maximum diameter was 932 256m. According to lens status, 50% were phakic and without cataract, 11.1% had cataracts and 50% were pseudophakic. All phakic patients had combined surgery.For a mean follow-up of 7.0 2.9 months, the closure rate was 100%, with BCVA improving from 1.17 0.47 to 0.67 0.36 logMAR units (- 3.733; p = 0.000). The complication rate was 5.6% with respect to a case of intraopera-tive peripheral iatrogenic tear. All patients improved their BCVA.Conclusion: ILM peeling with the technique of inverted flaps is an effective and safe technique in macular surgery. In this study, with macular holes of large dimensions, the anatomic success rate was 100% and the gain in terms of functional BCVA was significant.

FP-RET-0005

Postoperative endophthalmitis: what role does vitrectomy play?Gouveia P., Correia-Pinto J., Alves-Faria P., Rocha-Sousa A., Falco-Reis F.Faculdade de Medicina, Universidade do Porto, Porto, Portugal

Purpose: To review the indications for vitrectomy in the treatment of acute postoperative endophthalmitis.Method: Retrospective study of all patients diagnosed with postoperative en-dophthalmitis (up to 42 days following surgery) treated in the Ophthalmology Department, Hospital So Joo, from January 2000 through July 2014. Charts were reviewed and data was collected regarding patient age, sex, symptoms on presentation, number of days following surgery, visual acuity on presenta-tion, type of surgery performed, Department where surgery was performed, etiologic agent, treatment and visual acuity after treatment. For patients that underwent vitrectomy data was collected on the number of days until vitrec-tomy and the type of retinal tamponade applied. Results: 89 eyes from 89 patients were included in this study. 53.4% of pa-tients were males. 25% were diabetic and 1.1% were under systemic cortico-steroids. Mean visual acuity on presentation was of hand movements (log-MAR 2.30) and the mean time following surgery until presentation was 7.62 days (range 0-42 days). 31.8% of patients underwent vitrectomy. 60.7% of these patients underwent vitrectomy up until the third day following presenta-tion. Vision improved significantly in both treatment groups (medical treat-ment versus surgical treatment). However, the degree of vision improvement was most severe in the group that underwent vitrectomy up until the third day following presentation (p=0.056). Conclusion: This study questions current indications for early vitrectomy in the treatment of postoperative endophthalmitis. The data presented suggests that, irrespective of visual acuity on presentation, vitrectomy performed up until the third day following presentation might result in a bigger improve-ment in visual acuity.

FP-RET-0006

Choroidal thickness after combined encircling scleral buckle surgery-pars plana vitrectomy for repair of macula-off rhegmatogenous retinal detachment - a long-term evaluationGama I.F., Proena H., Faria M., Almeida L.D., Bernardo T., Couceiro R., Monteiro-Grillo M.Hospital Santa Maria - Centro Hospitalar Lisboa Norte, Ophthalmology Department, Lisbon, Portugal

Purpose: To evaluate the long-term effect of combined pars plana vitrectomy and encircling scleral buckling surgeries on choroidal thickness. Method: This observational study included 15 eyes of 15 patients who un-derwent a scleral buckling surgery with an encircling band (2,5mm wide) and 23G pars plana vitrectomy for primary repair of unilateral macula-off rheg-matogenous retinal detachment. Choroidal thicknesses(CT) in operated eyes were compared with CT in the other 15 normal fellow eyes (control group). Exclusion criteria were: glaucoma, previous macular degeneration, uveitis, retinal vascular diseases, refractive errors6D, diabetes or previous ocular sur-gery other than uncomplicated cataract surgery. CT were obtained by manual segmentation provided by Heidelberg Eye Explorer software, at the fovea, at a distance of 1000,2000 and 3000 m from the fovea, at nasal, temporal, superior and inferior locations.Results: The mean time between surgery and Enhanced Depht imag-ing (EDI) OCT Spectralis (Heidelberg,Germany) was 14,537,82 months (Meanstandard deviation, min.6-max.28). The mean age was 60,9313,18 years and the mean axial length was 25,892,55mm in operated eyes and 24,271,03mm in the control group. Mean subfoveal CT was 233,9393,75m in operated eyes and 194,8777,63m in the control group. Mean CT at a dis-tance of 1000m, 2000m and 3000m from the fovea were 221,7787,49m, 202,5279,03m and 197,5564,33m, respectively, in operated eyes and 194,6780,25 m, 176,4074,70 m, 158,9356,66 m, respectively, in the control group. All differences between the 2 groups were statistically signifi-cant (p< 0,05).Conclusion: Combined pars plana vitrectomy and encircling scleral buckle for primary repair of macula-off rhegmatogenous retinal detachment caused choroidal thickening in this study(p< 0,05). The choroidal thickening may be related to a reduction in blood circulation caused by the encircling procedure and consequent venous stasis, which may be long lasting.

FP-RET-0007

Efficacy of a 532 nm micropulse laser in diabetic macular edemaQueirs T.1, Rodrigues R.2, Sousa K.1, Gentil R.1, Ferreira C.1, Mendona L.1, Gomes N.11Hospital de Braga, Braga, Portugal, 2Universidade do Minho - Escola Cincias da Sade, Braga, Portugal

Purpose: To evaluate the efficacy of a 532 nm micropulse laser for the treat-ment of center-involving diabetic macular edema.Methods: A retrospective study was conducted in patients submitted to a 532 nm micropulse laser (Quantel SupraScan 532 nm) for the treatment of center-involving diabetic macular edema, between June 2012 and June 2014, at the Ophthalmology department of Hospital de Braga. Subthreshold reti-nal photocoagulation was applied in areas with exudation, as determined by fluorescein angiography. The following laser parameters were used: 200 ms duration with a 10% duty-cycle, 70% of the power necessary to cause a vis-ible burn and a 50 m spot diameter. To evaluate the efficacy, best corrected



visual acuity, optical coherence tomography quantitative parameters and area of leakage on fluorescein angiography were compared, before and after treat-ment. The influence of previous treatments on the efficacy of micropulse laser and the need for further treatment were also analyzed.Results: A total of 115 eyes of 84 patients with a mean age of 64.9 years ( 9.94) were analyzed. A significant decrease was observed in the thickness of the treated area and in the area of leakage after treatment, as well as mainte-nance of best corrected visual acuity. Time free of treatment was significantly longer in nave patients in comparison with those who had previously been submitted to intravitreal injections alone or combined with conventional laser. No complications were reported.Conclusion: Micropulse laser with a 532 nm wavelength proved to be effec-tive and safe for the treatment of center-involving diabetic macular edema. Additional studies are needed to further assess the benefits of this therapy in diabetic patients.

FP-RET-0008

Vitrectomy in the management of diabetic macular edema in treatment-nave patientsMichalewska Z.1, Michalewski J.2, Adelman R.A.3, Bednarski M.2, Nawrocki J.21Ophthalmic Clinic Jasne Blonia, Ophthalmology, Lodz, Poland, 2Ophthalmic Clinic Jasne Blonia, Lodz, Poland, 3Yale University School of Medicine, Yale, United States

Purpose: To evaluate the potential benefit of vitrectomy in treatment nave di-abetic macular edema (DME) and to study postoperative retinal morphology.Method: Retrospective, nonrandomized, study of 44 consecutive patients with treatment-nave DME. Complete ophthalmic examination and SD-OCT were performed before and after vitrectomy with inner limiting membrane (ILM) peeling. ILM was stained with Membrane Blue, and then peeled. Data from postoperative month six and the end of available follow up were ana-lyzed. Main outcome measures were: final visual acuity, final central retinal thickness, need for repeated therapy.: Retrospective, nonrandomized, clinical study.Results: An epiretinal membrane was observed preoperatively in 38% of cases (17/44). The follow up period ranged from 8 to 48 months (mean 16 months). Mean preoperative visual acuity was 0.09 Snellen lines (1.2 log-MAR). Mean visual acuity improved to 0.25 Snellen lines (0.82 logMAR) at postoperative month six (p< 0.001) and to 0.29 Snellen lines (0.78 logMAR) at the end of follow up. Overall, 31% of patients gained more than two lines and 84% of patients gained at least one Snellen line, and. Visual acuity was unchanged in 15% of cases, and decreased by one Snellen line in one eye. Average central retinal thickness decreased from 595 m to 266 m at the end of follow up (p< 0.001). Final visual acuity was inversely associated with duration of diabetes (p=0.01) and presence of epiretinal membrane (p=0.02) and initial visual acuity (0.03). Reappearance of macular edema was noted in three cases (6%), one of which received anti-VEGF treatment.Conclusion: Vitrectomy may result in long lasting, satisfactory anatomical and functional results in treatment-nave DME. Similar results were achieved in eyes with and without visible traction on SD-OCT. Vitrectomy may be more convenient for some patients than multiple intravitreal injections, especially for patients with transportation difficulties.

