June 17-19, 2011 Ebeltoft, Aarhus Denmark - AU Purepure.au.dk/portal/files/41642306/ECC_2011_Program_etc_3.pdf · June 17-19, 2011 Ebeltoft, Aarhus Denmark 37th!! 37th meeting …

June 17-19, 2011

Ebeltoft, Aarhus

Denmark

37th

37th meeting … Ebeltoft – Aarhus – Denmark … June 17–19, 2011

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Conference venue:

Hotel Ebeltoft Strand

Ndr. Strandvej 3

8400 Ebeltoft

Denmark

Phone: +45 86 34 33 00

Web: www.ebeltoftstrand.dk


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Welcome!

On behalf of the organising committee, I wish you a very warm welcome to the 37th European Cornea Conference.

Based on your contributions, we have scheduled a programme with sessions on

• Case reports • Stem cells & stromal dystrophies • Keratoconus • Cross-‐linking • Fuchs’ dystrophy & Endothelial keratoplasty • Ocular biometry, Synthetic cornea & Keratoprostheses • DALK • Allergy & inflammation

In addition, we hope the social programme including visit and dinner on the Frigate “Jylland”, excursion to Mols Bjerge, and the conference dinner Saturday evening will work as a perfect frame for discussions.

Jesper Hjortdal


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Programme overview

Friday

11.00-‐13.00 Bus transfers from Aarhus and Billund airports

14.30-‐15.15 Sandwich / coffee

15.15-‐15.25 Welcome

15.25-‐17.00 First afternoon session

17.00-‐17.15 Short break

17.15-‐18.30 Second afternoon session

19.00 Visit and dinner at the Frigate ”Jylland”

Saturday

7.30 Breakfast

8.30-‐9.45 First morning session

9.45-‐10.15 Coffee break

10.15-‐12.00 Second morning session

12.00-‐13.00 Lunch

13.00-‐15.45 Excursion to Mols Bjerge

16.00-‐17.15 First afternoon session


17.30-‐18.30 Second afternoon session

19.00 Conference dinner

Sunday

7.30 Breakfast

8.30-‐9.30 First morning session

9.30-‐9.45 Business: Next years meeting


10.00-‐11.15 Second morning session

11.15 Lunch-‐to-‐go

11.30 Bus transfers to Aarhus and Billund airports


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Scientific programme – Friday

15.25-‐17.00: First afternoon session: Case presentations Moderators: W. J. Rijneweld & Ilse Claerhut 15.25 Bilateral congenital corneal deficit: corneal coloboma?

Cathrien Eggink. UMC St Radboud Nijmegen, The Netherlands 15.37 An association for patients suffering from corneal diseases

W.J. Rijneveld. Westfriesgasthuis Hoorn, VUmc, Hoornvlies Patienten Vereniging, The Netherlands

15.49 Periferal ulcerative keratitis post intrastromal corneal rings segments implantation. A case report D. Almánzar. Fundación de Investigación Oftalmológica, Oviedo, Spain

16.01 Graft melt down in keratoconus Helena Sönne & Jes Mortensen. Ögonkliniken, USÖ Örebro, Sweden

16.13 Herpes in disguise? Ilse Claerhout. Ghent University Hospital. Belgium

16.25 Primary graft failure due to graft-‐to-‐host transmission of herpes simplex virus ? Seitz B1, Hasenfus A2, Stavridis E1, Gatzioufas Z1 . 1 Dept. of Ophthalmology, 2 Dept. of Pathology, Univ. Hospital of Saarland, Germany

16.37 Shallow anterior chamber with elevated intraocular pressure during DSAEK surgery Arie Marcovich. Department of Ophthalmology, Kaplan Medical Center, Israel

16.49 Bilateral Chronic Pseudomembranous Conjunctivitis: a challenging case. Paulo F. Torres, MD, PhD, Vasco Miranda MD. Cornea and Ocular Surface Unit, Hospital de Santo António (HSA), University of Porto, PORTUGAL

17.00-‐17.15: Break

17.15-‐18.30: Second afternoon session: Stem cells & dystrophies Moderators: Liv Drolsum & Francois Majo 17.15 The early developing human cornea from an immunohistochemical perspective.

Lyngholm M et al. Department of Ophthalmology, Aarhus University Hospital, Denmark & Department of Cellular and Molecular Medicine, Developmental Biology Unit, The Panum Institute, University of Copenhagen, Copenhagen, Denmark

17.30 Transcriptome analysis of discrete corneal subpopulations and development of optimized cLESC culture systems Chris Bath Søndergaard et al. Laboratoty for Stem Cell Research, Aalborg University & Department of Ophthalmology, Aarhus University Hospital, Denmark

17.45 Transplantation of ex vivo expanded autologous limbal epithelial cells on amniotic membrane using a culture medium free of animal derived products Liv Drolsum, Morten Moe, Bjørn Nicolaissen. Department of Ophthalmology, Oslo University Hospital Ullevål, and University of Oslo, Norway

18.00 Corneal stem cells in the central cornea: from the bench to the bed side François Majo1, Manuel Deprez1,2, Michael Nicolas1 . 1Jules-‐Gonin Eye Hospital, Lausanne, Switzerland. 2 Laboratory of Neuropathology, Centre Hospitalier Universitaire, University of Liège, Belgium

18.15 Paediatric corneal dystrophies –a plea for pictures. H U Møller. Eye Clinic. Viborg Hospital. Denmark


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Scientific programme – Saturday

08.30-‐09.45: First morning session: Keratoconus Moderators: Jesus Merayo & P.M. Leuenberger 8.30 The genetics of keratoconus – a status report

Kim Nielsen, Jesper Hjortdal, Maria Philmann, and Thomas J. Corydon Dept of Ophthalmology, & Dept of Human Genetics, Aarhus University, Denmark

8.45 Outcome analysis of Ferrara ICRS implantation for the orthopedic and refractive management of patient with keratoconus. Jesús Merayo, D. Almanzar, C. Lisa, B. Valcarcel, A. Poo, José F. Alfonso Fundación de Investigación Oftalmológica. Instituto Oftalmológico Fernández-‐Vega. Avda Dres Fernández-‐Vega 34. Asturias. Spain

9.00 Intrastromal Corneal Ring Segments in Corneal Ectatic Disease: Complications. Nuno Alves, Lisboa, Portugal

9.15 Toric IOL’s in irregular astigmatism P.M.Leuenberger. Centre Ophtalmologique de Rive, Geneva, Switzerland

9.30 Split-‐cornea transplantation by combining DMEK and DALK to reduce donor shortage and costs Claus Cursiefen. Dept. of Ophthalmology, University of Erlangen, Germany

09.45-‐10.15: Break

10.15-‐11.45: Second morning session: Corneal cross-‐linking Moderators: Dan Epstein & Philip Maier 10.15 Pathways and Mechanisms Underlying the Photophysics and Photochemistry of

Riboflavin induced cornea cross-‐linking . Thomas Breitenbach & Peter Ogilby. Depr. of Chemistry, Aarhus University, Denmark

10.30 Pachymetric changes during corneal collagen cross-‐linking and effect of hydroxipropylmethylcellulose on corneal thickness. Faik Orucoglu (Orucov), Kudret Eye Hospital, Turkey

10.45 UVA riboflavin collagen cross-‐linking lowers stromal swelling pressure. A. P. Soendergaard, A. Ivarsen, J. Hjortdal. Aarhus University Hospital, Denmark.

11.00 Drug penetration after corneal cross-‐linking. B E Frueh1, M Tschopp1, M Stary1, W Thormann2, J de Smet3, C Tappeiner1. 1) Dept Ophthalmology & 2) Dept of Pharmacology, University of Bern, Bern, Switzerland 3) Dept of Pharmacology, University of Ghent, Ghent, Belgium

11.15 Corneal cross-‐linking in children with progressive keratoconus: a prospective 24-‐month study. D Epstein1, BE Frueh2, E Albé3, P Vinciguerra3. 1) Dept Ophthalmology, University of Zurich, Zurich, Switzerland 2) Dept Ophthalmology, University of Bern, Bern, Switzerland 3) Dept Ophthalmology, Istituto Clinico Humanitas, Milan,Italy

11.30 Randomized, prospective, multicentre trial to investigate the efficacy of riboflavin/UVA corneal collagen cross-‐linkage to halt the progression of keratoconus. P. Maier et al.. 1University Eye Hospital Freiburg, & 2Eye Hospital of Ludwig-‐Maximilans-‐University Munich 3University Eye Hospital Würzburg, 4University Eye Hospital Düsseldorf, Germany, 5Department of Ophthalmology, University Hospital “Alexandrovska”, Sofia, Bulgaria

11.45 Collagen Crosslinking (CXL) as Keratitis Therapy Experimental & Clinical Research Jes Mortensen & Karim Makdoumi. University Hospital Örebro, Sweden


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12.00-‐16.00: Break

16.00-‐17.15: First afternoon session: Fuchs’ dystrophy & Endothelial Keratoplasty Moderators: Björn Bachmann & G. Van Rij 16.00 The role of complement activation in the pathogenesis of Fuchs’ dystrophy and

pseudophakic bullous keratopathy. Füst Á, Csuka D, Süveges I, Imre L, Bausz M, Nagymihály A, Csorvási Á, Füst G. Semmelweis University, Budapest, Department of Ophthalmology, Hungary

16.15 A Standardized Technique for Descemet Membrane Endothelial Keratoplasty (DMEK): Results after 12 Months Björn Bachmann, Kathrin Laaser, Claus Cursiefen, Friedrich E. Kruse Department of Ophthalmology, University of Erlangen-‐Nürnberg, Germany.

16.30 Descemet Stripping Automated Endothelial Keratoplasty (DSAEK) – is supine positioning the first hours after surgery necessary? Liv Drolsum, Marit Sæthre. Department of Ophthalmology, Oslo University hospital Ullevål, and University of Oslo, Norway

16.45 Descemetorhexis as treatment for Fuchs endothelial dystrophy: a report of 10 patients Bleyen I, Saelens EY, van Dooren BTH, van Rij G. Erasmus MC, Rotterdam, The Netherlands

17.00 Visual outcomes after DSAEK surgery: Which visual quality is primarily improved? Esben Nielsen, Jesper Hjortdal. Ophtalmological Department J, Aarhus University, Aarhus C, Denmark.

17.15-‐17.30: Break

17.30-‐18.30: Second afternoon session: Ocular biometry, Synthetic Cornea & Keratoprostheses Moderators: Per Fagerholm & Jesper Hjortdal 17.30 Activated keratocytes in in vivo confocal laser-‐scanning microscopy.

Falke K, Hovakimyan M, Stachs O, Guthoff RF. Department of Ophthalmology, Rostock University, Germany

17.45 Inter-‐examiner reproducibility of the AS-‐OCT Visante corneal thickness. David Galarreta, Ana del Rio, Raul Martin, Angela Morejon, Jesús Merayo. Hospital Clinico Universitario Valladolid, IOBA University of Valladolid, Spain

18.00 Developing biosynthetic corneas to substite human donor corneas at corneal grafting. Fagerholm P, Lagali N and Griffith M. Dept. of Clinical and Experimental medicine, Dept. of Ophthalmology, University of Health, Linköping, Sweden

18.15 An Update on Keratoprostheses Christopher Liu. Sussex Eye Hospital, UK


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Scientific programme – Sunday

08.30-‐9.45: First morning session: DALK Moderators: Paolo Rama & Michael Thiel 8.30 Deep anterior lamellar keratoplasty using an original manual technique.

