Contentssos.org.sa/Files/114037104004.pdf · Conference at a Glance ... but also extends to...

Contents

Forewords

Prince Abdulaziz Ahmed Abdulaziz Al-Saud ........................................................................ 1

Dr Abdul Elah Abad Al-Towerki ............................................................................................ 2

Conference at a Glance ................................................................................................................ 3

Floor Plan ...................................................................................................................................... 4

Speakers

International Guest Speakers .............................................................................................. 6

Presenters ............................................................................................................................ 7

Symposium Committees .............................................................................................................11

Scientific Program

Monday, March 7 ................................................................................................................ 14

Tuesday, March 8 ............................................................................................................... 17

Wednesday, March 9 ......................................................................................................... 21

Thursday, March 10 ........................................................................................................... 25

Poster Presentations .......................................................................................................... 28

Video Presentations ........................................................................................................... 30

Abstracts

Monday, March 7 ................................................................................................................ 31

Tuesday, March 8 ............................................................................................................... 32

Wednesday, March 9 ......................................................................................................... 40

Thursday, March 10 ........................................................................................................... 51

Posters ............................................................................................................................... 63

Videos ................................................................................................................................ 72

Participating Organizations and Exhibitors ................................................................................. 76

Saudi Ophthalmology 2016: Program and Abstracts

Saudi Ophthalmology 2016: Program and Abstracts 1

Foreword

Prince Abdulaziz bin Ahmedbin Abdulaziz Al Saud

President, SOS

Welcome to Saudi Ophthalmology 2016 (SO 2016), a combined meeting of the

28th Annual Scientific Meeting of the Saudi Ophthalmological Society (SOS)

and 33rd Annual Symposium of the King Khaled Eye Specialist Hospital (KKESH)

in collaboration with the Department of Ophthalmology, College of Medicine, King

Saud University (KSU).

This combined annual meeting is an educational activity that continues to build a

proud tradition of service in the Kingdom of Saudi Arabia and to its neighboring

countries, striving to serve as a bridge for ophthalmological innovation.

Since the establishment of SOS on 16th September 1985, being one of the first Saudi Scientific Medical Societies

and the only ophthalmological to be formed, ophthalmologists in the Kingdom of Saudi Arabia. Under the

leadership of the Custodian of the Two Holy Mosques, King Salman bin Abdulaziz Al Saud, and Honorary

President of SOS HRH Prince Ahmed bin Abdulaziz Al Saud, the Society continues to strive to achieve its future

goals. This is in accordance with our government’s mandate to raise the scientific standards of ophthalmology

personnel, as well as the quality of eye care services provided to our patients.

This is the 18th combined scientific meeting of the two leading organizations, SOS and KKESH, in collaboration

with KSU. We continue to unite our efforts and goals to provide the strongest and most comprehensive meeting

in the region, in order to better serve ophthalmologists and optometrists.

The SO 2016 will focus on the new developments in: Anterior Segment, Retina, Optometry, Prevention of

Blindness, Pediatric Ophthalmology and Neuro Ophthalmology through lectures, courses, posters and video

presentations as well as workshops. We are grateful to our international and local speakers for sharing their

clinical experiences and research with us.

This year’s exhibition will feature the latest technology from leading companies in the region. The exhibition

will cover a wide array of ophthalmic equipment and supplies.

The Saudi Journal of Ophthalmology (SJO) is an English language, peer-reviewed scholarly publication in the

area of ophthalmology. It is the official journal of the SOS and publishes original research papers, clinical

studies, review articles and case report on a quarterly basis. SJO is indexed with PubMed and SCOPUS –

popular scientific databases and search engines. It is also available on Science Direct. The journal was founded

in 1986 and has a rich history in serving the ophthalmic community in the Kingdom, Gulf States and the Middle

East. It is an open access journal and all the articles are available free of charge to readers. The society distributes

2000 print copies of the journal free of charge to all SOS members in the Kingdom and aboard, in addition to

many ophthalmologists, medical organizations and medical schools, globally. The society strives continuously

to enrich scientific research by presenting an award for the best published research by its members.

I would like to express my personal gratitude to HE Eng. Khalid bin Abdulaziz Al-Falih, Minister of Health,

Executive Director of KKESH and Dean, College of Medicine and Supervisor of the University Hospitals, KSU

for their continuous support of our activities in general and this meeting in particular. I would also like to thank

the Steering, Scientific and Organizing committees for their genuine efforts and dedication in organizing Saudi

Ophthalmology 2016.

Saudi Ophthalmology 2016: Program and Abstracts2

Foreword

Dr AbdulElah AbadAl-Towerki

Gen. Exec. Director, KKESH

On behalf of King Khaled Eye Specialist Hospital (KKESH), I would like towelcome you to the 33rd Annual Symposium of KKESH jointly convened with the 28th

Scientific Meeting of the Saudi Ophthalmological Society (SOS) in collaboration withKing Saud University (KSU). KKESH has played a key role in organizing the annualmeeting since 1982, in which the latest developments in ophthalmic medicine and sur-gery are reviewed. HRH Prince Abdulaziz bin Ahmed bin Abdulaziz Al Saud, Presidentof SOS, has been an enthusiastic facilitator and leader in unifying the scientific efforts,into one convention for the greater benefit of Ophthalmic care providers in Saudi Arabia

and neighboring countries. This year’s meeting will focus on: Cataract, Cornea & Refrac-tive Surgery, Prevention of Blindness, Optometry, Retina, Pediatric Ophthalmology and

Neuro-Ophthalmology. A large number of world renowned experts in these subspecialties, from Saudi Arabia and othercountries, will participate in this gathering. Evelyn Annette Paysse, MD, will present the King Khaled Memorial Lecture.

The mission entrusted to KKESH is not limited to providing patient care, but also extends to education, training andresearch. The Department of Medical Education plays a significant role in keeping ophthalmologists in the region

abreast of the latest developments in their field, providing the educational programs of the highest caliber such as theweekly Regularly Scheduled Conferences Program, the Annual Ophthalmology Symposium, the International Visi-tors Program as well as Clinical Training/Observership Programs. The International Visitors Program brought severalglobally renowned clinicians and scientists to KKESH who contributed to our efforts in providing the highest stan-dards of clinical care, new therapies and research ideas.

The Department of Medical Education at KKESH also continues its strong commitment to the Residency program in

Ophthalmology since its inception in 1984 in collaboration with KSU. The program, under the umbrella of Saudi Commis-sion for Health Specialties has trained two hundred and eighty (280) ophthalmologists to date. In 2015, the KKESH Resi-dency Program was accredited by the Saudi Commission for Health Specialties wherein the hospital accepted the 1st batch of8 first year KKESH residents. Our KKESH Subspecialty Fellowship Program, which was launched in 1994, has graduatedtwo hundred and eighty eight (288) ophthalmology subspecialists. In 2013, the KKESH Fellowship Subspecialty Programwas accredited in 7 Subspecialties by the Saudi Commission for Health Specialties as the first Saudi Ophthalmology Subspe-

cialty Fellowship Program. In 2015, the 2nd batch of fellows at KKESH graduated from the accredited Saudi Ophthalmol-ogy Subspecialty Fellowship Program, which is the 21st batch that graduated from the KKESH Subspecialty FellowshipProgram. I would like to thank the Associate Medical Director of Education and the Director of the Residency Program fortheir relentless efforts in training and promoting continuing medical education programs.

The Department of Training and Scholarship at KKESH provides training and education of crucial importance thatcontributes to the professional development and competency of our Technical and Support Staff. In the area of Re-

search, KKESH has taken large strides and gained increasing visibility as an elite research center that is recognizedglobally. Intramural research efforts have been expanded and so have our collaborations with institutions around theworld. KKESH is now a participant in two multicenter international clinical trials funded by the National Eye Institute,USA. Our thanks are extended to all our physicians who diligently contribute to the research endeavor through publi-cations in indexed journals and presentations at major scientific meetings.

With the continued generous and unwavering support of the Government of the Custodian of The Two Holy Mosques,

the Crown Prince and the sound management of His Excellency the Minister of Health we have continued to realizeour mission of patient care, teaching and research.

I would like to thank HRH Prince Abdulaziz bin Ahmed bin Abdulaziz Al Saud, President of the Saudi OphthalmologicalSociety and Regional Chair of the International Agency for the Prevention of Blindness, for his efforts to improve ophthalmol-ogy in the Kingdom and for his unlimited contribution that aims to prevent blindness nationally regionally, and internationally.

I would also like to extend my thanks to our colleagues in the Saudi Ophthalmological Society for their effective participation

in this conference, and the Symposium Committees and all medical companies who have supported this symposium.

I pray to God Almighty that this medical and scientific gathering will be benefit all the participants and will contributeto the upgrading of health standards in this country.


Conference at a Glance


Program and Abstracts Book Prepared By:

Mohammed MohsinAssistant Editor

Saudi Journal of Ophthalmology (SJO)

Rana Al-ShubaianAdministrative Assistant I

Medical Education Department, King Khaled Eye Specialist Hospital

Under the Supervision of:

Ali A. Al-Rajhi, MD, FRCS, FRCOphthChief, Continuous Medical Education Committee, Saudi Ophthalmology Society

Professor, College of Medicine, Al Faisal University

Senior Consultant Ophthalmologist, Al Hokama Eye Specialist Center and Magrabi Hospital, Riyadh

Editor-in-Chief, Saudi Journal of Ophhalmology (SJO)

Abdullah G. Al-Otaibi, MDDeputy President, Saudi Ophthalmological Society (SOS)

Assistant Professor and Consultant, Pediatric Ophthalmology Division

Department of Ophthalmology, College of Medicine, King Saud University (KSU), Riyadh

Eman Al-Kahtani, MDAssociate Medical Director of Education

Consultant, Vitreoretinal Disease and Surgery Division

Program Director, Saudi Ophthalmology Subspecialty Fellowship Program

Co-Chair, Scientific Program Committee/Saudi Ophthalmology Conference, King Khaled Eye Specialist Hospital, Riyadh


International Guest Speakers

Prof Alan William Johnston

Principal Optometrist

East Melbourne Optometry & Low Vision Centre

Australia

Michael Kalloniatis, BSc (Optom), PGCerOculTher

(Melb), PhD (Houston), FAAO

Director and Professor of Optometry and Vision Science

Centre for Eye Health, UNSW, Australia

David Kevin Coats, MD

Professor of Ophthalmology and Pediatrics

Baylor College of Medicine

Chief of Service/Section Chief – Ophthalmology Texas

Children’s Hospital, USA

Rajendra Shridhar Apte, MD

Director of Education

Assistant Professor of Ophthalmology and Visual Science

Department of Ophthalmology and Visual Sciences

Washington University School of Medicine, USA

Fion Domnall Bremner, MD, MSc, MBBS, PhD, FRCOphth

NHS Consultant Ophthalmic Surgeon

University College Hospital, the Royal Free Hospital and

the National Hospital for Neurology and Neurosurgery,

London, UK

Patrick YU WAI MAN, MD

MRC Clinician Scientist/Clinical Senior Lecturer/

Honorary Consultant Ophthalmologist

Wellcome Trust Centre for Mitochondrial Research

Institute of Genetic Medicine

Newcastle University, UK

Stephen Dale McLeod, MD

Professor

Chair of the Ophthalmology Department at UCSF

Specializes in Refractive Surgery, Cataract and Corneal Disease

University of California San Francisco, USA

Elmer Tu, MD

Professor of Clinical Ophthalmology

Director, Cornea Service

Illinois Eye and Ear Infirmary

Chicago, Illinois, USA

Muhammad Babar Qureshi, MD

Chief Executive Officer/ Executive Director

Comprehensive Health and Education Forum International

(CHEF Int’l), Senior Medical Advisor CBM, Board

Member of International Council of Ophthalmology, Chair

ICO Task Force on Uncorrected refractive errors, Co-

Chair IAPB – EMR and Chair EMR-HRWG

King Khaled Memorial Lecturer

Evelyn Annette Paysse, MD

Professor, Department of Ophthalmology

Baylor College of Medicine

Houston, TX, US

Physician, Texas Children’s Hospital Clinical Care Center

Saudi Ophthalmology Society Gold Medal Lecturer

Stephen R. Russell, MD

Service Director, Vitreoretinal Diseases and Surgery

Dina J Schrage Professor of Macular Degeneration Research

Professor of Ophthalmology and Visual Sciences


Presenters

Abdullah A. Al-Marshood, MD

4th Year Program Resident and Chief of Program Residents

Eastern Province Ophthalmology Training Program, KSA

Abdullah Assiri, MD

Senior Consultant Ophthalmologist

Cornea, Refractive (Lasik) and Cataract

Clinical Asst. Professor, King Saud University

Magrabi Hospital, Riyadh, KSA

Abdulrahman Al-Jasser, MBBS

Medical Intern

King Saud University, Riyadh, KSA

Abdulrahman Al-Oraini

Ophthalmic Photographer

King Khaled Eye Specialist Hospital, Riyadh, KSA

Abdulrahman Al-Bloushi, MD

Ophthalmology Resident

Joint Residency Training Program, Riyadh Center

Abdulaziz Al-Dhafeeri, MBBS

Medical Intern

UOD, KFHU

Adel Al-Akeely, MD

Vitreoretinal Fellow


Ahmad Al-Ghamdi, COMT

Technical Instructor, Training and Scholoarship Program


Ahmed Abu El-Asrar, MD, PhD

Professor and Consultant Ophthalmologist

Chief of Vitreoretinal Division

Department of Ophthalmology, College of Medicine


Ahmed Al-Yahya, MD


Joint Residency Program in Ophthalmology, Riyadh Center

Alberto Galvez, MD

Senior Consultant

Neuro-Ophthalmology Division


Ali Al-Halafi, MD

Consultant Vitreo-Retinal Surgeon

Department of Ophthalmology

Security Forces Hospital, Riyadh, KSA

Alicia Galindo, MD

Senior Consultant

Oculoplastics and Orbit Division


Alka Mahale, PhD

Senior Research Scientist

Research Department


Amal Al-Humaidan, MD, FRCS (ED)

Consultant Pediatric Ophthalmology and Strabismus

King Faisal Specialist and Research Center, Riyadh, KSA

Amr Radwan, MD

Assistant Lecturer

Faculty of Medicine, Alexandria University, Egypt

Athari Al-Duraibi

Optometrist, MSc in Health and Hospital Administration

Acting Chief of Optometry


Awad Al-Qarni, MD

Associate Consultant

Member, Anterior Segment Division


Bader Al-Qahtani, MBBS

Medical Intern

King Saud bin Abdulaziz University for Health Sciences, KSA

Bassima Aldulaigan, OD

Chief of Optometry Department

AlRaed Consultant Medical Center, KSA

Craig Simms

Supervisor and Chief Ophthalmic Medical Technologist

Hotel Dieu Hospital, Department of Ophthalmology

Kingston, Ontario, Canada

David Gritz, MD

Professor of Ophthalmology and Epidemiology (PAR)

Wilmer Eye Institute

Dana Center for Preventive Ophthalmology

Johns Hopkins University School of Medicine

Johns Hopkins University School of Public Health

Baltimore, MD

Chief of Anterior Segment Division



Deepak Edward, MD

Senior Academic Consultant

Executive Medical Director

Member, Glaucoma Division


Jonas S. Friedenwald Professor of Ophthalmology


Professor of Pathology, Johns Hopkins University School

of Medicine Baltimore, MD, USA

Donald Stone, MD

Director, Research Department

Senior Consultant, Anterior Segment Division


Eman Al-Kahtani, MD

Associate Medical Director of Education

Consultant, Vitreoretinal Disease & Surgery Division

Program Director, Saudi Ophthalmology Subspecialty

Fellowship Program Co-Chair, Scientific Program

Committee/Saudi Ophthalmology Conference


Eman Al-Sharif, MD

Ophthalmology Resident (R1)

King Abdulaziz University Hospital, King Saud University, KSA

Enrique Suarez, MD

Senior Academic Consultant, Anterior Segment Division


Hanan Al-Kozi, MD

Hany Helaly, MD

Lecturer of Ophthalmology

Alexandria University, Egypt

Hassan Al-Dhibi, MD


Chief, Uveitis Division

Member, Vitreoretinal Division


Heba Khashoggi, MSc Orthoptics

Orthoptist, OPS

Member of Australian Orthoptic Association


Helmieh Fayad, COMT

Technical Instructor

Monitoring Department


Huda Al-Dhaheri, MD

Anterior Segment Consultant

Tawam Hospital, Al-Ain, UAE

Igor Kozak, MD


Vitreoretinal Division


Ismael Al-Ghamdi, MD

Pediatric Ophthalmologist



Jesus Pintor, MD

Full Professor

Department of Biochemistry and Molecular Biology IV

Faculty of Optics and Optometry

Universidad Complutense De Madrid, Spain

Jose Vargas, MD

Consultant and Member

Anterior Segment Division


Khaled Al-Arfaj, MD

Assistant Professor

Chairman of Ophthalmology Department

Dammam University, KSA

Khalid Al-Husseiny, MD

Vitreoretinal Consultant

Cairo University, Egypt

Riyadh Eye Center, KSA

Khalid Jamous, MOptom, PhD

Low Vision Consultant

Chief of Optometry Unit

King Saud Medical City, Riyadh, KSA

Laila Al-Ghaferi, MD

Oculoplastics and Orbit Fellow


Leen Safieh, PhD

Senior Research Scientist

Research Department


Leyla Al-Jasim, MD

Consultant I

Glaucoma Division


Majid Abalkhail, MBBS

Medical Intern

King Abdulaziz Hospital, Jeddah, KSA

Manal Al-Harbi, MS, Optometrist

Lecturer at King Saud University, Riyadh, KSA


Marco Mura, MD


Chief, Vitreoretinal Division


Marwan Abouammoh, MD

Associate Professor and Consultant Ophthalmologist

Vitreo-Retinal Division



Md. Anwarul Azim, MD

Director General and Chief Physician

Doctor Azim Ltd., Moscow, Russian Federation

Medhat Eldakhakhny, MD

Consultant Pulmonologist and Hyperbaric Physician

King Abdulaziz Hospital, Jeddah, KSA

Mohammad Al-Ahmari, COMT

Acting Manager

Case Management Department


Mohammad El Banna

Visual Field Technician

Outpatient Services


Mohammad Ghulam, PhD

Assistant Professor


King Saud University, KSA

Mohammad Asiri, MD



Mohammed AbaHussain, M.Optom, PhD, FBCLA

Consultant and Assistant Professor

Optometry Department, King Saud University, Riyadh, KSA

Mohammed Al-Blowi

Optometrist

Optometry Division


Mohammed Badran

Ocularist

OPC Department


Mohammed Shaikh, MD

Consultant Ophthalmologist

Moneera Al-Ogla

Optometrist

Private Medical Center

Nayef Al-Ateeq

Electrophysiologist

Outpatient Services


Noor Al-Anazi, MBBS

Medical Intern


Omar Abdulsalam, MD



Omar Basamh, MD

Pediatric Ophthalmology Fellow


Omar Husain, MD


Joint Residency Training Program in Ophthalmology

Riyadh Center, KSA

Patrick Schatz, MD

Senior Consultant

Vitreoretinal Division


Raghad Al-Rasheed

5TH Year Medical Student


Raja Hariz

Chief of Ultrasound

King Abdulaziz University Hospital, KSA

Reem Al-Ahmadi, MBBS

Medical Intern


Reem Al-Qhahtani, MSc. Optometry

Practicing Senior Optometrist

King Abdulaziz University Hospital, Riyadh, KSA

Reham Al-Qahtani, MBBS

Medical Intern

King Saud bin Abdulaziz University for Health Sciences, KSA

Rizwan Malik, MD

Consultant I




Saad Al-Thiabi, MD

Resident

Qassim University, KSA

Saba Al-Rashaed, MD

Senior Consultant

Associate Chief, Vitreoretinal Division


Said JamalEddin, MD

Specialist Ophthalmologist

Baish General Hospital, Jizan, KSA

Salwa Al-Shibani, MBBS

Medical Intern


Samir Shoughy, MD, FRCS

Ophthalmologist

Subspecialized in Uveitis

The Eye Center, Riyadh, KSA

Sara Al-Ohali, MSc

Optometrist I

Contact Lens Specialist

King Fahad Medical City, KSA

Shaban Shaban, COT

Senior Technical Instructor

Training and Scholarship Department


Tariq Al-Hamad, PhD

Vice Dean for Academic Affairs

Consultant and Asst Prof of Cornea and Clinical Optometry

College of Applied Medical Sciences

Qassim University, KSA

Turki Dakhil, MD

Anterior Segment Fellow


Waleed Al-Rashed, MD

Head of Ophthalmology Department

Collage of Medicine, Al Imam Mohammad Ibn Saud

Islamic University (IMSIU), Riyadh, KSA

William Ehlers, MD

Staff Physician, UCONN Health

Associate Professor, University of Connecticut Medical

School, USA

Zainab Al-Khodairi, MSc Orthoptics

Certified Dyslexic Therapist

King Fahad University Hospital, Alkhobar, KSA


Symposium Committees

HRH Prince Abdulaziz Ahmed Abdulaziz Al Saud

President, Saudi Ophthalmological Society (SOS)

Board of Trustees Member, International Agency for the Prevention of Blindness (IAPB)

and Chair, Eastern Mediterranean Region (EMR)

AbdulElah Abad Al-Towerki, MD


Anterior Segment Division; Cornea, Refractive Surgery

General Executive Director

King Khaled Eye Specialist Hospital (KKESH)

Steering Committee

Chairs:

Abdullah Al-Otaibi, MD

Deputy President, Saudi Ophthalmology Society

Assistant Professor

Consultant Pediatric Ophthalmology



Deepak Edward, MD

Executive Medical Director




Jonas S. Friedenwald Professor of Ophthalmology,


Professor of Pathology, Johns Hopkins University School

of Medicine Baltimore, MD, USA

Members:

Eman Al-Kahtani, MD


Consultant, Vitreoretinal Disease and Surgery Division


Fellowship Program

Co-Chair, Scientific Program Committee/Saudi

Ophthalmology Conference


Ali Al-Rajhi, MD

Chief, Continuous Medical Education Committee

Saudi Ophthalmology Society, Riyadh, KSA


Senior Consultant Ophthalmologist, Al Hokama Eye

Specialist Center and Magrabi Hospital, Riyadh, KSA

Adel Al-Suhaibani, MD, FRCS, MSc HCM


Chairman, Department of Ophthalmology

College of Medicine, King Saud University, Riyadh, KSA

Ahmed Al-Eid

Symposium Affairs Coordinator

Training & Scholarship Department


Mohammed Fasihuddin

Registration and Exhibitions Coordinator


Rana Al-Shubaian

Administrative Assistant

Medical Education Department


Scientific Program Committee

Chairs:

Eman Al-Kahtani, MD




Fellowship Program




Ali Al-Rajhi, MD

Chief, Continuous Medical Education Committee



Senior Consultant Ophthalmologist, Al Hokama Eye

Specialist Center and Magrabi Hospital, Riyadh, KSA


Adel Al-Suhaibani, MD, FRCS, MSc HCM


Chairman, Department of Ophthalmology


Members:

Mohammad Al-Amry, MD

Senior Consultant

Anterior Segment Divison


Majed Al-Kharashi, MD

Assistant Professor and Consultant Ophthalmologist

Cornea, External Disease and Refractive Surgery Division



Abdullah Al-Assiri, MD

Senior Consultant Ophthalmologist

Cornea, Refractive (Lasik) and Cataract

Clinical Ass. Professor, King Saud University

Magrabi Hospital, Riyadh, KSA

Igor Kozak, MD


Member, Vitreoretinal Division



Associate Professor and Consultant Ophthalmologist

Vitreo-Retinal Division, Department of Ophthalmology


Ali Al-Halafi, MD, FRSC

Consultant Vitreo-Retinal Surgeon

Department of Ophthalmology

Security Forces Hospital, Riyadh, KSA

Alberto Galvez, MD

Senior Consultant

Member, Neuro-Ophthalmology,


Thomas Bosley, MD


Neuro-Ophthalmology, Department of Ophthalmology


Maha Badr, MD

Senior Clinical Consultant Neuro-Ophthalmology

Prince Sultan Military Medical City, Riyadh, KSA

Mohammed Al-Shamrani, MD

Consultant I

Member, Pediatric Ophthalmology

King Khaled Eye Specialist, Riyadh, KSA


Pediatric Ophthalmologist



Lina Al-Kahmous, MSc, OC(C) Canadian Certified

Orthoptist

Senior Orthoptist, Pediatric Ophthalmology Department



Low Vision Consultant

King Saud Medical City, Riyadh, KSA

Khaled Al-Arfaj, MD

Assistant Professor

Chairman of Ophthalmology Department

Dammam University, KSA

Mohammed Fasihuddin

Registration and Exhibitions Coordinator


Rana Al-Shubaian




Organizing Committee

Chair:

Abdullah Otaibi, MD

Deputy President, Saudi Ophthalmological Society

Associate Professor and Consultant

Pediatric Ophthalmology Division



Members:

Eman Al-Kahtani, MD




Fellowship Program




Abdulrahman Al-Faran, MD

Chief, Ophthalmic Unit, KKUH

Assistant Professor and Consultant

VitreoRetinal Division, Department of Ophthalmology



Waseem Aalam, MD

Assistant Professor

Ophthalmologist, Cornea Cataract, Refractive Surgery

Taibah University, KSA

Abdulaziz Al-Huthaili

Director, Protocol, Public Relations and Information


Ahmed Al-Eid

Training and Symposium Affairs Coordinator

Training and Scholarship Department


Mohammed Fasihuddin

Registration and Exhibition Coordinator


Rana Al-Shubaian




Majed Wahbi

Public Relations Manager

Saudi Ophthalmological Society, Riyadh, KSA

Saud Zahrani

Manager Medical Television


Karam Hamweyah, MBBS

Research Fellow

Research Department


Poster Committee

Rana Al-Shubaian




Sahar Al-Sarhan

Programmer/Analyst

Information Technology Department


Adolph Cabanas

Senior Graphic Designer

Design and Publications Department


Ahmed Al-Eid

Symposium Affairs Coordinator

Training & Scholarship Department


Maria Pabillano

Secretary, Medical Education Department


Coordinators

SO 2016 Program Office

Mohammed Fasihuddin – Registration and Exhibition

Rana Al-Shubaian – Administrative Assistant I

Maria Pabillano – Secretary

Michelle Rasonabe – Medical Secretary

Conference Website

Rana Al-Shubaian – Administrative Assistant I, KKESH

Fahad Al-Qahtani – System Developer, KKESH

Sahar Al-Sarhan – Programmer/Analyst, KKESH

Audio Visual

Saud Al-Zahrani – Manager Medical Television, KKESH

Ali Al-Kahtani – Audio Visual Technician, KKESH

Majed Al-Wadaani – Audio Visual Technician, KKESH

Yihia Zakariya – Audio Visual Coordinator, Riyadh, KSA

Public Relations

Abdulaziz Al-Huthaili – Director of Protocol, Public

Relations and Information, KKESH

Abdullah Al-Salman, PhD – Hospital Advisor, Protocol,

Public Relations and Information, KKESH

Maged Wahbi – Public Relations Manager, SOS

Additional Services

Mohammed Fasihuddin – Registration and Exhibition, SOS

Abdullah Al-Dossari – Acting Director, Security, KKESH

Mohammed Al-Wadani – Coordinator, Training and

Scholarship Department, KKESH


Program

Monday, March 7

M1A 3rd Ophthalmic Technical Seminar (Auditorium A)