FP-RET-0009

Intra- and postoperative subretinal hyporeflectivity following membrane peelingHackl C., Leisser C., Hirnschall N., Luft N., Dller B., Rigal K., Findl O.Hanusch Krankenhaus Wien, Vienna Institute for Research in Ocular Surgery, Vienna, Austria

Purpose: During the last decades in vivo macula imaging advanced by spec-tral domain optical coherence tomography. Particularly for membrane peeling it has been shown that the use of an intraoperative SD-OCT is possible. The formation of a subfoveal hyporeflective zone has been described intra- and postoperatively for this procedure. The aim of this study is to show whether there are differences in the intra- and postoperative hyporeflective zone be-tween finishing vitrectomy with air endotamponade compared to balanced salt solution (BSS).Method: In this study 30 patients with epiretinal membrane are scanned with intraoperative SD-OCT Rescan 700 (Carl Zeiss Meditec AG, Jena, Germany) intra- and postoperatively and are assessed concerning subfoveal hyporeflec-tivity. 15 patients will be randomized in the air-group and the remaining 15 patients will receive BSS. Second outcome ist the retinal thickness and the visual acuity over a follow up peroid of 3 months.Results: Intraoperative hyporeflectivity has been shown in 38,5% which reab-sorbed between day one and four after surgery. In addition to that changes in the ellipsiod zone and postoperative cystic macula edema - which disappeared spontaneously - have been found in single cases. Due to the fact that the study is still ongoing detailed results will be presented at the congress.Conclusion: The aim of the study is to show whether there are differences in postoperative subfoveal hyporeflectivity in the two study groups and to place a basis for further studies.

FP-RET-0010

Pars plana vitrectomy in proliferative diabetic retinopathy - retrospective analysis of results and complicationsLemos J.A.P.M., Carvalho R., Teixeira C., Menezes C., Gonalves R., Coelho P., Tenedrio P.Hospital Pedro Hispano, Ophthalmology, Matosinhos, Portugal

Purpose: To analyze the results and complications of pars plana vitrectomy (PPV) in the treatment of patients with proliferative diabetic retinopathy (PDR). Method: Longitudinal, retrospective, descriptive, observational study. All pa-tients that underwent PPV for PDR in the period between April 2012 and June 2014 and with a minimum follow-up of 2 months were evaluated. Data col-lected included baseline demographics, best-corrected visual acuity (BCVA), indications for surgery, complications, anatomic and functional success.Results: 108 eyes of 85 patients underwent PPV for PDR in the referred pe-riod. Patients mean age was 62,4510,89 years, with female predominance (55,3%). Mean follow-up time was 12,24 months. Preoperative mean BCVA was 1,370,69 logarithm of the minimum angle of resolutions (logMAR). The four main indications for surgery were: vitreous hemorrhage (VH) in 68 eyes, tractional retinal detachment (TRD) in 9 eyes, VH associated with TRD (11 eyes) and extensive neovascular proliferation (12 eyes). 59 eyes underwent phacoemulsification in the same surgery. In the last follow-up appointment, mean BCVA was superior to that registered preoperatively (0,870,76 log-



MAR, p< 0,001). Functional success rate was 80,6%, and it was superior in the HV group (89,7%). Anatomic success rate was 98,1%.Conclusion: Our study suggests PPV can be used successfully to treat PDR complications and often results in patients visual acuity improvement.

FP-PED-0011

A validated system for centralized grading of retinopathy of prematurity: telemedicine approaches to evaluating acute phase ROP (e-ROP) studyDaniel E.1, Quinn G.E.1, Hildebrand L.2, Ells A.3, Hubbard B.4, Capone A.5, Martin R.W.1, Ostroff C.P.1, Smith E.1, Pistilli M.1, Ying G.-S.1, e-ROP Cooporative Group1University of Pennsylvania, Philadelphia, United States, 2University of Oklahoma, Dean McGee Eye Institute, Oklahoma City, United States, 3University of Calgary, Calgary, Canada, 4Emory University, Atlanta, United States, 5Associated Retinal Consultants, Oakland University, Rochester, United States

Purpose: To describe a centralized system for grading digital images of retinopathy of prematurity (ROP) by non-physician Trained Readers (TR) in the Telemedicine Approaches to Evaluating Acute-phase Retinopathy of Prematurity (e-ROP) Study.Method: Multi-center observational cohort study. TRs were trained by expe-rienced ROP specialists and certified to grade ROP under supervision of an ophthalmologist Reading Center Director (RCD). An ROP Reading Center was established and equipped with standard hardware, secure Internet access, customized image viewing software and electronic grading form. A protocol detailing morphological features of ROP observed in digital retinal images was developed. Based on the features documented by the TRs, a computerized algorithm determined the presence of Referral-Warranted ROP (RW-ROP) defined as presence of any plus disease and/or zone I ROP, and /or stage 3 or worse ROP. Independent double grading was done by TRs masked to clinical data with the RCD adjudicating discrepant fields. Quality assurance included masking, assessment of intra-grader and inter-grader variability and temporal drift of image grading.Results: Four TRs underwent rigorous training and certification. 5,520 image sets were double graded with one quarter requiring adjudication for at least one component of RW-ROP. The weighted kappa for inter-grader agreement (N= 80 image sets) were 0.57 (95% CI: 0.37 - 0.77) for plus disease, 0.43 (0.24 - 0.63) for zone I ROP, 0.67 (0.47 - 0.88) for Stage 3 or worse ROP and 0.72 (0.52 - 0.93) for RW-ROP. The weighted kappa for grade re-grade agreement were 0.87 (0.67 - 1.00) for plus disease, 0.70 (0.51 - 0.90) for zone I ROP, 0.77 (0.57 - 0.97) for Stage 3 or worse ROP and 0.77 (0.57 - 0.97) for RW- ROP. Conclusion: The e-ROP system with trained non-physician readers grading ROP images under supervision reliably detects potentially serious ROP with good intra-grader and inter-grader consistency and minimal temporal drift.

FP-PED-0012

Unexpected diplopia after cataract surgery: analysis of causes and managementRizk A.Research Institute of Ophthalmology Cairo, Cairo, Egypt

Purpose: To know the causes and treatment of diplopia observed after cata-ract surgery. Method: We make a descriptive retrospective study on 21cases with persis-tent binocular diplopia following cataract surgery. They were collected be-tween 2012 and 2014. Results: They were classified by aetiology in four groups: myotoxic effects in surgery (19%), Decompensated phorias / shift of dominance in intermit-tent exotropia (19%), Aniseikonia (14.3%), stroke and nerve palsy (14.3%), temporary due to prolonged effect of peribulbar anesthesia (14.3%), Divergent paralysis (9.5%), and thyroid (9.5%). Initially, treatment with prisms, was tol-erated on19.4% and surgery was required on 71.5%.Conclusion: Complaint of double vision after cataract surgery can be disturb-ing not only for patients, but also for their surgeon, who have to find the root cause of the symptom.

FP-PED-0013

Muscle displacement esotropia - much more common than you thinkMorad Y.1, Nemet A.2,31Asaf Harofeh Medical Center, Pediatric Ophthalmology Unit, Tel Aviv University, Zrifin, Israel, 2Asaf Harofeh Medical Center, Pediatric Ophthalmology Unit, Zrifin, Israel, 3Hebrew University, Medicine, Jerusalem, Israel

Purpose: To describe our results in surgically treating muscle displacement esotropia in adults in which the lateral rectus is displaced inferiorly and the su-perior rectus is displaced nasally, and to compare patients characteristics with the characteristics of other adult patients who were operated for esotropia.Methods: Charts of all adult patients operated for esotropia between January 2011 and December 2014 were reviewed. The characteristics of patients op-erated by suturing the superior rectus belly to the lateral rectus belly with or without additional medial/inferior rectus recession (study) were compared with those of patients who were operated by conventional horizontal muscle recession/resection (control). Results: There were 22 study patients and 50 controls. Study patients were older (47.3Y vs 34.2Y p=0.04) and more myopic (-8.2D vs -1.3D, p=0.03). Forty two percent had diplopia as opposed to only 10% of controls (p=0.01). Average deviation in study patients was larger for distance (30.8 D) than near (25.8D), but in controls the deviation for near was larger (28.3D) than dis-tance (25.2D). Ninety two percent of study patients had some limitation in abduction as opposed to 11% of controls (p=0.001). All study patients showed muscle displacement at CT/MRI. Following surgery 86% of study patients and 82% of controls had deviation less than 8D.Conclusion: Inferior displacement of the lateral rectus and nasal displacement of the superior rectus is a relatively frequent cause for esotropia in adults. Restoring muscle position by suturing the bellies of both muscles together is effective in restoring alignment.