Paolo Rama, Karl Anders Knuttsson, Giulia Razzoli, Stanislav Matuska, Maurizia Viganò, Giorgio Paganoni. San Raffaele Scientific Institute, Ophthalmology-‐Cornea and Ocular Surface Unit, Milano, Italy

8.45 Deep Anterior Lamellar Keratoplasty (DALK) in Keratoconus Patients. Stoiber J, Ruckhofer J, Seyeddain O, Grabner G. Paracelsus Medical University Salzburg, Dept. of Ophthalmology, Austria.

9.00 Corneal lamellar ablation for transplantation (CLAT) -‐ first experiences with a Excimer laser -‐ assisted anterior lamellar keratoplasty technique Claude Kaufmann, Michael A. Thiel. Cantonal Hospital Lucerne, Lucerne, Switzerland

9.15 National follow up of cornea transplants in the Netherlands Jeroen van Rooij. Eye Hospital Roterdam, Rotterdam, The Netherlands

9.30-‐9.45: Next years meetings

9.45-‐10.00: Break

10.00-‐11.15: Second morning session: Allergy & inflammation Moderators: Hanne Olsen Julian & Frank Larkin 10.00 Secondary glaucoma in allergic eye disease.

Frank Larkin & Laura De Benito Llopis. Moorfields Eye Hospital, London 10.12 Risk Factors and Antibiotics in Bacterial Keratitis – Are We Hitting The Target?

Luís Torrão1, Luís Figueira1,2, Jorge Palmares1, Raul Moreira1, F. Falcão-‐Reis1,2 1 Ophthalmology Department, Hospital S. João, Porto, 2 Faculty of Medicine, University of Porto, Portugal

10.24 Ready made allogenic serum eye drops for severe dry eye disease. Hanne Olsen Julian & Lene Holm Harritshøj. Eye Clinic Glostrup Hospital & Department of Clinical Immunology, Rigshospitalet, Copenhagen, Denmark

10.36 Transplantation of individualized recipient-‐serum-‐adapted cornea (RSAC) in high-‐risk keratoplasty. Zisis Gatzioufas 1, Holger Busse 2, Simone König 3, Solon Thanos 2 (1) Department of Ophthalmology, University of Saarland, Homburg/Saar, Germany, (2) Department of Ophthalmology, University of Münster, Münster, Germany (3) Interdisciplinary Center for Clinical Research, University of Münster, Münster, Germany

10.48 Treating Meibonian Gland Dysfunction with a new thermotherapy approach. The Portuguese MGD Group – Coordinator Paulo F. Torres, MD, PhD. Portugal

11.00 Penetration of topically administered antibody fragments into the eye. Michael A. Thiel. Cantonal Hospital Lucerne, Lucerne, Switzerland


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Abstracts

37th


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Friday 15.25-‐17.00:

First afternoon session: Case presentations

Moderators: W. J. Rijneweld & Ilse Claerhut 15.25 Bilateral congenital corneal deficit: corneal coloboma?

Cathrien Eggink. UMC St Radboud Nijmegen, The Netherlands 15.37 An association for patients suffering from corneal diseases

W.J. Rijneveld. Westfriesgasthuis Hoorn, VUmc, Hoornvlies Patienten Vereniging, The Netherlands

15.49 Periferal ulcerative keratitis post intrastromal corneal rings segments implantation. A case report D. Almánzar. Fundación de Investigación Oftalmológica, Oviedo, Spain

16.01 Graft melt down in keratoconus Helena Sönne & Jes Mortensen. Ögonkliniken, USÖ Örebro, Sweden

16.13 Herpes in disguise? Ilse Claerhout. Ghent University Hospital. Belgium

16.25 Primary graft failure due to graft-‐to-‐host transmission of herpes simplex virus ? Seitz B1, Hasenfus A2, Stavridis E1, Gatzioufas Z1 . 1 Dept. of Ophthalmology, 2 Dept. of Pathology, Univ. Hospital of Saarland, Germany

16.37 Shallow anterior chamber with elevated intraocular pressure during DSAEK surgery Arie Marcovich. Department of Ophthalmology, Kaplan Medical Center, Israel

16.49 Bilateral Chronic Pseudomembranous Conjunctivitis: a challenging case. Paulo F. Torres, MD, PhD, Vasco Miranda MD. Cornea and Ocular Surface Unit, Hospital de Santo António (HSA), University of Porto, PORTUGAL


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Title: Bilateral congenital corneal deficit: corneal coloboma?

Authors: Cathrien Eggink

Institution: UMC St Radboud Nijmegen

Text: A newborn presents with a bilateral developmental corneal opacity and a cheilo-‐

gnato-‐palato-‐schizis. A corneal cystlike structure is seen, an arrest in the early

closing development is suspected.

Early perforation necessitated corneal transplantation. Results of pathological

examination and genetic research are presented.


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Title: An association for patients suffering from corneal diseases

Authors: W.J. Rijneveld, M.D, Ph.D , Prof. H.J.M. Völker-‐Dieben, M.D, Ph.D. and J. Veltkamp

Institution: Westfriesgasthuis Hoorn, VUmc, Hoornvlies Patienten Vereniging The Netherlands

Text: Associations for patients suffering from common diseases as Diabetes mellitus

or Cardiovascular diseases are well established in the Netherlands, however an

association for patients with corneal diseases did not exist in the Netherlands

until six years ago.

In 2005, the Hoornvlies Patienten Vereniging was founded. Presently, almost 900

patients are member of this association.

Purpose of this association is firstly to provide information to the patients,

therefore a national meeting together with the ophthalmologists is organised on

a yearly basis, secondly to be an interlocutor to the insurance companies and

the government and finally to make suggestions to the ophthalmologists for

studies on subjects that were considerd important by their members. We have

evaluated the role of this Association for as well the patients as for the corneal

surgeons. The effects will be presented.


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Title: Periferal ulcerative keratitis post intrastromal corneal rings segments implantation. A case report

Authors: D. Almánzar, J. Merayo, J. Alfonso, C. Lisa, G. Ferrara, P Barrio

Institution: Fundación de Investigación Oftalmológica, Oviedo, Spain

Text: A Case Report of 42 years old female keratoconus patient that underwent intracorneal rings segment surgery for orthopedic and visual rehabilitation. 9 moths post op, patient developed Pheriferal Ulcerative Keratitis, and severe dry eye. Past medical history revealed Rheumatoid Arthritis and Sjögren Syndrome. Clinical management included adjust systemic inmunosupresive therapy, topical steroids, antibiotics and enriched lubricants (Plasma Rich Growth Factor, PRGF). One year after onset of the PUK visual acuity was 20/40, with no symptoms of dry eye and mild haze in the area of the former ulcer.


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Title: Graft melt down in keratoconus

Authors: Helena Sönne & Jes Mortensen

Institution: Ögonkliniken, USÖ Örebro, Sweden

Text: Case presentation: Man, 30 years of age with keratoconus. Anterior lamellar

keratoplasty was done. Several transplants melted down. Finally we found

Mycobacterium chelonae


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Title: Herpes in disguise?

Ilse Claerhout

Institution: Ghent University Hospital

Text: To report on the findings in a boy who presented with corneal lesions in the left

eye reminiscent of a herpetic ghost dendrite. It wasn’t until the other eye

became involved that the parents volunteerd the information that he had an

underlying systemic condition which was known to cause corneal lesions. We

report on the confocal findings in this rare case.


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Primary graft failure due to graft-‐to-‐host transmission of herpes simplex virus ?

Seitz B1, Hasenfus A2, Stavridis E1, Gatzioufas Z1

1 Dept. of Ophthalmology, University Hospital of Saarland

2 Dept. of Pathology, University Hospital of Saarland

Background and Purpose: Primary graft failure after uncomplicated penetrating keratoplasty (PKP)

for keratoconus in a young patient is very rare, but the reason often remains unclear. Herpetic

endotheliitis of the graft has been accused to be potentially causative. The purpose of this case report

was to differentiate whether primary graft failure may be attributed to donor contamination or latent

viral load of the host.

Patient and Methods: A 43-‐year-‐old male with long-‐standing neurodermitis received an

uncomplicated PKP in the interval after an acute hydrops due to of pellucid marginal degeneration.

Due to primary graft failure of an organ cultured donor from a German eye bank a repeat PKP was

necessary. Unfortunately, there were persistent epithelial defects and a tendency towards melting in

the second graft. Due to perforation at the corneal graft-‐host-‐junction a third graft became necessary

with larger diameter (8.5/8.6 mm, excimer laser trephination) simultaneous amniotic membrane

patch and temporary lateral tarsorraphy. At this point in time all three grafts were examined by means

of immunohistochemistry to detect HSV-‐1 antigens.

Results: The patient’s own cornea was negative for HSV-‐1. However, the two excised corneas were

severely positive for HSV-‐1 especially in the keratocytes of the deep stroma. After adequate therapy

with acyclovir topically and systemically the third graft remained clear up to now (for more than one

year).

Conclusions: In case of primary graft failure or persistent epithelial defects after uncomplicated PKP

in a young patient with ectatic corneal disease, graft-‐to-‐host transmission of HSV should be considered

as the primary reason. A ping-‐pong infection from graft to host and back may be responsible for the

delayed failure of further grafts. To enables an appropriate prophylactic acyclovir treatment in distinct

cases after PKP, we advocate the screening of donor and patient corneas for HSV-‐1 by use of PCR.


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Title: Shallow anterior chamber with elevated intraocular pressure

during DSAEK surgery

Authors: Arie Marcovich MD

Institution: Department of Ophthalmology, Kaplan Medical Center, Rehovot, Israel

Text: A 65 year-‐old women developed corneal edema in her left eye, following

phacoemulsification of cataract with posterior chamber intraocular lens.

Specular microscopy demonstrated low endothelial count of less than 800 cells

without guttae in both eyes.

The patient underwent Descemet stripping endothelial keratoplasty in her left

eye. During the surgery, after stripping of her Descemet’s membrane, the eye

became firm with shallowing of the anterior chamber, that remained shallow

throughout the surgery. Injection of air, to attach the corneal lamellar graft,

caused attachment of the iris to the peripheral cornea. Iris manipulation with a

spatula resulted in bleeding that entered the graft-‐host interface. One day after

the surgery, the chamber was deep with inferior peripheral sinechia. The

corneal graft was attached. There was corneal edema that cleared gradually over

one month of follow up.

A suggested etiology, management and prevention of such complication will be

discussed.


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Title: Bilateral Chronic Pseudomembranous Conjunctivitis: a challenging case

Authors: Paulo F. Torres, MD, PhD, Vasco Miranda MD

Institution: Cornea and Ocular Surface Unit, Ophthalmology Department, Hospital de Santo António (HSA), University of Porto, PORTUGAL

Text: Purpose: To describe a case of bilateral chronic pseudomembranous conjunctivitis Methods: Retrospective study of a unique clinical case Results: AMT, male, 64 years of age was referred to our clinical practice at the Cornea and Ocular Surface Unit of the Ophthalmology Department at HSA, Porto. The previous clinical eye history revealed several visits to different ophthalmologists to solve his chronic bilateral conjunctivitis resistant to 8 months of topical therapy with several antibiotics, anti-‐inflammatories and lubricant eye drops. Two months before, he experienced a sudden onset of erithematous cutaneous lesions on his entire body, including lesions of the oral mucosa and marked bilateral conjunctival hyperemia and pseudomembranes. Systemic lesions showed resolution with systemic corticoids; however, bilateral pseudomembranous conjunctivitis persisted. Conclusion: After excluding infectious, malignant, allergic, iatrogenic and autoimmune disorders, a diagnosis of atypical and active pseudomembranous ocular pemphygoid was made. However, this was not consistent with the typical basal membrane diagnostic immunofluorescence of linear deposits of IgG, IgA, C3 or C4 (IgM is rare). Also, the prolonged active phase that leaded to such a dramatic clinical picture with corneal perforation has never been described. This aggressive evolution is more consistent with ocular Stevens-‐Johnson syndrome that could be implicated in the initial clinical picture as a response to any of the many medications used. Alternatively, the compounding cytotoxicity of the imunosuppressors and the chronic inflammation of this case, where limbic corneal stem cells were already failing, could be enough to result in a lack of corneal regeneration and subsequent perforation. Despite our efforts, this chronic inflammatory disorder continued to progress and patient’s visual acuity is irreparably compromised.