Moderator Jamal Al-Raaei, COA

08:30 - 09:00 Corneal Topography

Mohammed Al-Ahmari, COMT

09:00 - 09:30 Wave Front Technology in Refractive Surgery: Concepts and Applications

Dr. William Ehlers

09:30 - 10:00 Post refractive Surgery IOL Calculations

Mr. Craig Simms

M1C Neuro Ophthalmology Workshop (Auditorium C)

Moderator Alberto Galvez, MD

08:30 - 08:55 Leber Hereditary Optic Neuropathy


08:55 - 09:20 Autosomal Dominant Optic Atrophy


09:20 - 09:45 Other Inherited Optic Neuropathies


09:45 - 10:00 Discussion

10:00 - 10:20 Break


Moderator Shaban M. Shaban, COT

10:20 - 11:10 Difficult Refractions

Dr. William Ehlers

11:10 - 11:40 Implantable Contact Lens

Shaban M. Shaban, COT

11:40 - 12:00 Aphakic Spectacles

Ahmad Al-Ghamdi, COMT

M2B Pediatric Ophthalmology Workshop (Auditorium B)

Chair Mohammad Al-Shamrani, MD

Moderator Dora Al-Harkan, MD; Amani Al-Bakri, MD

10:20 - 12:00 Pediatric IOL Implantation


M2C Optometry - Contact Lenses (Auditorium C)

Chair Tariq Al-Hamad, PhD

Moderator Muneera Al-Ogla, Optometrist

10:20 - 10:35 Post- Penetrating Keratoplasty Hard Contact Lenses Fitting

Muneera Al-Ogla, Optometrist

10:35 - 10:50 In Vitro and In Vivo Delivery of The Secretagogue Diadenosine Tetraphosphate from Conventional

and Silicone Contact Lensesses

Dr. Jesus Pintor

10:50 - 11:10 Fitting Strategies for Keratoconus

Bassima Al-Dulaigan, OD

11:10 - 11:25 Fitting Keratoconus Patients with Soft CL: Case Presentation

Athari Al-Duraibi, Optometrist, Msc

11:25 - 11:40 Contact Lenses and Corneal Hypoxia, What Is The Minimum DK/t

Mohammed Abahussain, M.Otom, PhD, FBCLA

11:40 - 11:55 Compare between Different Types of Contact Lenses and How They Influence The

Biomechanica Properties of The Cornea

Tariq Al-Hamad, PhD



Moderator Mohammed Al-Ahmari, COMT

12:45 - 13:15 Keratoconus

Donald Stone, MD

13:15 - 13:50 Contact lenses: Keratoconus, Penetrating Keratoplasty and post refractive surgery

Dr. William Ehlers

13:50 - 14:20 Anterior Segment Pathology Imaged with UBM

Mr. Craig Simms

14:20 - 14:45 Ophthalmic Technical Programs in Canada

Mr. Craig Simms

14:45 - 15:20 Visual Field Testing with The Humphery Field Analyzer

Mohammad El Banna

M3B Optometry - Orthopic & Free Paper (Auditorium B)

Moderator Lina Al-Kahmous, Senior Orthoptist

13:30 - 13:45 Comparison of The Value of The Phenol Red Thread Test With and Without Topical Anaesthesia

in Normal Adults

Sara Al-Ohali, Optometrist, MSc of Optometry

13:45 - 14:05 A and V Patterns

Heba Khashoggi, MSc Orthoptics

14:05 - 14:25 A Comparison of EFG Therapy vs Patching for the Treatment of Amblyopia in Children Aged 9-17 Years

Manal Al-Harbi, MSc Optometry

14:25 - 14:50 Orthoptic Role in Bilaterall 6th Nerve Palsy

Zainab Al-Khodairi, MSc Orthoptics

14:50 - 15:10 New Evidence-based Guidelines for Amblyopia Treatment

Bassima Al-Dulaigan, OD


12:00 - 12:45 Lunch


M3C Refractive /Cataract /Cornea Workshop (Auditorium C)

Moderator Prof. Hani Al-Mezaine

13:30 - 14:30 Lasers and Lenses: Emerging Cataract Technology

Stephen McLeod, MD

15:20 - 15:45 Break

M4A 3rd Ophthalmic Techical Seminar (Auditorium A)

15:45 - 16:15 Neuro Visual Field Defects with Goldman Perimetry

Helmieh Fayad, COMT

M4B Neuro Ophthalmology (Auditorium B)

Moderator Maha Bader, MD

15:45 - 16:15 Ptosis

Fion Domnall Bremner, MD

16:15 - 16:45 Anisocoria


16:45 - 17:15 Botulinum Toxin



M4C Uveitic Glaucoma Workshop (Auditorium C)

Chair Hassan Al-Dhibi, MD

Moderator Sami Al-Shahwan, MD

15:45 - 17:30 Uveitic Glaucoma Management

Hassan A Al-Dhibi, MD; Sami Al-Shahwan, MD; Ibrahim Al-Jadaan, MD; Deepak Edward, MD;

Sameer Ahmad, MD; Rizwan Malik, MD; Saleh Al-Obeidan, MD; Essam Osman, MD;

Faisal Al-Mobarak, MD


Tuesday, March 8

T1A Cornea Session (Auditorium A)

Chair Prof. Mubarak Al Faran

Moderator Hafez Al Faleh, MD

08:00 - 08:15 Epidemiology of Herpes Simplex Eye Disease in an Urban Population

David C. Gritz, MD

08:15 - 08:30 New Paradigms in the Treatment of Fungal Keratitis

Elmer Tu, MD

08:30 - 08:45 Tobacco Smoking and Sjogren Syndrome - A Complicated Relationship

Donald Stone, MD

08:45 - 09:00 Ocular Pathogens and Antibiotic Sensitivity in Bacterial Keratitis Isolates at King Khaled Eye

Specialist Hospital 2011-2014

Huda Saif Al-Dhaheri, MD

09:00 - 09:15 Update on The Management of Parasitic Keratitis

Elmer Tu, MD


09:30 - 09:45 Break

T1B Neuro Ophthalmology (Auditorium B)

Chair Samira Awaji, MD

Moderator Lama Enani, MD

08:00 - 08:25 Ocular Motor Palsies


08:25 - 08:50 Painful Ophthalmoplegia


08:50 - 09:15 Myasthenia Gravis


09:15 - 09:30 Acupuncture Treatment in Patients with Optic Neuropathy

Md. Anwarul Azim, MD

T1C Retina (Auditorium C)

Chair Igor Kozak, MD

Moderator Abdulelah Abdullah, MD

08:00 - 08:20 Visual Cycle Modulation in Central Serous Retinopathy

Rajendra Apte, MD, PhD

08:20 - 08:30 High Mobility Group Box-1 Regulates The Expression of Matrix Metalloproteinase-9 in Diabetic Retina

Mohammad Ghulam, PhD

08:30 - 08:40 Vitreous Levels of Placental Growth Factor Correlates with Activity of Proliferative Diabetic

Retinopathy and Is Not Influenced by Bevacizumab Treatment

Eman Al-Khatani, MD

08:40 - 08:50 The Chemokine Platelet Factor-4 Variant (PF-4var) CXCL4L1 Inhibits Diabetes-induced

Blood Retinal Barrier Breakdown



08:50 - 09:10 Seeing Through VEGF: Inflammation and Angiogenesis in Retinal Vascular Disease


09:10 - 09:20 Serum Molecular Signature for Proliferative Diabetic Retinopathy in Saudi Patients with Type 2

Diabetes

Eman Al-Khatani, MD


T2A Cataract Session (Auditorium A)

Chair Sabah Jastanieh, MD

Moderator Abdullah Al-Fawaz, MD

09:45 - 10:00 Toric IOLs in Patients with Previous Corneal Refractive Surgery and Ectasias

Enrique J. Suarez, MD

10:00 - 10:15 Capsule Challenges

Stephen McLeod, MD

10:15 - 10:30 Impact of Axial Length and Preoperative Intraocular Pressure on Postoperative Intraocular

Changes in Non-glaucomatous Eyes Following Phacoemulsification in a University Hospital,

Riyadh, Saudi Arabia

Noor M. Al Anazi, MD

10:30 - 10:45 Management of The Small Pupil

Stephen McLeod, MD


T2B Pediatric Ophthalmology (Auditorium B)

Chair Abdullah Al-Otaibi, MD

Moderator Mohammed Al-Shamrani, MD

09:45 - 10:00 Refractive Errors in Pediatric: Solutions and Challenges


10:00 - 10:20 Surgical Tips in Strabismus Surgery

Evylene Paysse, MD

10:20 - 10:35 Anatomic Indices following Photorefractive Keratectomy in Children 5+ Years after Surgery

Evylene Paysse, MD

10:35 - 10:45 Secondary Implantation of Implantable Collamer Lens (ICL) for Correction of Anisometropic

Hyperopia in A 3-year-old Pseudophakic Child

Saad Al-Thiabi, MD

10:45 - 11:00 Practical Guide to Refractive Surgery

Evylene Paysse, MD

T2C Neuro Ophthalmology (Auditorium C)

Chair Majed Al-Obailan, MD

Moderator Danya Al-Showair, MD

09:45 - 10:15 Chronic Progressive External Ophthalmoplegia


10:15 - 10:45 Treatment Strategies for Inherited Neurodegenerative Disorders


10:45 - 11:00 Clinical Variability in Wolfram syndrome

Alberto Galvez, MD



Saudi Ophthalmological Gold Medal Lecture (Auditorium B)

Chair Abdullah Al-Otaibi, MD

Moderator Ali Al-Halafi, MD

11:00 - 11:05 Introduction of Dr. Stephen Russull

Ali Al-Halafi, MD

11:05 - 12:00 Gene Therapy Results from The RPE65 Phase 3 Trial for Lebers Congenital Amaurosis

Stephen Russell, MD

12:00 - 12:30 Lunch Break & Prayer

12:30 - 13:45 Opening Ceremony (Auditorium A)

T3A Neuro Ophthalmology (Auditorium A)

Chair Maha Bader, MD

Moderator Lama Enani, MD

13:45 - 14:15 Optic Neuritis


14:15 - 14:45 Papilloedema


14:45 - 15:15 Giant Cell Arteritis



T3B Prevention of Blindness (Auditorium B)

Chair Saad Hajer, MD

Moderator Khalid Al-Arfaj, MD

13:45 - 13:50 Introduction of Dr Babar Qureshi

Khaled Al-Arfaj, MD

13:50 - 14:20 POB Shield Lecture: Changing Trends in Ophthalmic Medical Education

Khaled Al-Arfaj, MD

14:20 - 14:30 Validity and Usefulness of ‘RETEVAL’ a Hand-held Electro-physiological Tool in Diabetic

Retinopathy Screening Compared to Conventional Digital Fundus Photography

Khaled Al-Arfaj, MD

14:30 - 14:45 Neglected Tropical Diseases and Eye Health


14:45 - 14:55 Risk of Glaucoma in Obstructive Sleep Apnea Patients in King Abdulaziz University Hospital

Alberto Galvez, MD

14:55 - 15:10 Developing Eye Care Teams


15:10 - 15:20 Uncorrected Refractive Errors, How Do We Address It


15:20 - 15:30 Control of Diabetic Retinopathy in Health Systems



T3C Optometry - Low Vision (Auditorium C)

Chair Prof. Alan Johnston

Moderator Khalid Jamous, MOptom, PhD

13:45 - 14:05 Low Vision - Identifying Disability and Rehabilitation Need from Clinical Diagnosis


14:05 - 14:25 The Log MAR Visual Acuity Calculator - Making Certain Decisions for The Prescription of Magnification

Prof. Alan Johnston

14:25 - 14:45 The Simple Magnifier - Maximising The Interaction between Image Enlargement and Field of View

Prof. Alan Johnston

14:45 - 15:05 The Low Vision Telescope - An Underused but Highly Effective Device for Distance and

Intermediate Visual Tasks

Prof. Alan Johnston


15:20 - 15:45 Break

T4A Cataract Session (Auditorium A)

Chair Ali Al-Rajhi, MD

Moderator Maan Al-Barry, MD

15:45 - 16:00 Posterior Polar Cataract

Stephen McLeod, MD

16:00 - 16:15 Assessment of Learning Curve in Phacoemulsification Surgery among Eastern Province

Ophthalmology Program Residents

Abdullah Abdulrahman Al-Marshood, MD

16:15 - 16:30 Lens Calculations after Refractive Surgery

Stephen McLeod, MD

16:30 - 16:45 Utility of VERUS Ring in Performing Safe and Efficient Capsulorhexis with Corneal Scarring

Enrique J. Suarez, MD

16:45 - 17:00 Comparison between Digital and Manual Marking for Toric Intraocular Lenses

Hany Ahmed Helaly, MD

17:00 - 17:15 Management of Loose Zonules

Stephen McLeod, MD


T4B Prevention of Blindness (Auditorium B)

Seminar, Rights of Blind and Low Vision in Saudi Arabia

T4C Pediatric Ophthalmology (Auditorium C)

Chair Ismael Al-Ghamdi, MD

Moderator Saif Al-Obaisi, MD

15:45 - 16:05 New Surgical Procedures for Incomitant Strabismus

Evylene Paysse, MD

16:05 - 16:30 In Situ Dissection for Topical Adjustable Strabismus Surgery

David Coats, MD

16:30 - 16:50 New Surgical Approaches for Nystagmus

Evylene Paysse, MD

16:50 - 17:05 True Micro-Incisional Strabismus Surgery Using the Coats Double Ended Curved Hook

David Coats, MD

17:05 - 17:15 ET go home

Evylene Paysse, MD



Wednesday, March 9

W1A Cornea Session (Auditorium A)

Chair Samar Al-Swailem, MD

Moderator Khaled Al-Arfaj, MD

08:00 - 08:15 The Challenge of Herpetic Viral Keratitis

Elmer Tu, MD

08:15 - 08:25 Clinical Results of a Foldable Artificial Cornea – Personal Experience

Jose Manuel Vargas, MD

08:25 - 08:40 The Unique Role of Confocal Microscopy in the Diagnosis of Corneal Disease

Elmer Tu, MD

08:40 - 08:50 Corneal Myxoma Presentation and Management - A Case Series

Bader Saad Al-Qahtani, MD

08:50 - 09:00 Safety of Long-term Treatment with Topical Tacrolimus 0.01% Eye Drops

Samir Shawki Shoughy, MD

09:00 - 09:15 The Diagnosis and Management of Ocular Surface Tumors

Elmer Tu, MD


W1B Neuro Ophthalmology (Auditorium B)

Chair Alberto Galvez, MD

Moderator Danya Al-Showair, MD

15:40 - 16:05 Neuromyelitis Optica


16:05 - 16:30 Traumatic Optic Neuropathy


16:30 - 16:55 Congenital Optic Disc Abnormalities


16:55 - 17:20 Non-glaucomatous Optic Neuropathy



W1C Optometry - The Role of Optometrists in The Delivery of Eye Health Care (Auditorium C)

Chair Prof. Michael Kalloniatis

Moderator Lina Al-Kahmous, Senior Orthoptist, MSc of Canadian Certified Orthoptist

08:00 - 08:15 The Need for Eye Care

Prof. Michael Kalloniatis

08:15 - 08:30 Models Integrating Optometrists in Eye Health Delivery


08:30 - 08:45 The Short-sighted Perspective of Long-term Eye Health Care

Reem Al-Qhahtani

08:45 - 09:00 Evidence-based Approach to Improving Optometrist Contribution to Eye Health Care

Importance of Education


09:00 - 09:15 The Future of Eye Health Care



09:30 - 09:45 Break


W2A Retina (Auditorium A)

Chair Sawsan Nowilaty, MD

Moderator Fadwa Al Adel, MD, FRCSC

09:45 - 10:05 Automated Detection of Diabetic Retinopathy and The Need for Telescreening

Stephen Russell, MD

10:05 - 10:15 Congenital Stationary Night Blindness with Defective Signal Transmission at The Level of the

Bipolar Cells

Patrick Schatz, MD

10:15 - 10:35 Methods and Surgical Technique for Gene and Cell-Based Retinal Therapies

Stephen Russell, MD

10:35 - 10:45 Coats’- like Retinopathy in Joubert Syndrome

Salwa Khider Al-Shibani, MD


W2B Pediatric Ophthalmology (Auditorium B)

Chair Shahira Turkmani, MD

Moderator Elham Al-Qahtani, MD

09:45 - 10:00 Visual Acuity Assessment in Amblyopic Children

Amal Al-Humaidan, MD

10:00 - 10:20 PEDIG: Overview

Omar Basamh, MD

10:20 - 10:30 Compliance with Amblyopia Treatment

Ahmed Al-Yahya, MD

10:30 - 10:45 My Amblyopia Treatment Is Not Working: What Am I Doing Wrong?

David Coats, MD

10:45 - 11:00 Amblyopia Treatment: What’s New?

Amal Al-Humaidan, MD

King Khaled Memorial Lecture (Auditorium B)

Chair Abdulelah Al-Towerki, MD

Moderator Mohammed Al-Shamrani, MD

11:00 - 11:05 Introduction of Dr. Evylene Paysse

Mohammed Al-Shamrani, MD

11:05 - 12:00 Refractive Surgery in Children

Evylene Paysse, MD

12:00 - 12:30 Poster & Video Award

12:00 - 12:15 Lunch Break & Prayer

12:15 - 13:00 SOS General Assembly (Auditorium B)

W3A Refractive Surgery Session (Auditorium A)

Chair Abdulrahman Al-Moammer, MD

Moderator Salem Al-Malki, MD

13:00 - 13:20 Outcome of Intrastromal Corneal Ring (INTACS SK) Using Femtosecond Laser In Keratoconus

Patients (KKESH Experience)

Awad Ali Al-Qarni, MD


13:20 - 13:35 Correlation between Practice Location as a Surrogate for UV Exposure and Practice Patterns to

Prevent Corneal Haze after Photorefractive Keratectomy (PRK)

Eman Al-Sharif, MD

13:35 - 13:50 I-year Follow Up of Implantable Collamer Lens (ICL) Anismetropic Amblyopia of Children

Amr Said Radwan, MD

13:50 - 14:10 Management of Perforation in LKP, Review and Report of Unusual Complication


14:10 - 14:25 Herpetic Keratitis after Cross-linking for Keratoconus



W3B Pediatric Ophthalmology (Auditorium B)

Chair Saleh Al-Mesfer, MD

Moderator Amal Al-Humidan, MD

13:00 - 13:15 Acquired Non-accommodative Esotropia: When to Worry?

Evylene Paysse, MD

13:15 - 13:40 Complications of Strabismus Surgery in Adults

David Coats, MD

13:40 - 13:50 New Technique for Squint Surgery

Said Abdulkader Jamal eddin, MD

13:50 - 14:00 Small incision Strabismus Surgery using the Paysse Hook

Evylene Paysse, MD

14:00 - 14:20 Double Vision: The Patient Experience

David Coats, MD

14:20 - 14:30 The Profile of Pediatric Ophthalmic Emergency Cases Presented to King Abdulaziz University

Hospital’s Emergency Department in Riyadh, Saudi Arabia: A Six-month Retrospective Study

Abdulrahman Abdulaziz Al-Jasser, MD


W3C Retina (Auditorium C)

Chair Saad Al-Dahmash, MD

Moderator Abdullah Al-Mousa, MD

13:00 - 13:20 The Lost Art of Retinal Drawing

Stephen Russell, MD

13:20 - 13:30 Precision in Vitreoretinal Surgery, Manual versus Assisted Instrument Positioning

Marco Mura, MD

13:30 - 13:50 Surgical Management of Diabetic Retinopathy


13:50 - 14:00 Predicting Factors for Visual Acuity Outcomes following Surgery for Epiretinal Membranes

Ali Al-Halafi, MD

14:00 - 14:10 A New Complication of Cataract Surgery: Hemorrhagic Occlusive Retinal Vasculitis

Stephen Russell, MD

14:10 - 14:20 Role of Intravitreal Bevacizumab As Adjunctive Therapy in Retinopathy of Prematurity

Khalid Al-Husseiny, MD

14:20 - 14:40 Scleral Buckling Using Wide Angled Chandelier Illumination as an Educational Tool


14:40 - 15:00 Controversies in Management of Dislocated IOLs

Stephen Russell, MD



W4A Cornea Workshop (Auditorium A)

Chair Othman Al-Omar, MD

Moderator Abdullah Assiri, MD

15:40 - 17:30 Keratoconus Management: Stepwise Approach

Maan Al-Barry, MD - Majed Al-Kharashi, MD - Sabah Jastaniah, MD - Abdullah Assiri, MD

W4C Retina (Auditorium C)

Chair Ahmed Abu El-Asrar, MD, PhD

Moderator Abdullah Al-Kharashi, MD, FRCS

15:40 - 16:00 Positional and Other Dynamic Changes on Optical Coherence Tomography

Stephen Russell, MD

16:00 - 16:20 Retinal Degeneration 2016


16:20 - 16:30 Use of New Intraocular Spectral Domain Optical Coherence Tomography in Vitreoretinal Surgery

Marco Mura, MD

16:30 - 16:40 Correlation between Microperimetry and Optical Cohernce Tomography in Macular Edema

Secondary to Acute Retinal Vein Occlusuon Before and After Bevacizumab Injection

Turki Abdulaziz Bin Dakhil, MD

16:40 - 16:50 Presumed Intraocular Tuberculous Uveitis in Tertiary Hospital in Riyadh

Awad Al-Qarni, MD

16:50 - 17:00 Indocyanine Green Angiographic Findings in Initial-onset Acute Vogt-Koyanagi-Harada Disease


17:00 - 17:10 Myofibroblasts in Proliferative Diabetic Retinopathy Can Originate from Infiltrating Fibrocystes

and Through Endothelial-to-mesenchymal Transition (EndoMT)




Thursday, March 10

Th1A Free Paper (Auditorium A)

Chair Prof. Adel Al Suhaibani, MD

Moderator Alicia Galindo, MD, PhD

08:00 - 08:10 Troubles from Trichomegaly of the Eyelashes: A Case Report of Erlotinib Induced Trichomegaly

Mohammed yusuf Hasambhai Shaikh, MD

08:00 - 08:20 Blow In Orbital Fracture in Endoscopic Turbinate Surgery

Alicia Galindo Ferreiro, MD, PhD

08:20 - 08:30 Tuberculous Conjunctivitis in an Anophthalmic Socket

Omar Abdulsalam, MD

08:30 - 08:40 Frontalis Sling Silicone Rode Open Crease vs Closed Stab Technique to Correct Severe Ptosis

with Poor Levator Function


08:40 - 08:50 Blind Painful Eyes: What to Inject? Comparative Study of Retrobulbar Injection of Ethanol

versus Chlorpromazine


08:50 - 09:00 Orbital Lymphoma Behaves as Subperiosteal Mass

Abdulrahman Faisal Al-Bloushi, MD

09:00 - 09:10 Localized Orbital Amyloidosis: Case Report

Laila Salem Al-Ghaferi, MD

09:10 - 09:20 Skin Wrapped Conformer over a Temporalis Muscle Transfer to Reconstruct Severely Contracted Socket

Omar BenHusain, MD

09:20 - 09:30 Eye Diseases Due to/and Treated by Hyperbaric Oxygen Therapy

Medhat Mohamed Eldakhakhny, MD

09:30 - 09:40 Perceptions and Career Expectation in Ophthalmology among Saudi Undergraduate

Medical Students

Majid Bahaa Abalkhail, MD

09:40 - 09:50 Assessment of Awareness of Patients’ Rights and Attitude toward Ophthalmology Residents

in University of Dammam (Ophthalmology Department)

Abdulaziz Hamdan Al-Dhafeeri, MD


Th1B Retina (Auditorium B)

Chair Saba Al-Rashaed, MD

Moderator Yahya Al-Zahrani, MD

08:00 - 08:12 Upregulated Expression of Heparanase in the Vitreous of Patients with Proliferative Diabetic

Retinopathy Originates from Activated Endothelial Cells and Leukocystes


08:12 - 08:24 Diabetic Retinopathy: Knowledge, Awareness and Practices of Physicians in Primary-Care

Centers in Riyadh, Saudi Arabia

Raghad Al-Rasheed, MD

08:24 - 08:36 Atypical Finding of Idiopathic Macular Telangiectasia Type 2 with Peripheral Vascular Anomaly

Saba Al-Rashaed, MD

08:36 - 08:48 Purtscher-like Retinopathy as a First Manifestation of Systemic Lupus Erythematosus

Reem Al-Ahmadi, MD

08:48 - 09:00 Rare Presentation of Dome-Shaped Maculain Saudi Patient

Adel Al-Akeely, MD


09:00 - 09:12 Ocular Injuries Secondary to Alexandrite Laser-Assisted Hair Removal

Mohammed Asiri, MD

09:12 - 09:24 T-shaped Macula Buckling Combined with Pars Plana Vitrectomy for Macular Hole, Macular

Schisis and Macular Detachment

Marco Mura, MD

09:24 - 09:36 Retinopathy of Prematurity (ROP) Prevalence and Risk Factors in King Abdulaziz Medical

City (KAMC) in Riyadh

Bader Al-Qahtani, MD

09:36 - 09:48 Incidence of Retinal Detachment in Patients with Bechet’s Disease

Samir Shawki Shoughy, MD


Th1C 3rd Ophthalmic Technical Seminar (Auditorium C)

Moderator Shaban Shaban, COT

08:00 - 08:30 Recognizing and Handling Unusual Contact Lens Problems

Dr. William Ehlers

08:30 - 08:50 Contact Lens Fitting in Infants

Mohammed Al Blowi

08:50 - 09:20 Overview of Ocular Electrophysiology

Nayef Al-Ateeq

09:20 - 10:00 Latest Technology in Electrophysiology

Mr. Craig Simms

10:00 - 10:20 Break

Th2A Free Paper (Auditorium A)

Chair Deepak Edward, MD

Moderator Prof. Essam Osman, MD

10:20 - 10:30 Safety and Efficacy Comparison between Brand-name and Localy Manufactured Generic Fixed

Combination of 2% Dorzolamide/0.5% Timolol

Leyla A Ali Al-Jasim, MD

10:30 - 10:40 Elevated Intraocular Pressure Increases Melatonin Levels in the Aqueous Humour

Hanan Awad Al-Kozi, MD

10:40 - 10:50 Bottle Characteristics of Topical International Glaucoma Medications versus Local Brands

in Saudi Arabia

Reham Dakam Al-Qahtani, MD

10:50 - 11:00 Histopathologic and Immunohistochemical Features of Capsular Tissue around Failed