FREE PAPER PRESENTATIONSFP02: Paediatric Ophthalmology and Strabismus and Refractive Surgery



FP-PED-0014

Strabismus in non-syndromic craniosynostosisChaudhuri Z.1, Sharma A.21Lady Hardinge Medical College & Associated Hospitals, University of Delhi, PGIMER & Dr RML Hospital, Department of Ophthalmology, New Delhi, India, 2GB Pant Institute of Postgraduate Medical Education and Research, Department of Neurosurgery, New Delhi, India

Purpose: Craniosynostosis may give rise to strabismus due to heterotopy of extraocular muscle (EOM) pulleys, muscle force imbalance due to orbital asymmetry and absent or anomalous EOMs. We aimed to study the profile of ocular mis-alignment in a unique population of non-syndromic craniosyn-ostosis, to enable understanding of the pathogenesis of this condition, aiding subsequent appropriate management. Method: 53 patients (31 males) with non-syndromic craniosynostosis of aver-age age 4.5 years at presentation were prospectively evaluated over a period of 18 months for the prevalence and profile of associated ocular misalignment. The cranial shapes were phenotypically classified as trigonocephaly (metopic suture stenosis, 13), brachycephaly (bicoronal and / or lambdoid suture steno-sis, 20), scaphocephaly (sagittal suture stenosis, 9), plagiocephaly (unilateral coronal and /or lambdoid suture stenosis, 5) and oxycephaly (stenosis of coro-nal, lambdoid and sagittal suture producing a tower skull, 6).Results: 31/53 (58.5%) patients comprising all with plagiocephaly (5), none with trigonocephaly (13), 17/20 (85%) with brachycephaly, 6/9 (67%) with scaphocephaly and 3/6 (50%) with plagiocephaly had strabismus. This differ-ence in distribution of strabismus in specific types of craniosynostosis was sig-nificant (p< 0.005, chi-square), which probably helps establish focus for man-agement. 27/31 (87%) patients demonstrated exodeviation associated with pattern strabismus (5), dissociated strabismus (1), nystagmus (1) and hyperde-viations (5, all patients with plagiocephaly) while 4 patients had esodeviation.Conclusion: The clinical profile and distribution of strabismus in cranio-synostosis indicates a neuroanatomical rather than neural basis. Preoperative high resolution orbital imaging could help localize the position of abnormally placed / absent EOMs, thus aiding customized sequential management com-prising correction of skull shape, orbital misalignment and strabismus.

FP-PED-0015

Cystoid macular lesions are resistant to topical dorzolamide treatment in enhanced S-cone syndrome child - a case reportBui M., Bjelo M., Bosnar D.University of Osijek, University Eye Clinic, University Hospital Sveti Duh, Zagreb, Croatia

Purpose: To evaluate whether cystoid macular lesions respond to treatment with dorzolamid 2% drops in the enhanced S-cone syndrome (ESCS) child, as favourable resolution is documented in adults.Method: Seven-years-old boy with ESCS and cystoid macular lesions was treated with dorzolamid 2% in both eyes t.i.d. for a period of 7 months. The efficacy of treatment was analyzed functionally, by VA assessment (ETDRS) and mfERG, and anatomically by SD-OCT central foveal thickness (CFT) mesurement. Results: Baseline, RE CFT was 540 m and 453 m in the LE, with ampli-tude of P1-wave density 39.8 nV/deg and 50.4 nV/deg respectively. Best corrected visual acuity (BCVA) was 0.3 logMAR RE and 0.3 logMAR LE at distance, with cycloplegic refraction of +7.50D/+0.75 Dcylax90 RE and +8.50D LE. At 7-months follow-up examination, CFT showed no reduction in thickness (RE 599 m, LE 521m). P1-wave density increased (RE 49.2 nV/

deg, LE 85.6 nV/deg), with BCVA 0.3 logMAR RE and 0.2 logMAR LE. Conclusion: Topical dorzolamide demonstrated no improvement in macu-lar morphology as evidenced by SD-OCT. No reduction in central macular thickness was encountered and the cystoid macular appearance qualitatively remained the same. Although BCVA LE improved, the authors believe it was due to intensive amblyopia treatment, while increase in P1-wave density amplitudes probably resulted from the childs better cooperation during the exam. This case report supports the hypothesis that microcystoid changes in ESCS appear due to defects in cell-to-cell adhesion rather than oedema. Furthermore, it enhances that BCVA does not reflect the degree of macular structural derangement. The marked differences between the adult and child treatment response to CAI suggest that the breakdown of the blood-retinal barrier maybe plays more important role later in life.

FP-PED-0016

Graves orbitopathy in children and adolescents: the Vienna experiencePapp A., Guido D., Neumayer T.Medical University of Vienna, Department of Ophthalmology and Optomery, Vienna, Austria

Purpose: To assess the demographics, risk factors, clinical features and treat-ment options for pediatric Graves orbitopathy (GO) in our tertiary referral centre.Design: Retrospective case series.Method: In our retrospective case series we analyzed the charts of all pediat-ric and adolescent patients (aged 18 years and younger) who presented at our GO clinic between January 2008 and December 2013.Results: 48 patients (96 eyes) were identified; 36 females (75.0%) and 12 males (25.0%). Ethnicity: 40 (83.0 %) were Caucasian, 4 (8.0%) were Asian, 3 (6.0%) were African and 1 (2.0%) was of Arabic descent. Mean age at presen-tation was 12.0 years (range 2.2-18.1). Positive family history was recorded in 8 (17.0 %) cases. Smoking: 16 (33.0 %) were active and 8 (17%) passive smokers. Additional autoimmune disorder was present in 3 patients (6.0%).Mild disease was observed in 49.0%, moderate in 40.0% and 11.0% developed severe pediatric GO. The most frequent ophthalmic symptom was exophthal-mos (77%), followed closely by lower eyelid retraction (75,0%) then upper eyelid retraction (52%). Conjuntival injection with sicca symptomatic was observed in 48.0%, pain (retrobulbar or on eye movement) occurred in 44.0%, followed by lid edema and/or erythem (38.0%). 4.0% developed acquired epiblepharon. Ocular motility involvement was noted in 38.0%; limitation of abduction in 27.0%, of elevation-deficit in 21.0%. Interestingly, in 6.0% of the cases symptomatic optic neuropathy was diagnosed.Management: 75.0% was treated with anti-thyroid medication alone, 23.0 % received combination therapy with beta-blockers. Five patients required, however, iv methylprednisolone pulse therapy that resulted in prompt clinical improvement. Conclusion: Although the course of pediatric Graves orbitopathy is proved to be mild to moderate in most of our patients, severe, sight threatening GO - requiring immunosuppression - may occur at young age, as in our 5 patients over a period of five years.



FP-REF-0017

The evaluation of laser correction results in induced postkeratoplastic ametropia by FemtoLASIK and LASIKKarimova A., Doga A., Kachalina G., Mushkova I., Kishkin Y.The S. Fyodorov Eye Microsurgery State Institution, Moscow, Russian Federation

Purpose: To compare the results of FemtoLASIK and LASIK methods in an induced refractive error correction after penetrating keratoplasty (PKP).Method: We observed 49 eyes with residual ametropy after the PKP, out of which 21 eyes were operated by the FemtoLASIK technology - group I, 28 eyes by the standard LASIK - group II. In both groups, the diameter of the cor-neal flap was calculated taking into account optometric parameters depending on the ablation zone and was independent of the graft diameter. The thickness of the flap was selected based on data of the central graft pachymetry and the degree of refractive error.Results: After the keratorefractive surgery the mean cylinder decreased in the group from -4.532.7 D to -1.231.64 D, in the group II from -4.482.72 D to -1.341.62 D (< 0.05). ncorrected visual acuity compared with preopera-< 0.05). ncorrected visual acuity compared with preopera-< 0.05). Uncorrected visual acuity compared with preopera-tive values increased in the group I from 0.120.1 to 0.510.23, in the group II from 0.110.1 to 0.50.24. The average deviation of the obtained thickness of the flap from the proposed using the femtosecond laser was 8.41.8 mm. In formation of corneal flap with a mechanical microkeratome was 23.43.8 mm. There was not a cutting of flap edge about 3 mm long during the FemtoLASIK in 4 eyes with a pronounced fibrosis in the area of the scar. In the group II epithelial defects were appeared during the formation of corneal flap with mi-crokeratome and the removal of the vacuum ring in 10 eyes with changed epithelial cytoarchitectonic.Conclusion: Corneal flap formed by a femtosecond laser, is more uniformity and has less deviation in thickness than a flap formed with microkeratome. The graft fibrosis is contraindication for induced refractive error correction after the PKP by the FemtoLASIK. The FemtoLASIK and the LASIK are effective and safe technologies to achieve high functional results in the cor-rection of induced ametropia in patients after the PKP.