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Friday 17.15-‐18.30:

Second afternoon session: Stem cells & dystrophies

Moderators: Liv Drolsum & Francois Majo 17.15 The early developing human cornea from an immunohistochemical perspective.

Lyngholm M, Høyer PE, Vorum H, Nielsen K, Ehlers N, Møllgård K. Department of Ophthalmology, Aarhus University Hospital, Denmark & Department of Cellular and Molecular Medicine, Developmental Biology Unit, The Panum Institute, University of Copenhagen, Copenhagen, Denmark

17.30 Transcriptome analysis of discrete corneal subpopulations and development of optimized cLESC culture systems Chris Bath Søndergaard, Jesper Hjortdal, Vladimir Zachar, Jeppe Emmersen & Henrik Vorum. Laboratoty for Stem Cell Research, Aalborg University & Department of Ophthalmology, Aarhus University Hospital, Denmark

17.45 Transplantation of ex vivo expanded autologous limbal epithelial cells on amniotic membrane using a culture medium free of animal derived products Liv Drolsum, Morten Moe, Bjørn Nicolaissen Department of Ophthalmology, Oslo University Hospital Ullevål, and University of Oslo, Norway

18.00 Corneal stem cells in the central cornea: from the bench to the bed side François Majo1, Manuel Deprez1,2, Michael Nicolas1 . 1Jules-‐Gonin Eye Hospital, Lausanne, Switzerland. 2 Laboratory of Neuropathology, Centre Hospitalier Universitaire, University of Liège, Belgium

18.15 Paediatric corneal dystrophies –a plea for pictures. H U Møller. Eye Clinic. Viborg Hospital. Denmark


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Title: The early developing human cornea from an immunohistochemical perspective.

Authors: Lyngholm M, Høyer PE, Vorum H, Nielsen K, Ehlers N, Møllgård K

Institution: Department of Ophthalmology, Aarhus University Hospital, Norrebrogade 44, 8000 Aarhus C, Denmark bDepartment of Cellular and Molecular Medicine, Developmental Biology Unit, The Panum Institute, University of Copenhagen, Blegdamsvej 3, 2200 København N, Denmark

Text: The corneal epithelium is continuously being renewed. Differentiated epithelial

cells originate from limbal stem cells (LSCs) located in the periphery of the

cornea, the corneoscleral limbus. We have previously identified superoxide

dismutase 2 (SOD2) and cytokeratin (CK) 15 as limbal basal cell markers and

potential markers for LSCs and early transient amplifying cells in human adults.

We describe the development of the ectodermally derived LSCs and the

mesodermally derived niche cells from the time at which the cornea is defined

(week 6) until the formation of the early limbal niche (week 14) in human

embryos and fetuses. The expression of SOD2 and CK15 was investigated

together with other identified limbal proteins. Previously suggested LSC and

differentiation markers (PAX6, CK3/12 and connexin 43) were also investigated.

Both SOD2 and CK15 were present in the corneal epithelium from week 6.

However, in week 14 they were predominantly expressed in the limbal

epithelium. Connexin 43 (and CK3/12) showed a reverse pattern of distribution.

SOD2 and CK15 were expressed already from week 7 in a stromal triangular

region from which the early mesodermal limbal niche most likely originates.

PAX6 was expressed in both ectodermally and mesodermally derived parts of

the limbal niche, underscoring the importance of PAX6 in niche formation.


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Title: Transcriptome analysis of discrete corneal subpopulations and development of optimized cLESC culture systems Authors: Chris Bath Søndergaard1-‐3 (E-‐mail: [email protected]), Jesper Hjortdal2 , Vladimir Zachar3, Jeppe Emmersen3 Henrik Vorum1

Institution: 1 Department of Ophthalmology (Aalborg Hospital, Aarhus University Hospital), Hobrovej 18-‐22, 9100, Aalborg, Denmark, 2 Department of Ophthalmology (Aarhus University Hospital), Nørrebrogade 44, 8000 Aarhus C, Denmark, 3 Laboratory for Stem Cell Research, Aalborg University, Fredrik Bajersvej 3B, 9220 Aalborg Øst, Denmark.

Text: Background: Corneal blindness can be caused by limbal stem cell deficiency (LSCD), which is characterized by dysfunction or depletion of the limbal epithelial stem cells residing in limbus next to the cornea. Since 1997 experimental transplantation of ex vivo expanded LESCs has been performed on hundreds of patients suffering from LSCD worldwide.

Hypothesis: Laser Capture Microdissection and RNA-‐sequencing of discrete subpopulations of human corneal epithelial cells, niche cells, and conjunctival cells can reveal specific stem cell markers and increase knowledge about stem cell biology of the ocular surface.

Ex vivo expansion of Limbal Epithelial Stem Cells is expected to change stem cell phenotype. RNA-‐sequencing data from optimized culture systems will be compared to data from in situ captured cells.

Materials and Methods: Discrete corneal subpopulations will be captured using UV cutting and IR capturing on PEN membrane slides. RNA integrity will be assessed using the Agilent Bioanalyzer. In parallel, human suspension-‐cultures will be grown on inactivated feeder cells, including 3T3 cells and human foreskin fibroblasts. Hypoxic growth conditions (1%, 2%, 5%, 10%, 15% oxygen) will be compared to normoxia. Transcriptomes of individual LCM captured cells and selected culture systems will be analysed and compared using RNA-‐seq and bioinformatics.

Perspectives: This study will increase knowledge about the stem cell biology of ocular surface and the effect of culture systems on stem cell phenotype. It will directly procure cell material for future transplantation to Danish patients.


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Title: Transplantation of ex vivo expanded autologous limbal epithelial cells on amniotic membrane using a culture medium free of animal derived products

Authors: Liv Drolsum, Morten Moe, Bjørn Nicolaissen

Institution: Department of Ophthalmology, Oslo University hospital Ullevål, and University of Oslo

Text: INTRODUCTION: The limbal epithelial stem cells found within the basal layer are the source of continuous renewal and repair of the corneal epithelium. In limbal stem cell deficiency (LSCD), recurrent epithelial defects, neovascularisation of the cornea, scarring and chronic inflammation will occur. Grafting of limbal fragments or transplantation of ex vivo expanded limbal epithelium may in these cases restore the surface and the transparency. Traditionally, the culture media contain animal derived products. These products are potentially a risk both of transmitting viruses or prions, and also cellular accumulation of xenogeneic protein. We have successfully expanded limbal epithelium on amniotic membrane (AM) in a culture containing autologous serum, with no animal-‐derived products or human recombinant growth factors. The results after transplantation of the first four patients with LSCD will be presented. METHODS. A 1.5x2.5X0.25 mm autologous limbal biopsy was performed from healthy limbal area, and epithelial tissue was expanded on AM for 2 – 3 weeks in a medium containing autologous serum. The AM with the expanded cells was then transplanted to the ocular surface of the diseased cornea. The patients were followed for at least 1 year after surgery. RESULTS. Three out of four transplanted patients improved both in subjective symptoms and in objective findings.

CONCLUSIONS. Our preliminary experiences suggest that transplantation of limbal epithelium expanded ex vivo on AM in a culture medium with human serum as single supplement is a promising way of treating patients with LSCD.


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Corneal stem cells in the central cornea: from the bench to the bed side

François Majo1 MD PhD, Manuel Deprez1,2 MD PhD, Michael Nicolas1 PhD. 1) Jules-‐Gonin Eye Hospital, Lausanne, Switzerland. 2) Laboratory of Neuropathology, Centre Hospitalier Universitaire, University of Liège, Belgium.

Purpose :

We demonstrated in 2008 that there is epithelial stem cells in the central cornea in mammals. Moving from the bench to the patient, we investigated immunohistological characterization of epithelial ingrowth (EI) after ALTK (Automated Lamellar Keratoplasty) or LASIK.

Setting/venue:

Retrospective case series of one ALTK and three LASIK investigated at the Jules-‐Gonin Eye Hospital.

Methods :

Four patients were included in this interventional non-‐comparative case series (two LASIK, one FemtoLASIK and one ALTK). EI specimens were removed surgically and examined by light microscopy with antibodies against cytokeratin 3 (CK3), cytokeratin 15 (CK15), cytokeratin 19 (CK19), Muc5AC, full length a isoform of p63 protein (p63 a), CCAAT enhancer binding protein delta (C/EBP d), the polycomb gene product BMI1, the ATP-‐binding cassette transporter protein BCRP/ABCG2 and Ki-‐67.

Results :

On slit lamp examination, early EI appeared as whitish islets while late EI presented as a confluent whitish opacity. EI persisted below the flap or the lamellar graft for up to 36 months. Microscopically, the epithelial ingrowths consisted of a squamous non keratinizing epithelium. Ki-‐67 labelling of 3 cases showed a low proliferative index of 4%, similar to control corneal epithelium. Superficial squamous cells strongly expressed CK3. Expression of BMI1, C/EBP d, BCRP/ABCG2 and p63 a was seen in a majority of cells in the specimens tested.

Conclusions :

We report the immunophenotype of one post-‐ALTK and three post-‐LASIK epithelial ingrowths specimens. Ingrowth cells showed signs of corneal differentiation (CK3+), low proliferative activity and positivity for 3/4 markers associated with corneal stem cell phenotype. Our observations on EI therefore suggest a limbal independent renewal of the cornea. According to these results, we propose a new surgical technic for retreatment after LASIK.


32

Title: Paediatric corneal dystrophies –a plea for pictures

Authors: H U Møller

Institution: Eye Clinic. Viborg Hospital. DK 8800 Viborg

Text:

The IC3D Classification of corneal Dystrophies comprises 25 entities included as

a corneal dystrophy. Following the classification it is proposed to publish a multi

author paper on the Clinical presentation in childhood of corneal dystrophies;

particularly because these pictures hardly ever have been published. Most of the

dystrophies are dominantly inherited, and many families have been described,

but nevertheless the ophthalmological literature lacks illustrative, didactic, spot-‐

on pictures on the slit lamp appearance in children at the time of presentation.

The present paper is an invitation to collaboration on this project.

1. Weiss JS, Moller HU, Lisch W et al. IC3D classification of the corneal

dystrophies. Cornea 2008, Suppl 2,1-‐42. (English & Spanish) & IC3D

Klassifikation von Hornhautdystrofien,. Klin Monatsbl Augenheilkd, 2011, 228;

suppl1:S1-‐S39 (in German).

2. Møller HU, Kestelyn P, Weiss JS. Pediatric corneal dystrophies. A plea for

pictures. Letter. Cornea 2010;29:1469.