Ahmed Glaucoma Valves

Alka M Mahale, PhD

11:00 - 11:10 Ocular Side Effects of Topical Prostaglandins in Childhood Glaucoma

Edward Deepak, MD

11:10 - 11:20 Diagnostic Accuracy of Spectral Domain Optical Coherence Tomography and Scanning Laser

Tomography for Identifying Glaucoma in Myopic Eyes

Rizwan Malik, MD

11:20 - 11:30 Ergonomic in Preventing Work Related Musculoskeletal Disorders in Ophthalmic Practice

Waleed Abdulaziz Al-Rashed, MD

11:30 - 11:40 Genetics of Congenital Glaucoma in Saudi Arabia, Phenotype-Genotype Correlation

Leen Jameel Abu Safieh, PhD



Th2B Optometry - Color vision (Auditorium A)

Moderator Lina Al-Kahmous, Senior Orthoptist, MSc of Canadian certified orthoptist

10:20 - 10:40 Color Vision Processing in the Visual System: Retina to Cortex


10:40 - 11:00 Color Vision Testing


11:00 - 11:20 Congenital and Acquired Color Vision Deficiencies


11:20 - 11:40 Giving Practical Advice Relating to Color Vision Results




Moderator Ahmad Al-Ghamdi, COMT

10:20 - 10:50 Introduction to Anaplastology

Mohammed Badran

10:50 - 11:20 Imaging of the Posterior Segment of the Eye

Igor Kozak, MD

11:20 - 12:00 Diagnostic Ultrasound

Mr. Craig Simms

12:00 - 13:00 Lunch

Th3A Comprehensive B-Scan Ultrasound Course (Auditorium A)

13:00 - 15:00 Instructors: Raja Hariz, Chief Ultrasound and Talal Al Anazi, Optometrist

Th3B Optometry Workshop ( Auditorium B)

13:00 - 15:00 Low Vision Workshop

Prof. Alan Johnston and Khalid Jamous, MOptom, PhD


Moderator Salah Al-Megrin, COMT

13:00 - 13:30 Ophthalmic Ultrasound in Ocular Trauma

Mr. Craig Simms

13:30 - 13:45 Fluorescein Angiography

Abdulrahman Al-Oraini

13:45 -15:00 Ocular Topography Workshop


Poster Presentations

1. Fungal Sclerokeratitis

Salem Al-Malki, MD; Abdulrahman Gormallah Al-Malki, MBBS

2. Post BKpro Endophthalmitis in Steven Johnson Syndrome Patient due to Streptococcus Agalacticae

Donald Stone, MD; Igor Kozak, MD; Omar Kirat, MD; Mohammad Ahmed Talea, MD; Humoud

Mohammad Al-Otaibi, MBBS

3. Genetics of Congenital Glaucoma in Saudi Arabia, Phenotype-Genotype Correlation

Leen Jameel Abu Safieh, PhD; Leyla Al Jasim, MD; Ohood Owaydha, MD; Deepak Edward, MD

4. Combined Central Retinal Artery Occlusion with Central Retinal Vein Occlusion after Blunt

Trauma

Mohammad Abdullah Al-Amry, MD; Hassan Al-Dhibi, MD; Sahar M ElKhamary, MD; Abdulrahman

Al-Qaeed

5. Signal Transducer and Activator of Transcription 3 Expression is Regulated by High-Mobility

Group Box-1 Protein in Diabetic Retina

Deema Essam Jomar, MBBS; Ghulam Mohammad, MD; Ahmed M. Abu El-Asrar, MD, PhD

6. Late Onset Endophthalmitis Associated with Unexposed Glaucoma Valve Drainage Device

Abdulaziz Mohammad Al-Hadlaq, MD

7. Atypical Presentation of Cone-rod Dystrophy with Huge Bull’s Eye Maculopathy and Diffuse

Vascular Leakage

Hamad Mohammad Alsulaiman, MD; Sawsan R Nowilaty, MD; Patrik S. Schatz, MD

8. Retinal Complications after Anterior versus Posterior Chamber Phakic Intraocular Lens

Implantation in a Myopic Cohort

Abdulelah Abdulaziz Al-Abdullah, MD; Mohammad A. Al-Falah, MD; Saba A. Al-Rasheed, MD; Rajiv

Khandekar, MD; Enrique Suarez, MD; J. Fernando Arevalo, MD

9. Acupuncture Treatment in Patients with Retinitis Pigmentosa, Tapetoretinalabiotrophy and

Macular Dystrophy

Md Anwarul Azim, MD; Kuznetsova TS, MD

10. Effect of Vitamin Deficiency and Insufficiency on Patient with Diabetic Retinopathy

Amjaad Hamad Al-Mohawis; Moutaz GUMA; Ahoud Al-Mutairi; Ghada Al-Duraye

11. Choroidal Thickness in Hypertensive Patients and Healthy Controls

Hanan Abdullah Al-Shalan, MD; Faisal Abdulaziz AlMobarak, MD

12. Immunohistochemical Characterization of Subretinal Bands in Proliferative Vitreoretinopathy

Mohammed D. Al-Otaib, MBBS; Azza Maktabi, MD; Hind Al-Katan, MD; Deepak Edward, MD;

Igor Kozak, MD

13. Chiasmal Optic Neuritis

Abdulaziz Mohammad Al-Hadlaq, MD; Aliyah Hadi Al-Amery, MBBS; Alberto Galvez, MD


14. Duane Retraction Syndrome Associated with a Small X Chromosome Deletion

Taif A. Azad, MSc; Khaled K. Abu-Amero, PhD; Altaf Kondkar, PhD; Hessa Al-Odan, MD;

Arif Khan, MD; Darren T. Oystreck, MMed Sci; Ali M. Hellani, PhD; Thomas M. Bosley, MD

15. Pattern of Neuro Ophthalmic Cases Presented to King Abdulaziz University Hospital’s Emergency

Department in Riyadh, Saudi Arabia: A Two-year Retrospective Study

Abdulrahman Abdulaziz Al-Jasser, MD; Majed Mohammad Al-Obailan, MD; Yafa Abdulrahman

Al-Shamlan, MBBS; Lolwah Mohammed Alashgar, MBBS; Norah Ahmed Musallam, MBBS;

Ahmed Mousa Abdul Rahim, MBBS

16. Anophthalmic Chronic Inflammation due to RTV Orbital Implant

Silvana Schellini, MD; Alicia Galindo-Ferreiro, MD; Laila Al-Ghafri, MD; Sahar ElKhamary, MD;

Azza Maktabi, MD

17. Outcomes of Two Surgical Techniques for Major Trichiasis

Silvana Artioli Schellini, MD; Lucieni Barbarini Ferraz, MD; Roberta Lilian Fernandes de Sousa

Meneguim, MD; Alicia Galindo-Ferreiro, MD; Ana Cláudia Viana Wanzeler, MD; Michelli Massae

Saruwatari; Larissa Horikawa Satto; Carlos Roberto Padovani

18. Analysis of Toll-like Receptor rs4986790 Polymorphism in Saudi Patients with POAG

Mohammad Taif Anwar Azad, MD; Saleh A. Al-Obeidan, MD; Altaf A. Kondkar, MD;

Ahmed Mousa, MD; Tahira Sultan, MD; Essam A. Osman, MD; Khaled K. Abu-Amero, PhD

19. Congenital Hemifacial Hypertrophy and Glaucoma

Reham Dakam Al-Qahtani, MBBS; Halla Al Abdul-Hadi, MBBS; Ahmed Al-Habash, MD;

Sami Al-Shahwan, MD

20. Paintball Ocular Injury

Mohammad Al-Amry, MD; Nora Abdulmohsen Al-Yousif, MBBS; Halla Al-Abdulhadi; MBBS;

Huda A Al-Ghadeer, MD

21. Compliance of Glaucoma Patients to Ocular Hypertensive Medications among the Saudi Population

Priscilla Wairimu Gikandi

22. Severe Bilateral Episcleritis after Incidental Trauma by Eye Lashes Serum

Mohammad Al-Amry, MD; Halla Ahmed Al-Abdulhadi, MD; Nora Abdulmohsen Al-Yousif;

Saleh Al-Othaimeen, MD

23. Congenital Ptosis, Scoliosis and Malignant Hyperthermia Susceptibility in Siblings with Recessive

RYR1 Mutations

Amani Saeed Al-Bakri, MD


Video Presentations

1. Double Layer AMT for Conjunctival Reconstruction after Recurrent Squamous Cell Carcinoma

Hernan M Osorio, MD

2. Surgical Treatment of Conjunctival MALT L ymphoma

Hernan M Osorio, MD

3. Corneal Subepithelial Hemorrhage: Diagnosis and Management

Salman Abumazyad, MD

4. The Management of Black Cataract with Pseudoexfoliation (PXF) and Phacodonesis in Small Pupil

Saeed Al-Gehedan, MD

5. Challenging Cataract Surgery in Case of Corneal Cystinosis


6. Cataract Management in Marfan’s Syndrome: Techniques and Outcomes


7. Management of Subluxated Lens

Saad Saleh Al-Harbi, MD

8. Lessons from White Cataract

Abdulelah Abdulaziz Al-Abdullah

9. New Technique to Overcome Difficult Posterior Vitreous Detachment

Mohammed Salem Asiri, MD

10. Spontaneous Internal Limiting Membrane Detachment Mistaken as a Retinal Detachment


11. Surgical Procedure of Implanting Argus II Retinal Prosthesis System

Eman Saeed Al-Kahtani, MD

12. Rhegamtogenous Retinal Detachment in Immunocompromised Patient with PORN Secondary to

CMV Infection


13. Funnel Shape Retinal Detachment: It Is Not Operable!! “My Fellow Said”

Abdulelah Abdulaziz Al-Abdullah, MD

14. Replacement of Phakic IOL: Techniques and Outcomes



Abstracts

Monday, March 7

M2B - Pediatric Ophthalmology Workshop

Pediatric IOL Implantation

Mohammed AlShamrani

Purpose: T explore variable methods of optical correction in pediatric population.

Course Goals and Objectives: 1) Aphakia and aphakic correction other than IOL (contact lenses and glasses: pros and

cons); 2) Why not to implant IOL in children; 3) History of IOL implantation in pediatric; 4) Issues related to IOL

calculation in pediatric and power selection; 5) Secondary IOL implantation in pediatric; 6) Lens based refractive

surgery in pediatric (clear lens extraction, phakic IOLs); 7) Challenging cases (video or cases discussion).

Target Audience: Ophthalmologist and optometrist.

Education Level: Bachelor degree in medicine and optometry.

M2C - Optometry - Contact Lenses

Post-Penetrating Keratoplasty Hard Contact Lenses Fitting

Muneera Al-Ogla

Hard contact lenses fitting can be quite challenging after Penetrating Keratoplasty but with the tips given, associated

with explanation of some of the corneal topography classifications with an example image of each, one can give

general idea of what is acceptable fitting and what is not.

M3B - Optometry - Orthopic & Free Paper

A and V Patterns

Heba Khashoggi

A and V patterns are common terminologies that are used when the size of Eso/Exo deviation significantly changes as

the eyes move from up gaze to down gaze. This presentation will discuss the classification, etiology and management

of each pattern.

A Comparison of EFG Therapy vs Patching for The Treatment of Amblyopia in Children Aged 9-17 Years

Manal Al-Harbi

To compare the effectiveness of Eyetronix flicker glasses (EFG) therapy and patching for improving distance vision

acuity and stereopsis in children 9 to 17 years of age with strabismic or anisometropic amblyopia.

Orthoptic Role in Bilateral 6th Nerve Palsy

Zainab Al-Khodairi

Highlighting the role of the orthoptist in diagnosing and being involved non-surgically in the initial management of

ocular motor palsies. The purpose of the treatment is to improve patient comfort and visual function by eliminating

diplopia and helping the patient to regain his binocular single vision and be able to practice every day activity normally.


Tuesday, March 8

T1A – Cornea Session

Epidemiology of Herpes Simplex Eye Disease in an Urban Population

David C. Gritz

Purpose: To determine whether HIV/AIDS, diabetes mellitus, and atopic disease are associated with herpes simplex

virus (HSV) eye disease, and to examine the characteristics of HIV-positive patients with HSV eye disease.

Methods: This retrospective case-control study compared cases (inclusion criteria: a diagnosis of HSV eye disease by

an ophthalmologist and residency in the Bronx) with a medical center outpatient-based control group (attending an

outpatient clinic and residency in the Bronx). The study period was June 1, 2010 through May 31, 2014 and included

all outpatient visits within the Montefiore Medical Center healthcare system (Bronx, NY, USA). Ratio of cases to

controls was 1:4. Associations evaluated included age, gender, HIV/AIDS, diabetes mellitus, and atopic disease.

Results: HSV eye disease was confirmed in 70 patients, who were compared to 280 controls. Patients with ocular

HSV had a greater prevalence of HIV/AIDS compared to controls (8.6% and 2.9%, respectively). Using multivariate

analysis to control for age and gender, atopic dermatitis (OR 3.08, 95% CI: 0.84 to 11.20) and diabetes with chronic

complications (OR 2.25, 95% CI: 0.91 to 5.61) approached significance, while HIV/AIDS (OR 3.37, 95% CI: 1.09 to

10.40), an age less than 45 years (OR 2.89, 95% CI: 1.54-5.41), and male gender (OR 1.85, 95% CI: 1.07 to 3.18)

were significant. Among the HIV-positive group of HSV eye disease patients, 5 of 6 (83.3%) were on HAART

therapy and all 6 (100%) presented with a form of keratitis or retinitis.

Conclusions: HIV-positive status results in more than a three-fold increased risk of developing ocular HSV. To our

knowledge, this study represents the first time strength of association has been calculated between HIV and HSV eye

disease.

New Paradigms in The Treatment of Fungal Keratitis

Elmer Tu

Fungal keratitis remains one of the most challenging corneal infections to diagnose and treat successfully. The out-

comes of fungal keratitis are significantly worse than those for bacterial keratitis with both a higher likelihood of

significant visual loss as well as a need for therapeutic surgical intervention. The number of anti-fungals, commercial

and compounded, is limited in comparison to anti-bacterial drugs with generally poorer tissue penetration and a

narrower anti-fungal spectrum. Clinical signs and symptoms can be helpful in suspecting potential cases of fungal

keratitis, but definitive diagnosis requires microbiologic testing and corneal imaging. Although polyenes, amphoteri-

cin B and natamycin, continue to be mainstays of therapy, the most significant development is the introduction of the

newer triazoles, voriconazole and posaconazole, as well as the new echinocandin class of anti-fungals, micafungin,

caspofungin and anidulafungin. These newer agents not only offer a wider spectrum of activity and better tissue

penetration, but also new routes of administration to achieve cure of ocular infections including oral, topical,

intracameral and intrastromal.

Tobacco Smoking and Sjogren Syndrome – A Complicated Relationship

Donald Stone

Background: Several avenues of research and clinical observation suggest that Sjogren’s syndrome (SS) is an autoim-

mune disease that triggers inflammatory responses. Tobacco smoking is associated with worsening of some inflam-

matory conditions such as rheumatoid arthritis, but with amelioration of others such as ulcerative colitis and mucosal

Behçet’s disease.


Purpose: Evaluate the association of tobacco smoking with the diagnosis and clinical features of SS in a carefully

characterized cohort.

Methods: Cross-sectional case-control study of patients with sicca symptoms in a multispecialty SS research clinic.

Patients with SS were compared to non-SS sicca patients. Smoking prevalence was also compared to a systemic lupus

erythematosus cohort and community prevalence data.

Results: The current smoking rates were 2.7% for SS patients, 10.5% for non-SS sicca patients (p=0.0019), and 18%

(p=1.33x10-7) and 26% (p=3.50x10-18) in a lupus and community cohort respectively. The previous smoking rates

were similar for SS and non-SS patients. A comparison of subjective ocular surface complaints revealed 53.6% of

those with dry eye symptoms reported ever smoking (current or past), compared to 76% of those without ocular

symptoms (p=0.0453). Smoking was also associated with a lower focus score on lip minor salivary gland biopsy (OR

0.24, P=0.0017)

Conclusion: SS and keratoconjunctivitis sicca are associated with a lower likelihood of current smoking. Patients

with ocular symptoms were less likely to have ever smoked in the past. The mucosal irritating effects of tobacco

smoking may serve as a deterrent in patients with keratoconjunctivitis sicca associated with SS; however an immuno-

suppressive effect of tobacco use cannot be excluded. The lower lip biopsy focus score suggests a local immunosup-

pressive effect of tobacco smoking.

Ocular Pathogens and Antibiotic Sensitivity in Bacterial Keratitis Isolates at King Khaled Eye Specialist

Hospital (2011-2014)

Huda S. Al-Dhaheri

Background: To investigate prevalence and in-vitro susceptibility trends of commonly isolated bacteria among pa-

tients with bacterial keratitis from 2011-2014 in a tertiary care eye hospital in Saudi Arabia.

Methods: We retrospectively reviewed bacterial isolates from corneal scraping of eyes with microbial keratitis. The

most common isolates and their antibiotic resistance profiles were identified; trend analysis was performed over the

study period.

Results: There were 3,506 bacterial isolates during the study period. Gram positive bacteria accounted for 91.4% of

isolates. They mainly included Staphylococcus epidermidis 962 (27.4%), other coagulase-negative staphylococci

289 (8.2%), Staphylococcus aureus 237(6.8%), and Streptococcus pneumonia 159 (4.5%). Pseudomonas aeruginosa

was the most common gram negative isolate (38.4%). All tested isolates maintained 100% sensitivity to vancomycin

over the study duration. As a whole, isolates were most sensitive to moxifloxacin and ciprofloxacin with resistance of

3.7% and 3.3% respectively. Oxacillin resistance was increasingly found in Staph. aureus (14.8% in 2011 to 27.8% in

2014. P<0.05) but was without significant change in Staph. epidermidis and other coagulase-negative Staph (range

19.4-32.0%). Staph. aureus isolates demonstrated an increase in moxifloxacin resistance from 2011 - 2014, increas-

ing from 0 to 14% (P=0.05). Using a logistic regression model, the change in resistance of bacteria to antibiotics by

year was not significant (P<0.05).

Conclusion: Gram positive bacteria represented the majority of bacteria isolated, with a significant prevalence of

methicillin resistance in Staphylococcus species. Fluoroquinolone resistance was lower than in other regions, but

may be increasing. There was no overall significant trend in antibiotics resistance, however a longer duration surveil-

lance study is recommended.

Update on The Management of Parasitic Keratitis

Elmer Tu

There are a variety of organisms which may be classified as parasitic keratitis making a consistent approach to their

diagnosis and treatment difficult. These infections can generally be classified as direct infections of the cornea (

exogenous) or indirect spread ( endogenous). While Onchocerciasis, a parasitic infection of endogenous origin from

a systemic infestation, remains the most significant infection affecting in terms of corneal blindness, Acanthamoeba

and Microsporidia constitute the most significant isolated parasitic infections of the cornea. These infections are

always more difficult to diagnose and treat because of their rarity which lowers clinical suspicion early in the disease

course and the lack of development of effective therapies because of the small number of patients affected. Special


laboratory and histologic tests as well as imaging are necessary in order to detect these infections and selection of anti

- parasitic medications is limited and poorly supported by antimicrobial sensitivity testing. Specific management

strategies will be discussed as well as unusual complications which may affect prognosis.

T1B – Neuro Ophthalmology

Acupuncture Treatment in Patients with Optic Neuropathy

Md. Anwarul Azim

Background: Glaucoma can damage the optic nerve and results in vision loss and blindness. Anyone can develop

glaucoma. Although, a large amount of research is done to improve its diagnostics, prevention and treatment, it

remains a major problem of modern ophthalmology.

Purpose: To estimate the application of the acupuncture treatment, and modern energy-informational method bio

resonance therapy (BR_) for optic neuropathy.

Methods: In my clinic Doctor Azim Ltd 15 patients with optic neuropathy have been surveyed and have passed the

treatment by acupuncture, needle reflexo therapy (NRT), acupressure, bio resonance therapy (BRT) by fixed fre-

quency waves (impulses), and multi resonance therapy (MRT): induction therapy and bio resonance therapy along

meridians (organs and systems) for one year supervision.

Results: All patients regardless of their age noticed general somatic symptoms improvement, irritability decrease,

sleep normalization, visual fatigue decrease. In all cases an increase of visual acuity from 20 up to 40 % and visual

field restoration were marked. Some subjective symptoms have also disappeared or have been considerably reduced,

such as: mycropsia, metamorphopsia, infringement of color perception.

Conclusions: 1. Acupuncture and bio resonance therapy are highly effective non-medicamentous ways of the optic

neuropathy treatment. 2. The application of the above-mentioned methods results in partial or full restoration of

visual functions which is both effective and safe. 3. In carrying out acupuncture and bio resonance therapy the ad-

verse side effects and complications have not been revealed.

T1B – Retina

High Mobility Group Box-1 Regulates The Expression of Matrix Metalloproteinase-9 in Diabetic Retina

Mohammad Ghulam

Purpose: To test the hypothesis that upregulated expression of the pro-inflammatory cytokine high-mobility group

box-1 (HMGB1) in the eyes from patients with proliferative diabetic retinopathy (PDR) regulates the expression of

matrix metalloproteinase-9 (MMP-9) in diabetic retina.

Methods: Vitreous samples from 25 PDR and 17 non-diabetic patients, retinas from 1-month diabetic rats and normal

rats intravitreally injected with HMGB1and human retinal microvascular endothelial cells (HRMEC) were studied with

the use of enzyme-linked immunosorbent assay, Western blot analysis and RT-PCR. We also studied the effects of

HMGB1 inhibitor glycyrrhizin and targeted deletion of the MMP-9 gene on diabetes-induced biochemical changes in

the retina. An assay for in vitro cell migration was performed on human retinal microvascular endothelial cells (HRMEC).

Results: Levels of HMGB1 and MMP-9 were significantly higher in the vitreous fluid from PDR patients compared

with non-diabetic patients (p<0.001 for both comparisons) and these were significantly correlated (r=0.5, p=0.003).

Diabetes induction and intravitreal injection of HMGB1 in normal rats induced significant upregulation of MMP-9

and downregulation of tissue inhibitor of metalloproteinase-1 (TIMP-1) mRNA levels. Constant glycyrrhizin intake

from onset of diabetes attenuated diabetes-induced upregulation of MMP-9, but did not affect TIMP-1 expression in

the retina. Deletion of the MMP-9 gene in mice did not inhibit diabetes-induced upregulation of HMGB1 in the

retina. However, the MMP-9 inhibitor inhibited HMGB1-induced MMP-9 upregulation and migration in HRMEC.

Conclusions: Our findings suggest that MMP-9 acts downstream of HMGB1 and mediates the effect of HMGB1 in

diabetic retinopathy.


Vitreous Levels of Placental Growth Factor Correlates with Activity of Proliferative Diabetic Retinopathy

and Is Not Influenced by Bevacizumab Treatment

Eman Al Kahtani, Elia J. Duh

Purpose: Placental growth factor (PlGF) is a member of the VEGF family that plays an important role in experimental

models of diabetic retinopathy and retinal neovascularization. We aimed to investigate whether vitreous levels of

PlGF correlated with proliferative diabetic retinopathy (PDR) status, VEGF levels, and bevacizumab treatment. We

also analysed PDR membranes to confirm the presence of the PlGF receptor, Flt1, in endothelial cells.

Methods: Case-control study: Undiluted vitreous fluid samples were obtained from 28 active PDR patients without

bevacizumab treatment, 21 active PDR patients with bevacizumab treatment, 18 inactive PDR patients, and 21 control

patients. PlGF and VEGF levels in samples were determined by enzyme-linked immunosorbent assay. Immunohis-

tochemistry for Flt1was performed on human PDR membranes.

Results: Compared to control, vitreous PlGF levels were higher in both active PDR without bevacizumab (P< 0.0001)

and with bevacizumab (P<0.0001). There was no significant difference in PlGF between active PDR patients without

and with bevacizumab (P = 0.56).Compared to active PDR, PlGF levels were significantly reduced in inactive PDR (P

= 0.004). PlGF levels were highly correlated with VEGF levels in active PDR. VEGFR1 was expressed in endothelial

cells in human PDR membranes.

Conclusion: The strong correlation of PlGF levels with PDR disease status and expression of Flt1 in human PDR

membranes suggest that PlGF has a pathogenic role in diabetic retinopathy. Therapeutic targeting of PlGF with agents

like aflibercept may be beneficial.

Identification of Serum Molecular Signature for Proliferative Diabetic Retinopathy in Saudi Patients with

Type 2 Diabetes

Eman Al Kahtani, Jiang Qian

Purpose: Proliferative diabetic retinopathy can eventually lead to vision loss without timely detection and treatment.

We aimed to identify predictive serum biomarkers capable of detecting patients with proliferative diabetic retinopa-

thy (PDR).

Methods: A total of 40 patients with diabetes were recruited at King Khaled Eye Specialist Hospital in Riyadh, Saudi

Arabia and they were separated into two groups. Of these patients, 20 have extensive PDR, while other 20 have mild

non-proliferative diabetic retinopathy [NPDR]. The two groups were matched with age, gender and duration of dia-

betes history. We examined whole genome expression of blood samples using RNA-seq. We built a model using

support vector machine (SVM) approach to identify a combination of genes that can classify the two groups.

Results: Differentially expressed genes were calculated from a total of 25,500 genes. Six genes (CCDC144NL,

DYX1C1, KCNH3, LOC100506476, LOC285847 and ZNF80) were selected from top 26 differentially expressed

genes and a biomarker was built based on the expression of the 6 genes. The mean area under ROC was 0.978 in the

cross validation. The corresponding sensitivity and specificity were 91.7% and 91.5%, respectively.

Conclusions: The combinatorial biomarker identified herein is a potentially useful biomarker for detecting prolifera-

tive diabetic retinopathy in patients with diabetes.

T2A – Cataract Session

Toric IOLs in Patients with Previous Corneal Refractive Surgery and Ectasias

Enrique J. Suarez

Personal experience with Toric Intraocular Lenses in 255 cases with previous Corneal Refractive Surgeries (Radial

Keratotomy, LASIK) and Corneal Ectasias (Keratoconus, Pellucid Marginal Degeneration) will be presented.


T2C – Neuro Ophthalmology

Clinical Variability in Wolfram Syndrome

Alberto Galvez

Introduction: Wolfram syndrome is an autosomal recessive disease characterized by the presence of diabetes mellitus

(DM), optic atrophy (AO), central diabetes insipidus, hearing loss and neurological disorders such as cerebellar

ataxia and psychiatric manifestations. It is caused by mutations in the WFS1 gene. The aim of this study is to present

a sample of 16 patients with Wolfram syndrome.

Methods: We present a sample of 16 patients with Wolfram syndrome, analyzing mutations in the WFS1 gene and

describing the clinical manifestations. We performed a complete neurological and ophthalmological examination of

these patients, including visual perimetry, fundus and OCT (optical coherence tomography) of optic nerve, when the

age of the patients allowed a proper cooperation.

