1st EuCornea Congress

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1st EuCornea Congress venice, 17-19 june 2010 INVITED SPEAKERS Belin, Michael Evaluation of the Ectasia Risk Scoring System M. Belin University of Arizona, Tucson, USA The original Risk Assessment Scoring System was published in Ophthalmology in 2008 and a subsequent validation study was published in the American Journal of Ophthalmology later in the same year. Since its publication refractive surgeons have debated the clinical applicability of the Scoring System. While the study evaluated a number of preoperative parameters, age and preoperative abnormal anterior curvature (topography) were the most statistically valid. The ERSS, however, in the author’s own validation study showed a false negative rate of 8% and a false positive of 6%. While the exact incidence of iatrogenic ectasia is unknown, estimates are 1:2,500. A 6% false positive rate (eyes) would potentially exclude 12% of the refractive surgical population (patients). Newer screening parameters have evolved since the original ERSS was proposed. A revised screening regimen will be discussed. Birnbaum, Florian Systemic immunosuppression and HLA matching in penetrating risk keratoplasty F. Birnbaum, D. Bohringer, T. Reinhard University Eye Hospital Freiburg, Killianstraße Freiburg, Germany Immune reactions are still the leading cause for graft failure following penetrating keratoplasty, especially in risk situations such as vascularization of the recipient cornea, graft position close to the limbus or repeatkeratoplasty. A midterm systemic immunosuppression as secondary prophylaxis following risk keratoplasty, in addition to the topical immunosuppression with steroids is widely used in Germany and should be standard of care. To date, predominantly cyclosporine A (CSA) und mycophenolate mofetil (MMF) are administered. Superiority of systemic MMF compared to only topical treatment with steroids was demonstrated in a recent clinical trial. A substantial reduction of the antigenic load can be achieved by matching for HLA and minor transplantation antigens. This strategy might qualify as primary prophylaxis of graft rejection from preliminary data. Reluctance in the clinical routine has recently been addressed by predicting individual matchability from the HLA phenotype and the HLAMatchmaker method. Both methods can help in improving histocompatibility within reasonable waiting time. Matching certain minor antigens seems additionally reasonable from recent clinical data as well. Bonini, Stefano Clinical trials in ocular allergy B. Stefano Dept Ophthalmology University of Rome Campus Bio-Medico, Rome, Italy Background: Ocular allergy represents one of the most common clinical conditions encountered by ophthalmologists. Ocular allergy includes different clinical conditions such as seasonal or perennial allergic conjunctivitis (SAC and PAC), vernal keratoconjunctivitis, giant papillary conjunctivitis, and atopic keratoconjunctivitis. These clinical entities show different response to topical antiallergic, anti-inflammatory, or immunosuppressive agents. Actually, there is wide variability of study designs in clinical trials, which results in conflicting evidence on the optimal management of ocular allergic diseases. We conducted a systematic review of clinical trials performed since 1965 in order to critically evaluate their quality and to highlight biases to be avoided in future clinical research on ocular allergy. Methods: Clinical trials for allergic conjunctivitis performed since 1965 were retrieved and data on patients, interventions, comparison of interventions, and outcomes were extracted. 428 trials were retrieved and evaluated to be included in the systematic review. Results 362 trials were included in the study. Most of clinical trials were performed on SAC and PAC (81%), trials on VKC and AKC account only for 13% and 4%, respectively, and trials on GPC for 2%. Most of the studies investigated the efficacy of antiallergic compounds (65%),followed by immuno-modulatory agents (13%), sublingual immunotherapy and vaccines (13%), non-steroidal antiinflammatory drugs (5%), and other therapies (4%). Only a minority of trials fulfilled all criteria of proper clinical trial design. The main clinical parameters considered as primary outcomes in most of the studies were total symptoms and signs, followed by itching. In most of the studies there is a very limited use of objective parameters for patients’ selection and for evaluation of drugs efficacy. Several outcomes of primary importance, such as disease relapses rate, are largely omitted in most of clinical trials. Conclusions: The evidence coming out of clinical trials on ocular allergy is disparate,resulting in lack of strength to recommend any therapeutic intervention. To reduce the burden on patients and healthcare organizations, future clinical trials should increase the use of specific primary outcomes and quantifiable laboratory parameters. Cerulli, Luciano Management of acanthamoeba keratitis L. Cerulli Rome, Italy Acanthamoeba is a