[email protected]


33

Saturday 08.30-‐09.45:

First morning session: Keratoconus Moderators: Jesus Merayo & P.M. Leuenberger 8.30 The genetics of keratoconus – a status report

Kim Nielsen, Jesper Hjortdal, Maria Philmann, and Thomas J. Corydon Dept of Ophthalmology, & Dept of Human Genetics, Aarhus University, Denmark

8.45 Outcome analysis of Ferrara ICRS implantation for the orthopedic and refractive management of patient with keratoconus. Jesús Merayo, D. Almanzar, C. Lisa, B. Valcarcel, A. Poo, José F. Alfonso Fundación de Investigación Oftalmológica. Instituto Oftalmológico Fernández-‐Vega. Avda Dres Fernández-‐Vega 34. Asturias. Spain

9.00 Intrastromal Corneal Ring Segments in Corneal Ectatic Disease: Complications. Nuno Alves, Lisboa, Portugal

9.15 Toric IOL’s in irregular astigmatism P.M.Leuenberger. Centre Ophtalmologique de Rive, Geneva, Switzerland

9.30 Split-‐cornea transplantation by combining DMEK and DALK to reduce donor shortage and costs Claus Cursiefen. Dept. of Ophthalmology, University of Erlangen, Germany


34

Title: The genetics of keratoconus – a status report

Authors: Kim Nielsen, Jesper Hjortdal, Maria Philmann, and Thomas J. Corydon

Institution: Department of Ophthalmology, Aarhus University Hospital, Aarhus Department of Human Genetics, Aarhus University, Aarhus

Text: Most cases of keratoconus appear sporadic. In some families, however, the corneal disease is observed with a higher prevalence, indicating a pattern of inheritance. Over the last decade several genetic studies have been performed worldwide using state-‐of-‐the-‐art techniques. And surprisingly, no consensus is observed among the studies. Numerous loci on half of the human chromosomes have thus been suggested involved in the disease. Could it be that the conical shape is merely a common clinical sign of different pathological mechanisms? This hypothesis is actually not new but was proposed back in 1984. The genetic literature will be reviewed in attempt to answer the question.


35

Title: Outcome analysis of Ferrara ICRS implantation for the orthopedic and refractive management of patient with keratoconus

Authors: Jesús Merayo, D. Almanzar, C. Lisa, B. Valcarcel, A. Poo, José F. Alfonso

Institution: Fundación de Investigación Oftalmológica. Instituto Oftalmológico Fernández-‐Vega. Avda Dres Fernández-‐Vega 34. Asturias. Spain

Text: Patients, Material & Method: From a total of 63 consecutive keratoconus patients (39 males, mean age of 33 yo) that underwent surgery with ICRS there were select a cohort that meet the inclusion criteria: keratoconus grade I and II (Rabinowitz) pericentral ectasia (3 to 5 mm from the center of the visual axis), oblique astigmatism (45º right eye and 135º left eye) and axis of coma aberration included from 0º to 75º from the astigmatism axis. All patients underwent intrastromal tunelization performed by Femtosecond laser (Intralase). ICRS implanted were Ferrara Type. Outcome analysis measured was mean UCVA, BCVA, Orbscan II and CA100 (Topcon) before and 3 months after surgery. Also, the presence of complications (infections, segment removal, extrusion) was analyzed. Results: Mean UCVA improved from 0,21 ± 0,20 to 0,39 ± 0,28, and mean BCVA improved from 0,72 ± 0,23 to 0,78 ± 0,20. 50% of the patients gained 1 or more lines of vision, 37,5% remained unchanged and 12,5% of patients had lost 1 line of vision. Orbscan II and CA100 showed corneal flattening, with significant decrease of the keratometry, with mean astigmatism ranging from 3,87 ±1,94 to 2,13 ± 1,49 postoperatively. No complications were observed. Conclusions: The implantation of Ferrara type ICRS in the keratoconus patient select is effective, safe and have predictable orthopedic and refractive effects. A prospective multicentric study should be performed to confirm our results


36

Intrastromal Corneal Ring Segments (ICRS) in Corneal Ectatic Disease: Complications.

Nuno Alves.

Serviço Oftalmologia -‐ Centro Hospitalar de Lisboa -‐ zona central, Lisboa, Portugal.

Purpose: To evaluate the complications of the first 300 patients submitted to Ferrara intrastromal corneal ring segment (FICRS) implantation using mechanical tunnelization.

Methods: In this retrospective study, 300 keratoconus eyes that had FICRS implantation were reviewed. All patients had contact lens intolerance and clear corneas. Uncorrected visual acuity (UCVA), best corrected visual acuity (BCVA), topographic evaluation with Pentacam topographic system, intra and post-‐°©-‐operative complications were analyzed. FICRS were inserted according to the manufacturer´s nomograms and standard mechanical surgical method.

Results: The overall complication rate was 8%. Minor complications such as periannular deposits were often seen in FICRS implanted eyes. Extremity ring fracture was detected in 8 eyes. Ring migration and extrusion occurred in 5 eyes each. We describe the surgical resolution and outcome of an unusual post-‐°©-‐operative anterior chamber FICRS migration.

Conclusion: Implantation of FICRS in patients with keratoconus is a safe procedure, which entails a low complication rate even when performing a mechanical tunnelization. Despite the low complication rate, we should not disregard it especially in the beginning of the learning curve, and when mechanically implanting 2 FICRS.


37

Title: Toric IOL’s in irregular astigmatism

Authors: P.M.Leuenberger

Institution: Centre Ophtalmologique de Rive, Geneva

Text: Irregular astigmatism occurring in keratoconus or after corneo-‐scleral injuries

may be corrected with contact lenses in a majority of cases. When these

patients develop cataracts, implantation of toric IOL’s allows in all cases for

significant improvement of uncorrected vision as well as abandon of contact

lens wear.

Calculation of the toric lenses is done by optical measurements/formula for the

two main optical planes, correcting and ajusting according to topography

(Langenbucher). The IOL used was a three-‐piece silicone optic with spherical

front-‐side and toric back-‐side and Z-‐haptics ( Dr.Schmidt MicroSil). Mean age of

the patients (n= 11) operated upon was 67 (+/-‐ 5,5) y, mean uncorrected

visualacuity was 0,46; best corrected it was 0,63.


38

Title: Split-‐cornea transplantation by combining DMEK and DALK to reduce donor shortage and costs

Authors: Claus Cursiefen

Institution: Dept. of Ophthalmology, University of Erlangen

Text: Aim of the talk is to discuss new options to combat corneal donor shortage by

combining modern lamellar techniques of corneal transplantation. By combining DMEK

and DALK surgeries, ONE donor cornea can be used for TWO recipients. The first 100

patients having undergone this approach are reviewed. Split cornea transplantation by

combining DMEK and DALK surgeries is a promising new strategy to reduce corneal

tissue shortage.


39

Saturday 10.15-‐12.00:

Second morning session: Corneal cross-‐linking

Moderators: Dan Epstein & Philip Maier 10.15 Pathways and Mechanisms Underlying the Photophysics and Photochemistry of

Riboflavin induced cornea cross-‐linking . Thomas Breitenbach & Peter Ogilby. Depr. of Chemistry, Aarhus University, Denmark

10.30 Pachymetric changes during corneal collagen cross-‐linking and effect of hydroxipropylmethylcellulose on corneal thickness. Faik Orucoglu (Orucov), Kudret Eye Hospital, Turkey

10.45 UVA riboflavin collagen cross-‐linking lowers stromal swelling pressure. A. P. Soendergaard, A. Ivarsen, J. Hjortdal. Aarhus University Hospital, Denmark.

11.00 Drug penetration after corneal cross-‐linking. B E Frueh1, M Tschopp1, M Stary1, W Thormann2, J de Smet3, C Tappeiner1. 1) Dept Ophthalmology & 2) Dept of Pharmacology, University of Bern, Bern, Switzerland 3) Dept of Pharmacology, University of Ghent, Ghent, Belgium

11.15 Corneal cross-‐linking in children with progressive keratoconus: a prospective 24-‐month study. D Epstein1, BE Frueh2, E Albé3, P Vinciguerra3. 1) Dept Ophthalmology, University of Zurich, Zurich, Switzerland 2) Dept Ophthalmology, University of Bern, Bern, Switzerland 3) Dept Ophthalmology, Istituto Clinico Humanitas, Milan,Italy

11.30 Randomized, prospective, multicentre trial to investigate the efficacy of riboflavin/UVA corneal collagen cross-‐linkage to halt the progression of keratoconus. P. Maier et al.. 1University Eye Hospital Freiburg, & 2Eye Hospital of Ludwig-‐Maximilans-‐University Munich 3University Eye Hospital Würzburg, 4University Eye Hospital Düsseldorf, Germany, 5Department of Ophthalmology, University Hospital “Alexandrovska”, Sofia, Bulgaria

11.45 Collagen Crosslinking (CXL) as Keratitis Therapy Experimental & Clinical Research Jes Mortensen & Karim Makdoumi. University Hospital Örebro, Sweden


40

Title: Pathways and mechanisms underlying the photophysics and photochemistry of riboflavin induced cornea crosslinking

Authors: Thomas Breitenbach & Peter R. Ogilby

Institution: Department of Chemistry, Aarhus University, Denmark

Text: In this talk, we will describe general pathways involved in the photophysics of a

photosensitized process, which can lead to crosslinking due to light excitation of

Riboflavin in the cornea. Furthermore, we will elucidate different aspects of

reactions that can produce crosslinks, with respect to polymer knowledge and

the current literature. We will also discuss a mechanism which involves the

formation of singlet molecular oxygen O2(a1Δg) as the main triggering species.


41

Title: Pachymetric changes during corneal collagen cross-‐linking and effect of hydroxipropylmethylcellulose on corneal thickness

Authors: Faik Orucoglu (Orucov)

Institution: Kudret Eye Hospital

Text: Purpose: To evaluate central corneal pachymetric changes during corneal collagen cross-‐linking (CXL) and effect of hydroxipropylmethylcellulose.

Method-‐Material: Two groups were formed in patients with keratoconus undergoing cross-‐linking. Riboflavin drops every 3 minutes after epithelial abrasion was applied to group one (N=18). Riboflavin drops every 3 minutes and hydroxipropylmethylcellulose every 5 minutes after epithelial abrasion were applied to group two (N=21). Central corneal thicknesses (CCT) were measured by ultrasound pakimetry before epithelial abrasion, after epithelial abrasion and 30 minutes after beginning riboflafin installation respectively.

Result: The CCT was 457.2 + 62.6 microns in the first group, and, 449.7 + 62.6 microns in the second group. The difference in these values were insignificant statistically (p=0.668). There was a significand decrease in corneal thickness at both groups following epithelial peeling (p<0.001 and p=0.009). In the 30 minutes procedure of riboflavin installation the decrease of corneal thickness from 395+54.9 microns to 360+44.4 microns was significant (p<0.001) in the first group , while the decrease of corneal thickness from 389.4+44.2 microns to 374.4+38.1 microns was insignificant statistically (p=0.08) in the second group.

Conclusion: Decrease of corneal thickness continues with epithelial peeling. This decrease in corneal thickness is significantly reduced by continuing the procedure with the addition of hydoxipropymethylcellulose.