FP-REF-0018

Safety, efficacy and predictability of lenticule extraction surgery (SMILE) by micro-incision of two millimetersFernndez J., Rodrguez-Vallejo M., Martnez J.QVision (Virgen del Mar Hospital), Ophthalmology, Almera, Spain

Purpose: To evaluate the safety, efficacy, and predictability of two millimeter micro-incision lenticule extraction surgery to correct myopia at 3 months after surgery.Method: A random selection from both operated eyes of forty-four myopic subjects was included in the statistical analyses, mean ( SD) astigmatism of -0.59 ( 0.62 D). Eyes were classified in three groups depending on pre-operative spherical equivalent refractive error. Low myopic (lower than -3 D, n=14), medium (from -3.25 to -5 D, n=22) and high (from -5.25 to -7 D, n= 8). Refractive error, corrected (CDVA) and uncorrected distance vi-sual acuity (UDVA), and intraocular pressure were measured before and after three months of surgery. A Kruskal-Wallis test was conducted to determine if there were differences between groups for non-normal distributed vari-ables. Pairwise comparisons were performed using Dunns procedure with a Bonferroni correction for multiple comparisons. Adjusted p-values are pre-sented.Results: Safety in terms of change in CDVA showed statistical significant dif-ferences between low and high (p< 0.001), and medium and high (p< 0.005) groups. Only one eye from low group lost a line while four eyes improved

CDVA in the high group in at least one line. 97.7% from the total sample ob-tained a CDVA equal or better than before surgery. Predictability was perfect, slope equal to one, with a determination coefficient of 0.996 and no statistical differences in efficacy were found between groups. DVA was better or equal to 20/20 in 84.1% and better or equal to 20/25 in all cases. A Wilcoxon signed-rank test determined that there was not a statistically significant median differ-ence in intraocular pressure before surgery and after three months.Conclusion: Micro-incision lenticule extraction is a safe, effective and predictable procedure with independence on the refractive error level. Improvements in CDVA in high myopic subjects can be explained by spec-tacle magnification.

FP-REF-0019

Changes in corneal epithelial thickness after femtosecond laser small incision lenticule extractionLuft N.1, Dirisamer M.1, Kreutzer T.1,2, Bolz M.1, Wimmer E.1, Pretzl J.1, Priglinger S.G.11AO - Ars Ophthalmica Study Center, Department of Ophthalmology, General Hospital Linz, Linz, Austria, 2Ludwig-Maximillians-University, Department of Ophthalmology, Munich, Germany

Purpose: To assess the changes in central and peripheral corneal epitheli-al thickness in the first six months after small incision lenticule extraction (SMILE). Methods: This prospective study included patients that underwent unevent-ful SMILE refractive surgery. Anterior segment SD-OCT (RS-3000 Advance; NIDEK Co.) was used to evaluate corneal epithelial thickness (CET) and total corneal thickness (TCT). Thickness values were assessed at 17 points 1.25mm apart across the central 5mm of the corneal apex in the horizontal, vertical and oblique meridians. Biometric measurements were taken preop-eratively as well as at five time points during the first 6 postoperative months. Furthermore, subjective refraction, best corrected visual acuity, corneal to-mography (Pentacam; OCULUS Optikgerate) were assessed preoperatively and after 3 and 6 months. Results: Forty eyes of 20 patients were included. Mean age was 367.3 years. Mean spherical equivalent of the extracted lenticule was -4.921.25 diopters and mean lenticule thickness was 9520m. Preliminary results showed that mean change in central TCT from baseline was -75m on the first postopera-tive day and -81m one week postoperatively. Mean change in central CET from baseline was +1m one day after surgery and -5m one week after sur-gery. Paracentral and mid-peripheral CET change from baseline was +3m on the first day and -2m one week postoperatively.Conclusion: Preliminary results suggest that SMILE refractive surgery induces only subtle change in CET during the first postoperative week. Furthermore, TCT seems to further decrease after the first postoperative day. A comprehensive analysis of corneal biometric changes within the central 5mm zone in the first six months after SMILE refractive surgery will be presented. Furthermore, the influence of refractive correction, residual stroma bed thick-ness and surgical lenticule preparation on CET as well as the impact on visual and refractive outcome will be analyzed.



FP-REF-0020

Initial clinical outcomes with the image guided system for surgical planning and digital alignment on patients implanted with toric IOLSlade S.1, Solomon K.2, Cionni R.3, Lane S.4, Crozafon P.51Slade and Baker Vision, Houston, United States, 2Carolina Eyecare Physicians, Mt Pleasant, United States, 3The Eye Institute of Utah, Salt Lake City, United States, 4Associated Eye Care, Stillwater, United States, 5Cabinet dOphtalmologie, Nice, France

Purpose: To evaluate the residual refractive cylinder, accuracy to target and refractive outcomes when using a new image guided system for surgical plan-ning and and digital alignment during implantation of a single piece hydro-phobic, acrylic Toric intraocular lens (IOL) at 3 months postop. Method: Open label, prospective, non randomized, multi center study of 110 eyes (110 patients) using a new image guided system (Verion) for standard surgical planning. All patients underwent femtosecond laser (LenSx) assisted cataract surgery with digital alignment (Verion Digital Marker M) and all eyes were implanted with a single piece hydrophobic Toric IOL (AcrySof Toric IOL). Residual refractive cylinder, manifest refractive spherical equivalent (MRSE) accuracy to target, uncorrected visual acuity (UCVA) were recorded at 3 months postoperatively.Results: Residual refractive cylinder of 75% and 86% of patients had 0.50D and 0.75D respectively. 44% of patients had no residual refractive cylinder at 3 months postoperative. 80% had MRSE accuracy to target of 0.50D and 92% were within 0.75D accuracy.Conclusion: The result of this study indicates low residual refractive cylinder, good accuracy to target and refractive outcomes when using the image guided system for surgical planning on patients with Toric IOL.

FP-EPH-0021

Recognizing lyonization in female heterozygotes of X-linked ocular disease in the era of molecular diagnosticsKreps E.O.1, De Zaeytijd J.1, De Baere E.2, Leroy B.P.3,41University of Ghent, Ophthalmology, Ghent, Belgium, 2University of Ghent, Molecular Genetics, Ghent, Belgium, 3University of Ghent, Ophthalmology & Ctr for Medical Genetics, Ghent, Belgium, 4The Childrens Hospital of Philadelphia, Div of Ophthalmology & Ctr for Cellular & Molecular Therapeutics, Philadelphia, United States

Purpose: To investigate the clinical accuracy of recognizing female hetero-zygotes for X-linked retinitis pigmentosa (XLRP) and choroideraemia (CHM) using fundoscopy and blue-light fundus autofluorescence (FAF).Method: Retrospective analysis revealed 24 female XLRP heterozygotes from 15 different families (age 3-77 years) and 8 CHM heterozygotes from 5 families (age 14-65 years). Molecular diagnosis has been obtained for all subjects.Results: In XLRP, 16 of 24 patients (66.7%) mentioned decreased night vi-sion. RPGR mutations were identified in 17 subjects - 8 of which in ORF15. A causative mutation was found in RP2 in the remaining 7 subjects. Fundus examination showed no abnormalities in 8 subjects, a tapetoid reflex in 2,

regional pigmentary changes with or without bone spiculae in 15 and full-blown RP features in 1 patient. Both patients with a tapetoid reflex - aged 18 and 34 - had a mutation in RPGR-ORF15. An abnormal FAF pattern was found in 16 of 24 patients (70.8%). Of the 24 female XLRP heterozygotes, 21 (87.5%) showed abnormalities on fundoscopy and/or FAF. In CHM, only 1 of 8 patients - aged 40 - mentioned visual difficulties at night. In each of the 8 subjects, typical equatorial mottled pigmentary changes were evident. FAF revealed multiple small hyper- and hypoautofluorescent flecks in all 8 patients. In both XLRP and CHM, clinical findings were independent of age or specific mutation. Conclusion: Female heterozygotes of X-linked retinitis pigmentosa show ab-normalities on dilated fundoscopy and/or blue-light fundus autofluorescence in 87.5% of cases with a molecularly proven diagnosis. The most characteris-tic feature is a radial pattern of alternating areas of hyper- and hypoautofluo-rescence. In choroideraemia, all carriers exhibit pigmentary changes in the retinal midperiphery and scattered autofluorescence changes, despite a lack of visual symptoms. Fundoscopy is thus a sensitive means of detecting female heterozygotes in choroideraemia.

FP-CAT-0022

Epidemiology of 411,140 cataract operations performed in public hospitals and private hospitals/clinics in Denmark between 2004 and 2012Solborg Bjerrum S.Glostrup Hospital, Department of Ophthalmology, Glostrup, Denmark

Purpose: To study the epidemiology and mortality in patients who had cata-ract surgery in public hospitals and private hospitals/clinics in Denmark be-tween 2004 and 2012 and to assess the validity of the Danish cataract registriesMethod: Register- and chart based studyResults: A total of 411,140 cataract operations were performed in 243,856 patients. Patients who had cataract surgery in public hospitals had an overall statistically significantly 62% higher mortality compared to patients who had cataract surgery in private hospitals/clinics. The decrease in mean age at first eye cataract surgery in private hospitals/clinics was statistically significantly greater compared to the decrease in mean age at first eye cataract surgery in public hospitals (p< 0.001). The median time interval between first and sec-ond eye cataract surgery decreased statistically significantly during the study period (p< 0.001) and was statistically significantly shorter in all calendar years for patients operated in private hospitals/clinics compared to patients operated in public hospitals (p< 0.001). In all, 46 % of the cataract operations performed in private hospitals/clinics that led to cases of postoperative endo-phthalmitis were not registered in any registry.Conclusion: In general, patients who had cataract surgery in private hospitals/clinics were healthier, had first eye cataract surgery at an increasingly younger age and had a reduced time interval between cataract surgery in the two eyes compared to patients who had cataract surgery in public hospitals. The lack of registration of cataract surgery by the private hospitals/clinics limits the quality of the registries.