Results: All individuals in the sample have mutations in the WFS1 gene, communicating in this work at least 5 new

mutations not described in the scientific literature. All patients have optic atrophy and ceco-central visual defects in

perimetry. However, other typical clinical manifestations present in Wolfram syndrome varies greatly in its clinical

expression. In this manner in this sample are presented in one hand patients with mild visual disturbances secondary

to optic atrophy, without any other clinical alteration; and patients with severe optic atrophy, diabetes mellitus, diabe-

tes insipidus, deafness and severe ataxia.

Conclusions: The sample presented here shows that the spectrum of clinical expression of this syndrome is very

variable, without an adequate phenotype-genotype correlation.

Saudi Ophthalmological Gold Medal Lecture

Gene Therapy Results from the RPE65 Phase 3 Trial for Lebers Congenital Amaurosis

Phase 3 Trial of AAV2-hRPE65v2 (SPK-RPE65) to Treat RPE65 Mutation-Associated Inherited Retinal

Dystrophies: Aggregate 1-Year Outcomes

Stephen Russell, Jean Bennett, Katherine A. High, Daniel C. Chung, Jennifer A. Wellman, Albert M. Maguire

Purpose: Multiple early-phase human trials provided preliminary evidence of safety and efficacy for adeno-associated

virus-mediated human RPE65 augmentation for RPE65-mutation-associated inherited retinal dystrophies. Here we re-

port baseline demographics, safety, and one-year aggregate outcomes of a Phase 3, open-label, randomized, controlled

trial that began in November 2012 at Children’s Hospital of Philadelphia and the University of Iowa evaluating the

safety and efficacy of AAV2-hRPE65v2 (SPK-RPE65) to treat RPE65-mutation-associated disease (NCT00999609).

Methods: Twenty-eight eligible subjects with disease-causing biallelic RPE65 mutations were randomized 2:1 to

intervention or control. Eligibility criteria included age ≥3 years-old; bilateral visual acuity worse than 20/60 and/or

visual field less than 20 degrees in any meridian; evidence of sufficient viable retinal cells; ability to be evaluated on

mobility testing; and willingness to provide consent or parental permission and assent, where appropriate. Subjects in

the intervention group received subretinal injections of AAV2-hRPE65v2 sequentially to each eye within an 18-day

window. Using a standardized subretinal delivery procedure and under general anesthesia, 1.5E11 vector genomes/

eye were delivered in a total volume of 300 µl. Standardized mobility testing under different luminance conditions

was the primary efficacy endpoint.

Results: All subjects completed Year 1 follow-up testing. Analyzed on a modified intent-to-treat basis, the mean

bilateral mobility test scores (performance at 1 year compared with baseline) for the intervention group show a mean

difference of 1.6 light levels (p < 0.004). A similar time course was found for the mean bilateral full-field light

sensitivity which improved at one year by 2.10 log units (p < 0.001). Aggregate visual acuity improvement did not

reach statistical significance. However, acuity improved by 3 lines in 7 of 15 intervention eyes (1st eye), 4 of 15

intervention eyes (2nd eye) and in none of the controls.

Conclusions: Results of this study, the first Phase 3 gene therapy study completed for a retinal dystrophy (and for any

genetic disease), provides additional evidence regarding the efficacy and safety of gene therapy intervention by surgical

subretinal administration of AAV2-hRPE65v2 (SPK-RPE65) as measured by mobility testing, visual acuity and safety.


T3B – Prevention of Blindness

Validity and Usefulness of ‘RetEval’ – A Hand-held Electro-physiological Tool in Diabetic Retinopathy

Screening Compared to Conventional Digital Fundus Photography

Md. Anwarul Azim

Purpose: To study the validity, time required to detect different stages of diabetic retinopathy in eyes by using a hand-

held electro-physiological tool compared to digital fundus photography.

Method: Patient with diabetes attending eye screening unit of King Khaled Eye Specialist Hospital were evaluated

for the presence and the grade of DR by performing electrophysiological test using RetEval’(LKC technologies Inc,

USA). Each eye was also tested for digital fundus photography after pupillary dilatation using three fundus images.

The time taken and feedback of screener and patient were noted. Fundus images were evaluated by retina specialist.

The sensitivity and specificity of DR screening by RetEval compared to photography were calculated.

Result: The prevalence of sight threatening diabetic retinopathy (STDR) and DR was 23% and 42.9%. We screened

510 eyes of 255 patients. 68 eyes of 34 patients passed the RetEval test and 442 eyes of 221 patients failed the test.

Digital photography was possible in 416 eyes only. PDR was present in 35 (13.6%) of eyes. The sensitivity and

specificity of RetEval test to detect PDR was 100% & 15% respectively. The sensitivity and specificity of RetEval

test to detect DR was 95.5% & 25.4% respectively. The mean time for RetEval test was 5.7 ± 2.3 minutes. The median

time for digital fundus photography (n = 202) was 20 minutes (25% quartile 15). In 47 (18.4%) patients who could

not be assessed by digital fundus photography due to media opacities, one could undertake DR screening with RetEval.

Conclusions: RetEval seems to be a good 1st level screening tool for detecting sight threatening diabetic retinopathy

and DR to suggest prompt action for STDR cases and preventive measures for DR cases.

Risk of Glaucoma in Obstructive Sleep Apnea Patients in King Abdulaziz University Hospital

Alberto Galvez

Purpose: Glaucoma is a group of disorders with characteristic optic neuropathy leading to unique visual field defects

and increased cupping of the optic disc. Recently, much attention has been drawn to the possible link between Ob-

structive Sleep Apnea (OSA) and Primary Open Angle Glaucoma (POAG). In the present study, we aim to investigate

the relationship between OSA and glaucoma. Whether OSA increases risk of developing glaucoma or has a direct

causative effect is still an issue of debate among researchers. The link between the two disorders has been postulated

to be due to the effect of hypoxia and impaired autoregulation of optic nerve perfusion that occurs in OSA .This study

may help the researchers for better understanding the link between the two entities and guide clinicians regarding

appropriate screening. According our knowledge, this is the first study to investigate the association locally.

Method: Case Control study involving 40 OSA patients with Apnea Hypopnea Index ( AHI) = 5 and 30 controls

with AHI < 5. Exclusion criteria: patients on steroids, those with narrow angle of anterior chamber or with other

ocular diseases such as cataract, diabetic retinopathy and keratoconus. All subjects underwent a screening visit fol-

lowed by a confirmatory visit if glaucoma was suspected. Informed consents were obtained from all participants and

an approval was granted from the Ethical Committee at our hospital.

Results: The association between OSA and glaucoma was significant, P = 0.034. Six patients from the OSA group

(15.0%) were diagnosed with POAG, while no subjects from the Control group were found to have the disorder.

Correlation of AHI with Intraocular pressure (IOP) is significant , r=0.2, P = 0.03. None of the presumed predictors

of glaucoma (gender, age, BMI, DM, HTN, smoking, ex-smoking status and family history of glaucoma) were

confounders in the relationship between OSA and POAG.

Conclusion: Although we found a significant correlation between AHI and IOP and a significant relationship be-

tween OSA and POAG. Thus, we recommend that all OSA patients to be referred to Ophthalmology clinics for full

glaucoma assessment.


T3C – Optometry - Low Vision

The Log MAR Visual Acuity Calculator — Making Certain Decisions for The Prescription of Magnification

Alan Johnston

Visual acuity is one of the most common functional attributes measured by clinicians, optometrists and vocational

assessors for employment suitability. The original Snellen chart has inconsistencies in layout that were addressed by

logMAR, with the introduction of precise symbol design, spacing and progression of size. Each line of symbols is

1.26 times larger than the previous, a geometric progression in size that is also 100.1, or a log 0.1 linear progression.

The advantage of this format is the ability to use charts at non-standard viewing distances to measure severe visual

impairment and predict the need for magnification to meet patient goals. LogMAR is particularly well suited for the

prediction of near magnification to provide confident outcomes for daily tasks such as reading. The sliding scale

calculator is a teaching tool that simplifies the application of logMAR principles, and includes the ETDRS letter

counting score used to monitor vision status following anti-VEGF injection for neovascular AMD.

The Simple Magnifier – Maximising The Interaction between Image Enlargement and Field of View

Alan Johnston

The ‘simple’ magnifier is usually a single lens held between the face and the page to magnify print or vocational task

demand. When the magnifier is held more than its focal length away from the face, image enlargement and field of

view may be less than indicated by the manufacturer but not in an intuitive way. Understanding how these functions

interact enables us to prescribe magnifiers so that predicted magnification is realized with a field of view wide

enough to accomplish the task. Options for specific patient demands are spectacle magnification, head borne loupes,

hand-held and stand magnifiers. Smartphone and electronic magnification may be good alternatives to optical mag-

nification, but present other demands on near spectacle prescription.

The Low Vision Telescope – An Underused but Highly Effective Device for Distance and Intermediate Visual

Tasks

Alan Johnston

Optical magnification that is independent of viewing distance requires a telescope. Galilean and Keplerian tele-

scopes have specific but quite different properties that affect their suitability for different purposes. Binoculars and

monoculars can be hand-held, but spectacle mounted types may be more suitable for sustained vocational use or

where both hands are occupied on a task. In this lecture I review the concepts of image and object space, vergence

amplification that limits accommodation effectiveness through a telescope, focusing options, eyepiece design and

practical decisions relating to weight, field of view, binocularity and spectacle mounting for bioptic use. Practical

advice for telescope trial and prescription is given.

T4A – Cataract Session

Assessment of Learning Curve in Phacoemulsification Surgery among Eastern Province Ophthalmology

Program Residents

Abdullah A. Al-Marshood

Purpose: To evaluate the learning curve in phacoemulsification surgery training among program residents, and to

investigate the prevalence of complications.


Method: A questionnaire is filled by the attending surgeon after each resident’s phacoemulsification surgery. A profi-

ciency grade is given for each step of the surgery. Total proficiency level is correlated with the resident’s experience

level. All complications, if happened, are noted.

Results: Under analysis

Utility of Verus Ring in Performing Safe and Efficient Capsulorhexis with Corneal Scarring

Enrique J. Suarez

Purpose: The Verus ring is a silicone ring-shaped intraocular device that can be injected onto the anterior lens capsule that

can assist with sizing and centration of the capsulorhexis. Capsulorhexis during cataract surgery in patients with corneal

scars can be challenging. In this study we determine the safety and efficacy of the Verus ring during anterior capsulorhexis.

Methods. Eyes with mild to moderate corneal scars undergoing cataract surgery (n=12) were subjected to implanta-

tion of the Verus ring during capsulorhexis by a single surgeon. Outcome measures included complications during the

capsulorhexis procedure and time taken to complete the capsulorhexis and surgeon feedback. Historical and surgeon

controls (n=12) for capsulorhexis in patients with clear cornea were used as a comparative group.

Results: There were no complications related to the insertion and removal of the device. Anterior capsular extensions

were not observed in any of the cases with corneal scarring. The capsulorhexis was well centered in all the eyes. The

average time for capsulorhexis using the Verus ring was 25.59 seconds. Average historical and surgeon control time to

perform capsulorhexis was 28.21 seconds. This difference was 2.62 stats. Surgeon feedback indicated that the insertion

of the device did not require steep learning curve other than careful following the instructions as noted in the instruction

video and was of the opinion that it greatly enhanced safety and efficiency during the capsulorhexis process.

Conclusion: The Verus ring appears to be a useful device in performing safe and efficient capsulorhexis in patients

with corneal scars undergoing cataract surgery.

Comparison between Digital and Manual Marking for Toric Intraocular Lenses

Hany A. Helaly

Setting: Faculty of Medicine, Alexandria University, Egypt

Purpose: To compare the clinical outcome of digital and manual marking for toric IOL alignment.

Methods: This is a prospective clinical study that included 60 eyes of 60 patients undergoing cataract surgery with co-

existing corneal astigmatism more than 1 diopter (D). The eyes were randomly assigned to either digital image

guidance using VERION digital marker (Alcon Laboratories, Ft. Worth, USA) or manual slitlamp-assisted preopera-

tive marking using pendulum-attached marker. Tecnis toric IOL (Abbott Medical Optics, Inc, Santa Ana, California,

USA) was implanted in all cases.

Results: The mean postoperative UCDVA for the digital marking group was 0.12 + 0.12 logMAR, and for the manual

marking group was 0.18 + 0.14 logMAR (p = 0.104). The mean deviation from targeted induced astigmatism (TIA)

for the first group was 0.10 + 0.08 D and for the second group was 0.20 + 0.14 D (p = 0.001). The mean postoperative

toric IOL misalignment measured by the slitlamp was 2.4 + 1.96 degrees for the first group and was 4.33 + 2.72

degrees for the second group (p = 0.003).

Conclusion: Accurate alignment of the toric IOL is important to achieve the desired astigmatism correction. VERION

system has the advantage of preoperative planning and intraoperative digital guidance of the toric IOL alignment.

The use of VERION system resulted in less postoperative deviation from TIA and showed less postoperative toric

IOL misalignment than using manual marking technique.


Wednesday, March 9

W1A – Cornea Session

The Challenge of Herpetic Viral Keratitis

Elmer Tu

The Herpes family of viruses which may affect the cornea and anterior segment include Herpes simplex (HSV),

Herpes zoster (HZV), Epstein Barr (EBV) and cytomegalovirus (CMV). Herpes simplex virus is the most common

cause of visual loss in developed countries and has one of the highest prevalences of any infectious disease around the

world with nearly 100% of those aged 70 or over having evidence of HSV infection. Primary infection may manifest

as a blepharoconjunctivitis, epithelial keratitis, stromal keratitis, endotheliitis, trabeculitis, or anterior uveitis and

glaucoma. Landmark studies including the HEDS have given guidelines for management of these viral infections, but

cure is elusive. Vaccinations for HZV promises to change the paradigm of HZO management, but in ways that are not

clearly understood. CMV is an emerging cause of corneal failure and glaucoma that is poorly recognized early in the

process. Treatment options will be discussed for Herpes virus infections of the anterior segment.

Clinical Results of a Foldable Artificial Cornea: Personal Experience

Jose M. Vargas

Purpose: To evaluate the safety and effectiveness of a foldable artificial cornea for the treatment of cornea blindness.

Methods: 19 Patients with corneal blindness due to failed grafts, burns, scars, dystrophies and Keratoconus had the

Keraklear artificial cornea implanted into a corneal pocket using a femtosecond laser.

Results: 100% of these patients had improvement in vision. There were no cases of endophthalmitis , retroprosthetic

membrane or glaucoma. There was one case of infection and one case of corneal melt. Follow up was from 38 to 50 months.

Conclusion: These results of the Keraklear artificial cornea show that this device can improve vision in cornea blind

patients and may be used as an alternative to PKP as a primary procedure.

The Unique Role of Confocal Microscopy in the Diagnosis of Corneal Disease

Elmer Tu

In recent years, an unprecedented expansion in our capabilities in imaging the anterior segment of the eye has occurred.

These technologies include anterior segment Optical Coherence Tomography (OCT), Scheimpflug imaging, Ultrasound

Biomicroscopy, and Confocal Microscopy. All of these technologies have their strengths as well as considerable overlap

in their ability to provide accurate depth, corneal curvature and anterior segment anatomy detail. The exception is

confocal microscopy which provides cellular detail in an en face image which allows correlation with traditional histol-

ogy but in vivo, but only images the cornea well. The best known use for confocal microscopy is in the diagnosis of

atypical forms of infectious keratitis where organisms are large and the cornea is only mildly suppurative as to allow

contrast from surrounding structures. It has shown great utility in the diagnosis and management of fungal and

acanthamoeba keratitis. As the technology becomes more commonly available, other indications including diagnosis of

epithelial disorders, corneal innervation abnormalities, corneal dystrophies as well as endothelial disorders such as

epithelial downgrowth, iridocorneal endothelial syndrome and Fuchs dystrophy are becoming better known.


Corneal Myxoma: Presentation and Management - Case Series

Bader S. Al-Qahtani

Purpose: To describe presentation and outcome of management of eyes with corneal myxoma.

Methods: This was a retrospective review of cases presented with corneal myxoma at cornea unit of King Khaled Eye

Specialist Hospital between January 2001 and October 2014. The demographic, clinical evaluation, mode of treat-

ment and final outcomes in relation to visual acuity, corneal clarity and duration of follow up were evaluated.

Results: We had ten eyes of ten patients with clinical diagnosis of corneal myxoma that was confirmed subsequently

by histopathology. The preoperative vision was 20/20 to 20/40 in three eyes. Two patients had family history of

anterior segment dysgenesis. Four had defective vision and one had discoloration of affected eye. Eight eyes were

treated by penetrating keratoplasty and one had keratectomy. Lesion was white opaque in seven eyes, one was dome

shaped and two had hydrops. The median size of lesion was 46mm2. Four eyes had stable graft. One had phthisis, two

had peters anomaly and one had graft rejection. Vision was 20/20 to 20/60 in four eyes, <20/60 to 20/200 in one eye

and <20/200 to 20/400 in two eyes.

Conclusion: Corneal myxoma a rare anomaly could be managed with penetrating keratoplasty and restoration of

vision was possible in 80% of eyes.

Safety of Long-term Treatment with Topical Tacrolimus 0.01% Eye Drops

Samir S. Shoughy

Purpose: To evaluate the safety and efficacy of long-term term use of topical tacrolimus 0.01% eye drops in patients

with vernal keratoconjunctivitis (VKC).

Methods: We included a total of 26 consecutive patients with VKC resistant to conventional therapy. Signs and

symptoms were recorded before and after therapy. Ocular and systemic side effects were monitored.

Results: There were 22 male and 4 female patients with a mean age o 16 years. The follow up period ranged from 6

to 29 months. There were statistically significant improvement of all signs and symptoms. None of the patients

developed elevation of intraocular pressure, cataract, infectious keratitis or systemic side effects.

Conclusion: Topical tacrolimus 0.01% is safe and effective for long-term treatment in patients with VKC.

The Diagnosis and Management of Ocular Surface Tumors

Elmer Tu

Although most ocular surface tumors are either benign or slow growing, conjunctival malignancies are one of the few

disorders of the anterior segment which can result in significant morbidity and mortality. Diagnosis, management and

prognosis are highly dependent on the underlying origin of the tumor. Those of squamous origin tend to be slow

growing, slow to invade and locally recurrent while those of pigment epithelial origin have a risk of malignant

transformation, local invasion and distant metastases which may result in death several years later. Differentiating

melanocytic tumors as benign or malignant by clinical appearance can be unreliable with pathologic examination

required regardless of underlying race or ethnicity in at risk lesions. Lymphoid tumors and inflammatory lesions are

often difficult to discern and may also have systemic implications, although many remain restricted to the eye. Treat-

ment of lymphocytic tumors is rarely local excision alone and may require local irradiation for control with all of its

attendant side effects. Melanocytic lesions require excisional biopsy with wide margins and adjunctive cryotherapy

to reduce risk of recurrence and distal spread. Chemotherapeutic regimens for melanocytic lesions is controversial

with mitomycin C as the most common agent. The options and management of squamous lesions offer the most

options with the introduction of a number of topical chemotherapeutic drugs including mitmoycin C, but also 5-

fluorouracil and interferon alpha 2b which result in successful management in greater than 80% of cases. Excisional

biopsy remains a proven option, but incisional biopsy, imaging, impression cytology and other modalities have been

employed as alternative prior to institution of chemotherapy malignancies of squamous origin.


W1C – Optometry – The Role of Optometrists in The Delivery of Eye Health Care

The Need for Eye Care

Michael Kalloniatis

The aim of this lecture is to provide an overview of the likely areas of need relating to vision impairment and blind-

ness that Saudi Arabia may face. Using available statistics relating to economic development and causes of vision

loss throughout the world, comparisons will be made with other countries to identify similarities and differences in

major causes of vision loss in Saudi Arabia.

Models Integrating Optometrists in Eye Health Delivery

Michael Kalloniatis

The aim of this lecture is to identify possible models of vision care that may assist in dealing with current and future

needs. After reviewing ophthalmic manpower (ophthalmologist and optometrist numbers), the scope of practice of

optometry will be discussed and how various models have been used integrating ophthalmologists, optometrists,

nurses and other personnel in ophthalmic health care delivery. Models in the UK and Australia where optometrists

have been integrated in ophthalmic patient pathways will identify possible ways to integrate optometry into health

care delivery.

Evidence-based Approach to Improving Optometrist Contribution to Eye Health Care Importance of

Education

Michael Kalloniatis

The aim of this lecture is to outline research showing the importance of education to improve the optometric contri-

bution to health care delivery. Studies from the UK showing increased education leads to better referrals by optom-

etrists will be followed by research from our Centre highlighting some clinical skills areas requiring attention and

how further education leads to better outcomes. The studies will include a review of the efficacy of optometrists in

diagnosis and follow up of patients with glaucoma. The importance of improved optometric education correlated

with improved management will be highlighted.

The Future of Eye Health Care

Michael Kalloniatis

The aim of this lecture is to identify areas where optometry can contribute to health care delivery. These include

participation in epidemiological research; population awareness; service delivery; planning intervention and evaluat-

ing outcomes and planning optometric education programs and evaluating competencies.

W2A – Retina

Automated Detection of Diabetic Retinopathy and the Need for Telescreening

Stephen Russell

Purpose: The population of patients at risk for Diabetic Retinopathy (DR) is increasing due to: 1) increasing preva-


lence of diabetes mellitus in the population, 2) aging demographics, and 3) less active lifestyles. To combat this

“perfect storm” we compared the sensitivity and specificity of the IDx-DR photographic device to clinical examina-

tion by ophthalmologists to identify Diabetic Eye Disease (DED).

Methods: Five hundred-twenty eight patients were recruited at seven sites that included general ophthalmology or

retinal specialty practices. Criteria for inclusion was diagnosis of diabetes; age ≥18 years; no history of other ocular

diseases affecting the retina or optic nerve. Ophthalmologists performed a dilated fundus examination including

stereoscopic biomicroscopy. Two, 45°, color photographs of each eye were taken with a Topcon NW 200 non-

mydriatic camera. Images were processed by the IDx-DR v1.0 algorithm and graded at a central reading center by

readers masked to results of the clinical examination and the device. DED was defined as more than mild

nonproliferative diabetic retinopathy as detected by the Reading Center (>= ETDRS level 35) or macular edema

within one disc diameter from the fovea as detected by either the Reading Center or the ophthalmologist. Patients

were classified based on the worst gradings of the 2 eyes.

Results: Prevalence of DED was 38.1% (201/528). Sensitivity was 86.1% (173/201) for the device compared to 53.7%

(108/201) for clinical examination; the difference was 32.3% (95% CI: 25.1% to 38.2%). Specificity was 68.5% (224/

327) for the device compared to 99.1% (324/327) for clinical examination; the difference was -30.6% (95% CI: -35.8%

to -25.7%). When DED was restricted to potentially treatable disease (severe nonproliferative or proliferative retinopa-

thy or macular edema), sensitivity was 96.8% (61/63) and compared to 95.2% (60/63) for clinical examination; the

difference was 1.6% (95% CI: -4.7% to 8.8%). Differences were similar for different racial and ethnic groups.

Conclusions: The IDx-DR automated screening detected a higher proportion of people with Diabetic Eye Disease

than clinical examination. For treatable disease, automated screening was comparable to clinical examination. Low-

cost application of automated detection of DED (using IDx-DR) would avoid the adverse burden on eye care practi-

tioners of screening increasing numbers of “at risk” patients with diabetes.

Congenital Stationary Night Blindness with Defective Signal Transmission at the Level of the Bipolar Cells

Patrick Schatz

Purpose: To describe a family with complete stationary night blindness (CSNB).

Method: Clinical examination including Magnetic Resonance Tomography (MRI) of the brain, optical coherence

tomography and electrophysiological examination.

Results: Two siblings with CSNB presented with nystagmus, high myopia, hypoplastic discs and negative electrore-

tinogram with no measurable rod response. MRI was done in both to rule out midline abnormalities in the central

nervous system. Retinal structure was analyzed qualitatively with spectral domain optical coherence tomography,

showing normal retinal structure and layers. There was no significant change in the electroretinogram after prolonged

2 hour dark adaptation compared to standard 30 minute dark adaptation.

Conclusion: These clinical findings are compatible with complete CSNB. The lack of improvement of rod responses

after prolonged dark adaptation is in keeping with a postreceptoral transmission dysfunction in the bipolar cells in

this form of CSNB. This is discussed in relation to findings in other types of CSNB.

Methods and Surgical Technique for Gene and Cell-Based Retinal Therapies

Stephen Russell

Gene therapy is a new and potentially revolutionary treatment for inherited and non-inherited ocular diseases. Gen-

eral concepts of gene replacement and several currently active trials will be discussed including the pivotal FDA

Phase III RPE65 study. Trials involving extension of gene therapy to non-inherited diseases such as age-related

macular degeneration will be presented.

Coats’-like Retinopathy in Joubert Syndrome

Salwa K. Al-Shibani

An 11-year-old girl with Joubert syndrome (JS) was evaluated because of a dim red reflex in her left eye. Fundus


examination revealed features of Coats’-like pigmentary retinopathy bilaterally, a phenomenon not previously re-

ported in JS. The exudative retinopathy was controlled after multiple sessions of indirect laser photocoagulation and

cryotherapy with a good visual outcome. Coats’-like exudative retinopathy may occur in JS and other ciliopathies.

Permanent visual loss may occur if the process is left untreated, so early diagnosis and treatment are vital to achieve

a good final visual outcome.

W3A – Refractive Surgery Session

Outcome of Intrastromal Corneal Ring (INTACS SK) using Femtosecond Laser in Keratoconus Patients

(KKESH Experience)

Awad A. Al-Qarni

Purpose: To evaluate the safety and efficacy of appropriate thicknesses of Intacs SK in all stages of KC and in form

frusta keratoconus using femtosecond assisted laser technology, to assess the outcome, complications, rate of re-

moval of Intacs SK segments , and the need for secondary surgeries after Intacs SK .

Methods: In this retrospective, all keratoconus patients file (diagnosis based on clinical and topographic data ) who

underwent INTACS -SK between January 2008 to July 2013 in King Khaled Eye Specialist Hospital were reviewed.

The Amsler-Krumeich keratoconus classification used to categorize keratoconus patients . Data collection sheet for

preoperative and postoperative examinations include: slit lamp evaluation, uncorrected visual acuity (UCVA), best

corrected visual acuity (BCVA), manifest refraction, spherical equivalent, cylinder power, pachymetry, keratometry

data, intraoperative and post operative complications, the rate of removal of INTACS-SK, and the need for second-

ary cross linking or keratoplasty.

Results: One hundred and thirteen eyes ( of 83 patients) were identified. There were 58 [69.88%] males and 25

[30.12 %] females with mean age of 28.3 ± 6.3 years. At 6 months post operative , the median UCVA change from

20/200 (CF, 20/40) to 20/50 (CF, 20/25) . There was statistically significant decrease in both the spherical equivalent

(- 5.73 ± 3.07 D to - 3.68 ± 2.59 D (P < 0.0001)) and the manifest sphere ( - 3.84 ± 3.17 D to - 2.88 ± 2.84 D (P <

0.0001)). At 2 years post operative , the median UCVA changed from 20/200 (CF, 20/40) to 20/50 (CF, 20/25) . The

difference in the spherical equivalent continue to be significant (from - 5.05 ± 2.5 D to - 2.86 ± 2.14 D (P < 0.0001)).