42

UVA riboflavin collagen cross-‐linking lowers stromal swelling pressure Authors: A. P. Soendergaard, A. Ivarsen, J. Hjortdal,. Dept Of Ophthalmology, Aarhus University Hospital, Aarhus, Denmark. Purpose: To evaluate whether UVA riboflavin cross-‐linking reduces stromal swelling pressure in porcine corneas. Methods: In 16 porcine eyes ex vivo, the central corneal thickness (CCT) was determined by ultrasound pachymetry. The treatment group (n=7) was treated using a standard UVA riboflavin cross-‐linking procedure (CXL), applying riboflavin solution for 30 minutes followed by a 30-‐minute UV-‐A radiation under continued riboflavin administration. In the control group (n=7) only riboflavin solution was applied. The central 8 mm cornea was trephined and the weight measured. After a pre-‐swelling period of 2 hours, the swelling of the corneal buttons in isotonic saline was measured in a custom engineered biomechanical setup. The force exerted by the corneas during swelling in the anterior-‐posterior direction was recorded at different thicknesses (+30%, +20%, +10%, +5%, and -‐5% of initial CCT) and the swelling pressure calculated. Dry weights were obtained for solids correction. Results: No significant difference in mean dry weight was observed between groups. The reduction of central corneal thickness after treatment was similar in the two groups (88.0 µm and 87.9 µm in the control-‐ and treatment groups, respectively). The hydration change in the CXL group (0.0686g) compared to the control group (0.0862g) in the pre-‐swelling period was significantly lower (p = 0.004). Linear regressions of CCT and swelling force were significantly different in the two groups. Conclusions: The stromal swelling pressure is lowered after a standard CXL procedure ex vivo, suggesting that CXL treatment can reduce corneal edema in vivo. The results obtained, when testing full thickness corneal buttons, may not completely describe the changes induced by CXL, since only the anterior segment of the stroma is cross-‐linked. Segmental testing is currently conducted to detect differences in the anterior vs. posterior stroma. Preliminary data suggest that the swelling pressure is reduced in the anterior approximately 200µm stroma in the treatment group.


43

Title: Drug penetration after corneal cross-‐linking

Authors: B E Frueh1, M Tschopp1, M Stary1, W Thormann2, J de Smet3, C Tappeiner1

Institution: 1) Dept Ophthalmology, University of Bern, Bern, Switzerland

2) Dept of Pharmacology, University of Bern, Bern, Switzerland 3) Dept of Pharmacology, University of Ghent, Ghent, Belgium

Text: Purpose: To analyze the influence of corneal cross-‐linking (CXL) on the

penetration of topically applied ofloxacin and voriconazole.

Methods: In an ex-‐vivo porcine eye model, eyes were randomly assigned for

CXL and control treatment. Central corneal thickness (CCT) and anterior

chamber depth (ACD) were measured with a Pentacam unit. Standard CXL was

performed using riboflavin and UV-‐A (370 nm). Subsequently, ofloxacin 0.3%

(n=40 eyes) or voriconazole 1% (n=40 eyes) eye drops were applied to the

cornea every 5 minutes for 30 minutes in both groups. Aqueous humor samples

were obtained through an anterior chamber tap. The concentration of ofloxacin

and voriconazole was analysed with high-‐pressure liquid chromatography

(HPLC). Groups were compared using a Mann-‐Whitney test.

Results: In the CXL group, the mean concentration of ofloxacin (13.33 ± 4.67

µg/ml) and voriconazole (52.70 ± 8.76 µg/ml) obtained from the anterior

chamber were significantly lower than in the untreated control group. For

ofloxacin the control group values were 18.51 ± 6.08 µg/m (p=.005), for

voriconazole 62.43 ± 13.5 µg/ml (p=.01). CCT and ACD were comparable in the

CXL and control group (p>0.05 for both measurements).

Conclusion: CXL reduces the corneal permeability for topically applied

ofloxacin and voriconazole.


44

Title: Corneal cross-‐linking in children with progressive keratoconus: a prospective 24-‐month study

Authors: D Epstein1, BE Frueh2, E Albé3, P Vinciguerra3

Institution: 1) Dept Ophthamology, University of Zurich, Zurich, Switzerland

2) Dept Ophthamology, University of Bern, Bern, Switzerland 3) Dept Ophthalmology, Istituto Clinico Humanitas, Milan,Italy

Text: Purpose: to measure corneal and refractive changes of keratoconic eyes after corneal cross-‐linking (CXL) in a pediatric population.

Material and methods: 80 eyes of 78 patients (25 female, 53 males) were included. Inclusion criteria were progressive keratoconus, minimal corneal thickness of 400 µm and age under 18 years. Minimum follow-‐up was 24 months. Follow-‐up exams including corneal topography and Pentacam measurements were performed prior to and 1, 6, 12, and 24 months after CXL. The cross-‐linking was performed using riboflavin and ultraviolet A, after epithelial abrasion.

Results: Both UCVA and BSCVA improved significantly over 2 years. Mean average corneal power was 49.7±0.2D at baseline and 48.9±0.1 at 24 months. Higher order corneal aberrations had significantly decreased by 24 months. Endothelial cell counts remained stable. Two patients developed sterile infiltrates.

Conclusion: CXL arrested progression in children with keratoconus in the 24-‐month observation period. In addition, UCVA and BSCVA improved, apical corneal power decreased, and total as well as corneal aberrations were reduced. No significant complications were noted.


45

Title: Randomized, prospective, multicentre trial to investigate the efficacy of riboflavin/UVA corneal collagen cross-‐linkage to halt the progression of keratoconus

Authors: P. Maier1, S.J. Lang1, E. M. Messmer2, G. Geerling3,4, T. Brunner1, S. Dollak1 , M.J. Mackert2, B. Kutchoukov5, D. Böhringer1, T. Reinhard1

Institution: 1University Eye Hospital Freiburg, Germany 2Eye Hospital of Ludwig-‐Maximilans-‐University Munich, Germany 3University Eye Hospital Würzburg, Germany 4University Eye Hospital Düsseldorf, Germany 5Department of Ophthalmology, University Hospital “Alexandrovska”, Sofia, Bulgaria

Text: Purpose: Efficacy of corneal collagen cross-‐linkage with riboflavin for halting progession of keratoconus was for the first time investigated in a randomised, interindividual, multicentric clinical trial. Methods: A total of 28 patients with keratoconus and keratoconus progression were randomised (centres 1, 2, and 3). The mean age at inclusion was 28 (range: 17 to 53) years. According to the protocol the worse eye was either treated with collagen cross-‐linkage or sham procedure. For each patient the longitudinal change in corneal refraction (maximum of the simulated K-‐readings) was calculated by means of linear regression. These data were analysed according to the intention-‐to-‐treat principle. We applied the Kruskal-‐Wallis test to compare keratoconus progession between both groups. Results: 14 patients had been randomised to the treatment, and 14 to the control group. The mean follow-‐up was 1.7 (range 0.5 to 3) years. The corneal refractive power decreased in the treatment group on average (+/-‐standard deviation) by 0.46 +/-‐ 0.68 dioptres/year, whereas in the control-‐group there was an increase by 0.12 +/-‐ 0.80 dioptres/year. The results were statistically significant (p=0.048). Conclusions: The results of the 28 patients demonstrate, that corneal collagen cross-‐linking can reduce the progression of keratoconus. We will follow the treated patients longer in order to assess whether keratoconus progression will halt permanently.


46

Title: Collagen Crosslinking (CXL) as Keratitis Therapy Experimental & Clinical Research

Authors: Jes Mortensen, MD Karim Makdoumi, MD

Institution: University Hospital Örebro, Sweden

Text: In CXL a photo-‐activation of riboflavin is used, which is also used in Pathogen Inactivation Therapy in transfusion medicine. Several groups have presented treated ulcers and cases of infectious keratitis successfully treated with CXL. Based on these experiences a protocol to study CXL as a primary treatment for bacterial keratitis has been created.

The study was to involve two major ophthalmological centers. The primary center is the dept. of ophthalmology, Örebro University Hospital and the secondary the dept. of opthalmolgy at Ryhov, Region Hospital, Jönköping, Sweden.

The study is a clinical non-‐randomized pilot study of 8 patients at each center to evalutate the CXL as a primary treatment for bacterial keratitis.

Aim: To Study the effect of CXL as a primary treatment for bacterial keratitis in two ophthalmological centers.


47

Saturday 16.00-‐17.15:

First afternoon session: Fuchs’ dystrophy & Endothelial Keratoplasty

Moderators: Björn Bachmann & G. Van Rij 16.00 The role of complement activation in the pathogenesis of Fuchs’ dystrophy and

pseudophakic bullous keratopathy. Füst Á, Csuka D, Süveges I, Imre L, Bausz M, Nagymihály A, Csorvási Á, Füst G. Semmelweis University, Budapest, Department of Ophthalmology, Hungary

16.15 A Standardized Technique for Descemet Membrane Endothelial Keratoplasty (DMEK): Results after 12 Months Björn Bachmann, Kathrin Laaser, Claus Cursiefen, Friedrich E. Kruse Department of Ophthalmology, University of Erlangen-‐Nürnberg, Germany.

16.30 Descemet Stripping Automated Endothelial Keratoplasty (DSAEK) – is supine positioning the first hours after surgery necessary? Liv Drolsum, Marit Sæthre. Department of Ophthalmology, Oslo University hospital Ullevål, and University of Oslo, Norway

16.45 Descemetorhexis as treatment for Fuchs endothelial dystrophy: a report of 10 patients Bleyen I, Saelens EY, van Dooren BTH, van Rij G. Erasmus MC, Rotterdam, The Netherlands

17.00 Visual outcomes after DSAEK surgery: Which visual quality is primarily improved? Esben Nielsen, Jesper Hjortdal. Ophtalmological Department J, Aarhus University, Aarhus C, Denmark.


48

Title: The role of complement activation in the pathogenesis of Fuchs’ dystrophy and pseudophakic bullous keratopathy

Authors: Füst Á, Csuka D, Süveges I, Imre L, Bausz M, Nagymihály A, Csorvási Á, and Füst G

Institution: Semmelweis University, Budapest, Department of Ophthalmology

Text: Inflammation can be an ethiologic factor of Fuchs’ dystrophy and pseudophakic bullous keratopathy (PBK), according to some studies. Our aim was to get information on the activation of the complement system in the aqueous humor in these pathologies.

100μl aqueous humor sample was taken during keratoplasty of 9 Fuchs dystrophic and 15 PBK patients and during phacoemulsication surgery of 18 control patients. The samples were mixed with EDTA and stored at -‐80oC. Concentration of C1rC1sC1Inh, C3bBbP complex and C3a as marker of classical, alternative and common pathway of complement activation, respectively, was measured with ELISA method. The results of the two patient groups and the control group were compared and correlation was searched between concentration of C1rC1sC1Inh and C3bBbP complexes with statistical analysis (Mann Whitney non-‐ parametric test, correlation analysis).

The Fuchs’ dystrophic (C1rC1sC1Inh: 8,98 (0,83-‐27.57), C3bBbP: 10,77 (6,01-‐22.23)) and the PBK group (C1rC1sC1Inh: 49,82 (31.54-‐69.32), C3bBbP: 30.89 (19.19-‐52.87)) differed significantly both from the control group (C1rC1sC1Inh: 0.00 (0.00-‐5.63), C3bBbP: 1,41 (0.00-‐7.80)), both from each other regarded the C1rC1sC1Inh and C3bBbP complexes. As with C3a, the difference was significant only between the PBK (772.00 (154.00-‐1062.00)) and control (0,00 (0,00-‐116.00)), and the PBK and the Fuchs’ (0.00 (0.00-‐149.00)) groups. The results are given in AU/ml, median (25 and 75 percentiles).