FREE PAPER PRESENTATIONSFP03: Cataract and Electrophysiology



FP-CAT-0023

Defining the individual near and intermediate distances in different multifocal intraocular lenses designsKretz F.T.A., Atttia M., Linz K., Auffarth G.U.International Vision Correction Research Centre (IVCRC) & David J Apple International Laboratory, University Hospital Heidelberg, Ophthalmology, Heidelberg, Germany

Purpose: The aim of this study was to determine the best near and intermedi-ate distance in patients that underwent implantation of different multifocal intraocular lens (MIOL) models. Method: In a prospective study patients that underwent cataract and refractive lens exchange with implantation of different MIOLs (Tecnis: ZKB00, ZLB00, ZMB00; Alcon Restor SN6AD1; Oculentis: Comfort, MF30; AT LISA 839; PhysIOL Micro-F) were examined. Outcome parameters were UNVA, UIVA, DCNVA, DCIVA monocular and binocular as well as reading speed and read-ing distance (Salzburg reading desk). Results: Mean uncorrected binocular reading distances were: ZKB00 = 50.8cm, ZLB00 = 40.2cm, Restor = 41.3cm, Comfort = 47.4cm, MF30 = 39.30cm, AT LISA 839 = 38.9cm and Micro-F = 37.25cm. There was a statis-tical significant difference between the reading distances.Conclusion: Finding the right MIOL for each patient is a difficult task. Daily activities and especially work or hobbies under dim light conditions are one crucial influence factor. With the option to know the individual near and inter-mediate distances of or patients, we can additionally fulfil their needs perform-ing their daily tasks and their favourite distance.

FP-CAT-0024

Awareness of the potential for post-operative diplopia among consultant ophthalmic surgeons in ScotlandRadwan M.1, Williams G.2, Fleck B.31NHS Lothian, Princess Alexandra Eye Pavilion, Edinburgh, United Kingdom, 2University Hospital of Wales, Swansea, United Kingdom, 3Edinburgh University, Edinburgh, United Kingdom

Purpose: To explore the views of consultant Ophthalmic surgeons in Scotland in the context of planning cataract surgery in patients with amblyopia. To com-pare preferences and decision making with recommendations in published lit-erature.Method: Across-sectional survey was conducted in which different grade ophthalmologists working in Scotland were invited to complete an online sur-vey designed using the Survey Monkey tool (http://www.surveymonkey.com). The survey included a clinical scenario involving an amblyopic patient with bilateral cataracts with questions designed to elicit responders preferences with regards to which eye they would operate on first as well as the reasoning behind their clinical decision making.Results: 43 out of 50 consultants responded to the survey (a response rate of > 85%). With regards to the chronological order of surgery 26 (60.4%) indicated that they would perform cataract surgery first on the non-amblyopic eye. 13 (30.23%) would surgically address the amblyopic eye first and four (9.3%) indicated that the patient preference would dictate the choice regard-ing the laterality of the eye to be operated first. While 12 responders (27.90%) had encountered amblyopic patients who had developed diplopia after cataract surgery 18 (41.86%) thought that a formal guideline from the Royal College of Ophthalmologists would be valued. Conclusion: Operating on the amblyopic eye first can result in fixation switch, with diplopia. According to these results the awareness of post cataract sur-gery diplopia and in particular fixation switch diplopia is not wide spread among consultant ophthalmic surgeons in Scotland.

FP-CAT-0025

The overlap of the femto and manual capsulorhexis changes refractive outcome and axial IOL positionFedor P.Comenius University, Traverse City and Bratislava, United States

Purpose: To determine the effect of the femto and manual capsulorhexis over-lap over the IOL optic on the axial position of the IOL and refractive outcome.Method: This retrospective intraindividual study comprised 44 eyes of 22 patients after cataract surgery with more than 180 degrees (50%) difference in the amount of the capsulorhexis overlap over the IOL optic in the right eyes as compared to the left eyes. We included only patients with the same platform of IOL in each eye and similar biometry in each eye. Pseudophakic anterior chamber depths were measured using Lenstar interferometry, ultra-sound biomicroscopy, immersion or contact Ascan. Pseudophakic anterior chamber depths, postoperative refractions and errors of predicted refractions of IOL power calculation formulas were compared in the right and left eyes of patients with similar ocular biometry that only differed in the amount of the capsulorhexis overlap over the IOL optic.Results: The mean overlap of the capsulorhexis over the IOL was 81% +/- 18% in group 1 with smaller capsulorhexis and 8% +/- 14% in group 2 with the larger capsulorhexis. The difference between the overlap of the capsu-lorhexis over the IOL optic was 72 % +/- 19% between groups 1 and 2. Larger capsulorhexis with less overlap over the IOL optic compared to a smaller capsulorhexis with a larger overlap of the IOL optic is associated with an average anterior displacement of the IOL optic of 0.24 mm and an average myopic shift of 0.5 D. Measurements obtained using Lenstar interferometry, ultrasound biomicroscopy, immersion and contact A-scan all confirmed the different axial IOL position. Subgroup analysis revealed, that the effect of overlap is present in femto and manual capsulorhexis, different IOL platforms and after 10 years of follow-up.Conclusion: The overlap of femto and manual capsulorhexis has a clinically significant effect on the postoperative axial position of the IOL and refractive outcome.

FP-CAT-0026

Influence of the IOL design on capsular bag stability in patients with Pseudoexfoliation syndromeWeber M.1, Draschl P.1, Hirnschall N.1, Findl O.1,21Vienna Institute for Research in Ocular Surgery (VIROS), a Karl Landsteiner Institute, Vienna, Austria, 2Moorfields Eye Hospital, London, United Kingdom

Purpose: To evaluate the influence of two different Intraocular lens (IOL-) designs on post-operative IOL stability concerning IOL tilt and decentration in patients with Pseudoexfoliation syndrome (PES).Methods: This randomised trial included patients diagnosed with PES who were scheduled for cataract surgery. One eye of each patient was allocated to the test group in which the Tecnis 1-piece ZCB00 (AMO, USA) was implant-ed while the other eye was allocated to the control group in which the Acrysof SA60AT (ALCON, USA) was implanted. Both IOLs are hydrophobic acrylic open loop IOLs. The main difference between the IOLs is the anterior surface curvature. Aim of this study was to assess differences in anterior chamber depth (ACD) and in IOL tilt and IOL decentration 1 hour, 3 months and 1 year post-operatively between test and control eyes. Results: Fourty eyes of 20 patients were included. Mean ACD in test and control eyes was 5.12 0.35 mm and 4.80 0.24 mm 1 hour post-operatively and 5.11 0.34 mm and 4.64 0.35 mm 1 year post-operatively. There was a significant difference 1 hour and 1 year post-operatively



(p< 0.01 and p< 0.01). Mean IOL decentration 1 hour post-operatively was 0.3 0.2 mm in both groups and 1 year post-operatively 0.5 0.1 mm in the test group and 0.4 0.2 mm in the control group. These differences were not found to be significant (p=0.53 and p=0.36). Mean IOL tilt in test and control eyes was 2.9 1.5 and 3.6 2.0 1 hour post-operatively and 3.2 2.0 and 4.5 2.2 1 year post-operatively. There was no significant difference between both groups 1 hour and 1 year post-operatively (p=0.45 and p=0.18).Conclusion: In eyes with Pseudoexfoliation syndrome where the Tecnis 1-piece ZCB00 is implanted the anterior chamber is deeper 1 year post-op-eratively in comparison to eyes where the Acrysof SA60AT was implanted. No differences were found in tilt and decentration between these IOLs 1 year post-operatively.