The UCVA improved more than one line in 90 eyes ( 87.3%) in 6 months , and 77 eyes (92.8%) in 2 years . While the

BCVA improved in 39 eyes ( 37.9 %) in 6 months , and 27 eyes (32.5%) in 2 years. Intraoperative complication as

incomplete tunnel seen in 5 eyes (4.42%), migration (2.7%). Post operative complication: dissatisfaction (12.4%),

clinically significant glare (3.5%), excursion (1.8%), infection (1.8%), neovascularization (1.8%), epithelial ingrowth

(0.9%). Removal of the ring done in 14 eyes (12.4 %) . Keratoplasty done in 7 eyes (6.2 %) as secondary procedure

. Cross linking done for documented progression in 11 eyes (9.7%) .

Conclusions: Our study demonstrated that Intacs SK is a safe and efficacious option for the treatment of patients with

keratoconus who are contact lens intolerant. The improved functional vision associated with this treatment modality

can defer or potentially eliminate the need for corneal transplantation. Complication of Intacs SK are uncommon and

treatable. In patients whose visual outcomes is unsatisfactory due to disease progression, the segments can be re-

moved easily and safely then corneal transplantation performed.

Correlation between Practice Location as a Surrogate for UV Exposure and Practice Patterns to Prevent

Corneal Haze after Photorefractive Keratectomy (PRK)

Eman Al-Sharif

Purpose: PRK is a refractive surgery that reshapes the corneal surface by excimer laser photoablation to correct

refractive errors. One of the most important postoperative complications is corneal haze. The effect of increased UV

light exposure on aggravating post-PRK corneal haze had been reported in the literature; however, information is

lacking regarding the effect of ambient UV exposure on physician practice patterns. This study aims to evaluate the

effect of ophthalmologists’ practice location on their employed practice patterns to prevent post-PRK corneal haze.

Methods: This is a cross-sectional observational study conducted through an online survey sent to Ophthalmologists


performing PRK in different countries. The survey recorded the primary city of practice from which the two indepen-

dent variables, latitude and average annual sunshine days, were determined. It also measured the frequency of use of

common postoperative preventive interventions (dependent variables) which are: intraoperative Mitomycin-C, oral

vitamin C, sunglasses, topical corticosteroids, topical cyclosporine, topical tetracyclines and amniotic membrane

graft. SPSS (22.0) was used for data analysis and level of significance was 0.05.

Results: Fifty-one ophthalmologists completed the survey. Practice locations’ mean latitude was 37oN whereas the

average sunshine days annually accounted for 60 % of year days. There was no significant relation between latitude/

average annual sunshine days and usual post-PRK prophylactic treatments (P>0.05). The commonest protective treat-

ments were sunglasses (78%), prolonged topical corticosteroids (57%), Mitomycin-C (39%) and oral vitamin C (37%).

Conclusion: We found no significant difference in ophthalmologists’ practice patterns to prevent post-PRK corneal

haze in relation to practice location latitude and average sunshine days. Moreover, the results demonstrated that the

most widely used postoperative preventive measures are sunglasses, Mitomycin-C, topical corticosteroids, and oral

Vitamin C.

1-year Follow Up of Implantable Collamer Lens (ICL) Anismetropic Amblyopia of children

Amr S. Radwan

Purpose: To evaluate the safety and efficacy during 1-year follow-up of implantable collamer lens (ICL) to correct

high anisometropia in amblyopic children who were non-compliant with spectacles or contact lenses.

Methods: Retrospective study of 12 eyes of 12 children with high anisometropia who underwent ICL implantation

(phakic posterior chamber IOL). Patient age at the time of implantation ranged from 2 to 10 years. Mean preoperative

spherical equivalent refraction was -10 diopters (D). Mean logMAR uncorrected visual acuity (UCVA)was .03 and

corrected distance visual acuity (CDVA) was .3.occlusion therapy was done after surgery in all cases.

Results:UCVA and CDVA improved in all children. At 12 months, logMAR UCVA and CDVA were .5 and 0.7

respectively (P=.01). Improvement of more than three logMAR lines of CDVA was achieved in all children. No loss

of CDVA was detected in any patient.

Conclusions: ICL is a safe and effective treatment option for childhood anisometropic amblyopia.

W3B – Pediatric Ophthalmology

New Technique for Squint Surgery

Said A. Jamaleddin

Objective: To explain a new surgical technique in squint surgery and to discuss and compare with old conventional

ones.

Background: There is a taboo in all kinds of medicine which we did not discuss. A taboo such as conventional squint

surgery and motility of the eye which we are following many years. In my study I do only myectomy/myectomy

without any suture with very good results. We know that ocular muscle is controlled by brainstem. The classical

surgical squint techniques mostly depend on changing the mechanical action of the muscle. By resections or reces-

sions and thoserules explain the movement of the eye. I think there may be ocular muscles itself has control center

like the heart muscle or there have been some neurogenic control (supranuclear) of ocular muscles. We don’t have

any idea about these. Or there may be another rule which need to discuss more.

Material and methods: I have operated about 69 primary squint patients (XT-ET and some secondary cases -reoper-

ated). And the observations of their results after using this new technique for one year , two years and three years .

Results: We found that when we do a myectomy especially to the medial rectus or lateral rectus .and leaves it as it is.

There is no need to reinsert the muscle because the muscle will adjust and reinsert by itself as the eye motility require.

Conclusion: This new technique is a new revolution in our ophthalmic field because it is simple, easier to do, require

less time, no need of suturing, under local anesthesia no side-effects with more efficient results. And the cosmetic

improvement is round 85-95 %. And the binocular vision is improved in young children about 45%.


The Profile of Pediatric Ophthalmic Emergency Cases Presented to King Abdulaziz University Hospital’s

Emergency Department in Riyadh, Saudi Arabia: A Six-month Retrospective Study

Abdulrahman A. Al-Jasser

Purpose: To determine the profile of pediatric ophthalmic emergency cases, the pattern of their complaints and the

percentage of true emergencies among them. Taking into account the limited information available regarding the

epidemiology of pediatric ophthalmic emergency cases worldwide and especially in our country.

Methods: A cross-sectional study was carried out using the ophthalmic emergency registry book at King Abdulaziz

University Hospital (KAUH). All pediatric cases (<13 years) presented from November 2014 to April 2015 were

included. Some patients were seen and given follow-up appointments in the emergency department (E/D); their later

visit was excluded as it is usually for assuring that the treatment course was followed.

Results: Within the defined period, 1716 subjects presented to (E/D) primarily categorized as pediatric cases. Sub-

jects were in the mean (SD) age of 67.6 months (43.5), out of whom, 956(55.7%) were males. Saudi citizens consti-

tuted the majority of cases 1529 (89.1%). After detailed examination, the two major diagnoses were: Corneal Epithe-

lial Defect (CED) 481(28%) and viral conjunctivitis 288(16.8%). In terms of management, only 36 cases (2.1%) were

admitted to the inpatient ward. The preliminary categorization of cases demonstrated that 1435(83.6%) were esti-

mated as emergency cases, while the final confirmed diagnoses proved that 1345(78.4%) were actual emergency

cases while 67(3.9%) were normal, and 304(17.7%) were non-emergency cases

Conclusion: Our principal recommendation targets policy makers to recognize the patterns of ocular injuries in order

to construct and adequately dispense resources in an efficient way and to encourage them to enforce safety measures.

Moreover, raising the public awareness on first-aid practices is crucial since the most common cause of ophthalmic

ER visits is CED, which is mainly caused by trauma.

W3C – Retina

The Lost Art of Retinal Drawing

Stephen Russell

Purpose: To demonstrate the relationship, variation, beauty and artistic progression of retinal drawings over a three

decade span.

Methods: Based upon a collection of over 12,000 retinal drawings performed by residents, retina fellows and faculty

from 1958 to 1990, a variety and progression of artistic styles were observed. Images were qualitatively analyzed for

style, drawing techniques and common stylistic features.

Results: Over multi-year intervals, retinal drawings demonstrated some core commonalities of style, although indi-

vidual artists showed numerous differences in individual interpretation and feature representation. The style of retinal

drawings demonstrated a progression from realistic (1950’s and 60’s) to iconic (1970’s) to caricature/simplistic (1980’s)

Conclusions: Despite great differences in the representation of individual fundus features, contemporaneous clusters

of faculty and trainees share recognizable artistic styles. Retinal drawings that differ from their period style often

demonstrate unique representations of fundus structures that remain rapidly comprehensible and esthetically pleas-

ing. Similarities of representation suggest that the influence of contemporaneous colleagues likely explains the

harmonization of style over time.

Precision in Vitreoretinal Surgery: Manual versus Assisted Instrument Positioning

Marco Mura

Purpose: Vitreoretinal (VR) surgery requires a high level of surgical skill. High-precision robot assistance can im-

prove a surgeon’s skills. E.g., higher precision improves the reproducibility of existing procedures and the develop-

ment of new, high-precision procedures that cannot be performed manually. The PRECEYES Surgical System was


developed to assist in VR surgery. The surgeon uses a motion controller to manipulate an instrument manipulator,

which controls the instrument. The purpose of this study is to evaluate positional precision and steadiness of a sur-

geon, comparing manual and assisted instrument positioning inside the eye.

Setting: Tests were performed by a surgeon in an eye simulator at the Medical Robotic Technologies lab of PRECEYES,

Eindhoven, the Netherlands.

Methods: To measure positional precision and steadiness, a tracing test was developed. A test model was created,

resembling the VR environment. The model consisted of a hollow styrofoam bottom half which is lined inside with

millimeter (mm) paper. The top half, composed of transparent plastic resembling an artificial sclera was placed

above. A trocar was present through which an instrument can be inserted into the model. With the tip of the instrument

a square of 4 by 4 mm was traced on the mm paper, in the region corresponding to the macula. The test person was

asked to freeze the instrument for 3 seconds at the corners of the square. Image analysis was used to calculate i) the

deviation between the tip of the instrument and the line that was traced and ii) the deviation between the tip of the

instrument and the corners of the square during the freezing step. These deviations provide measures for positional

precision and steadiness, respectively. Each test was repeated 3 times in manual and robotic mode.

Results: Manual use of the instrument resulted in an average positional deviation between the tip of the instrument

and the line of 80.8 _m ± 50.6 _m. The average deviation between the position of the tip and the position of the corner

was 125.7 _m ± 62.9 _m. It took 62.8 ± 7.7 seconds to complete these manual experiments. Robot-assisted use

resulted in an average positional deviation between the tip of the instrument and the line of 49.6 ± 28.5 _m. The

average deviation between the position of the tip and the position of the corner was 55.9 _m ± 23.5 _m. It took 95.6

± 9.4 seconds to complete these assisted experiments. Furthermore, literature shows that manual positioning preci-

sion of a good surgeon is in the order of 125 _m. Off-line experiments with the stand-alone robotic assistant have

demonstrated its intrinsic precision to be below 10 _m. Its steadiness can only be compromised by movement of the

eye model, as it freezes at its exact position.

Conclusion: The results indicate that positional precision and steadiness in the X-Y plane, using a simulated surgical

environment to be twice as high with assisted surgery as compared to manual surgery. This relative improvement is

significant, whilst the difference in procedural time is relatively small. However, the absolute values of the results

have to be interpreted carefully. Comparing the values from literature and off-line experiments with the measurement

results demonstrates that these values are highly dependent on the imaging modality used, in this case a Zeiss OPMI

stereoscopic microscope, and the interpretation of the surgeon analyzing the images in real-time and correcting the

instrument positioning accordingly. Furthermore, the evaluation method will influence the results. E.g., the steadi-

ness of the robotic system, measured whilst freezing the instrument position at the corner of the grid, was measured

± 23.5 _m. This deviation is introduced by the evaluation method and/or movement of the eye model, as the robot

freezes the exact position. Summarizing, it can be concluded that assisted surgery allows for significant improvement

of both positional precision and steadiness, which will benefit reproducibility of existing treatments as well as enable

the development of high-precision procedures. To obtain absolute values, further experiments are required.

Predicting Factors for Visual Acuity Outcomes following Surgery for Epiretinal Membranes

Ali Al-Halafi

Purpose: To evaluate the predicting factors for good VA after PPV for ERM.

Methods: The medical records of 29 eyes seen in the Retina Clinic and diagnosed to have ERM were reviewed.

Investigating potential predicting factors for achieving good vision included a mean change in best-corrected visual

acuity (BCVA) before and after PPV, mean change in CMT before and after PPV, age, sex and duration of the disease.

Results: In the current study, 29 eyes (19 (65.5% OD and 10 (34.5% OS) of 29 patients were recruited. The mean (SD)

age of our sample was 60.8 (10.6), range [33-78]. Comparing the mean (SD) LogMAR of preoperative and the last

follow-up values, the detected difference was found to be statistically significant (0.5 (0.3), [95% CI: 0.394 - 0.608];

p<0.0001). The mean (SD) OCT decreased postoperatively to 352 (128), then to 313 (101.5) in the last follow-up visit

assessment, where such decrease from preoperative to the last follow-up assessment was statistically significant (139.2

(92.5), [95% CI: 103.311 - 175.046]; p<0.0001). Investigating potential predicting factors for achieving vision = 20/60,

patients who entered the cohort in a relatively higher age and with a better initial visual acuity were found to be more

likely to achieve better postoperative vision (p= 0.016 and 0.004 for age and visual acuity respectively).

Conclusion: This study shows improvement in VA after PPV and ERM removal. Patients with better initial VA achieve higher

levels of visual outcome. Postoperative improvement in vision is slow. OCT appearance cannot predict visual outcome.


A New Complication of Cataract Surgery: Hemorrhagic Occlusive Retinal Vasculitis

Stephen Russell

Purpose: To review cases that represents phenotypic extremes of postoperative hemorrhagic occlusive retinal vascu-

litis (HORV) due to intracameral injection of vancomycin.

Methods: Two cases of HORV were evaluated. Clinical evaluations included comprehensive ocular examination,

testing and investigation for endogenous uveitis or non-HORV cause.

Results: Case 1: A 65-year-old woman developed progressive visual loss over a 3 week period following uncompli-

cated cataract surgery with intracameral injection of 1 mg of vancomycin. Initially the patient was minimally symp-

tomatic. Observed over the course of several weeks were transitory afferent pupillary defect and reductions in visual

acuity, visual field, retinal hemorrhage and edema. She returned to 20/20 with minimal structural and visual sequella.

Case 2: A 75-year-old male developed delayed onset, bilateral, severe sequential bilateral panuveitis and hemorrhagic

occlusive vasculitis within 10 days of otherwise uncomplicated bilateral cataract surgeries with injections of 1 mg of

intracameral vancomycin. Over the ensuing weeks he developed bilateral neovascular glaucoma requiring bilateral

seton implants for IOP control.

Conclusions: Presentation of postoperative hemorrhagic occlusive retinal vasculitis may range in severity and may

require a high degree of suspicion for correct diagnosis. It is unclear whether current methods for detection (and

treatment if necessary) of HORV is sufficient to assess its incidence.

Role of Intravitreal Bevacizumab as Adjunctive Therapy in Retinopathy of Prematurity

Khalid Al-Husseiny

Purpose: To determine the effect of adding intravitreal bevacizumab to conventional laser photocoagulation in stage

3 retinopathy of prematurity (ROP).

Methods: A prospective, controlled, interventional fellow eye study in patients with bilateral stage 3 ROP necessitat-

ing bilateral laser photocagulation of non-perfused retina. Patients received diode laser photocoagulation in one eye

group (A) (LP group), and the same treatment in the fellow eye with the addition of an intravitreal injection of

bevacizumab at the end of the procedure group (B) (LP/IVB group). The primary outcome measures were resolution

of neovascularization and occurrence of retinal detachment, and secondary outcome measures were speed of resolu-

tion of plus disease, and the intensity of the cicatricial response.

Results: Fifteen patients met the study criteria. Seven patients had zone I disease, and 8 patients had posterior zone II

disease. All eyes (100%) in the LP/IVB group had complete resolution of neovascularization without occurrence of

retinal detachment. Out of the 15 eyes in the LP group, 12 eyes (80%) had complete resolution of neovascularization,

while 3 eyes (20%) had persistent neovascularization, which was successfully treated with intravitreal bevacizumab

and supplemental laser photocoagulation. In the latter 3 eyes, there was an exaggerated cicatricial response compared

to the fellow eye. None of the eyes in the LP group developed retinal detachment. The time from primary intervention

to resolution of plus disease ranged from 2-5 days in the (A) LP/IVB group, and 7-10 days in the ( B ) LP group.

Conclusion: The addition of intravitreal bevacizumab (IVB) to conventional laser photocogulation in stage 3 ROP

(zones I and II) resulted in faster resolution of plus disease, more complete resolution of neovascularization, and less

need for secondary intervention, without exaggeration of the cicatricial response. When IVB was added to supple-

mental laser treatment, the cicatricial response was more intense than cases where IVB was added to the primary laser

treatment, but without the occurrence of retinal detachment. Thus IVB may be useful as an adjunct to primary laser

treatment. The late addition of IVB to supplemental laser treatment requires further study.

Controversies in Management of Dislocated IOLs

Stephen Russell

Controversies in Ophthalmology: Is it better to remove, re-position or replace this dislocated intraocular lens?

Through a selection of cases, diagnostic and therapeutic challenges in managing dislocated intraocular lenses (IOLs)

will be demonstrated. Optional anterior segment approaches and posterior segment choices will be reviewed. Rela-


tive advantages and disadvantages of each approach will be presented. Engagement of IOA members will be encour-

aged through open discussion of these complex cases.

W4C – Retina

Positional and Other Dynamic Changes on Optical Coherence Tomography

Stephen Russell

Optical coherence tomographic images has proven to be a useful, and in some cases essential, imaging technique for

the diagnosis and management of retinal diseases. As with all newly introduced imaging methods, OCT has pro-

gressed from a modality of observation and discovery to numerical and quantitative analysis for specific applications.

Utilizing custom segmentation and image analysis of spectral domain OCT data, we will demonstrate dynamic physi-

ologic responses within the posterior pole. Examples will include the active thickening of the choroicapillaris when

changing position from sitting to lying down compared to the static thickening of the choriocapillaris found for

intermediate age-related macular degeneration (AMD). Additionally, the day-to-night thickness changes of the pho-

toreceptor outer segment length will be illustrated in normal turnover and those affected by Best disease.

Use of New Intraocular Spectral Domain Optical Coherence Tomography in Vitreoretinal Surgery

Marco Mura

Purpose: To describe the use of a novel intraocular side-scanning probe enabling the acquisition of Spectral Domain

Optical Coherence Tomography (SD-OCT) images during surgery in a series of patients with complex forms of

retinal detachment.

Methods: A 23 gauge, side-scanning SD-OCT probe (C7 System; LightLab Imaging, Inc/St Jude Medical, St. Paul,

MN, USA) in a 20 gauge catheter was used to acquire the intra-operative Optical Coherence Tomography (OCT)

images in 7 patients with vitreoretinal diseases. 25 Gauge pars plana vitrectomy (PPV) was performed in every

patient in a standard fashion. After enlarging the temporal sclerotomy to a 20 gauge port, all the patients were scanned

with intraocular side scanning SD- OCT, during different steps of the surgery based on surgeon needs. Scans were

recorded real time and directly evaluated on a screen during surgery. OCT scans were judged beneficial when they

would recognize structures otherwise not seen on biomicroscopy.

Results: The intraocular SD-OCT has been helpful in acquiring extra information during vitreo retinal surgery such as

the detection of the presence of otherwise invisible membranes (epiretinal membrane, subretinal membrane), the

location of small tears, the identification of the retinal plane under suboptimal conditions for visualization .

Conclusion: The use of an intraocular SD-OCT, can expand upon visual cues during surgery, helping in the decision-

making process and allowing additional deliberate surgical maneuvers aimed at improving surgical outcomes.

Correlation between Microperimetry and Optical Cohernce Tomography in Macular Edema Secondary to

Acute Retinal Vein Occlusuon Before and After Bevacizumab Injection

Turki A. Dakhil

Purpose: To evaluate the relationship between retinal thickness measured with optical coherence tomography (OCT)

and retinal sensitivity measured with the (MP-1) in eyes with macular edema secondary to acute retinal vein occlu-

sion before and after intravitreal Bevacizumab injection.

Methods: In this prospective study, 63 eyes were evaluated. Baseline optical coherence tomography and microperimetry

were taken at presentation. 43 eyes received intravitreal Bevacizumab injection at presentation. Optical coherence

tomography, visual acuity, and microperimetry were repeated after 7-10 days of treatment to evaluate the correlation

between functional and structural changes secondary to macular edema.

Results: In this prospective study, 63 eyes were evaluated. Univariate analysis demonstrated that the initial visual


acuity at presentation had no impact on the fixation stability (P=0.859).Fixation stability on microperimetry was

worse significantly associated with the unstable fixation (P=0.033).Unlike central macular thickness, presence of

subretinal fluid had a significant impact on fixation stability (P=0.007). Univariate analysis demonstrated a signifi-

cant positive association between mean sensitivity and nature of retinal vein occlusion (ischemic versus non-is-

chemic), in which ischemic type had significantly worse prognosis (p=0.001). Patients presented with subretinal fluid

had a significant worse mean sensitivity (P=0.004).Mean sensitivity on microperimetry shown to be affected by

duration of symptoms from onset, patients presented earlier than 14 days had significant higher mean sensitivity

mean 4.2 (SD=2.8) than patients presented at 14 days or later 2.2 (SD=2.4) (P=0.005).In addition, for final visual

acuity, the presence of subretinal fluid attained a statistical significant value toward a worse vision (p=0.001).In the

analysis of optical coherence tomography and vision after Bevacizumab injection in eyes with interrupted inner-outer

segment and presence of subretinal fluid were shown to be significantly associated with worse final visual acuity

(p=0.001). After bevacizumab injection, significant improvement of visual acuity, mean sensitivity, central macular

thickness, and subretinal fluid were noticed.

Conclusions: At presentation, morphological changes secondary to macular edema was significantly correlated with

functional changes. Intravitreal bevacizumab shown to be effective in treating macular edema based on structural and

functional changes. Treatment by intravitreal bevacizumab injection should be initiated as early as possible to avoid

irreversible structural and functional photoreceptors damage.

Presumed Intraocular Tuberculous Uveitis in Tertiary Hospital in Riyadh

Awad Al-Qarni

Purpose: To define the clinical characteristics including macular edema, to assess the outcome of treatment, compli-

cations, and rate of recurrence in patients with presumed intraocular tuberculous uveitis.

Methods: All patients diagnosed with presumed tuberculous uveitis at King Abdulaziz University Hospital between

January 1996 and March 2013 were reviewed. The diagnosis was made when findings were consistent with possible

intraocular tuberculosis with no other cause of uveitis suggested by history, symptoms, or ancillary testing, strongly

positive PPD, and response to antituberculous therapy.

Results: Ninety one patients (141 eyes) were identified. There were 43 males (47.3%) and 48 females (52.7%) with a

mean age of 48.2 years (±14.4) (range 18 -80 years). Seventy nine eyes (56%) had panuveitis and thirty four eyes

(24.1%) had posterior uveitis at presentation. Macular edema presented in 33.3% of eyes with highest incidence in

intermediate uveitis group (61.1%). All patients received antituberculous therapy and systemic systemic corticoster-

oid s. After a mean follow-up of 36 months (±2.5) all eyes showed resolution of inflammation, associated with

significant improvement in visual acuity (VA) (P =0.003) , with only 2 eyes with recurrences. There was a significant

positive correlation between initial and final VAs (P<0.001). Forty seven eyes with macular edema were examined at

baseline and at follow-up with OCT. At final follow-up, there was a significant reduction in CMT associated with a

significant improvement in VA .

Conclusions: Treatment with antituberculous therapy combined with systemic systemic corticosteroidinduced reso-

lution of inflammation with very low incidence of recurrences and associated with a significant improvement in

visual acuity (20/40 or better vision in 56.7%).


Thursday, March 10

Th1A – Free Paper

Troubles from Trichomegaly of The Eyelashes: A Case Report of Erlotinib Induced Trichomegaly

Mohammed YH Shaikh

Purpose: Trichomegaly of the eyelashes is an uncommon side effect of epidermal growth factor receptor inhibitor

therapy which is increasingly used in wide variety of cancers. The purpose of this case presentation is to highlight

occurrence and implications of erlotinib induced trichomegaly and review the pertinent literature.

Method: Case Report: A 65-year-old lady with unremarkable systemic history had been for about 7-years on topical

dorzolamide/timolol eyedrops for stable glaucoma. She never had used any prostaglandin analogues. On her routine

six monthly follow up she reported excessive growth of eyelashes which significantly interfered with her ability to

instill drops correctly in her eyes, also caused physical obscuring of vision and bothered her with spectacle wear from

eyelashes rubbing the lenses. Examination revealed long, dark, thick curly eyelashes with intervening zones devoid of

eyelashes. She admitted to having resorted to self-epilation to rid her difficulties from enlarged lashes. Systemic

review of her history confirmed recent diagnosis of advanced metastatic breast disease and chemotherapy with erlotinib.

She was happy to be managed by epilation of bothersome eyelashes allowing her ocular and visual comfort.

Results: Simple management options such as trimming of lashes and epilation can spare the patient from significant

cosmetic and functional effects of erlotinib induced eyelash trichomegaly.

Conclusion: The recognition of this sporadically reported uncommon condition and its management is essential not

only to ensure acceptable cosmesis and ocular comfort but also to prevent serious ocular surface complication in an

otherwise already predisposed patient. Proper attention to the side- effects would remove any potential hindrance to

the compliance to targeted chemotherapy.

Blow in Orbital Fracture in Endoscopic Turbinate Surgery

Alicia G. Ferreiro

Objective: Orbital blow-in fracture type are characterized by the displacement of the bony structures into the orbital

cavity, resulting in decreasing the volume of the orbit causing exophthalmos.

Material: 54 years old male referred to oculoplastics with acute exophthalmos right eye (OD), ocular motility restric-

tion in abduction and exotropia immediately after inferior turbinectomy surgery when extubating the patient with a big

Valsalva Maneuveur. Ophthalmic exam revealed visual acuity 20/20 OD normal globe and restricted medial rectus

right eye and exophthalmos OD 25. Computed tomography showed medial rectus damaged by a 2mm bone fragment.

Orbital subconjuntival approach was done and the fragment was excised.

Conclusions: We think fragments of the orbital medial wall were forced into the orbit by a sudden increase in pressure

in the ethmoide sinus in this patient when extubated. Until our knowledge this is the first case described in the litera-

ture with blow-in and medial wall caused by Valasalva while extubated.