significant clinical problem. Early diagnosis and early therapy leads to a better prognosis. Confocal microscopy, PCR, histology and cultural procedures are the basic elements for diagnosis. Limits and reliability of these procedures are discussed. Cursiefen, Claus Complications after posterior lamellar keratoplasty (DSAEK): Prevention, detection and treatment C Cursiefen University of Erlangen Erlangen Germany Purpose: To outline typical complications after Descemet’s stripping automated endothelial keratoplasty (DSAEK) and to discuss their prevention and management. Methods: Own clinical results and PUBMED literature search. Results: Postoperative flap dislocation, which can be effectively treated by re-bubbling the graft, is the most common and typical complication after DSAEK. Conclusions: Careful preoperative indication, surgery and postoperative care make DSAEK a safe and effective new therapeutic option for patients with endothelial corneal disease. Dekaris, Iva European Eye Bank Association - EEBA I. Dekaris European Eye Bank Association The European Eye Bank Association (EEBA) is a technical-scientific organization comprising individual members from 83 eye banks from 22 European countries. Founded with the simple objective of sharing information regarding eye-banking, the Association is today the leading pan-national association in Europe dedicated to the advancement of eye-banking and an authoritative reference point for eye banks wishing to work according to quality standards. AIMS: The Association is formed for the advancement of eye banking (tissues and cells for treatment of eye diseases): ‘ to contribute to the development and maintenance of standards for the practice of eye banking in Europe ‘to establish and maintain an agreed set of EEBA Standards ‘ to promote data collection on graft outcome in order to validate eye bank techniques ‘to facilitate the interchange of information between eye banks ‘ to provide opportunities for the discussion of all aspects of eye banking practice including eye donor selection and procurement ‘ to encourage relevant research and development ‘ to provide informed comment to external agencies ‘ to foster education and training in eye banking ‘ to maintain national and international links with corneal transplant 30
1st EuCornea Congress venice, 17-19 june 2010 INVITED SPEAKERS communities and relevant bodies ‘ to make knowledge in the field of eye banking available to any person for the general good of society. ACTIVITIES: In the last 5 years the number of corneas received in EEBA member eye-banks was 33653(±5019) corneas. The overall percentage of corneas issued for transplantation was 54%. Most of the corneas were transplanted in the hospital housing the eye-bank or in the own country, whilst export to other countries was 7%. According to their activities, expressed as number of corneas issued per year, 34 European eye banks are issuing 100-500 corneas, 12 are issuing 50-100 and only 3 eye banks >1000 corneas per year. Of the received corneas 49% was retrieved by enucleation and 51% by corneosclearal disc excision. Organ-culture remains the preferred storage methods in EEBA (70% of preserved corneas). In recent years EEBA Technical guidelines have been developed and published describing selection criteria deemed acceptable for cornea evaluation. Of all corneas that were not selected for grafting, more than half was excluded because of morphology (16,3%) and other reasons were serology (11.5%), medical history (2,9%), microbiology (3,4%) and others. All banks test all donors for HIV Abs, Hepatitis B and C, either antigen, antibodies or both and most eye banks additionally test for syphilis. Mean frequency of positive serology ranges from 6-8.56% in the last 5 years. In 2008, 13% of the corneas was selected and issued for lamellar grafting, and sometimes lamellar grafts were pretreated in the bank. Only a small proportion of the transplanted corneas were tissue-typed; typing for HLA 1 was done for 15,2% of all donors and for HLA11 fro 12,3%. Adverse reactions (such as primary failures and endophthalmitis) occurred at 0.1 and 0.01% risk. Of other tissues used for ocular surgery EEBA banks were issuing sclera, limbal graft, stem cells and amniotic membranes. “ Dua, Harminder Singh Limbal niches and stem cells: is the paradigm changing H.S. Dua, A. Miri, D. Said University of Nottingham, Nottingham, UK A large body of clinical and laboratory evidence supports the notion that stem cells of the corneal epithelium reside at the corneoscleral limbus. They are slow cycling and constitute a small proportion of the total cell mass. Their progeny, termed transient amplifying cells (TAC), form the basal cells of the cornea and can proliferate and migrate rapidly in response to injury. Distinct anatomical structures, termed limbal epithelial crypts (LEC), have been demonstrated to extend as a solid cord of cells from the peripheral end of the interpalisade (of Vogt) body of epithelial cells. Morphological, immunohistochemical and molecular characterisation of the cells of the LEC strongly