In pseudophakic bullous keratopathy, and to less extent in Fuchs dystrophy the complement system is activated in the aqueous humor. Mediators produced by the pathologic endothelial cells may be the activators. The active complement can play a role in the increased endothelial loss.


49

Title: A Standardized Technique for Descemet Membrane Endothelial Keratoplasty (DMEK): Results after 12 Months

Authors: Björn Bachmann, Kathrin Laaser, Claus Cursiefen, Friedrich E. Kruse

Institution: Department of Ophthalmology, University of Erlangen-‐Nürnberg, Erlangen, Germany.

Text: Purpose: Descemet membrane endothelial keratoplasty (DMEK) is a new technique for

the replacement of diseased corneal endothelium which can render visual results of

unsurpassed quality. However, technical issues regarding tissue preparation, insertion

and graft adhesion limit the use of this technique. Here we present mid term results of a

novel, standardized approach to DMEK.

Methods: Donor preparation was performed by a bimanual scuba technique, donor

insertion using an IOL shooter with air bubbles allowing for correct graft orientation in

all patients. BCVA, endothelial cell density, anterior chamber OCT and pachymetry were

quantified at 3, 6 and 12 months.

Results: Donor preparation was uneventful except in 3 donors due to central

adhesions. With the novel shooter/air bubble technique orientation was preserved in

95% of surgeries. After surgery 68% of all patients developed partial, peripheral graft

detachment necessitating rebubbling. Nonimmunological graft failure occurred in

14/184 grafts. 8 failed DMEKs were among the first 20 surgeries performed during the

early learning curve of the procedure. Mean visual acuity (logMAR) improved from 0,68

+ 0,45 preoperatively to 0,14 + 0,11 12 months after DMEK. Endothelial cell density

decreased by 42 % after 12 months. Pachymetry decreased from 665 + 102 µm

preoperatively to 516 + 42 µm 12 months postoperatively.

Conclusions: Important modifications of the original technique allow significant

improvements and enhance reproducibility of the surgery. In our hands DMEK

rendered unsurpassed functional and morphological outcome which is stable at least 12

months after surgery.


50

Title: Descemet Stripping Automated Endothelial Keratoplasty

(DSAEK) – is supine positioning the first hours after surgery

necessary?

Authors: Liv Drolsum, Marit Sæthre

Institution: Department of Ophthalmology, Oslo University hospital Ullevål, and University of Oslo

Text: PURPOSE: Most surgeons prefer the patients to lie on their backs the first hours

after DSAEK surgery. The reason for that is that it is believed that the air bubble

placed in the anterior chamber at the end of the surgery will rise and help the

graft attaching to the posterior corneal surface. However, not all patients are

able to lie down for so long period, and also this positioning requires facilities

like a hospital bed. The purpose of the present study was to compare the

dislocation rate of the graft in patients who lied on their backs to patients sitting

in a chair the two first hours after DSAEK surgery.

METHODS: A randomized prospective study was conducted evaluating a total of

44 patients (22 patients in each group). A standard DSAEK surgery using the

Busin injector was performed. At the end of the surgery, an air bubble was

injected to completely fill the anterior chamber with intended IOP between 15 –

25 mmHg. The IOP was recorded at the end of the surgery and after 2 hours.

After 2 hours the air was partly removed. The donor endothelial cell density

(ECD) was recorded, and compared to the ECD six months after surgery. The

dislocation rate was compared in the two groups.

RESULTS/CONCLUSIONS: The dislocation rate in the two groups will be

presented and discussed. Any correlation between ECD reduction and IOP in the

immediate postoperative phase will be evaluated.


51

Title: Descemetorhexis as treatment for Fuchs endothelial dystrophy: a report of 10 patients

Authors: Bleyen I, MD, PhD, Saelens EY, MD, van Dooren BTH, MD, PhD, van Rij G, MD, PhD

Institution: Erasmus MC, Rotterdam, The Netherlands

Text: Purpose: To report possible corneal clearance after descemetorhexis as treatment for Fuchs endothelial dystrophy. Methods: Ten patients with central Fuchs endothelial dystrophy and clear peripheral corneal rim underwent descemetorhexis without endothelial keratoplasty. Eight of them underwent combined surgery with phakoemulsification and intraocular lens implantation. Preoperative parameters included best spectacle corrected visual acuity (BCVA), central corneal thickness and slit lamp measurements of the corneal guttae. Postoperatively, BCVA at 3, 6, and 9 months, slit lamp findings at 1 week postoperatively and at 1, 3, 6 and 9 months, central corneal thickness and endothelial cell count at 6 and 9 months were documented. Results: Mean follow up was 8.5 months (median 8.5 months). Thirty percent of cases (3/10) reached a BCVA of ≥ 20/28 (0.7) with improved corneal clearance. Mean central corneal thickness was 554µ. Endothelial cell density measurement was possible in 2 patients (458 cells/mm2 and 488 cells/mm2

respectively). Two patients (20%) obtained a BCVA ≥ 20/100 (0.2) and further corneal clearance was awaited. Five patients (50%) obtained no corneal clearance after at least 6 months. BCVA remained ≤ 20/200 (0.05) in 3 of them. Two of them underwent uneventful DSAEK; the other 3 are awaiting DSAEK surgery. Conclusion: Corneal clearance after descemetorhexis only is possible in a minority of patients. Further studies are necessary to determine which selection of patients might benefit from this procedure. Reducing the number of endothelial keratoplasty surgeries would lead to less graft rejections and less cases of secondary glaucoma cases owing to prolonged steroid use.


52

Title: Visual outcomes after DSAEK surgery: Which visual quality is primarily improved?

Authors: Esben Nielsen, Jesper Hjortdal

Institution: Dept. of Ophthalmology, Aarhus University, Aarhus C, Denmark.

Text: Purpose: It has previously been reported that patients who suffer from Fuchs’ endothelial dystrophy have decreased contrast sensibility threshold. The removal of endothelial guttata by DSAEK surgery has also been demonstrated to decrease intraocular light scatter and improve contrast thresholds. The purpose of this study was to compare different visual qualities in patients that had undergone DSAEK surgery in one eye while having untreated Fuchs’ dystrophy in the other eye. Methods: 32 eyes of 16 patients with bilateral Fuchs’ endothelial dystrophy who had DSAEK surgery performed in one eye were enrolled. Visual acuity at 100% contrast and contrast sensitivity as evaluated by a modified simulation of the Freiburg Acuity and Contrast Test, FrACT, was measured in both eyes of each patient. Results: Snellen visual acuity improved in treated eyes from 0.67 ± 0.35 (SD) before surgery to 0.42 ± 0.21 after surgery (logMAR units; P=0.038). In eyes with untreated Fuchs’ dystrophy visual acuity was 0.48 ±0.13. In a pair-‐wise comparison, there was no difference in Snellen visual acuity between treated and non-‐treated eyes (P=0.39). Contrast sensitivity was significantly better in DSAEK treated eyes compared with untreated eyes. Mean logCS in DSAEK treated eyes was 1.06 ± 0.26 compared with a mean logCS of 0.85 ± 0.15 in untreated eyes (P=0,016). All patients reported a subjective improvement in vision from before to after DSAEK surgery. Conclusions: In this study of patients with Fuchs’ dystrophy treated in one eye with DSAEK surgery, we demonstrated improved contrast sensitivity in the DSAEK operated eyes while no difference in visual outcome was detected with standard Snellen visual acuity. This is an interesting finding, since it implies that subjective visual improvements caused by mainly an improved ability to discern contrast can be undetectable with standard Snellen BSCVA.


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Saturday 17.30-‐18.30:

Second afternoon session:

Ocular biometry, Synthetic Cornea & Keratoprostheses

Moderators: Per Fagerholm & Jesper Hjortdal 17.30 Activated keratocytes in in vivo confocal laser-‐scanning microscopy.

Falke K, Hovakimyan M, Stachs O, Guthoff RF. Department of Ophthalmology, Rostock University, Germany

17.45 Inter-‐examiner reproducibility of the AS-‐OCT Visante corneal thickness. David Galarreta, Ana del Rio, Raul Martin, Angela Morejon, Jesús Merayo. Hospital Clinico Universitario Valladolid, IOBA University of Valladolid, Spain

18.00 Developing biosynthetic corneas to substite human donor corneas at corneal grafting. Fagerholm P, Lagali N and Griffith M. Dept. of Clinical and Experimental medicine, Dept. of Ophthalmology, University of Health, Linköping, Sweden

18.15 An Update on Keratoprostheses Christopher Liu. Sussex Eye Hospital, UK


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Title: Activated keratocytes in in vivo confocal laser-‐scanning microscopy Authors: Falke K, Hovakimyan M, Stachs O, Guthoff RF

Institution: Department of Ophthalmology, Rostock University, Germany

Text: Background: Despite of growing popularity of refractive surgery, the tissue responses have not been thoroughly investigated. The better understanding of corneal repair cells -‐ activated keratocytes -‐ is required to control and, possibly, alleviate the wound healing processes. Recently, confocal laser-‐scanning microscopy (CLSM) has been introduced as a tool for in vivo investigation of cellular processes after refractive surgery, cross-‐linking, infections and traumas in the cornea. Nevertheless, there is some discrepancy in the morphology of activated keratocytes and their interpretation in in vivo CLSM. Present study addresses the morphology of activated keratocytes in different clinical cases. Methods: In vivo CLSM using HRTII+RCM (Heidelberg Engineering, Germany) was performed in fifteen cases, including chemical burn, infectious keratitis, penetrating keratoplasty and refractive surgery Results: Shortly after chemical burn needle-‐shaped elongated structures, presenting repair migratory fibroblasts were observed in the anterior and intermediate stroma. Their appearance correlated clinically with opacity. Massive keratocytes activation has been observed also in keratitis in form of hyperreflective elongated structures. Interestingly, the spindle-‐shaped activated keratocytes were detected even 2 years after penetrating keratoplasty, although in the LASIK-‐patients already 2 months after treatment activation of keratocytes had been significantly diminished. Conclusion: In our study activated keratocytes were documented in different clinical cases using in vivo CLSM as elongated, spindle-‐shaped hyperreflective structures, in consistent with existing in vitro studies. In vivo CLSM will help clinicians to detect activation of keratocytes as a sign of disturbances in corneal tissue at early stages, thus helping in diagnosis and therapy decision.


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Title: Inter-‐examiner reproducibility of the AS-‐OCT Visante corneal thickness

Authors: David Galarreta, Ana del Rio, Raul Martin, Angela Morejon, Jesús Merayo

Institution: Hospital Clinico Universitario Valladolid, IOBA University of Valladolid, Spain

Text: Purpose: To determine the inter-‐examiner reproducibility of the manual values of central and peripheral corneal thickness as measured by optical coherence tomography (AS-‐OCT Visante) and to assess the agreement between AS-‐OCT Visante pachymetry and other highly reliable devices and techniques, such as the Orbscan II and ultrasound pachymetry (USP). Methods: Central and peripheral (4.0 mm from the corneal apex to the superior, inferior, nasal and temporal areas of the tissue) corneal thickness was analyzed in 30 healthy eyes with the AS -‐OCT Visante both automatically (Global-‐Pachymetry Map) and manually (Flap Tool). The Orbscan II and USP (Corneo-‐Gage Plus) pachymetry were also assessed. Inter-‐examiner reproducibility for the manual values of the AS-‐OCT Visante was calculated. Automatic and manual AS-‐OCT pachymetries were compared for all corneal locations. Differences and correlations between the AS-‐OCT Visante, the Orbscan II, and USP were calculated. Results: Good inter-‐examiner reproducibility was obtained for the manual values of the AS-‐OCT Visante for all locations studied (p=1.00 on ANOVA analysis with Bonferroni correction). The automatic value was significantly different from the manual value for both central (automatic=544±34 μm, examiner #1=576±39 μm, examiner #2=584±32 μm, examiner #3=582±37 μm) and inferior pachymetry (automatic=643±42 μm, examiner #1=669±37 μm, examiner #2=672±43 μm, examiner #3=668±39 μm) (p<0.05 ANOVA). Good linear correlation was found between the automatic AS -‐OCT Visante, the Orbscan II and USP, although there were statistically significant differences (p<0.01 Student's paired t-‐test) between all of the corneal locations, with the exception of the manual values of the AS-‐OCT Visante and the Orbscan II for the central corneal thickness (CCT) measures. Conclusions: The AS-‐-‐OCT Visante has high inter-‐examiner reproducibility for manual values (Flap Tool). The automatic analysis (Global-‐Pachymetry Map) provides different corneal thickness values (centrally and peripherally) than those obtained manually for the same corneal scan.