Tuberculous Conjunctivitis in an Anophthalmic Socket

Omar Abdulsalam

Tuberculous conjunctivitis was not an uncommon condition before the early 20th century, and is nowadays a rare

occurrence, especially in the developed countries. We report a 27 year-old Saudi woman who underwent enucleation

of the right eye at the age of 20 following a penetrating eye injury. She had a history of miliary tuberculosis (TB) that

was treated at the age of 22. She presented with chronic purulent discharge from her right anophthalmic socket for 2

months. Cultures for bacteria and fungi were sterile. There was no response to empirical topical antibiotics and ste-

roids. Direct microscopic examination of conjunctival scrapings with Ziehl-Neelsen staining revealed no microorgan-


isms. Histopathological examination revealed epitheloid granulomas. Polymerase chain reaction (PCR) was negative

for Mycobacterium tuberculosis DNA. Tuberculous conjunctivitis was suspected from the history of miliary TB and

presence of epitheloid granulomas. Definitive diagnosis was made after prompt resolution of the ocular signs with no

recurrence only after systemic antituberculous therapy.

Frontalis Sling Silicone Rod Open Crease vs Closed Stab Technique to Correct Severe Ptosis with Poor

Levator Function

Alicia G. Ferreiro

Purpose: To compare outcomes of two techniques of frontalis sling suspension surgery using silicon rod to correct

severe upper eyelid ptosis with poor levator muscle function.

Methods: This was a retrospective, nonrandomized, clinical study. Medical records of patients undergoing frontalis

sling suspension to correct severe ptosis between January 2008 and December 2011 were reviewed. Silicone rods were

sutured to the tarsal plate through a lid crease incision (OM) or passed through stab incisions placed midway of the lid

margin and upper tarsal border (CM). Data retrieved included age, gender, type of surgery, preoperative and postopera-

tive margin reflex distance (MRD) and complications. Outcome was considered as success if MRD after surgery was

‘2 to 4’ score. If MRD at last follow up was better than before surgery, outcome was considered as success. Associated

conditions and post-operative complications were also documented.

Results: We studied 155 eyelids of 146 patients with ptosis (137 unilateral, nine bilateral). OM (n=60) and CM (n= 85)

groups had median follow-up of 1.5 and 1.4 years respectively. The satisfactory grade of success rate (2<MRD>4mm)

in OM group was 30 [50%, (95% CI 37.3 -66.7)] and in CM group, it was 44 [51.8% (95% CI 41.2-62.4)]. Improved

MRD in last follow up was obtained in OM group was 61 [71.8%, (95% CI62.2 -81.3)] and in CM group, it was 45

[75% (95% CI64-86)]. There was no significant difference in success rate between the two methods (P = 0.4). The

main complications were exposure keratitis, which was observed in 13% OM vs 12% CM and lash ptosis and lid

crease abnormalities, noted only in CM group.

Conclusions: Silicone frontalis sling have same success rates in OM and CM to correct upper severe lid ptosis with

poor levator function but lash and crease abnormalities occurred just with CM technique.

Blind Painful Eyes: What to Inject? – Comparative Study of Retrobulbar Injection of Ethanol versus Chlor-

promazine

Alicia G. Ferreiro

Purpose: Chronic orbital pain arising from blind eyes often does not respond to conventional medical therapy. The use

of retrobular injections with one of two agents were evaluated for efficacy and adverse events.

Methods: In this prospective randomized clinical trial, Group 1 (GR-I) received 1.5 mm of absolute ethanol (alcohol)

while Group 2 (GR-II) received 1.5 ml of chlorpromazine 25mg/ml for the retrobulbar injection. Verbal Numeric

Visual Analogue Scale (VAS) was used to rank the pain before, during and after intervention. Intraocular pressures

(IOP) and adverse events were recorded. Patients with no pain had complete success. Patients who went on to require

evisceration or enucleation or who had no change in the ranking of the pain were termed as treatment failures.

Results: GR-I and GR-II included 16 patients each. Complete success was achieved in 7/16 (43.7%) and 6/16 (37.5%)

in GR-I/ GR-II respectively. Failure rate was 5/16 (31.3%) and 6/16 (37.5%). Postoperative adverse events were seen

in 33.3% G-I and 56% G-II. Most pronounced was the eyelid edema seen with G-II. IOP reduction was seen in both

groups. While the mean IOP was higher at entry with the chlorpromazine group (24.3 mmHg versus 14 mmHg with G-

I,) the exit IOP was lower for this group as well (15 mmHg versus 18.8mmHg G-I.) None of the patients had interven-

tions to decrease IOP after the injections. All patients with IOP over 27 mmHg had pain scores of over 5 initially. Five

of the seven (71.4%%) patients with initial IOP over 45mmHg had severe pain. After injection, only one person (1/4)

with an IOP over 27mmHG had more than minimal pain.

Conclusions: Both retrobulbar alcohol and chlorpromazine injections had similar results in relieving pain. The injec-

tions did provide pain relief, but approximately 1/3 did continue to have enough pain requiring reinjections or enucle-

ation/evisceration. Both injections had few postoperative complications and all resolved. Decreased IOP and reduc-

tion of pain occurred after either injection for two-thirds of blind painful eyes.


Orbital Lymphoma Behaves as Subperiosteal Mass

Abdulrahman F. Al-Bloushi

We report atypical location of orbital lymphoma in 57-year-old male patient who is known to have type 2 diabetes

mellitus and essential hypertension present with progressive left eye proptosis over 5 years period. Orbital computed

tomography was performed at presentation and showed bilateral orbital roof subperiosteal masses and causing mild

proptosis. Incisional biopsy performed which revealed Non-Hodgkin’s extranodal marginal B cell (MALT) lymphoma.

Localized Orbital Amyloidosis: Case Report

Laila S. Al-Ghaferi

Aims/background: Localized amyloidosis is rarely encountered in the orbit. The typical clinical and radiological ap-

pearances have not been clearly established. The aim of this case report is to describe one case of a rare orbital disease

and to present the clinical features, radiological and histopathological findings of localized orbital amyloidosis.

Material and methods: The clinical features, radiological findings, and histopathology findings of one patient with

localized orbital amyloidosis were described here.

Conclusion: Localized orbital amyloidosis may present with a wide spectrum of clinical findings and result in signifi-

cant ocular morbidity. The goal of the treatment is to preserve function and to prevent sight threatening complications.

Skin Wrapped Conformer Over a Temporalis Muscle Transfer to Reconstruct Severely Contracted Socket

Omar BenHusain

Objective: To report a successful socket reconstruction technique consisting in temporalis muscle transfer with skin

graft wrapped conformer in 3 severely contracted anophthalmic socket.

Case Report. Three severely contracted sockets (grade 4) unable to hold the cosmetic prosthesis. Previously, they had

unsuccessful multiple surgeries with mucosal grafting and orbital implants. Surgical technique: temporalis muscle

transfer was done through a lateral orbitotomy, all cicatricial tissue within the socket was excised, and the skin graft

wrapped conformer was sutured at its mid-periphery to the inferior and superior orbital rim. Then second surgery was

done to open the skin bag horizontally and reform the lids margins. One year of follow-up showed that the three of

them were able to hold their external prosthesis.

Conclusions: A successfully rehabilitated anophthalmic socket must hold and support a prosthetic device that mimics

the contralateral globe. The goal is symmetry. The static symmetry of the palpebral apertures, canthal angles, and

superior sulci are basic objectives. Adequate lid levels and contours and sufficiently deep conjunctival fornices are

necessary to keep the prosthesis in place. Temporalis muscle flap transfer provides a well-vascularized bed for delayed

or at the same time reconstructions with skin bag shaped graft. This technique represents an effective approach to

successfully reconstruct and maintain stable ocular cul-de-sacs in cases of severe socket contracture or total symble-

pharon formation.

Eye Diseases Due to/and Treated by Hyperbaric Oxygen Therapy

Medhat M. Eldakhakhny

Hyperbaric Oxygen Therapy (HBOT) is an evolving treatment modality. It is well known to affect the eye either

temporarily by inducing temporary reversible myopia or it might accelerate the maturation of nuclear cataract. Con-

versely, it has been approved for treatment of central retinal artery occlusion with restoration of vision in the majority

of cases if applied early. Other eye indications are treated off guidelines pending approval or refutation by relevant

scientific hyperbaric associations. Review of HBOT with its utilities and implications in eye disease will be presented.


Perceptions and Career Expectation in Ophthalmology among Saudi Undergraduate Medical Students

Majid B. Abalkhail

Purpose: To assess perceptions about ophthalmology, as a career, and determinants of career choice in ophthalmology

among undergraduate medical students.

Method: A questionnaire was administered to all medical students in 4th, 5th and 6th year and interns. The question-

naire investigated demographic and academic data, factors influencing career choice, perception about ophthalmology

as a career and as a field, experience in ophthalmology and impact of ophthalmology rotation on the student’s percep-

tion.

Results: We recruited 519 (61.3% females) students, distributed as 37.4%, 31.0% and 22.0% in 4th, 5th and 6th year

respectively, and 8.9% interns. Ophthalmology appeared in 29 (5.6%) cases as the first choice; and in 70 (13.5%) cases

in the top three choices. Comparison between students who aspire for ophthalmology as a career (group A) and those

who do not (group B) showed a female proportion of 72.9% versus 55.6%, respectively, (p=0.009); and a comparable

distribution in grade. Analysis of career choice determinants showed more consideration for workload during resi-

dency (80.0% versus 65.6%, p=0.021) and less for the following factors: challenging intellectual features (58.0%

versus 78.7%, p<0.001); challenging instrumental features (62.3% versus 78.3%, p=0.007) and possibility to work in

urban settings (46.4% versus 59.8%, p=0.045), in group A versus group B, respectively. Analysis of the experience in

ophthalmology showed more attendance/participations in conferences (p<0.001), research (p<0.001) and community

services related to ophthalmology (p<0.001) in group A versus group B. Further, the ophthalmology rotation had

higher impact in scientific curiosity (p=0.002) and interest about ophthalmology (p<0.001) in students from group A.

Conclusion: Students aspiring for a career in ophthalmology display earlier engagement in related academic activities

and have less concern about related instrumental and intellectual challenges, in comparison with their peers. The

ophthalmology rotation may constitute a key-step to enhance the student’s predilection to the specialty. General coun-

seling in late clinical years is crucial in determining career specialty choice, specific counseling related to different

specialties should be encouraged as well.

Assessment of Awareness of Patients’ Rights and Attitude toward Ophthalmology Residents in University of

Dammam (Ophthalmology Department)

Abdulaziz H. Al-Dhafeeri

Background: General awareness of human rights has been on the rise recently. Cultural differences play an important

role in individuals’ attitudes and perception of rights in general and their rights as patients in particular. In the time

being and with the evolution of medical practice, its has become essential for patients to understand their rights clearly,

and be able to incorporate these rights in choosing the optimal treatment plan along with their treating physician. It is

also important to post resident physician in evaluating the patient’s condition and to take the appropriate management

plan is one of the basics of learning in their respective fields, and that’s will not incompatible with the rights of the

patient.

Method: Cross-sectional descriptive design using paper questionnaires in Arabic language to assess the awareness of

patients’ rights and patient attitude toward medical ophthalmology residents. In order to collect the data questionnaires

were handed to a sample size of 613 individuals both males and females, all were patients in the out-patient clinics of

ophthalmology department in King Fahad Hospital of the University. Participants were all informed that the data will

be anonymous and confidential, and the consent was verbally taken. Data entry and data analysis were done using

SPSS statistical software package.

Results: Knowledge of patient rights among the sample was 72.21% and the most scoring source of information was

social media by a percent of 49.27. The most scoring question was question number 3 in the data sheet (do you know

that you have the right to be provided with appropriate medical services available in hospital facilities regardless of

your ethnicity, religion, believes, doctrine, language, sex, age, or disability?) by 85.64% and the least scoring question

was question number 7 in the data sheet (Do you know that you have the right to be provided with interpreters to

communicate with health care staff?) by 55.63%. The most scored source of information was social media as a re-

source of information accounting for 49.59% and the least scored source of information was nursing staff accounting

for 11.75%. There is a direct proportion between knowledge of patient rights with their education level and with the

use of social media as a resource of information. Patients with advanced level of academic education have the highest

score of knowledge of their rights by a percent of 74.5% and the usage of social media as a resource of their informa-


tion accounts for 62.5%. The study also revealed that the illiterate patients have the lowest score of knowing their

rights at a percent of 60.95 and their use of social media as a resource of information was by 14.29%. High experience

resident with supervision of ophthalmologist is the most scoring in all attribute of involvement of residents as well as

having the least rejection, on examination; 53.34% of patients would like to be examined, 40.29% do not mind and

6.36% wouldn’t like. On management 46.17% of patients would like to be managed, 45.51% do not mind and 8.32%

wouldn’t like. On simple surgical procedure 36.54% of patients would like to undergo a procedure performed by the

resident physician, 51.06% do not mind and 12.4% wouldn’t like. On intermediately difficult procedure 31.48% would

like to undergo the procedure, 52.37% do not mind and 16.15% wouldn’t like. On difficult procedure 28.38% would

like to undergo the procedure, 43.32% do not mind, and 28.38% wouldn’t like. Patients’ knowledge of their rights

contributes to the involvement of residence & show low rejection. Low experience resident with supervision of oph-

thalmologist, Intermediate experience resident with supervision of ophthalmologist & high experience resident with-

out supervision of ophthalmologist shows inverse proportion to the patients knowledge of their rights & patients

rejection to the involvement of the residents in examination & management.

Conclusion: Patients have good knowledge about their rights. The study shows direct proportion between knowledge

of patient rights with their education level & the use of social media as a resource of information. As to the action

involving (management plans, and procedures) patients tend to reject the involvement of residents regardless how

experience they are and whether they are supervised by ophthalmologist or not. However, residents supervised by

ophthalmologist having less rejection comparing with residents that are not supervised by ophthalmologist. Patients

who have high knowledge of their rights contribute to the involvement of residence & show low rejection.

Th1B – Retina

Diabetic Retinopathy: Knowledge, Awareness and Practices of Physicians in Primary-care Centers in Riyadh,

Saudi Arabia

Raghad Al-Rasheed

Purpose: To evaluate the current knowledge, awareness, and to assess practices among primary care physicians work-

ing in primary care centers in Riyadh, regarding Diabetic Retinopathy (DR).

Method: We conducted a cross-sectional study covering 46 Ministry of Health primary care centers in Riyadh, Saudi

Arabia during October 2015. A Self-administered questionnaire was distributed to primary care physicians containing

3 main sections. The first section focused on participants’ demographics and professional background. The second

section contained multiple-choice questions on knowledge related to diabetes and DR. A Score of one was given for

each correct answer and zero for the wrong or did not know answers. The last section was to assess physicians’

practices. Data was analyzed using SPSS version 21.

Results: A total of 216 general physicians completed the questionnaire. The mean overall knowledge score for all the

respondents was 57±14 out of 100. Knowledge was significantly higher for physicians with >15 years of practice

(59±13 vs. 54±15, P=0.04). Male physicians scored better than females, 13% vs. 6.7% respectively scored >75. A

defect was noticed in area of screening and follow-up of type 1 diabetes, only 24% of physicians correctly referred

patients with type 1 diabetes to an ophthalmologist, whereas 71% referred patients with type 2 diabetes as recom-

mended by the guidelines. Another defect area was detected in treatment options. Majority agreed on the use of laser

photocoagulation as treatment. However, only 1/5 of participants were aware of the use of steroids and anti-VEGF as

possible options. 65% of physicians claimed the capability of using an ophthalmoscope, 74% of them have examined

their patients with it.

Conclusion: Our study uncovered areas of defects in knowledge among general practitioners regarding diabetes and

DR. Therefore, future seminars on diabetes emphasizing the proper ophthalmological screening and management of

patients are necessary.


Atypical Finding of Idiopathic Macular Telangiectasia Type 2 with Peripheral Vascular Anomaly

Saba Al-Rashaed

Purpose: To report a case of Idiopathic macular telangiectasia that had peripheral angiographic vascular anomaly.

Background: Macular telangiectasia type 2also known as idiopathic perifoveal telangiectasia and juxtafoveolar retinal

telangiectasis type 2A or Mac Tel 2 is an acquired bilateral neurodegenerative macular disease that usually manifests

itself during the fourth to sixth decades of life and is characterized by minimal dilatation of the parafoveal capillaries

with graying of the retinal area involved, a lack of lipid exudation, right-angled retinal venules, refractile deposits in

the superficial retina, hyperplasia of the retinal pigment epithelium, foveal atrophy, and subretinal neovascularization

(SRNV). Optical coherence tomography images typically demonstrate intraretinal hyporeflective spaces that are usu-

ally not related to retinal thickening or fluorescein leakage. The typical fluorescein angiographic finding is a deep

intraretinal hyperfluorescent leakage in the temporal parafoveal area. With time the leakage may involve the whole

parafovea, but does not extend to the center of the fovea. We are reporting case of or Mac Tel 2 that demonstrated

angiographic peripheral vascular anomaly that was not reported prevouisly.

Methods: Patient data including clinical examination fundus photos, OCT and (intravenous fluorescein angiography)

IVFA findings were reviewed.

Case report: 69 years old otherwise healthy women Presented with visual impairment since 6 months. Visual acuity in

right eye OD was 20/50 in left eye OS WAS 20/80. Anterior segment examination was unremarkable. Dilated fundus

examination in both eyes revealed loss of retinal transparency in the perifoveal region, dilation of the parafoveal

capillaries mainly in the temporal parafoveal area, Crystalline deposits at the vitreoretinal interface,right angle Blunted,

dilated retinal venules and RPE hyperplasia.Fundus autofluorescence showed the loss of the normal hypofluorescent

center. OCT showed an asymmetric foveal pit with the temporal area being thinner than the nasal and hyporeflective

cavities in the inner and outer neurosensory retina. hyperreflective intraretinal lesions with posterior shadowing corre-

sponds to foci of retinal pigment hyperplasia .60 degree field IVFA demonstrated parafoveal telangiectactic capillar-

ies which was predominantly temporal to the fovea. wide field angiography (optos) demonstrated prominent retina

telangiectasia at the peripheral with mild leak. Based on the clinical and retinal images findings the case was diagnosed

as Mac tal type 2 with unusual angiographic peripheral vascular telangiectasia

Conclusion: This study represents the first reported two cases of Idiopathic macular telangiectasia type 2 with proven

angiographic peripheral vascular anomaly. This finding may shed light on the possibility of this disease entity had

wider spectrum of vascular changes that might contribute to the pathogenesis of this condition therefore we recom-

mend to consider examination the peripheral retina vasculature to detect any subtitle vascular anomaly

Purtscher-like Retinopathy as a First Manifestation of Systemic Lupus Erythematosus

Reem Al-Ahmadi

Purpose: To report a case of bilateral Purtscher-like retinopathy in a female patient as a first presenting sign which led

to the diagnosis of systemic lupus erythematosus (SLE).

Case presentation: An otherwise healthy 21-year old female presented with bilateral rapid decrease in vision for one

month. Fundus examination revealed multiple cotton wool spots and flame-shaped hemorrhages in both eyes. Optical

coherence tomography displayed severe macular edema. Fundus fluorescein angiography showed multiple retinal arteri-

olar occlusions. Rheumatology was consulted for investigation. Work up for the patient confirmed the diagnosis of SLE.

She was diagnosed with SLE and subsequently treated with corticosteroids and immunosuppressive medication.

Conclusion: Although vaso-occlusive retinopathy is a rare presentation of SLE, it is important to suspect the diagnosis

of SLE in a patient with such presentation, in order to promptly initiate proper treatment.

Rare Presentation of Dome-Shaped Maculain Saudi Patient

Adel Al-Akeely

Dome-shaped macula (DSM) was first described by Gaucher et al as a convex protrusion of macula within a staphy-

loma in highly myopic eyes that causes visual impairment associated with serous foveal detachment (SFD). We de-


scribe a patient with persistent SFD in DSM documented by serial spectral domain optical coherence tomography

(SD-OCT) for 6 years with stable vision.

Ocular Injuries Secondary to Alexandrite Laser-Assisted Hair Removal

Mohammed Asiri

Purpose: To describe the clinical manifestations and outcome of three patients who sustained eye injury during Alex-

andrite laser assisted hair removal.

Methods: A retrospective case series of 3 patients. Data were collected on ophthalmic examination, spectral domain

optical coherence tomography (SD-OCT) and fundus fluorescein angiography (FFA).

Results: Three female patients sustained injury due to Alexandrite laser hair removal. One patient presented with acute

anterior uveitis while the other two patients presented with foveal intraretinal hemorrhage and subfoveal choroidal

neovascularization, respectively. Visual acuity at last follow up ranged from 20/15 to 20/20.

Conclusion: Laser-assisted hair removal may lead to various forms of ocular injuries if used improperly. Ophthalmolo-

gists should be aware of the ocular damage caused by these laser devices.

T-shaped Macula Buckling Combined with Pars Plana Vitrectomy for Macular Hole, Macular Schisis and

Macular Detachment

Marco Mura

Purpose: To report our experience using the T-shaped macular buckle (MB) with or without pars plana vitrectomy

(PPV) as a primary surgery or with a previous failed surgical approach in patients affected by high myopia and macular

hole (MH) with or without macular detachment (MD) and with or without macular schisis (MS). The primary goal was

to evaluate complete closure of the MH and reattachment of the retina.

Methods: Retrospective case series of 21 consecutive patients who underwent T-shaped MB implant alone or com-

bined with PPV at the Academic Medical Center in Amsterdam, The Netherlands, between January 2013 and Novem-

ber 2014. The mean axial length was 31,22 mm . The mean follow up period was 7 months.

Results: Retinal reattachment was achieved in 100% of cases while MH closure was achieved in 90.5%. No major

perioperative complications were observed. BCVA improved in 71.4% of patients.

Conclusion: MB combined with PPV should be considered as the preferred surgical approach both in primary and

recurrent retinal detachment secondary to MH in high myopic eyes.

Retinopathy of Prematurity (RoP) Prevalence and Risk Factors in King Abdulaziz Medical City (KAMC) in

Riyadh

Bader Al-Qahtani

Background: Retinopathy of prematurity (ROP) is an eye disease that affect premature infants. A small gestational

age, low birth weight and high oxygen therapy considered as risk factors for ROP. It is one of the common causes of

childhood blindness unless treated appropriately.

Objective: The aim of this project was to determine the prevalence of ROP in preterm infants in the Neonatal Intensive

Care Unit, to identify the risk factors that predispose to ROP and to assess the outcome of those infants.

Methods: This was a retrospective cohort study of premature infants with birth weight of =1500 grams or gestational

age of =32 weeks. Those infants were admitted to NICU of King Abdul-Aziz Medical City in Riyadh between January

2010 to December 2014. The demographic data, perinatal risk factors for ROP and outcomes of those patients were

assessed and analyzed by SPSS.

Results: Five hundred and ninety three infants were included in this study. Out of those, 224 infants (37.8%) had ROP.

A percentage of 11.1% of those infants had stage 3, which means a severe ROP disease. The mean body weight of

infants with ROP was 983 g and the mean gestational age at birth was 27 weeks. A significant relationship with a p-

value <0.05 has been found between the occurrence of ROP and small gestational age at birth, low birth weight, low


APGAR score at 1 minute and long duration of receiving O2 therapy. Among those infants with ROP, 3 infants had

Laser treatment and 14 had Anti-VEGF. Based on charts review, no one of those infants had blindness.

Conclusion: The prevalence of ROP in our study beside other local studies fall in the range of the disease prevalence

in the developing countries. It is recommended to control the duration of oxygen therapy.

Incidence of Retinal Detachment in Patients with Bechet’s Disease

Samir S. Shoughy

Purpose: To determine the incidence of retinal detachment (RD) in patients with Behcet’s disease.

Methods: We included a total of 47 consecutive patients with Behcet’s disease. Patient charts were reviewed to detect

RD and predisposing retinal lesions.

Results: There were 45 male and 2 female patients with a mean age o 28 years. RD occurred in 7 (15%) patients. Two

patients had predisposing retinal tears and 2 patients had macular holes. One patient had intravitreal injection 8 weeks

prior to development of RD.

Conclusion: RD should be kept in mind in patients with Behcet’s disease. Careful examination should be carried out to

in patients who receive intravitral injections and to detect predisposing retinal tears or macular holes.

Th2A – Free Paper

Safety and Efficacy Comparison between Brand-name and Localy Manufactured Generic Fixed

Combination of 2% Dorzolamide/0.5% Timolol

Leyla AA Al-Jasim

Purpose: To compare the available 2%Dorzolamide/0.5% Timolol fixed combination; the brand name Cosopt and

localy manifactured Xolamol.

Method: Double blinded clinical trial, 28 patients were on fixed combination Dorzolamid/Timolol, after wash out,

started on one drug for 6 weeks, then crossed over to the other; IOP levels, signs, symptoms and patient satisfaction

were monitored

Result: After wash out IOP was 19.5mmHg in first group; patient started on Cosopt IOP at 6 weeks 14.5, then crossed

over to Xolamol, IOP at 6 weeks 14.9 the other group IOP after washout 18.8, started Xolamol, IOP at 6 weeks 15,

crossed to Cosopt, IOP 13.6 after 6 weeks conjunctival injection increased with the use of Xolamol compared with

Cosopt use Patient satisfaction was high in use of both drugs. In view of small sample the difference in satisfaction rate

among two groups was not statistically significant.

Conclusion: No apparent difference in decline of IOP by both drugs.

Elevated Intraocular Pressure Increases Melatonin Levels in The Aqueous Humour

Hanan A. Al-Kozi

Purpose: To study the levels of melatonin in the aqueous humour of normotensive and hypertensive IOP patients and

to compare them in an animal model of glaucoma.

Methods: 37 eyes of 37 patients who underwent cataract surgery were included in the study and were divided into

normotensive patients, with IOP below 21 mmHg (n=23) and hypertensive patients, with IOP > 21 mm Hg (n=14).

Glaucomatous DBA/2J (n=6) and control C57BL/6J (n=6) mice presenting 3 and 15 months of age for each strain

were also used. Human and mice aqueous humours were aspirated using a 30-gauge Rycrof cannula on a tuberculin

syringe and further processed to quantify melatonin by HPLC analysis.

Results: Melatonin levels in normotensive patients (IOP below 21 mm Hg) presented values of 33.14 ± 11.61 ng/mL

(n=23), while hypertensive patients (IOP above 21 mm Hg) showed melatonin concentrations of 95.87 ± 28.23 ng/mL

(n=14) (p<0.039). Glaucoma mice presented melatonin values of 0.44 ± 0.06 ng/mL (at 3 months of age, before the

pathology starts) which raised to 1.45 ± 0.18 ng/mL (at 15 months of age, when the pathology is fully established and


IOP is maximum) (n= 6, p<0.001). Control mice did not significantly modified melatonin concentrations between 3

and 15 months of age.

Conclusion: Glaucoma patients with high IOP present increased concentrations of melatonin in their aqueous humour

compared to normotensive patients. This has been confirmed in a glaucomatous animal model in which it has been

possible to see a correlation between the development of the pathology, with an increase in IOP, and a concomitant

elevation of melatonin in the aqueous humour.