FP-CAT-0027

Sources of error in toric intraocular lens power calculationHirnschall N.1, Norrby S.2, Winter E.1, Leisser C.1, Hoffmann P.3, Findl O.41VIROS-Vienna Institute for Research in Ocular Surgery, a Karl Landsteiner Institute, Hanusch Hospital, Vienna, Austria, 2Retired, Former AMO, Groningen, Netherlands, 3Private Eye Policlinic, Castrop-Rauxel, Germany, 4VIROS-Vienna Institute for Research in Ocular Surgery, a Karl Landsteiner Institute, Hanusch hospital and Moorfields Eye Hospital NHS Foundation Trust, London, UK, Ophthalmology, Vienna, Austria

Purpose: To evaluate the influencing factors on remaining astigmatism af-ter implanting a toric intraocular lens (IOL) during cataract surgery using Gaussian error propagation. Method: In this study, consecutive cataract patients of three different cen-ters (Hanusch Hospital, Vienna, Austria; Castrop-Rauxel, Germany; and Moorfields Eye Hospital, London, K) that received toric IOLs were includ-ed. In a first step, all parameters that could have an influence on the post-operative remaining astigmatism were detected by screening the recent litera-ture. In a next step mean and standard deviation as well as reproducibility of pre-operative measurements were taken from our data set, or from the recent literature. Then thick lens ray tracing and Gaussian error propagation analysis was used to evaluate the influence of different parameters on the remaining post-operative astigmatism. Results: In total, 235 eyes of 200 patients were included. Mean corneal astig-matism measured pre-operatively with the optical biometry device was -2.24 D (SD: 0.87; -5.75 D to -1.00D). Mean absolute and vector difference be-tween the aimed and the post-operatively measured astigmatism were 0.48D (SD: 0.37; 0.00 to 2.05D) and 0.73D (SD: 0.46, 0.031 to -2.20), respectively (p=0.576). Results of the Gaussian error propagation analysis will be shown at the meeting. Conclusion: Main source of error when using toric IOLs is the pre-operative measurement of corneal astigmatism, especially in eyes with low astigmatism. The influence of the post-operative anterior chamber depth on the cylindrical power of toric IOLs and the effect of misalignment on the reduction of the astigmatism reducing effect can be easily calculated.

FP-CAT-0028

An audit to determine whether biometry, using two instruments, is resulting in acceptable post-op refractions for cataract surgery in a National Hospital settingCamilleri A.1, Carbonaro F.21Mater Dei Hospital, Gzira, Malta, 2Mater Dei Hospital, Msida, Malta

Purpose: In our Maltese National Hospital setting, two biometry instruments are used for pre-op cataract assessment. Unfortunately the Lenstar LS900 is not able to measure axial length for dense cataracts, so the Quantel Medical Axis-II Biometer is used but this does not measure astigmatism and axis. To determine whether our actual resulting postoperative refractive error (RE) was within the acceptable range from that predicted at biometry and whether there is a difference using each machine.Method: Data was collected retrospectively from 202 case files. Surgical technique, complications and general ocular pathology affecting visual out-come were recorded. Post op refractive data were available on 109 eyes. Results: The difference between predicted and actual RE in the 109 eyes ana-lysed ranged from -1.71DS to +1.92DS (average 0.05DS). 53.2% and 80.7% of eyes were found to be within 0.5D and 1.0D of predicted biometry re-sults, respectively.Of the patients with RE>0.5DS, 63.3% had biometry by AXIS-II while 32.7% by Lenstar and 4% by their combination. One eye was approached temporally, 2 had an extra incision placed at 180 for cortex as-piration, 14 had 1.0DC and all eyes had the lens inserted in the capsular bag. There were 5 amblyopic patients, two others with disc cupping and three with severe macular disease. Similarly, patients with RE 0.50DS, 57.4% had biometry via Axis-II and 38.3% by Lenstar. Also, one eye was approached temporally, 4 had an extra incision, 10 had 1.0DC, and all but one, had IOL in bag, with one in sulcus. There were no amblyopic patients in this group, one had disc cupping and four had advanced macular disease. Thus apart from the amblyopia, the patients seemed equally distributed. Conclusion: A post refractive error of 1.0D from predicted outcome was deemed acceptable. Nonetheless, using Lenstar more frequently and/or having pre-op refraction data available at the time of surgery, could reduce our postop astigmatism even further.

FP-CAT-0029

Choroidal thickness in clinically significant pseudophakic cystoid macular edemaOdrobina D., Laudaska-Olszewska I.Ophthalmology Clinic Boni Frates Lodziensis, Lodz, Poland

Purpose: To study the choroidal thickness with an enhanced depth imaging spectral-domain optical coherence tomography (EDI-OCT) in clinically sig-nificant pseudophakic cystoid macular edema (CME). Methods: 28 patients with CME after uneventful cataract surgery were in-cluded. Choroidal thickness was analyzed and measured at various points: subfoveal and 1,5 mm nasal, 1,5 mm temporal, 1,5 mm inferior, 1,5 mm su-perior from the center of the fovea. We compare choroidal thickness between affected and fellow eyes. Results: The mean subfoveal choroidal thickness measured in 28 eyes with CME was 229.14 62.61 m and 280.82 79.09 m in fellow eyes. At any point (subfoveal, 1500 m nasal, 1500 m temporal, 1500 m inferior, 1500 m superior from the center of the fovea), the choroidal thickness of the af-fected eye was significantly (P < 0.01) thinner than that of the fellow eye. Conclusions: The thinner choroid in eyes with CME than in fellow eyes may suggest that the reduced choroidal blood flow in the choriocapillaries is also possible factor of CME.



FP-CAT-0030

Fixing IOL to artificial iris using floating suturing techniquePfeifer V.University Eye Hospital Ljubljana, Ljubljana, Slovenia

Purpose: To present surgical technique of artificial iris (AI) and IOL implan-tation using fixation that does not trigger chronic inflammatory response. In patients implanted with artificial iris the chronic inflammation is common problem. The special suturing technique was developed to fixate AI to the sulcus. This technique can be used in aphakic eyes. The goal is to fixate AI and IOL to the sulcus in the way that it does not touch sulcus or posterior iris surface. Method: Patients with posttraumatic cataract and aniridia or large iris defects were implanted with AI alone or in combination with IOL sutured to the AI. Special loop sutures were used. With lasso technique IOL was sutured to the AI and later to the sulcus using the same suture and vertical zigzag suturing technique. Prior to implantation AI was trimmed or trephined to 10.5 mm. Before the end of the surgery the AI or AI IOL complex was centered to the anatomical axis of the globe by adjusting zigzag sutures. Results: Good centration of the AI to the anatomical axis of the eye was achieved. Photophobia was not a problem any more. Also aphakia could be corrected. Visual acuity improved markedly, especially in bright light and sunshine. No clinically relevant anterior chamber inflammation was noticed. Conclusion: AI and IOL implantation in aniridia and in severe iris defects is safe and effective procedure in combination with floating suturing technique. The photophobia disappears, visual acuity is improved and there is tremen-dous esthetic effect.

FP-RET-0031

Correlation between fundus autofluorescence and SD-OCT in exudative AMDMiranda A.F., Marques N., Cardoso J., Barros S., Telles P., Campos N.Hospital Garcia de Orta, E.P.E., Almada, Portugal

Purpose: Studies have shown that in exudative age-related macular degen-eration (AMD) a larger area of absence of autofluorescence is a significant predictor of visual acuity (VA). However, there are no published data integrat-ing anatomic information from spectral domain optical coherente tomography (SD-OCT) with fundus autofluorescence (FAF). The purpose of this study was to investigate correlation between FAF and SD-OCT in patients with exuda-tive AMD before and after treatment with intravitreal bevacizumab (IVB).Method: Retrospective study, with 38 eyes from 33 patients with exudative AMD who underwent IVB as their first treatment. An assessment of VA with logMAR chart, FAF and SD-OCT images were obtained before and after IVB (pre and post-IVB). We evaluated area of altered FAF and its pattern was classified. On SD-OCT we determined central macular thickness (CMT), the disintegration of the external limiting membrane (ELM) and of the junction between the inner and outer segment of the photoreceptor (IS/OS).Results: 33 patients with a mean age of 76,618,70 years were evaluated. Pre-IVB mean VA was 0,930,51 logMAR. The majority of FAF images were classified as a speckled pattern (65,8%). The mean area of altered FAF was

34,9118,12mm2 and it was significantly associated with ELM and IS/OS disintegration both pre-IVB (r=0.344, p< 0.05 and r=0.563, p< 0.001, respec-tively) and post-IVB (r=0.372, p< 0,05 and r=0.513, p< 0.05, respectively). Conclusion: In this study we concluded that the area of altered FAF is sig-nificantly associated with the status of the photoreceptor layer, as assessed by ELM and IS/OS integrity using SD-OCT. The association of FAF with SD-OCT parameters in patients with AMD could aid in the prediction of vi-sual recovery after IVB. This is particularly valuable in patients with a severe disease, in whom photoreceptor integrity before treatment could not be ad-equately evaluated, even with SD-OCT.