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Title: Developing biosynthetic corneas to substite human donor corneas at corneal grafting.

Authors: Fagerholm P MD,PhD ,Lagali N PhD and Griffith M PhD

Institution: Dept. of Clinical and Experimental medicine, Dept. of Ophthalmology, University of Health, Linköping, Sweden

Text: Purpose: To evaluate, biosynthetic corneas as substitutes for corneal grafts in human corneas.

HRC III collagen based biosynthetic matrices cross linked with watersluble carbodiimids were in a Phase I study implanted into 10 patients and followed for 3 years.A amellar implant technique was used.

Visual acuity was acceptable following contactlens fitting. Keratocytes invaded the cell free matrices as reveled by in vivo confocal microscopy. Reinnervation was better than after PKP. Tear production was always good and sensitivity (Bonnet-‐Cochet, improved with increasing reinnervation. Epithelialisation was good with the exception of som sutureinduced defects that caused opacifications in some of the grafts. None of the operated eyes has been regrafted.Negative events occurred during the first 2 months and all seemed related to increased inflammation

Much of the inflammation seemed to be caused by the overlying sutures.

For the Phase II study a change in the suture technique, the use of amniotic membrane and a more robust material (15 % collagen) was suggested and this concept has been evaluated, now for 9 months, in minipigs and seem to work . Part of the 12 months pig results will also be reported.


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Title: An Update on Keratoprostheses

Authors: Christopher Liu

Institution: Sussex Eye Hospital

Text: In this short talk, I shall update the European Corneal Conference with

developments in the OOKP, related devices, and the Boston Types 1 and 2 KPros.


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Sunday 08.30-‐9.30:

First morning session: DALK

Moderators: Paolo Rama & Michael Thiel 8.30 Deep anterior lamellar keratoplasty using an original manual technique.

Paolo Rama, Karl Anders Knuttsson, Giulia Razzoli, Stanislav Matuska, Maurizia Viganò, Giorgio Paganoni. San Raffaele Scientific Institute, Ophthalmology-‐Cornea and Ocular Surface Unit, Milano, Italy

8.45 Deep Anterior Lamellar Keratoplasty (DALK) in Keratoconus Patients. Stoiber J, Ruckhofer J, Seyeddain O, Grabner G. Paracelsus Medical University Salzburg, Dept. of Ophthalmology, Austria.

9.00 Corneal lamellar ablation for transplantation (CLAT) -‐ first experiences with a Excimer laser -‐ assisted anterior lamellar keratoplasty technique Claude Kaufmann, Michael A. Thiel. Cantonal Hospital Lucerne, Lucerne, Switzerland

9.15 National follow up of cornea transplants in the Netherlands Jeroen van Rooij. Eye Hospital Roterdam, Rotterdam, The Netherlands


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Title: Deep anterior lamellar keratoplasty using an original manual technique

Authors: Paolo Rama, Karl Anders Knuttsson, Giulia Razzoli, Stanislav Matuska, Maurizia Viganò, Giorgio Paganoni

Institution: San Raffaele Scientific Institute, Ophthalmology-‐Cornea and Ocular Surface Unit, Milano, Italy

Text: Objective: To evaluate the clinical results of deep anterior lamellar keratoplasty (DALK) using a dry manual dissection technique.

Design: Noncomparative, retrospective consecutive case series (2003-‐2008).

Participants: 288 eyes of 268 patients were treated by DALK using a dry manual dissection technique. They were examined clinically at 2 months, 6 months,1 year and 2 years.

Intervention: The surgical procedure consisted in corneal trephination and removal of a superficial lamella followed by the creation of a full diameter peripheral pocket from a deep corneal incision and dissection using a blunt spatula. After reaching a deep pre-‐Descemetic plane, an endothelium free graft was sutured.

Results: At the two-‐year post operative follow-‐up, mean logarithm of the minimum angle of resolution (LogMAR) uncorrected visual acuity was 0.545 ± 0.334 , LogMAR best spectacle corrected visual acuity (BSCVA) was 0.131 ± 0.087, and topographic astigmatism was 2.87 ± 1.57 diopters. Endothelial cell loss was statistically significant only in the interval from two to six months showing a stabilization of endothelial cell density at 6 months. Mean OCT residue thickness was 31.63 ± 24.57 µm. Eyes with a residue thickness ≤ 20 µm had a significantly higher BSCVA compared to eyes with values > 20 µm. Intraoperative perforation occurred in 22 cases (7.6 %). In 12 cases (4.2 %) a perforation of DM required conversion to PK, while in 10 cases (3.5%) the perforation did not influence the surgical outcome. Post-‐operative complications included 13 cases of graft rejection, one case of herpes reactivation and one case of steroid-‐related glaucoma.

Conclusions: this DALK technique provides results comparable to other deep lamellar techniques. Eyes with lower values of recipient residue thickness are associated with better visual acuity. Graft interface quality may also contribute to determine final visual acuity.


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Title: Deep Anterior Lamellar Keratoplasty (DALK) in Keratoconus Patients

Authors: Stoiber J, Ruckhofer J, Seyeddain O, Grabner G

Institution: Paracelsus Medical University Salzburg, Dept. of Ophthalmology

Text: Background: Deep anterior lamellar keratoplasty (DALK) in eyes with a healthy endothelium has gained increasing interest, as there is no risk for graft failure due to endothelial rejection.

Material and methods: DALK was performed in 35 eyes with keratoconus. We used the “big bubble” technique according to Anwar and Teichmann to detach Descemet’s membrane (DM) from the corneal stroma.

Results: A “big bubble” could be achieved in 63% of the cases. In 5 patients (14%) the procedure had to be converted to a conventional penetrating keratoplasty (PKP), due to rupture of DM during dissection. In 86 % the procedure could be completed as DALK. Visual acuity and astigmatism were found comparable to PKP. Scarring of the interface could not be detected in any of the cases.

Conclusions: DALK offers significant advantages compared to conventional PKP, as endothelial graft rejection cannot occur. As the endothelium of the donor is removed during the procedure, corneas with a low endothelial cell count can also be used for transplantation.


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Title: Corneal lamellar ablation for transplantation (CLAT) -‐ first experiences with a Excimer laser -‐ assisted anterior lamellar keratoplasty technique

Authors: Claude Kaufmann, Michael A. Thiel

Institution: Cantonal Hospital Lucerne, Lucerne, Switzerland

Text: PURPOSE: To prospectively evaluate the functional und morphological outcome of excimer laser-‐assisted anterior lamellar keratoplasty.

METHODS: Corneal lamellar ablation for transplantation (CLAT) was performed with the iRES ultrafast laser system (iVIS Technologies s.r.l., Italy). Pre-‐ and postoperative assessments included topography, anterior segment optical coherence tomography, and in vivo confocal microscopy for endothelial cell counts.

RESULTS & CONCLUSIONS: Preliminary results at the time of abstract submission suggest that CLAT represents a valid method for laser-‐assisted anterior lamellar keratoplasty, but comes at the price of endothelial cell loss.


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Title: National follow up of cornea transplants in the Netherlands

Authors: Jeroen van Rooij

Institution: Eye Hospital Roterdam, Rotterdam, The Netherlands

Text:


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Sunday 10.00-‐11.15:

Second morning session: Allergy & inflammation

Moderators: Hanne Olsen Julian & Frank Larkin 10.00 Secondary glaucoma in allergic eye disease.

Frank Larkin & Laura De Benito Llopis. Moorfields Eye Hospital, London 10.12 Risk Factors and Antibiotics in Bacterial Keratitis – Are We Hitting The Target?

Luís Torrão1, Luís Figueira1,2, Jorge Palmares1, Raul Moreira1, F. Falcão-‐Reis1,2 1 Ophthalmology Department, Hospital S. João, Porto, 2 Faculty of Medicine, University of Porto, Portugal

10.24 Ready made allogenic serum eye drops for severe dry eye disease. Hanne Olsen Julian & Lene Holm Harritshøj. Eye Clinic Glostrup Hospital & Department of Clinical Immunology, Rigshospitalet, Copenhagen, Denmark

10.36 Transplantation of individualized recipient-‐serum-‐adapted cornea (RSAC) in high-‐risk keratoplasty. Zisis Gatzioufas 1, Holger Busse 2, Simone König 3, Solon Thanos 2 (1) Department of Ophthalmology, University of Saarland, Homburg/Saar, Germany, (2) Department of Ophthalmology, University of Münster, Münster, Germany (3) Interdisciplinary Center for Clinical Research, University of Münster, Münster, Germany

10.48 Treating Meibonian Gland Dysfunction with a new thermotherapy approach. The Portuguese MGD Group – Coordinator Paulo F. Torres, MD, PhD. Portugal

11.00 Penetration of topically administered antibody fragments into the eye. Michael A. Thiel. Cantonal Hospital Lucerne, Lucerne, Switzerland


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Title: Secondary glaucoma in allergic eye disease

Authors: Frank Larkin & Laura De Benito Llopis

Institution: Moorfields Eye Hospital, London

Text: Twelve atopic keratoconjunctivitis (AKC) with secondary glaucoma were

reviewed. All had steroid-‐dependent allergic disease that was. IOP elevation in

most was secondary to topical dexamethasone, but in 6 cases secondary to

application of facial steroid cream. Topical cyclosporin as a steroid-‐sparing

agent was poorly tolerated in half of the patients. Allergy to topical glaucoma

drugs developed in only 3 patients. Poor control of IOP even with maximal

medical treatment in 10 patients required surgical management. Diode laser

cycloablation was unsuccessful in all patients. On the contrary, only one patient

after trabeculectomy and two after the tube implant still needed topical

hypotensive drops postoperatively.

Conclusions: Patients with AKC that require long-‐term steroid treatment need

close monitoring of the IOP. At the first sign of IOP elevation, baseline glaucoma

evaluation should be undertaken and surgical management considered at an

early stage.


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Title: Risk Factors and Antibiotics in Bacterial Keratitis – Are We Hitting The Target?

Authors: Luís Torrão1, Luís Figueira1,2, Jorge Palmares1, Raul Moreira1, F. Falcão-‐Reis1,2

Institution: 1 Ophthalmology Department, Hospital S. João, Porto, Portugal 2 Faculty of Medicine, University of Porto, Portugal

Text: Purpose: Microbial keratitis’ (MK) diverse agents account for its uncertain prognosis,

leading to our creation of a MK Clinic.