Bottle Characteristics of Topical International Glaucoma Medications versus Local brands in Saudi Arabia

Reham D. Al-Qahtani,

What is known and Objective: Physical bottle characteristics differ of brand name topical glaucoma medications and

local generic equivalents. This study compares the bottle characteristics of international topical glaucoma brands versus

local brands from the Kingdom of Saudi Arabia (KSA).

Methods: Data were collected on bottle drum volume, drop volume, bottle ‘squeezability’, bottle tip diameter, labels and

instructions, cap color coding and clarity of the drug label. Density-based calculations of drops in bottle volume were

assessed using an analytic balance. Bottle tip diameter was measured using 0.05 mm Vernier calipers. A Likert scale based

questionnaire was used to assess the subjective opinions of patients on bottle squeezability, clarity of usage and storage

instructions and the consistency of the cap color coding.

Results: The volumes of international brands were statistically significantly higher than the local brands (p<0.001). The

number of drops per bottle and tip diameter were comparable between international local brands. Cap color coding was

inconsistent for international and local brands. Patients were dissatisfied with the label font size. Patients reported that the

international and local brands were similar in terms of the ease of opening the bottle, instilling a drop and the clarity of the

instructions; but the local brands were subjectively easier to squeeze than international brands.

What is new and Conclusions: This is the first study to compare bottle characteristics of local Saudi Arabia brands with

international brands. The bottle characteristics and patient feedback were similar between local and international topical

glaucoma medications. However, there were differences between the local and international brands in drug volume,

bottle squeezability. Hence patient compliance and drop dosage may differ based on the origin of manufacture.

Histopathologic and Immunohistochemical Features of Capsular Tissue Around Failed Ahmed Glaucoma

Valves

Alka M Mahale

Purpose: Impervious encapsulation around Ahmed glaucoma valve (AGV) results in surgical failure raising intraocu-

lar pressure (IOP). Dysregulation of extracellular matrix (ECM) molecules and cellular factors might contribute to

increased hydraulic resistance to aqueous drainage. Therefore, we examined these molecules in failed AGV capsular

tissue.

Methods: Immunostaining for ECM molecules (collagen I, collagen III, decorin, lumican, chondroitin sulfate, aggrecan

and keratan sulfate) and cellular factors (aSMA and TGFß) was performed on excised capsules from failed AGVs and

control tenon’s tissue. Staining intensity of ECM molecules was assessed using Image J. Cellular factors were assessed

based on positive cell counts.

Results: Histopathologically two distinct layers were visible in capsules. The inner layer (proximal to the AGV) showed

significant decrease in most ECM molecules compared to outer layer. Furthermore, collagen III (p=0.004), decorin

(p=0.02), lumican (p=0.01) and chondroitin sulfate (p=0.02) was significantly less in inner layer compared to tenon’s

tissue. Outer layer labelling however was similar to control tenon’s for most ECM molecules. Significantly increased

cellular expression of aSMA (p=0.02) and TGFß (p=0.008) was detected within capsular tissue compared to controls.

Conclusion: Our results suggest profibrotic activity indicated by increased aSMA and TGFß expression and decreased

expression of proteoglycan (decorin and lumican) and glycosaminoglycans (chondroitin sulfate), which further stimu-

lates TGFß signalling. Additionally, decreased collagen III coupled with increased TGFß and aSMA is also linked to

increased myofibroblast contractility. Together these events lead to tissue dysfunction potentially resulting in hydrau-

lic resistance that may affect aqueous flow through the capsular wall.


Diagnostic Accuracy of Spectral Domain Optical Coherence Tomography and Scanning Laser Tomography

for Identifying Glaucoma in Myopic Eyes

Rizwan Malik, Anne C. Belliveau, Glen P. Sharpe, Lesya M. Shuba, Balwantray C. Chauhan, Marcelo T. Nicolela

Purpose: Ruling out glaucoma in myopic eyes often poses a diagnostic challenge because of atypical optic disc mor-

phology and visual field defects that can mimic glaucoma. We determined whether neuroretinal rim assessment based

on Bruch’s membrane opening (BMO), rather than conventional optic disc margin (DM)-based assessment or retinal

nerve fiber layer (RNFL) thickness yielded higher diagnostic accuracy in myopic glaucoma patients.

Methods: Case-control, cross sectional study with myopic glaucoma patients (n=56) and myopic normal controls

(n=74). Myopic subjects with refraction error greater than -2 D (spherical equivalent) and typical myopic optic disc

morphology, with and without glaucoma, were recruited from a glaucoma clinic and a local optometry practice. The

final classification of ‘myopic glaucoma’ or ‘myopic control’ was based on consensus assessment by 3 clinicians of

visual fields and optic disc photographs. Participants underwent imaging with confocal scanning laser tomography for

measurement of DM rim area (DM-RA) and with spectral domain optical coherence tomography (SD-OCT) for quan-

tification of a BMO based neuroretinal rim parameter, minimum rim width (BMO-MRW) and RNFL thickness. Sen-

sitivity of DM-RA, BMO-MRW and RNFL thickness at a fixed specificity of 90% and partial area under receiver

operator characteristic (ROC) curves for global and sectoral parameters for specificities = 90% (pAUC) were the main

outcome measures.

Results: Sensitivities at 90% specificity were 30% for DM-RA, and 71% for both BMO-MRW and RNFLT. The

pAUC was higher for the BMO-MRW compared to DM-RA (p<0.001), but similar to RNFL thickness (p>0.5). Sectoral

values of BMO-MRW tended to have a higher, but non-significant, pAUC across all sectors compared to RNFL

thickness.

Conclusions: BMO-MRW is more sensitive than DM-RA and similar to RNFL thickness for the identification of

glaucoma in myopic eyes and offers a valuable diagnostic tool for glaucoma patients with myopic optic discs.

Ergonomic in Preventing Work-related Musculoskeletal Disorders in Ophthalmic Practice

Waleed A. Al-Rashed

Purpose: To increase the awareness of eye health care providers about work-related musculoskeletal disorders.

Method: Literatures review of all aspect of work related musculoskeletal disorders pertaining to eye care providers.

Results: Work related Musculoskeletal disorders (WRMSDs) among health care workers including Physicians, Regis-

tered nurses, dental hygienist, and Custodial worker are well known. It has being noticed anecdotally and recently

substantiated by different studies an increase in the prevalence of WRMSDs on the above mention groups. Ophthal-

mologist in particular along with dentist and other surgical specialties (Laparoscope surgeon) are at even high risk of

developing WRMSDs. This was attributed to the nature of the job with prolonged awkward position and repetition.

This poster will try to highlight the most important areas where health care providers especially the ophthalmologist

should take care and aware of to prevent or at least reduce the WRMSDs. In different areas of work including:

A) In the clinic: The proper way of sitting and conducting slit lamp examination with or without the uses of different

lenses. How to perform indirect ophthalmoscope with the least stressful way to cervical and lumbar spine.

B) In the work station: How to select ergonomic and comfortable chair, tables, mouse, keyboard, screen and foot rest.

c) In the operating room: Tips in how to adjust surgeon chair, microscope, and operating table. Also hint in the proper

way to select and use of surgical loop.

High quality illustrations and photos will be included to help better understanding the massages.

Conclusion: Adopting a healthy posture and good basic ergonomics habit in different areas of ophthalmic works early

in the medical career and maintain regular exercise will reduce those unwanted Musculoskeletal squeals and hopefully

leading to prolonged most productive healthy career life.


Genetics of Congenital Glaucoma in Saudi Arabia, Phenotype-Genotype Correlation

Leen J.Abu Safieh

Purpose: Primary congenital glaucoma (PCG) is an autosomal recessive disorder, affects children between birth and 3

years old and cases improper development of the eye’s aqueous outflow system that results in optic nerve damage and

significant vision loss. PCG is predominantly caused by mutations in the CYP1B1 gene. The aim of the study is to

understand more about the genetic/environmental factors verse the phonotypic presentation that affect the develop-

ment and course of PCG in Saudi patients which will eventually help in diagnosis and patients care. PCG is more

common in Saudi Arabia than many other parts of the world. To date 3 mutations has been reported to be the major

cause of glaucoma in the Saudi population.

Methods: In this study we screened our cohort 75 of PCG families at KKESH for the common CYP1B1 mutations. We

collected blood and extracted DNA from affected individuals and available relatives. We performed PCR and direct

sequence analysis to detect mutations and perform genotype/phenotype correlation.

Results: In this study we identified one novel missense mutation to be responsible for disease in less than 1% of the

cases, the previously reported p.G61E mutation is found to be responsible for approximately 40% of all cases, empha-

sizing on the founder effect expected from a consanguineous population like the Saudi population. Screening our

cohort against the previously reported p.R469W mutation showed that it is responsible for approximately 1% of the

cases. Approximately 34% were negative for mutations in CYP1B1, disease in these cases would be either due to

regulatory or deep intronic mutations in the CYP1B1 gene or any of the other glaucoma known genes.

Conclusion: These results along with the clinical evaluations are being used in genotype phenotype correlation and

genetic counseling for family with PCG. We analyzed the age of onset, vision severity, myopia and other clinical

features and found significant different between the 3 mutations group.

Th2B – Optometry – Color Vision

Color Vision Processing in the Visual System: Retina to Cortex

Michael Kalloniatis

This is the introductory lecture for the series outlining the three fundamental discrimination functions: brightness, hue

and saturation. These core discrimination functions will be discussed including the processing of color vision informa-

tion in the visual system, prevalence of congenital color vision deficiencies and the design of color vision tests.

Color Vision Testing

Michael Kalloniatis

The aim of this lecture is to review clinical color vision testing using pseudo-isochromatic plates like the Ishihara;

sorting tests eg, Farnsworth panel D15, 100 hue and color matching tests like the Nagel as well as lantern tests used in

some occupational testing. A scheme will be developed to allow discrimination of different types of congenital color

vision deficiencies using a battery of color vision tests.


Congenital and Acquired Color Vision Deficiencies

Michael Kalloniatis

The aim of this lecture is to provide strategies on testing for congenital and acquired color vision deficiencies in

clinical practice. Various clinical color vision tests will be used to illustrate the different types of color vision deficien-

cies, including the application of Koellner’s rule to help differentiate the different types of acquired color vision

deficiencies. Examples from clinical cases seen at the Centre will inform differential diagnosis of acquired color vision

results.

Giving Practical Advice Relating to Color Vision Results

Michael Kalloniatis

The lecture will focus on occupational standards and other advice optometrists can provide relating to color vision

deficiencies or color vision aptitude. Examples will be provided where defective color vision has led to major acci-

dents: both recent as well as a historical perspective.


Poster Abstracts

1. Fungal Sclerokeratitis

Salem Al-Malki, MD; Abdulrahman Gormallah Al-Malki, MBBS

Inflammatory scleral disease is frequently associated with autoimmune disorders and only occasionally caused

directly by an infective agent. Fungal infections primarily involving the sclera are rare, and the outcome is

generally poor. Here we report patients with post-trumatic scleritis who was successfully managed by medical

therapy.

2. Post BKpro Endophthalmitis in Steven Johnson Syndrome Patient due to Streptococcus Agalacticae

Donald Stone, MD; Igor Kozak, MD; Omar Kirat, MD; Mohammad Ahmed Talea, MD; Humoud Mohammad

Al-Otaibi, MBBS

Purpose: To report undescribed case of Streptococcus agalacticae related endophtlamitis in a 25 years old male

patient with Boston Keratoprosthesis due to severe corneal scarring in Steven Johnson syndrome.

Methods: The patient was placed on fortified topical antibiotic regime, lunrication and systemic antibiotics.

Then, was started on systemic corticosteroids after questionable choroidal detachment on B-scan ultrasound.

After increase in ocular pain, intravitreal tap and injections of vancomysin and ceftazidin were performed. The

pain subsided but the vision was the same two days post treatment. The vitreous culture showed b-hemolytic

Streptococcus agalacticae with no fungal elements

Results: On follow-up visit two weeks later, the patient improved after treatment and became pain free, vision

improved to 20/200 and anterior segment was quiet.

Conclusion: In patients with Boston KPro the risk to develop endophtlamitis due Streptococcus agalacticae was

not described before. K-Pro surgery allows for visual recovery in patients who do not have other options for

vision restoration. While advances have been made with prophylaxis, patients with K-Pro still maintain a lifetime

risk of endophthalmitis.

3. Genetics of Congenital Glaucoma in Saudi Arabia, Phenotype-Genotype Correlation

Leen Jameel Abu Safieh, PhD; Leyla Al Djasim, MD; Ohood Owaydha, MD; Deepak Edward, MD

Purpose: Primary congenital glaucoma (PCG) is an autosomal recessive disorder, affects children between birth

and 3 years old and cases improper development of the eye’s aqueous outflow system that results in optic nerve

damage and significant vision loss. PCG is predominantly caused by mutations in the CYP1B1 gene. The aim of

the study is to understand more about the genetic/environmental factors verse the phonotypic presentation that

affect the development and course of PCG in Saudi patients which will eventually help in diagnosis and patients

care. PCG is more common in Saudi Arabia than many other parts of the world. To date 3 mutations has been

reported to be the major cause of glaucoma in the Saudi population.

Methods: In this study we screened our cohort 75 of PCG families at KKESH for the common CYP1B1 muta-

tions. We collected blood and extracted DNA from affected individuals and available relatives. We performed

PCR and direct sequence analysis to detect mutations and perform genotype/phenotype correlation.

Results: In this study we identified one novel missense mutation to be responsible for disease in less than 1% of the

cases, the previously reported p.G61E mutation is found to be responsible for approximately 40% of all cases,

emphasising on the founder effect expected from a consanguineous population like the Saudi population. Screening

our cohort against the previously reported p.R469W mutation showed that it is responsible for approximately 1% of

the cases. Approximately 34% were negative for mutations in CYP1B1, disease in these cases would be either due

to regulatory or deep intronic mutations in the CYP1B1 gene or any of the other glaucoma known genes.

Conclusion: These results along with the clinical evaluations are being used in genotype phenotype correlation


and genetic counselling for family with PCG. We analysed the age of onset, vision severity, myopia and other

clinical features and found significant different between the 3 mutations group.

4. Combined Central Retinal Artery Occlusion with Central Retinal Vein Occlusion after Blunt Trauma

Mohammad Abdullah Al-Amry, MD; Hassan Al-Dhibi, MD; Sahar M ElKhamary, MD; Abdulrahman Al-Qaeed

Purpose: To report a case of trauma to the Right eye while running and felled down on a sharp object.

Method: Case report

Result: A-20-year old male presented to the emergency room referred as a case of blunt trauma to his right eye.

He lost the vision in that eye immediately. On examination the best corrected visual acuity was No Light Percep-

tion (NLP) right eye and 20/20 in the left eye. Intraocular pressure (IOP) was 7 mmhg in the right eye and 10

mmhg in the left. Lids and adnexa were normal with no proptosis or ptosis and the extra ocular movement

showed full range of movement, conjunctival abrasion with sub conjunctival hemorrhage noticed, 2 conjunctival

sutures was performed locally .cornea was clear and anterior chamber deep with occasional cells, pupil showed

+ 4 pupillary afferent defect (APD).lens was clear .The possibility of globe ruptured ruled out. Optic disc was

swollen, hyperemic with picture of central retinal artery occlusion where retina background was pale with severe

neurosensory retinal layer edema, associated with tortuous veins, clotted blood seen in the major veins, scattered

retina hemorrhages going with the picture of central retina vein occlusion (Fig 1A-D). Intravenous Fluorescein

Angiography (FFA) and Optical Computed Tomography (OCT) confirmed the occlusion of both central retinal

artery and vein but normal choroidal fillings (Fig 2). The examination of the left eye was unremarkable. The

impression was combined central artery occlusion associated with central vein occlusion. Compression of optic

nerve (retrobulbar) to be ruled out. Computed Tomography CT scan was done to role out optic verve compres-

sion or optic Nerve avulsion but did not show any signs of Optic Neuropathy. Magnetic Resonance Imaging

(MRI) was performed and showed diffuse thickening and near total effacement of the subarachnoid CSF space

around the right optic nerve which appear markedly altered signal intensity with widening and broadening in the

first few millimeters. Mild edamtous swelling related to levator paplpera superior complex and superior oph-

thalmic vein (Fig 2 a-f). Partial optic nerve avulsion was suggested. A week later was seen in neuro-ophthalmol-

ogy and retina clinics with large angle exotropia. Global pallor with arterial attenuation and scattered retinal

hemorrhages and both opinions agreed on the diagnosis of combined central retinal artery associated with central

retinal vein occlusion

5. Signal Transducer and Activator of Transcription 3 Expression is Regulated by High-Mobility Group

Box-1 Protein in Diabetic Retina

Deema Essam Jomar, MBBS; Ghulam Mohammad, MD; Ahmed M. Abu El-Asrar, MD, PhD

Purpose: The expression of high-mobility group box-1 (HMGB1) and signal transducer and activator of tran-

scription 3 (STAT3) is upregulated in the diabetic retina. We hypothesized that the activation of STAT3 is under

the control of HMGB1.

Methods: Retinas from 1-month diabetic rats and from normal rats intravitreally injected with HMGB1 and

retinal müller cells (MIO-M1) stimulated with HMGB1 or 30mM glucose were studied by Western blot analysis

and immunofluorescence. We also studied the effect of the HMGB1 inhibitor glycyrrhizin on STAT3 transloca-

tion and diabetes-induced STAT3 expression in the retinas of rats (n=5-7 in each groups).

Results: Treatment of retinal müller cells with recombinant HMGB1 induces nuclear translocation of STAT-3,

but did not alter the STAT-3 expression. High gluocse induced significant upregulation of HMGB1 and STAT-3

in retinal müller cells and glycyrrhizin co-treatment normalized the HMGB1-induced upregulation of HMGB1

and STAT-3 expressions. Furthermore, our data show that intravitreal administration of HMGB1 in the vitreous

of normal rats and diabetes increases STAT-3 expression. The HMGB-1 inhibitor GA attenuated diabetes-in-

duced upregulation of STAT-3 in the retina.

Conclusions: The results of this study suggested the role of HMGB-1 in the modulation of STAT-3 expression in

the diabetic retina.


6. Late Onset Endophthalmitis Associated with Unexposed Glaucoma Valve Drainage Device

Abdulaziz Al-Hadlaq, Salem Al-Malki, Sami Al-Shahwan

Purpose: To report an extremely rare presentation of late-onset endophthalmitis in a patient with an unexposed

Ahmed tube implant.

Design: Retrospective case report.

Methods: A young adult female presented with endophthalmitis associated with Ahmed tube implant. The im-

plant was inserted 11 years prior to presentation. There was no history of trauma or any obvious exposure on

clinical examination and the tube plate was filled with purulent material.

Results: After aqueous and vitreous tap, the patient underwent intracameral, intravitreal subconjunctival antibi-

otic injections and was started on systemic antibiotics with good response.

Conclusion: Endophthalmitis associated with tube drainage device can presents as late as 11 years and even

without an unexposed tube.

7. Atypical Presentation of Cone-rod Dystrophy with Huge Bull’s Eye Maculopathy and Diffuse Vascular

Leakage

Hamad Mohammad Al-Sulaiman, MD; Sawsan R Nowilaty,MD; Patrik S Schatz, MD

Purpose: Cone-rod dystrophies are characterized by primarily cone dysfunction/degeneration with associated

rod dysfunction. Diffuse vascular leakage and huge bull’s eye maculopathy have not previously been reported in

the context of cone rod dystrophy.

Methods: Retrospective review of two male sibling’s KKESH records.

Results: The two male siblings (26 year old and 16 year old) were diagnosed with con-rod dystrophy based on

visual complaints, fundus appearance, autoflurescnce, and Full field electroretinography. Both carried huge

bilateral hyperautofluorescent bull’s eye lesions covering the posterior poles. In addition, the eldest brother was

found have para-arterial blockage of dye in the early and late phases of the FA with some subtle paravenous

staining and vascular leakage throughout the retina all the way to the far periphery. He underwent Uveitis work-

up investigations in the form of CBC, ESR, CRP, LFT, ANA, Anti DS-DNA Antibody, calcium, Syphilis Serol-

ogy, PPD testing, and chest x-ray and they were all within normal limits.

Conclusion: To the best of our knowledge this diffuse vascular leakage without telangiectasia or exudation, and

huge bull’s eye maculopathy has not been reported in association with cone rod dystrophy.

8. Retinal Complications After Anterior versus Posterior Chamber Phakic Intraocular Lens Implantation

in a Myopic Cohort

Abdulelah Abdulaziz Al-Abdullah, MD; Mohammad A. Al-Falah, MD; Saba A. Al-Rasheed, MD; Rajiv

Khandekar, MD; Enrique Suarez, MD; J. Fernando Arevalo, MD

Purpose: To compare the incidence and characteristics of retinal complications following implantation of two

types of phakic intraocular lenses (PIOLs) in patients with myopia.

Methods: In this comparative, retrospective study, 603 eyes of 344 patients with myopia underwent implantation

of either an Artisan iris-fixated phakic intraocular lens IOL (Artisan; Ophtec, Groningen, Netherlands) (Artisan

group) or a Visian implantable collamer lens (ICL; STAAR Surgical Company, Monrovia, CA) (ICL group)

between June 2005 and December 2013. Preoperative, operative, and postoperative clinical data were collected

on the incidence of retinal complications, including rhegmatogenous retinal detachment (RRD) or choroidal

neovascular membrane (CNVM).

Results: The Artisan lens was implanted in 185 (30.68%) eyes and 418 (69.32%) eyes underwent ICL implanta-

tion. Mean follow-up was 26.78 months (range: 9 days to 98 months). Mean preoperative spherical equivalent

(SE) was -12.44 ± 4.43 D (range: -1.13 to -31.00 D). The overall rate of retinal complications was 1%. Postopera-

tively, 3 (0.7%) eyes developed RRD in the ICL group, and no eyes developed RRD in the Artisan group.

Submacular hemorrhage was observed in 1 (0.24%) eye in the ICL group. Two (1%) eyes developed CNVM in


the Artisan group. The mean time from PIOL implantation to retinal complications was 15.6 months (range: 0.03

to 43 months).

Conclusions: Implantation of ICL or Artisan phakic IOL demonstrated comparable rates of retinal complications.

Anterior chamber PIOL does not increase the risk of retinal detachment or CNVM in patients with myopia.

9. Acupuncture Treatment in Patients with Retinitis Pigmentosa, Tapetoretinalabiotrophy and Macular

Dystrophy

Md Anwarul Md Anwarul Azim, MD; Kuznetsova T.S, MD

Background: Retinitis Pigmentosa,Tapetoretinal Abiotrophy and Macular Dystrophy are fairly common diseases,

yet little is known about their causes and conventional treatment with surgery or drug are largely ineffective, it

remains a major problem of modern ophthalmology.

Objectives: To evaluate the effectiveness of acupuncture and bioresonance therapy (BRT) in patients with above

mentioned diseases.

Methods: In my Clinic Doctor Azim Ltd 17 patients, aged between 25-40 with retinitis pigmentosa, tapetoretinal

abiotrophy of retina and macular dystrophy have been surveyed and passed the treatment by acupuncture and

BRT. All treatments are carried out by me and consist of 10-12 sessions for 25-30 minutes each over 2-3 weeks.

This is followed by continuous acupressure applied to some acupoints and bioresonance therapy (BRT) by fixed

frequency waves (impulses), BRT along meridians (organs and systems) for one year supervision.

Results: All patients regardless of their age noticed general somatic symptoms improvement, irritability de-

crease, sleep normalization, visual fatigue decrease. In all cases an increase of visual acuity from 10 up to 20%,

near vision and visual field restoration were marked. Some subjective symptoms have also disappeared or have

considerably reduced, enhanced clarity of vision, colors being brighter, better focus. The patients also noted

significant downturn of light sensitivity in the macular part of retina threshold values.

Clinical Examples: Patient aged 24; OE Vis: OD 0,01; OS 0, 2; IOP OU normal; DS. Abiotropy of retina, Retin-

opathy OU

After Acupuncture treatment, BRT and Color therapy:

Vis: OD 0,1 BCVA 0,3; OS 0,5

Case History: Patient aged 23; OE Vis: OD per L in certa; OS per L certa; IOP OU normal; DS: Retinitis Pigmentosa,

Atrophy of Optic Neuropathy OU (after removing brain tumour)

After Acupuncture treatment, BRT and Color therapy:

Vis: OD 0,09; OS 0,04

After a second course of treatment (3 months later)

Vis: OD 0,15; OS 0,05

Comments: The patient reported on almost immediate noticeable improvement in vision, specially near vision.

Additionally, the patient reported on a significant decrease in her anxiety levels. She now enjoys a new sense of

well-being after the treatment.

Conclusions: Acupuncture and bioresonance therapy are highly effective non-medicamentous ways of treatment

of these diseases. Acupuncture offers clear advantages and can be seen as a useful addition to standard treatment.

By using these methods results in partial or full restoration of visual functions which is both effective and safe. In

carrying out the above mentioned therapy adverse side effects and complications have not been revealed.

10. Effect of Vitamin Deficiency and Insufficiency on Patient with Diabetic Retinopathy

Amjaad Hamad Al-Mohawis; Moutaz GUMA; Ahoud Al-Mutairi; Ghada Al-Duraye

Purpose: The aim of this study is to explore the hypothesized effect of vitamin D deficiency on diabetic retinopa-

thy severity.

Methods: This observational cross-sectional study was conducted in KAMC, ophthalmology department, Riyadh,

KSA. The subjects were randomly selected (n=159). Every Saudi patient with DRP and aged between 30 to 70

years old was included. A multinomial logistics regression model was used to examine if vitamin D is a signifi-

cant predictor of progression of DR and Chi-square test.


Results: There’s no significant relationship between DRP severity and vitamin D. The test revealed that the

probability of the model chi-square was more than the level of significance (p<0.05). There is no significant

relationship between DRP level and vitamin D. There’s no statistically significant relationship between DRP and

gender (p=0.110)

Conclusion: This study found no significant relationship between DRP severity and Vitamin D, which could be

explained by the small number of patients. Propose that Prior studies suggesting the possibility of anti-inflamma-

tory and antiangiogenic qualities of vitamin D. The relationship between vitamin D serum levels and DRP del-

egates further study.

11. Choroidal Thickness in Hypertensive Patients and Healthy Controls

Hanan Abdullah Al-Shalan, MD; Faisal Abdulaziz AlMobarak, MD

Purpose: To investigate the effect of hypertension on macular choroidal thickness, as measured by enhanced

depth imaging optical coherence tomography, and to compare it to healthy normal subjects.

Methods: A cross-sectional study takes place at King Abdulaziz University Hospital, Riyadh, Saudi Arabia. A

total of 10 eyes of hypertensive patients and 10 eyes of healthy controls were included. No ocular abnormalities

were detected. Eyes were examined using enhanced depth imaging optical coherence tomography.

Results: The mean macular choroidal thickness was (253 ± 80 µm) in hypertensive patients compared with (270

± 87 µm) in healthy controls with borderline significant difference (p=0.045).