FP-RET-0032

Assessment of visual function by electroretinography and visual evoked potential before and after epiretinal membrane removalHri Kovcs A., Janky M., Gyetvai T., Petrovski G., Facsk A.University of Szeged, Ophthalmology, Szeged, Hungary

Purpose: To evaluate the change in the function of retinal ganglion cells and their axons following epiretinal membrane (ERM) removal. Method: Twenty four patients (12 males and 12 females) were enrolled to the investigation who underwent 23G pars plana vitrectomy with ERM-ILM peeling for symptomatic ERM. Mean age was 74,3 years (68-88 years), co-morbidities included age related macular degeneration (3/24), hypertension (8/24) and diabetes mellitus (8/24). Each patient developed macular oedema due to ERM proved by spectral domain OCT (Topcon 3D OCT-2000).Visual evoked potential (VEP) and pettern electroretinography were per-formed (Roland RETIport 32 program) for each patient before and 1 month and 3 month after the surgery. Results: The vitrectomies were performed without complications, the post-operative OCT scans proved complete ERM removal in each case. In 50% of patients, visual acuity improved at least two lines resulting full vision in 2 patients. Preoperatively, subnormal VEP amplitudes and delayed peak times, subnormal, often hardly detectable PERGs were recorded for all patients.After the surgery, half of the patients achieved better visual acuity, and both the amplitude and the latency of the VEP improved by 15 stimulation. However, significant improvement could not be found either in VEP or in PERG by 60 stimulation.Conclusion: Significant improvement was found in the 15 VEP, especially in the patients with no co-morbidities. Diabetes mellitus and severe hypertension may negatively influence the functional recovery of the macula. The abnormal VEP and PERG registered after the surgery by 60 stimulus probably mirror the permanent cell loss in the perifoveal area of the macula.

FREE PAPER PRESENTATIONSFP04: Retina 2: Experimental



FP-RET-0033

Randomized controlled trial assessing safety and preliminary efficacy of RTH258 (ESBA1008), a novel single-chain Fv antibody fragment, in neovascular age-related macular degenerationSilva R.1,2, Weichselberger A.3, Weissgerber G.3, Hamilton R.4, on behalf of the C-10-083 Study Investigators1Coimbra Hospital and University Centre (CHUC), Ophthalmology, Coimbra, Portugal, 2Association for Innovation and Biomedical Research on Light and Image (AIBILI), Coimbra, Portugal, 3Alcon Research, Ltd., Fort Worth, United States, 4Moorfields Eye Hospital NHS Foundation Trust, Ophthalmology, London, United Kingdom

Purpose: Single-chain antibody fragments (scFv) have the potential to pro-vide better retinal penetration and delivery of VEGF blockade to target tis-sues. The purpose of this study was to assess safety and preliminary efficacy, including durability of effect, of RTH258, a humanized novel scFv, in patients with neovascular age-related macular degeneration (nAMD).Methods: The trial was a prospective, multicenter, double-masked, random-ized, single-dose ascending, active-controlled, parallel-group study in patients with primary subfoveal choroidal neovascularization secondary to AMD. 194 patients were randomized to one of 5 groups. For RTH258, 11 patients re-ceived 0.5 mg, 31 received 3.0 mg, 47 received 4.5 mg and 44 received 6 mg; 61 patients received 0.5 mg ranibizumab. Efficacy assessments included change from baseline in central subfield thickness (CSFT) with pre-specified hypotheses testing of non-inferiority for the 4.5 and 6.0 mg RTH258 groups vs ranibizumab regarding the CSFT change at Month 1, applying a non-infe-riority margin of 40 microns. BCVA and time to receipt of standard of care treatment (duration of effect) were also assessed.Results: In this study RTH258 4.5 mg and 6.0 mg were found to be non-infe-rior to ranibizumab in CSFT mean change from baseline at Month 1. Duration of effect was longer for patients receiving RTH258 4.5 mg and 6 mg, with median time to receipt of standard of care treatment being 30 days longer for RTH258 6.0 mg than for ranibizumab (p=0.036). Adverse events were ob-served at low and similar rates across treatment arms.Conclusion: RTH258 demonstrated non-inferiority in CSFT reduction, and a longer duration of effect than ranibizumab. Further studies in larger popula-tions are ongoing.

FP-RET-0034

AQP-1 expression in retinal pigment epithelial cells overlying retinal drusenTran T.L.1,2, Bek T.3, Prause J.U.2, Hamann S.1, Heegaard S.11Glostrup Hospital, Eye Department, Glostrup, Denmark, 2University of Copenhagen, Eye Pathology Institute, Department of Neuroscience and Pharmacology, Copenhagen, Denmark, 3Aarhus University Hospital, Department of Ophthalmology, Aarhus, Denmark

Purpose: Aquaporins (AQP) are cell membrane channels that selectively al-low a passive transport of water. Changes in the hydration of the the outer retina leads to changes in the transcellular water transport mediated by co-transport proteins and possibly AQPs in the retina pigment epithelial (RPE) cells. In the RPE cells AQP1 has only been demonstrated in the cell membrane of cultured cells, but not in histological sections of human eyes. Drusen are of-ten formed when the transepithelial transport across the RPE decrease and are frequently present in eyes with ARM, AMD and space-occupying processes filling out the choriocapillaris. Therefore, we investigated the expression of AQP1 in RPE cells of human

eyes diagnosed with ARM, AMD and eyes with tumour associated drusen.Method: Nine human eyes with ARM, six eyes with AMD and nine eyes with choroidal malignantmelanoma were examined by immunoreactivty to AQP1. For each section of each group of eyes, all drusen were counted and the drusen diameters were measured at the base. Subsequently, the AQP1 labelling in the RPE cells was evaluated and scored positive/negative, and each drusen was grouped according to drusen size and AQP1 labelling. AQP1 labelling in the RPE outside drusen was also evaluated.Results: AQP1 labelling was observed in the apical membrane of the RPE cells situated above drusen in all three groups. There was a significant associa-tion between AQP1 labelling and drusen size (p < 0.001) and AQP1 labelling was more frequently observed in large drusen (>125 m) compared to small (< 62 m).Conclusion: AQP1 was expressed in RPE cells covering drusen but not in RPE cells outside drusen. Furthermore, AQP1 expression was positively cor-related to drusen size. We suggest that AQP1 expression is upregulated in the cell membranes of RPE cells above drusen in order to alleviate the increased need for fluid transport across the growing drusen.

FP-RET-0035

Metabolic and functional changes in retinitis pigmentosa: comparing retinal vessel oximetry to full-field ERG, EOG and mfERGTodorova M.G.1, Trksever C.1, Schorderet D.2, Valmaggia C.31University of Basel, Department of Ophthalmology, Basel, Switzerland, 2IRO- Institute for Research in Ophthalmology, Sion, Switzerland, 3Cantonal Hospital, Department of Ophthalmology, St. Gallen, Switzerland

Purpose: To determine a relationship between the retinal vessel saturation alterations and the residual retinal function measured by means of full-field ERG, EOG and mfERG in retinitis pigmentosa (RP) patients. Method: Retinal vessel Oximetry (RO), full-field ERG, EOG and mfERG were performed on 43 eyes of 22 patients suffering from RP and were com-pared to those of 26 eyes of 13 healthy controls. The oxygen saturation in all four major retinal arterioles (A-SO2) and venules (V-SO2) were measured and their difference (A-V SO2) was calculated. Full-field ERG amplitudes, EOG parameters and averaged mfERG response amplitudes (within central 3, between 3 and 8, 8 and 15, 15 and 24) were evaluated in relation to the RO measurements. Results: V-SO2 correlated well with the full-field ERG and EOG values: with increasing functional damage the V-SO2 was higher. The RP group was well distinguished from the controls when the RO measurements were correlated to the averaged N1, but also to the N1P1 mfERG response amplitudes. ROC-curve of V-SO2, compared to those of N1 and N1P1 mfERG response aver-ages (15-24), showed with an area under the ROC-curve of 0.912 (95% CI: 0.840-0.984), a high differential margin between RP and controls (p< 0.001).Conclusion: Retinal vessel saturation showed a significant relation to full-field ERG, EOG and mfERG. Thus, retinal vessel oximetry could potentially complement electrophysiological tests in monitoring disease progression in RP patients.



FP-RET-0036

Restoration of visual function to blind rats with a light-activated cellular prosthesis based on photovoltaic nanoswitchesZhang L.1, Lin M.-Y.2, Walston S.3, Thomas B.B.3, Humayun M.S.3, Pikov V.4, Gray H.B.5, Chow R.H.21School of Medicine, Zhejiang University, Eye Center, Hangzhou, China, 2Keck School of Medicine, University of Southern California, Department of Neuroscience, Los Angeles, United States, 3Keck School of Medicine, University of Southern California, Ophthalmology, Los Angeles, United States, 4Huntington Medical Research Institute, Pasadena, United States, 5California Institute of Technology, Pasadena, United States

Purpose: Retinal degeneration, including retinitis pigmentosa (RP) and age-related macular degeneration (AMD), are leading cause of blinding diseases worldwide. By targeting photovoltaic nanoswitches (PVN) to ganglion cells, we aimed to engineer a cellular prosthesis that converts absorbed light into an electrical signal. Here light-triggered neuron responses in blind rats treated with synthetic ruthenium based PVN (Rubpy) ex vivo and in vivo were re-ported.Methods: The Rubpy PVN was synthesised by Caltech. Ex vivo recording of membrane potential changes in leach ganglion was performed with patch clamp. Extracellular field potential changes of rat whole mount retina were detected ex vivo. RCS rats were used as blind model and administrated with intravitreal injection of PVN or BSS as control. Visual function tests includ-ing superior colliculus electrical activity recording and pupillary light-induced reflex, were then performed to PVN and BSS administrated rats.Results: Light-induced depolarizes the membrane and firing of neurons were detected in the leech ganglion cells as well as in rat retina incubated with PVN. Restoration of superior colliculus electrical response and pupillary reflex were recorded with intravitreal injection of Rubpy PVN. Histological results dem-onstrated no significant toxicity to retina tissue in vivo. Conclusion: Intravitreal injection of Rubpy PVN in blind RCS rats restored light response in superior colliculus and pupillary reflex. Our data demonstrate the therapeutic potential of photovoltaic nanoswitches in degenerative blind-ing diseases.