suggests that the LEC represents a niche for corneal epithelial stem cells. Damage to the limbus results in conjunctivalisation of the cornea, a hallmark of limbal stem cell deficiency and transplantation of the limbus helps restore normal corneal epithelial cover. We studied ten eyes of seven patients who presented with a central ‘island’ of normal epithelial cells surrounded with 360 degrees of limbal stem cell deficiency with conjunctivalization of the limbus and peripheral cornea. This was established by clinical features, in vivo confocal microscopy and impression cytology. The central islands of normal corneal epithelium survived over a follow up period of 1 to 12 years. Molecular characterisation of the central corneal epithelium of normal donor eyes revealed presence of several genes that are associated with stem cells in other organ systems. Other in-vitro studies on organ cultures human corneas and in-vivo transplant studies in beta galactosidase (blue) mice also strongly support the existence of progenitor cells in the central cornea. On the basis of the above observations we hypothesise that the limbus has a limited role to play in physiological homeostasis of the corneal epithelium, which can be sustained by the basal cells of the central cornea. However following insult or injury, the limbal stem cells have an important role in corneal epithelial regeneration. It is likely that the transition from stem cells to TAC occurs via a hierarchy of progenitor cells, which we have termed ‘transient cells’. It is likely that the central cornea is populated with such transient cells. El Danasoury, Alaa Deep lamellar keratoplasty with the big bubble & a femtosecond laser (iDALK) A El Danasoury Saudi Arabia Purpose: Reporting outcomes of the first 24 cases of DALK with baring of Descemet’s membrane using Femtosecond laser (Intralase) and big bubble technique. Methods: 24 eyes with advanced keratoconus had DALK; Intralase was used to create mushroom shaped trephinations for donors and recipients; big air bubble to separate recipients’ Descemet’s membrane from stroma. Donor button was secured with 12 bytes 10/0 running suture. Results: At 6 months (follow up; 91.6%), 83.3% eyes saw 20/40 or better with correction; mean cylinder was 3.61 ± 1.24 D. No vision-threatening complications were encountered. Conclusion: Femtosecond laser trephination can be combined with big bubble technique to expose Descemet’s membrane with good refractive outcome. Larger series and longer follow-up are needed. Fogla, Rajesh Modified instrumentation to simplify the big bubble technique of DALK surgery R. Fogla Hyderabad, India Big Bubble technique of deep anterior lamellar keratoplasty (DALK) helps retain the healthy host endothelium with good visual outcome. The original technique using a 27G needle is difficult to master, and often frustrating to the learning surgeon. Newer instruments designed to simplify the technique will be presented. With these instrument the Big Bubble separation of Descemet Membrane from stroma is achieved more consistently. These instruments simplify the learning curve making it easier for the corneal surgeon to adopt Big Bubble technique of DALK surgery in their practice. Gatzioufas, Zisis Effect of thyroxine on corneal biomechanics Zi Gatzioufas 1 , P. Charalambous 1 , V. Kozobolis 2 , B. Seitz 1 1. Department of Ophthalmology, University of Saarland, Homburg/Saar Germany 2. Department of Ophthalmology, Democritus University of Thrace Thrace Greece Background/Aim: Our research group has documented that normal human cornea expresses thyroxine receptors (THR). Keratoconus is characterized by differential THR expression in basal epithelial layer and anterior stroma. Aim of our study was to investigate the impact of thyroxine (T4) on corneal biomechanics. Methods: We examined 16 patients with hypothyroidism, 12 patients with hyperthyroidism and/or endocrine orbitopathy and 18 normal subjects by means of Ocular Response Analyzer and estimated the corneal hysteresis (mean value±SD, mm Hg). Fourteen rabbit corneas were cultivated for 10 days in organ culture (medium I) with and without T4 of 0.02 mM concentration (2.5 ng/dL) and afterwards the stress-strain curve for each cornea was determined with the aid of a biomaterial tester (mean value±SD, Pa). Young’s modulus E was also calculated. Corneal thickness was measured using ultrasound pachymetry (mean value±SD, µm). Cell cultures of rabbit corneal epithelial cells were established and the epithelial cell proliferation rate in cultures with or without T4 treatment was evaluated. Student’s t-test was used for statistical analysis in all experiments. P values < 0.05 were considered statistically significant. Results: Corneal hysteresis in patients with hyperthyroidism (14.1±2.4) was significantly increased compared to patients with hypothyroidism (9.8±2.5) and normal subjects (10.4±2.3) (p0.05, t-test). Stress values were compared at 10% strain. Mean stress value in corneas treated with T4 was 214±56 compared to 31
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