Conclusion: Macular choroidal thickness was found to be significantly thinner in subjects with hypertension.

Such a difference must be taken into consideration whenever measuring choroidal thickness

12. Immunohistochemical Characterization of Subretinal Bands in Proliferative Vitreoretinopathy

Mohammed D. Al-Otaib, MBBS; Azza Maktabi, MD; Hind Al-Katan, MD; Deepak Edward, MD; Igor Kozak, MD

Subretinal bands are frequently associated with proliferative vitreoretinopathy (PVR) and their removal is essen-

tial for reattachment of the retina. Thyey are maily composed of reactive avascular plaques of retinal pigment

epithelial fibrous metaplasia with macrophage infiltration.

13. Chiasmal Optic Neuritis

Abdulaziz Mohammad Al-Hadlaq, MD; Aliyah Hadi Al-Amery, MBBS; Alberto Galvez, MD

Chiasmal optic neuritis (ON), a rare condition that affects the optic chiasm, is mostly associated with inflamma-

tory demyelinating disorders and may be the initial manifestation of multiple sclerosis (MS). In this study we

evaluated three cases of chiasmal optic neuritis. The clinical manifestations, neuroimaging results, and visual

prognosis were evaluated in each patient. Routine eye examinations and auxiliary examinations including Ishihara

color plate, determination of the visual field (VF) and magnetic resonance imaging (MRI) of the optic nerve and

chiasm were performed. All patients presented with reduced visual acuity and visual field defects. The abnormal

enhancement of the optic chiasm was clearly demonstrated on MRI in all three patients. Two of our studied

patients were associated with underlying disease. The first patient was diagnosed with MS and the second patient

was diagnosed with Devic syndrome. In the last patient no underlying disease was identified .The patients re-

ceived systemic administration of steroids. The patient diagnosed with MS fully recovered however the other

two patients only partially improved. In conclusion, although rare chiasmal optic neuritis should be considered in

patients who develop bitemporal hemianopia. MRI is the modality of choice for accurate diagnosis and early

diagnosis with proper treatment is essential for the restoration of visual function.


14. Duane Retraction Syndrome Associated with a Small X Chromosome Deletion

Taif A. Azad, M. Sc.; Khaled K. Abu-Amero, PhD; Altaf Kondkar, PhD; Hessa Al-Odan, MD; Arif Khan, MD;

Darren T. Oystreck, MMed Sci; Ali M. Hellani, PhD &Thomas M. Bosley, MD

Purpose: To describe the phenotype and genotype of a girl with bilateral syndromic Duane retraction syndrome

(DRS) associated with a small deletion of the dystrophin gene.

Methods: Clinical examination, neuroimaging, and retrospective chart review together with Sanger sequencing

of the genes SALL4, CHN1, HOXA1, TUBB3, and KIF21A and array comparative genomic hybridization.

Results: This 16 year old girl had bilateral DRS, cleft palate, and partial deafness. She and her parents had no

mutations in SALL4, CHN1, HOXA1, TUBB3, or KIF21A, but the patient had a 12 kb deletion in chromosome

X involving only a portion of the dystrophin gene not present in her parents. Several of the patient’s maternal

family members had strabismus, but none had DRS.

Conclusion: Three males with Duchenne muscular dystrophy (DMD) have been reported with unilateral or

bilateral DRS, but this is the first female with a dystrophin mutation described with syndromic bilateral DRS.

This patient raises the possibility that dystrophin may on occasion be a factor in the development of DRS, per-

haps with both myopathic and neuropathic contributions to DRS.

15. Pattern of Neuro-ophthalmic Cases Presented to King Abdul-Aziz University Hospital’s Emergency

Department in Riyadh, Saudi Arabia: A Two-year Retrospective Study

Abdulrahman Abdulaziz Al-Jasser, MD; Majed Mohammad Al-Obailan, MD; Yafa Abdulrahman Al-Shamlan, MBBS;

Lolwah Mohammed Alashgar, MBBS; Norah Ahmed Musallam, MBBS; Ahmed Mousa Abdul Rahim, MBBS

Purpose: To assess the pattern and epidemiological characteristics of neuro-ophthalmic cases presented to oph-

thalmic Emergency Department (E/D) at a tertiary referral hospital, King Abdulaziz University Hospital (KAUH)

in Riyadh, Saudi Arabia from May 2013 to April 2015.

Method: A retrospective study that implied all patients who presented to the ophthalmology E/D from may 2013

to April 2015 at KAUH. Data were collected from ophthalmic emergency registry book for all patients fulfilling

the inclusion criteria and were analyzed according to demographics, date of visit, diagnosis and management.

Results: Among the emergency cases that presented to KAUH for two consecutive years, 414 cases were diag-

nosed as neuro-ophthalmic patients. Mean (SD) age was 38.1(19.0) (ranging from 2 months-88 years). Of them,

93.5% were above 15 years of age, gender was almost equally distributed, with the majority being Saudi citizens.

Most of cases (78.3%) had unilateral ocular involvement, while (21.7%) were bilateral. Optic neuritis was the

most prevalent diagnosis comprising (22.5%) of neuro-ophthalmic emergencies, leaving (15%) for 6th nerve

palsy, (10.9%) 3rd nerve palsy, (8.7%) bilateral optic disc swelling, and (7%) 7th nerve palsy in addition to other

causes.

Conclusion: Above all Neuro-ophthalmic emergencies, optic neuritis was the most prevalent diagnosis followed

by 6th cranial nerve palsy then 3rd cranial nerve palsy. Early detection and referral of Neuro-ophthalmic cases

would enable delivering the optimal healthcare to such cases.

16. Anophthalmic Chronic Inflammation due to RTV Orbital Implant

Silvana Schellini, MD; Alicia Galindo-Ferreiro, MD; Laila Al-Ghafri, MD; Sahar ElKhamary, MD; Azza

Maktabi, MD

Objective: To advise physicians about the possibility of chronic socket inflammation secondary to intraorbital

implants used to enhance anophthalmic socket volume or orbital fracture repair.

Cases report: Two anophthalmic cases who had enucleation and multiple orbital surgeries to improve the sunken

sockets developed pain, intense discharge and contracted cavities with chronic inflammation in the socket no re-

sponsive to clinical treatment. CT scan showed in each patient a hypodense foreign body involved by intense

inflammatory reaction. Both patients had the implants removed by excisional surgery and a RTV (Room themperature

vulcanize) silicone implant was recognized. After the implant removal patients had no more socket inflammation.


Conclusions: Chronic inflammation in the sockets from patient who had previous surgeries and received im-

plants should be suspected of intraorbital inflammatory reaction against the applied implant. We confirmed our

diagnosis using image exams and the definitive treatment was the implant removal.

17. Outcomes of Two Surgical Techniques for Major Trichiasis

Silvana Artioli Schellini, MD; Lucieni Barbarini Ferraz, MD; Roberta Lilian Fernandes de Sousa Meneguim,

MD; Alicia Galindo-Ferreiro, MD; Ana Cláudia Viana Wanzeler, MD; Michelli Massae Saruwatari; Larissa

Horikawa Satto; Carlos Roberto Padovani

Purpose: To analyze the patient outcomes of two surgical techniques for major trichiasis.

Method: A retrospective chart review was performed of 67 patients (89 eyelids) with major trichiasis who under-

went surgical treatment using one of two techniques: Van Millingen (intermarginal split with graft; ISG group)

technique or lid anterior lamella resection (ALR group). There were 30 eyelids in the ISG group with mean

patient age of 71.8 years and 63.3% were females. There were 59 eyelids in the ALR group with mean patient

age of 72.5 years and 52.5% were female. The minimum postoperative follow up was 6 months. Statistical

analysis included descriptive measures, Goodman association test for contrasts between and within multinomial

populations and non-parametric Mann Whitney test for comparison between groups. P<0.05 was considered

statistically significant.

Results: The underlying causes of trichiasis were, blepharitis (37.07%), chronic meibomitis (21.3%), multiple

causes (20.2%), ectropion (11.2%), actinic keratosis (6.7%) or prior ocular surgery (3.3%). Postoperatively, in

the ISG group, there were 20% eyelids with complete success, 50% underwent laser or electrolysis, 16.7% re-

quired further surgery and 13.3% were unsuccessful. Postoperatively, in the ALR group there were 47.5% eyelids

with complete success, 46.7% underwent laser or electrolysis, 6.8% required further surgery and 5.1% were

unsuccessful. There was a higher statistical chance of complete success with ALR (P<0.05).

Conclusions: ALR is superior than ISG surgery for major trichiasis. There is a greater chance of success with

ALR and it is technically simpler.

18. Analysis of Toll-like Receptor rs4986790 Polymorphism in Saudi Patients with POAG

Mohammad Taif Anwar Azad, MD; Saleh A. Al-Obeidan, MD; Altaf A. Kondkar, MD; Ahmed Mousa, MD;

Tahira Sultan, MD; Essam A. Osman, MD; Khaled K. Abu-Amero, PhD

Purpose: To investigate whether SNP rs4986790 in Toll-like receptor 4 (TLR) is a risk factor for primary open

angle glaucoma (POAG) in Saudi population.

Method: A cohort of 85 unrelated POAG patients and 95 unrelated control subjects from Saudi Arabia were

genotyped utilizing Taq-Man(r) assay. The association between mutant genotypes and various clinical indices

important for POAG was investigated.

Results: Among cases, the normal pattern (A/A) was detected in 70 (82.4%) of subjects, A/G in 14 (16.5%) and

G/G in one subject only (1.2%). Among controls, prevalence of the genotype (A/A) was detected in 86 (90.5%),

the (A/G) genotype in 8 (8.4%) and homozygous mutated genotype (G/G) in 1 (1.1%) subjects. Comparing cases

to controls, the odds ratio of having heterozygous mutation (A/G) was 2.15 [95% CI: 0.853 - 5.417], which was

not significant (p= 0.114). The odds ratio of having homozygous mutation (G/G) was 1.22 [95% CI: 0.075 -

19.99], which was statistically significant (p= 0.568). Likewise, the presence of the mutated allele (G) was

insignificantly different between cases and controls (p= 0.154). Comparing cases to controls as regards co-

morbidity with other systemic diseases, there were no statistically significant difference between groups in all

assessed diseases except for a family history of glaucoma (p = 0.014)

Conclusion: In conclusion, we could not detect any direct link between genotypes or allele frequencies of SNP

rs4986790 in the TLR4 gene and POAG. In contrast, genotype (A/A) may be protective against POAG espe-

cially among individuals with no family history of glaucoma.


19. Congenital Hemifacial Hypertrophy and Glaucoma

Reham Dakam Al-Qahtani, MBBS; Halla Al Abdul-Hadi, MBBS; Ahmed Al-Habash, MD; Sami Al-Shahwan, MD

Congenital Hemifacial hypertrophy (CHH) is a congenital malformation of unknown etiology characterized by

overgrowth of soft and hard tissues of one side of the head and face that may lead to ocular manifestations

ptosis, ectropion uvea, and glaucoma. Ipsilateral hemifacial hypertrophy often associated Prader Willi syndrome,

and neurofibromatosis. The diagnose of the disease is challenging since it is even rare than the true form to be

encountered in clinical practice. We report a case of a 30 years old female with congenital ectropion uveae,

glaucoma, ptosis,ipsilateral hemifacial hypertrophy and proptosis that ended with No Light Perception vision(NLP)

and optic atrophy.

20. Paintball Ocular Injury

Mohammad Al-Amry, MD; Nora Abdulmohsen Al-Yousif, MBBS; Halla Al-Abdulhadi; MBBS;

Huda A Al-Ghadeer, MD

Purpose: To present 3 cases of severe ocular injuries after trauma by paintball gun pellets

Method: Case report

Results: We had 3 cases presented to the emergency room at King Khaled Eye Specialist Hospital (KKESH) on

separate occasion after they sustained trauma by paintball gun pellets while involved in recreation games.one

case developed vitreous hemorrhage, commotion retinae with choroidal detachment, later he developed retinal

tear managed by laser retinopexy, he ended by vision of best correction 20/160 while 2 cases had severe hyphema

and developed cataract later on managed by cataract surgeries and lens implantation whom they regained vision

in the range of 20/30.

Conclusion: The paintball game is new to our community and needs safety roles, it resulted in severe ocular

injuries , it needs more highlighting of safety and awareness.

21. Compliance of Glaucoma Patients to Ocular Hypertensive Medications among the Saudi Population

Priscilla Wairimu Gikandi

Purpose: To evaluate the compliance of glaucoma patients to medical treatment and its impact on the intraocular

pressure (IOP) and to verify the associated risk factors for noncompliance.

Methods: All recruited patients were examined at the ophthalmology clinics of King Abdulaziz University Hos-

pital, Riyadh, Saudi Arabia between May and August 2012. Patients were interviewed and subjected to answer a

questionnaire that was developed based on a pilot test. Collected data included age, gender, number of prescribed

drugs, and different reasons for noncompliance to the prescribed drugs.

Results: Noncompliance was detected in 18 (19.4%) of the recruited patients. Factors associated with noncom-

pliance demonstrated a trend toward older patients, males, patients with lower IOP at presentation, higher cup to

disc ratio, and drug self-administering patients. However, the only statistically significant characteristic was

being under lifelong medications (P = 0.005).

Conclusion: Noncompliance was detected in around one-fifth of our glaucoma patients, particularly, the older

group. Awareness programs, maintaining good patient-physician relationship, and personalizing treatment can

lead to better adherence to treatment.

22. Severe Bilateral Episcleritis after Incidental Trauma by Eye Lashes Serum

Mohammad Al-Amry, MD; Halla Ahmed Al-Abdulhadi, MD; Nora Abdulmohsen Al-Yousif; Saleh Al-

Othaimeen, MD

Purpose: To present a case of severe bilateral episcleritis after use of eyelashes serum


Method: Case report

Results: A 50-year old lady presented to the emergency room complaining of severe redness and ocular pain in

both eyes after she used an eye lashes serum for cosmesis incidentally the chemical substance spilled into the

eyes on examination she had bilateral severe episcleritis with clear cornea and quiet anterior chamber did not

have visual disturbances BCVA:20/20 both eyes she was managed with application of topical steroid in the form

of fluorometholone drops 4 times daily for 2 weeks she recovered completely in 1 week with no sequelae

Conclusion: Cosmetic products can spill into the eyes and cause severe ocular surface inflammation like episcleritis.


Video Abstracts

1. Double Layer AMT for Conjunctival Reconstruction after Recurrent Squamous Cell Carcinoma

Hernan M Osorio, MD

Purpose: A 69-yr-old male diagnosed of temporal recurrent pterygium OD attended consultation for second

opinion.

Method: The patient clinical appearance was very concerning for OSSN. OSSN excision was done and conjunc-

tival reconstruction with double layer AMT was obtained. Histopathologic analysis demonstrated squamous cell

carcinoma without horizontal or margins extension. Topical chemotherapy with topical interferon alpha 2B (1

million units/mL) four times per day was administrated for 3 months.

Results: Double layer AMT and Interferon alpha 2B allowed complete remission of squamous cell carcinoma

without recurrence after 5 years. However by conjunctival impression cytology, goblet cells were absent over

AMT.

Conclusion: Double layer AMT and Interferon alpha 2B is useful to treat squamous cell carcinoma. Amniotic

membrane is fully integrated with the surrounding conjunctiva but not replace the normal epithelium.

2. Surgical Treatment of Conjunctival MALT Lymphoma

Hernan M Osorio, MD

Purpose: A 45-yr-old female was referred for confirmed conjunctival reactive lymphoid hyperplasia OS.

Method: Conjunctival biopsy was compatible with Conjunctival MALT Lymphoma OS. Systemic work up dis-

carded systemic extension and bacterial origin (Chlamydia sp or H. pylori). Patient refused local radiotherapy.

360º Conjunctival MALT Lymphoma excision was done and 3 cycles of rituximab chemotherapy was com-

pleted.

Results: After 5 years of follow-up patient has complete clinical remission.

Conclusion: Conjunctival MALT lymphoma can be successful treated with local excision and systemic chemo-

therapy with rituximab. Local side effects of radiotherapy, as cataract and dry eye, can be avoided with surgical

excision and systemic chemotherapy.

3. Corneal Subepithelial Hemorrhage: Diagnosis and Management

Salman Abumazyad, MD

A 72-year-old man complained of sudden loss of vision on his left eye upon waking up this morning. He gave a

history of uncomplicated cataract surgery of the same eye few years back. no history of contact lens wearing.

Ocular examination showed hemorrhagic corneal epithelium cyst that has no communication with anterior cham-

ber, Peripheral corneal vessels were seen at different portions of the cornea and the epithelial surface did not

reveal any fluorescein staining. Epithelial cyst was drained using fine needle puncture through the most inferior

part of the cyst resulted in complete passive blood drainage with excellent corneal clarity.

4. The Management of Black Cataract with Pseudoexfoliation (Pxf) and Phacodonesis in Small Pupil


Pseudoexfoliation, due to zonular instability with Phacodonesis and poor pupillary dilation, have been identified

during pre-op exam as high risk factors for surgical complications that require careful preoperative planning and

intraoperative care to ensure successful and safe surgery. The use of specialized adjunctive devices such as

highly cohesive viscoelastics, iris retractors and capsular tension devices has increased the margin of safety in

these potentially complex cataract surgeries.


5. Challenging Cataract Surgery in Case of Corneal Cystinosis


Cystinosis is a rare AR disorder characterized by widespread tissue deposition of non-protein cystine crystals as

a result of a defect in lysosomal transport. The deposition of cystine crystals in the cornea causes visual disability

and opacity which makes cataract surgery a challenge. Phacoemulsification and posterior chamber intraocular

lens implantation was performed under topical anesthesia. A procedure that was complication free and the patient

had excellent UCVA.

6. Cataract Management in Marfan’s Syndrome: Techniques and Outcomes


Cataract surgery in Marfan’s syndrome is a challenge with hallmark issues such as lens subluxation and progres-

sive zonular dehiscence. Phacoemulsification and Artizan lens implantation was done for a 40-year-old man,

under topical anesthesia for both eyes one week apart. No complications were encountered intraoperatively for

any of the eyes. one month Post-Op, the patient had (20/20) UCVA in both eyes

7. Management of Subluxated Lens

Saad Saleh Al-Harbi, MD

Purpose: To present surgical management of three cases in which the lens is subluxated.

Method: Surgical managements with different approaches will be presented to overcome difficulties that oph-

thalmologist faced with subluxated lens after trauma or in association with Marfan or Weil-Marchesani syn-

drome.

Results: All cases result in excellent visual outcome without complications.

Conclusion: The surgical management of ectopia lentis has numerous challenges and options. The Key of suc-

cess in management of these cases is to have proper clinical evaluation and plan the right surgical approach to

ensure the best possible outcome.

8. Lessons from White Cataract

Abdulelah Abdulaziz Al-Abdullah

Purpose: To discuss the diagnosis and management of couple of interesting and challenging cases with white

cataract presented to a vitreoretinal surgeon.

Method: five cases with their surgical video will be discussed in term of diagnosis and management

Results: The first was for young lady with spontaneous posterior capsule rapture and drop lens material. Eventu-

ally she was found to have stickler syndrome managed with PPV, PPL. Second case was for elderly man pre-

sented with nuclear sclerosis cataract with DME. He was scheduled for surgery in 2 months. His nuclear sclerosis

changed to white cataract? No history of trauma But he had history of high IOP after leaving the clinic2 months

earlier. Can high IOP cause posterior capsule rapture? Case three: white cataract due to lens touch post vitrectomy

with drop lens material in the vitreous recognized accidently since her posterior capsule was intact!! Can poste-

rior capsule heal itself? Case 4: white cataract post SO Removal with posterior capsular fibrosis. During surgery

anterior capsule was extended due to high intra-capsular pressure in both directions. In addition an intentional

posterior capsulrhexis was made. IOL was placed in the sulcus. Case 5 white cataract deflated from the anterior


capsule but it was deflated from posterior capsule as well. It is most likely secondary to unrecognized lens touch

in a previous vitrectomy.

Conclusion: in this presentation lessons from white cataract will be extended in term of causes and management.

9. New Technique to Overcome Difficult Posterior Vitreous Detachment


Purpose: to illustrates a new technique for induction of Posterior vitreous detachment (PVD) in difficult cases.

Method: this video will contrast the traditional way of inducing a PVD by applying suction over the disc which

can be difficult or impossible in certain cases to a new technique which is safe and effective. A 53-year-old male

underwent triamcinolone assisted-pars plana vitrectomy with difficult PVD induction using the traditional way,

this difficulty was overcome using this technique.

Results: successful induction of the posterior vitreous detachment was demonstrated in this case using 23 guage

Tano Diamond Dusted Membrane Scraper and 23-gauge membrane pick. Gentle pressure applied over posterior

hayloid nasal to the disc to release the vitreous from the retina at a small spot. A membrane pick then was used to

hook the vitreous and pull it up leading to complete PVD.

Conclusion: This video will highlight a new technique to overcome difficult situation in inducing PVD.

10. Spontaneous Internal Limiting Membrane Detachment Mistaken as a Retinal Detachment


Purpose: To report a case of spontaneous internal limiting membrane detachment following traumatic

endophthalmitis in a child.

Method: A 3-year-old boy presented with history of needle injury to his right eye underwent uneventful core

vitrectomy for traumatic endophthalmitis with intravitreal antibiotics injections, two weeks after, in the postop-

erative visit a hazy view to the retina raised the suspicion of retinal detachment, B-scan showed retinal detach-

ment involving the macula.

Results: Pars plana vitrectomy was done based on the result of the B scan for repair the presumed retinal detach-

ment. Intraoperatively, we noticed that the internal limiting membrane (ILM) was detached with flat retina.

Confirmatory staining with brilliant blue demonstrated the extent of ILM detachment.

Conclusion: This video demonestrated a unique and rare observation of spontaneous ILM detachment which

could mimic retinal detachment on ultrasonographic examination.

11. Surgical Procedure of Implanting Argus II Retinal Prosthesis System


The Argus II Retinal Prosthesis System is FDA approved as a humanitarian use device and the first implanted

device to treat adults with severe retinitis pigmentosa. The System is designed to improve the visual function of

patients and may produce the sensation of light? it has three parts: a small electronic device implanted in and

around the eye, a tiny video camera attached to a pair of glasses, and a video processing unit that is worn or

carried by the patient.

Selecting patient properly and proper handling of the implant during the implantation procedure with extreme

care especially the electrode cable and array, are the key of success.

The video describing the surgical procedure and implantation of the Argus II Implant, which shows crucial steps

of handling the implant and taking the array it onto the retina.


12. Rhegamtogenous Retinal Detachment in Immunocompromised Patient with PORN Secondary to CMV

Infection


I am presenting a video of the surgical procedure with pre and post photo, and OCT for a 58 years old male with

history of Liver transplant 7 yrs earlier due to chronic viral hepatitis B presenting with a one month history of

decreased vision and floaters in his right eye increasing over the past week secondary to foveal sparing

rhegmatogenous retinal detachment with large break superior nasal to the disc developed in the area of large

retinal infiltrate and necrosis. Also multiple smaller vitreoretinal infiltrates and arterial sheathing were noticed

mainly posterior to the equator.

OCT showed marked intraretinal fluid and epiretinal membrane with foveal sparing subtotal retinal detachment.

Clinical picture of progressive outer retinal necrosis (PORN), and secondary RRD, with positive PCR sample for

Cytomegalovirus (CMV) infection in immuno-compromised post liver transplantation was the final diagnosis.

Pars Plana Vitrectomy , given extra precaution during vitrectomy to avoid the multiplicity of atrophic posterior

breaks in thin necrotic retina, endolaser, intravitral Ganciclovir 2mg/0.1 mL and Silicon Oil 5000 Centistockes

injections were done. PCR testing of his vitreous was positive for CMV. He was then seen by his hepatologiest

who started him on systemic antiviral agents Valcyte valgancicovit 450 mg tab.

The outcomes of this entity may be devastating and include blindness from complicated retinal detachment and

optic atrophy. While early diagnosis, potent specific and supportive drug therapy and surgical treatment remains

the key to successful management.

The prognosis of untreated such a case has traditionally been poor, however good visual outcome of 20/70 as a

result of aggressive surgical and supportive drug intervention in an efficient and timely manner in our case.

13. Funnel Shape Retinal Detachment: It Is Not Operable!! “My Fellow Said”

Abdulelah Abdulaziz Al-Abdullah, MD

Purpose: To illustrates the challenges and difficulties in managing chronic traumatic retinal detachment.

Method: 20-year-old male with history of road traffic accident resulted in ruptured globe with corneal scleral

wound repaired on another facility and referred with hyphema and retinal detachment.

Results: 7 weeks post his primary repair the patient underwent retinal detachment surgery for total funnel shape

RD base on the B scan. There was no view to the fundus due to hyphema. My fellow started the surgery by

cleaning the anterior chamber then he looked at the retina which was in a funnel shape with retinal tissue adherent

to the iris detachment and its complexity to declare that it’s not operable. With the help of perfluorocarbon heavy

liquid and 360 relaxing retinoectomy we managed to flatten the retina under silicone oil.

Conclusion: This video will highlight some techniques to overcome complex retinal detachment.

14. Replacement of Phakic IOL : Techniques and Outcomes


This is a 28 year old male patient who underwent Cachet phakic AC IOL implantation four years back some-

where else. The patient was not happy by the cosmetic appearance of his eye and was complaining of glare &

halos with VA 20/20 in this eye. Patient was offered an exchange of the AC IOL by a PC phakic IOL , namely the

STAAR Visian ICL. A procedure that was complication free and 20/20 UCVA with a great patient Satisfaction.


Participating Organizations

Special thanks to all sponsors for participating in the Saudi Ophthalmology 2016

Booth No. Name of the Sponsors/Exhibitors

Diamond SponsorsD1 Koln Health CareD2 Medicals InternationalD3 BayerD4 AMICOD5 Magrabi Eye Hospitals & Centers

Platinum SponsorsP2 Experts Medical Supplies Est.P3 Jamjoom PharmaP4 Abdulrehman Al Gosaibi G.T.CP5 The Eye ConsultantsP6 Bauch & LombP7 Gulf Medical CompanyP8 First Gulf Medical Company (Medical)

Gold SponsorsG1 Saudi Services & Health CAREG3 Basha Medical GroupG4 Zarka Al Yamama Lens FactoryG5 Al Basar Medical Supplies

Silver SponsorsS1 Media CenterS2 Saudi Ophthalmological Society (SOS)S3 & 111 Al-Riyadh Medical ServicesS4 Red Sea Ophthalmology Symposium (RSOS2017)

Exhibitors101 Riyadh Ophthalmology Residency Community AP103 King Saud University105 Al Jamil Optical106 Health Mirrors Est. for Trade108 Saudi Medical Journal109 MEACO110 Al Basar International Foundation

Contentssos.org.sa/Files/114037104004.pdf · Conference at a Glance ... but also extends to...

Documents

Transcript of Contentssos.org.sa/Files/114037104004.pdf · Conference at a Glance ... but also extends to...