FP-RET-0037

Are eyes HAPIEE in Eastern Europe: the first ever population based fundus imaging study in Eastern EuropeSpeckauskas M.1,2, Hansen M.3, Leung I.3, Peto T.3, Tamosiunas A.4, Rumelaitiene U.1,2, Zaliuniene D.1,21Lithuanian University of Health Sciences, Medical Academy, Department of Ophthalmology, Kaunas, Lithuania, 2Hospital of Lithuanian University of Health Sciences, Eye Clinic, Kaunas, Lithuania, 3National Institute for Health Research Biomedical Research Centre at Moorfields Eye Hospital & University College London Institute of Ophthalmology, London, United Kingdom, 4Lithuanian University of Health Sciences, Medical Academy, Institute of Cardiology, Kaunas, Lithuania

Purpose: The multi-centre HAPIEE study (Health, Alcohol and Psycho-social factors in Eastern Europe) assesses the effects of alcohol consumption, dietary and psychosocial factors on health in Eastern Europe having recruited a ran-dom sample of subjects aged 45-64 in 5 locations; one of which is Kaunas, Lithuania, where the ophthalmic sub-study took place. Prevalence rates of

common eye diseases and their associations with modifiable risk factors (diet, smoking and alcohol) collected in the main study are investigated at Kaunas. This paper describes the ophthalmic sub-studys baseline results.Method: Patients were examined at Eye Clinic of Lithuanian University of Health Sciences in 2006. After consent, best corrected visual acuity (BCVA) and intraocular pressure (IOP) were taken; then dilated 2-fields photography of the posterior pole and the optic discs were done. Images were graded at Moorfields Eye Hospital Reading Centre, London, K by trained and certi-fied graders.Results: Of those invited to take part, 7087 (64.8%) attended the main study, and 1033 (14.6%) the ophthalmic sub-study. Altogether, 98.2% had imag-ing; 95.8% of these were gradable for diabetic retinopathy (DR), age related macular degeneration (AMD), and cup-disk ratio (C/D). DR was found in 163 (16.4%) patients, 564 (56.6%) had changes compatible with AMD and 23 (2.3%) had abnormal C/D. Low vision was found in 36 (3.5%), blindness in 10 (1.0%) patients. IOP was 21 mmHg or higher in 21 (2.0%) participants in either eye.Conclusion: To the best of our knowledge, this is the first population based study with fundus imaging conducted in Lithuania, and it proves that oph-thalmic sub-study can be conducted there with good quality data and image acquisition. While prevalence data look comparable to those elsewhere, it is imperative that further incidence data are established in order to allow for bet-ter understanding of ophthalmic health and disease in this country.

FP-RET-0038

Treatment of chronic central serous chorioretinopathy without definite angiographic leak with oral rifampicin and isoniazidGupta A.S., Arora S., Gupta A., Ghosh B.Guru Nanak Eye Centre, New Delhi, India

Purpose: Chronic central serous chorioretinopathy (CSC) is one of the impor-tant retinal causes of vision loss in young patients.Various treatment options like conventional laser, subthreshold micropulse diode laser, photodynamic therapy and ICG-mediated photothrombosis are being used for CSC.However, these modalities cannot be used if there is no definitive leak on fluorescein angiography. We describe a case series of 5 eyes with chronic CSC that were treated with oral rifampicin and isoniazid.Method: In this prospective interventional case series, 5 eyes of 3 patients were included. All eyes had chronic central serous chorioretinopathy with neurosensory detachment on optical coherence tomography (OCT), but no definitive leak on fluorescein angiography. All patients were treated with oral rifampicin 450 mg and isoniazid 600 mg once a day for 6 weeks. Results: 2 eyes responded with complete resolution of neurosensory detach-ment and significant improvement in visual acuity while 3 eyes did not re-spond at all. None of the patients had any side effects or complications due to the medication.Conclusion: Rifampicin and isoniazid might be effective in resolving sub-retinal fluid and improve visual acuity in some cases of chronic CSC, as they induce cytochrome P450, 3A4, and thus alter the metabolism of endogenous steroids, helping in resolution of chronic CSC. Hence, they can be tried in such cases.



FP-RET-0039

PEDF improves mitochondrial function in RPE cells during oxidative stressHe Y.1,2, Tombran-Tink J.21The Second Affiliated Hospital of Xian Medical University, Xian, China, 2Pennsylvania State University College of Medicine, Department of Neural and Behavioral Sciences, Hershey, United States

Purpose: The study investigates the role of PEDF in limiting oxidative stress-induced damage to RPE cells through mitochondrial pathways.Method: There was an age-related increase in LDH release, an increase in ROS levels, and a decrease in m in cultures exposed to oxidative stress alone. Treating pre- or post stressed cells with PEDF resulted in a marked increase in cell viability and improved mitochondria function indicated by decreased ROS levels and increased ATP production and m compared to stressed cultures alone. Pronounced mitochondrial aggregation and perinuclear redistribution was evi-dent in RPE cells from individuals >60 yo in stressed conditions compared to the branching morphology of these organelles in the 50-55 yo RPE or cells treated with PEDF. The negative effects of H2O2 on PI3K, Akt and ERK acti-vation were mitigated by PEDF and specificity of it action confirmed using the pharmacological inhibitors LY294002, SH6, and U0126. While PEDF potentiated both PI3K/Akt and MAPK/Erk signaling, its preser-vation of mitochondrial function and organization in the cell during oxidative stress was dependent on the PI3K/Akt pathway. PEDF modulated expression of Cyclophilin D, UCP2 and the apoptotic genes, Caspase 3, Bax, and Bcl2 in the RPE cells during oxidative stress. SiRNA mediated knockdown of the UCP2 gene was associated with elevated ROS production. UCP2 silenced cells treated with PEDF showed increased expression levels of UCP2 and lowered ROS levels in the presence or absence of oxidative stress.Conclusion: We provide evidence that PEDF promotes resilience of aging RPE cells to oxidative stress by stabilizing mitochondrial networks and func-tion and that mitochondrial dynamics in human RPE cells are controlled, in part, through the PI3K/Akt pathway.

FP-RET-0040

Ultrasound methods in assessment of ocular blood flow in endothelin-1 ischemia/reperfusion-induced retinal injury in ratsNeroev V., Kiseleva T., Chudin A., Ramazanova K.Helmholtz Moscow Research Institute of Eye Diseases, Russia, Moscow, Russian Federation

Purpose: This study was performed to estimate the blood flow in orbital ves-sels in vivo in rats model of ischemia-reperfusion with subconjunctival injec-tion of endothelin-1Method: 10 Wistar male rats were anesthetized with an intraperitoneal injec-tion of 50 mg/kg ketamine + 10 mg/kg xylazine for general anesthesia. They were injected 0, 3 ml of 4 -5 M endothelin-1 solution into the subconjunctival space of the left eye. There were estimated qualitative and quantitative char-acteristics of arterial and venous ocular blood flow using Power Doppler (PD) and spectral Doppler analysis with Ultrasound system VOLUSON 730 (GE Healthcare) and high-frequency probe SP 10-16 MHz with the high resolu-tion zoom function before and after endothelin-1 injection. The peak systolic velocity (PSV, cm/s), end-diastolic velocity (EDV, cm/s) and resistance index (RI) of blood flow in the orbital vessels were measured at the first hour and 3rd day after perfusion. Thickness of retinal layers and retinal cell apoptosis were detected by histological analysis.

Results: There was no echo-signal of blood flow in the orbit from 20 to 60 minutes after injection. At the 3rd day the blood flow velocities in superior oph-thalmic artery, central retinal artery (CRA) and long posterior ciliary arteries (LPCA) were increased. The indices of RI in CRA and LPCA were increased in comparison to those in fellow orbit. There were rising flow velocities in the central retinal vein and posterior ciliary veins. The morphological changes showed spasm of the small blood vessels, apoptosis and hemorrhages in retina. Conclusion: High-frequency ultrasound with Power Doppler and spectral Doppler analysis is the effective method for assessment of blood flow of the orbital vessels in vivo in ischemia/reperfusion model. Hyperperfusion in or-bital vessels with

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