Methods: Patients with MK were referred to optimize management and to study risk

factors (RF) and microbiological spectrum.

Results: 181 patients were referred (mean age 52 years). Over 95% had local RF

(contact lens wear, blepharitis, dry eye, trauma). Over 38% had systemic RF (diabetes

most common). Topical antibiotics were used alone in 89%, mainly levofloxacin,

gentamicin and chloramphenicol. Cultures were positive in 37,5%

(mostly Staphylococcus). The presence of risk factors significantly increased cultural

positivity, the most frequent being contact lens wear, blepharitis, trauma and diabetes

mellitus. The previous use of topical antibiotics did not appear to affect cultural

positivity. A correlation was found between the isolated strain and the healing time and

subsequent prognosis, Multidrug resistant strains of Staphylococcus and Pseudomonas

were found, namely to third generation cephalosporins and fourth generation

fluoroquinolones.

Conclusions: The diversity of MK's etiologic spectrum is responsible for its uncertain,

not seldom guarded, prognosis. It is crucial to understand RF and their interplay with

cultural results and antibiotic sensitivity. In this regard, local RF are more significant

than systemic RF in MK, and these correlate with cultural results. Multirresistant

bacteria seem to be emerging, but the overall prognosis with empiric therapy remains

good.


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Title: Ready made allogenic serum eye drops for severe dry eye disease

Authors: Hanne Olsen Julian, MD, Ph.D & Lene Holm Harritshøj, MD

Institution: Eye Clinic Glostrup Hospital & Department of Clinical Immunology, Rigshospitalet, Copenhagen, Denmark

Text: Purpose: To overcome the difficulties with preparation of autologous serum drops a production line based on donor serum of unrelated AB0 blood type identical Danish blood donors was set up. Efficacy and safety was evaluated in 22 patients with severe ocular surface disorders as an alternative to conventional medical therapy.

Methods: Serum donors were regular volunteer male blood donors tested for HIV 1+2, Hepatitis B and C according to regulations of blood donations in Denmark. Production of serum eye drops complied with good manufacturing practices. Serum was diluted to 20% and stored at -‐25° C. Frozen AB0 matched serum drops in lots of 14 bottles were provided from the blood-‐bank upon request within 30 minutes. During the test period 22 patients with severe dry eye disease refractory to conventional therapy were treated with allogenic serum eye drops for two to four weeks. Eye drops were applied 6 times/day. Patients were examined at day 0, day 15 and day 30.

Results: Twenty-‐two patients completed two or four weeks of treatment. No side effects were observed. Fourteen (63%) patients reported beneficial effects on subjective symptoms. In 12 (55%) patients ocular surface changes improved on slit-‐lamp examination. Patients with KCS had the highest rate of success with subjective relief in 10 of 11 cases. Partial or full healing of corneal changes was found in 9 of 11 cases. Patients with RES experienced no effect of serum treatment.

Conclusion: Allogenic serum drops is a safe treatment of severe dry eye disease. No side-‐effects were observed. Therapeutic efficacy is comparable to previous reports on autologous serum drops. This novel production and treatment principle greatly increases the availability to patients who might benefice from topical serum treatment.


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Title: Transplantation of individualized recipient-‐serum-‐adapted cornea (RSAC) in high-‐risk keratoplasty

Authors: Zisis Gatzioufas 1, Holger Busse 2, Simone König 3, Solon Thanos 2

Institution: (1) Department of Ophthalmology, University of Saarland, Homburg/Saar, Germany (2) Department of Ophthalmology, University of Münster, Münster, Germany (3) Interdisciplinary Center for Clinical Research, University of Münster, Münster, Germany

Text: Background/Purpose: Corneal diseases may cause severe visual impairment that necessitates corneal transplantation and, sometimes, repetitive procedures due to graft rejection. We tested the hypothesis that exposure of donor corneas to recipient-‐serum-‐derived factors during eye banking triggers a preoperative adaptation that is beneficial for postoperative tolerance. Methods: Donor corneas were incubated in a medium containing human serum (HS) obtained in each case from the prospective graft recipient, in order to individually expose the donor cornea to the recipient’s serum. All recipient-‐serum-‐adapted corneas (RSACs) fulfilled the clinical criteria required by the national law and they were transplanted successfully. The postoperative follow-‐up period extended up to 7 years. Proteomic analysis as well as immunohistochemical examination of corneas cultivated in culture medium containing either fetal calf serum (FCS) that is routinely used for cornea banking or HS was performed. Results: All RSACs were tolerated by their recipients and no graft rejection occurred. Proteomic analysis of corneas cultivated in culture medium containing either fetal calf serum (FCS) or HS revealed different patterns of proteins. Additional immunohistochemistry confirmed the differences in staining patterns of some typical corneal proteins between FCS-‐ and HS-‐cultured corneas. HS-‐cultured corneas showed a greater proteomic similarity with native human corneas than did the FCS-‐cultured corneas, suggesting a differential nutrification of the cultured corneal tissue by HS-‐derived factors. Conclusions: These results indicate for the first time that postoperative complications such as tissue intolerance and graft rejection might be managed if the corneal tissue is individually adapted to the recipient’s serum trophic factors. This new donor tissue-‐treatment procedure offers incontrovertible advantages and could be adopted for high-‐risk eyes as well as other transplantable tissues.


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Title: Treating Meibonian Gland Dysfunction with a new thermotherapy approach.

Authors: The Portuguese MGD Group – Coordinator Paulo F. Torres, MD, PhD

Institution: Several Cornea and Ocular Surface Units in Portugal

Text: Purpose: To show the efficacy of a new thermotherapy device in the treatment of MGD.

Methods and results: MGD patients from several centers in Portugal underwent a study

to show the efficacy of a new thermotherapy device. Clinical evaluation, scoring of the

disease and determination of patient compliance and satisfaction were performed.

Patients were asked to answer a simple questionnaire concerning symptoms, general

comfort and quality of vision and life.

Conclusion: This new thermotherapy device – Blephasteam -‐ showed to be efficient in

treating MGD patients.


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Title: Penetration of topically administered antibody fragments into the eye.

Authors: Michael A. Thiel.

Institution: Cantonal Hospital Lucerne, Lucerne, Switzerland

Text: Background: Single chain antibody fragments (scFv) represent the smallest functional

unit of an antibody that still retains full binding capacity and target specificity. Despite

their molecular size of 28 kDa they have been shown to penetrate the cornea after

topical administration in vitro. The aim of the present study was to test whether scFv

molecules penetrate into the eye in vivo and to investigate the pharmacodynamic

properties which are needed to establish clinically applicable treatment protocols for

clinical trials in humans.

Methods: ScFv were administered topically as eye drops using 4 or 8 hourly drops or 4

drops per day for 4 days before sampling aqueous humor from the anterior chamber.

ScFv penetration into the anterior chamber was measured by antigen binding activity

against the target antigen (anti TNF-‐α).

Results: Topical administration of scFv resulted in antigen binding activity inside the

anterior chamber within 4 hours and reached a steady state after 8 hourly drops. A

dosing protocol of 4 drops per day resulted in a scFv concentration high enough to fully

block TNF-‐α activity as reported in acute anterior uveitis .

Conclusion: ScFv fragments penetrate into the anterior chamber in vivo. Penetration is

sufficiently high to reach therapeutic levels with dosing protocols applicable for clinical

trials in humans.


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List of participants

Josef Stoiber Salzburg Austria [email protected] Ilse Claerhout Gent Belgium [email protected] Philippe Kestelyn Gent Belgium [email protected] Chris Bath Søndergaard Aalborg Denmark [email protected] Henrik Vorum Aalborg Denmark [email protected] Anders Ivarsen Aarhus Denmark [email protected] Anders Søndergaard Aarhus Denmark [email protected] Esben Nielsen Aarhus Denmark [email protected] Jesper Hjortdal Aarhus Denmark [email protected] Kim Nielsen Aarhus Denmark [email protected] Mikkel Lyngholm Aarhus Denmark [email protected] Thomas Breitenbach Aarhus Denmark [email protected] Hanne Julian Copenhagen Denmark [email protected] Klavs Højgaard Copenhagen Denmark [email protected] Hans Ulrik Møller Viborg Denmark [email protected] Hayette Rebika THEA France h.rebika@laboratoires-‐thea.fr Jean-‐Frédéric Chibret THEA France jf.chibret@laboratoires-‐thea.fr Björn Bachmann Erlangen Germany bjoern.bachmann@uk-‐erlangen.de Claus Cursiefen Erlangen Germany Claus.Cursiefen@uk-‐erlangen.de Friedrich Kruse Erlangen Germany Friedrich.Kruse@uk-‐erlangen.de Philip Maier Freiburg Germany philip.maier@uniklinik-‐freiburg.de Berthold Seitz Homburg/Saar Germany Berthold.Seitz@uniklinikum-‐

saarland.de Zisis Gkatzioufas Homburg/Saar Germany Zisis.Gkatzioufas@uniklinikum-‐

saarland.de Karen Falke Rostock Germany [email protected] Marina Hovakimyan Rostock Germany Ágnes Füst Budapest Hungary [email protected] Shmuel Levartovsky Ashkelon Israel [email protected] Arie Marcovich Tel Aviv Israel [email protected] Carlo Traverso Genova Italy [email protected] Paolo Rama Milan Italy [email protected] Iva Dekaris Zagreb Kroatia [email protected] B van Dooren Breda Netherlands [email protected] M. C. Bartels Deventer Netherlands [email protected] W.J. Rijneveld Heiloo Netherlands [email protected] Cathrien Eggink Nijmegen Netherlands [email protected] Annette Geerards Rotterdam Netherlands [email protected] Gabriel van Rij Rotterdam Netherlands [email protected] Isabel Bleyen Rotterdam Netherlands [email protected]


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Jeroen van Rooij Rotterdam Netherlands [email protected] A. Van der Lelij Utrecht Netherlands [email protected] Liv Drolsum Oslo Norway [email protected] Nuno Alves Lisboa Portugal [email protected] Pedro Candelária Lisboa Portugal Luís Torrão Porto Portugal [email protected] Paulo Torres Porto Portugal [email protected] Dagoberto Almanzar Oviedo Spain [email protected] Jesus Merayo Oviedo Spain [email protected] David Galarreta Valladolid Spain [email protected] Margareta Claesson Göteborg Sweden [email protected] Per Fagerholm Linköping Sweden [email protected] Helena Sönne Örebro Sweden [email protected] Jes Mortensen Örebro Sweden [email protected] Lars Karlsson Örebro Sweden [email protected] Peter Leuenberger Geneva Switzerland [email protected] Francois Majo Lausanne Switzerland [email protected] Claude Kaufmann Lucerne Switzerland [email protected] Michael Thiel Luzern Switzerland [email protected] Barbara Bachmann-‐Simmen Zürich Switzerland bachmann@augenpraxis-‐

weinbergstrasse.ch Beatrice Früh Epstein Zürich Switzerland [email protected] Dan Epstein Zürich Switzerland [email protected] Wolfgang Bernauer Zürich Switzerland [email protected] Faik Orucov Istanbul Turkey [email protected] Christopher Liu Brighton UK [email protected] Frank Larkin London UK [email protected]


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Documents

June 17-19, 2011 Ebeltoft, Aarhus Denmark - AU Purepure.au.dk/portal/files/41642306/ECC_2011_Program_etc_3.pdf · June 17-19, 2011 Ebeltoft, Aarhus Denmark 37th!! 37th meeting …