Scientific Program

Conference Series Ltd invites all the participants across the globe to attend Global Pediatric Ophthalmology Congress London, UK.

Day 2 :

Keynote Forum

Birgit Lorenz

Justus-Liebig University Giessen
Germany

Keynote: RPE65 deficiency: Natural history and insights from gene therapeutic trials

Time : 09:30 AM

OMICS International Pediatric Ophthalmology 2016 International Conference Keynote Speaker Birgit Lorenz photo
Biography:

Birgit Lorenz was graduated from the University of Munich, Germany where she also specialized in Ophthalmology and Genetics and received her MD and PhD. She is currently a Professor of Pediatric Ophthalmology, Neuro Ophthalmology and Ophthalmic Genetics, Director and Chair of the Department of Ophthalmology at the Justus-Liebig University Giessen, Germany. She was the President of several scientific societies and is currently a President of the ISGEDR and elected Member of the AOI and EAO. She has lectured worldwide, published over 300 original papers (h-index 43), edited several books and was Reviewer for many peer-reviewed journals and grant applications. Her main research interests are inherited retinal disorders including gene therapy, development of new readout parameters and ROP.

Abstract:

Mutations in the RPE65 gene result in RPE65 deficiency (LCA2) with diminished or abolished retinol recycling manifesting in severe night blindness from infancy on together with variably reduced cone function and progressive retinal degeneration. The wide range of phenotypes results from different degrees of enzyme malfunctioning and spans Leber Congenital Amaurosis LCA, early onset severe retinal dystrophy EOSRD and juvenile RP. Gene replacement therapy in dogs with naturally occurring mutations in RPE65 was very successful. To date, at least 150 patients with RPE65 deficiency have been treated with sub retinal AAV injections to reconstitute protein function in USA, England and in France. Treatment effects were generally much more modest than in the dog. To document smaller treatment effects, it has turned out that new readout parameters had to be defined and developed. With the current approaches, there is a clear rod effect but a much smaller cone effect. Also, some data would indicate that the degeneration process was not stopped by the currently used set-up. One of the challenges is to get novel readout parameters accepted by the authorities. Another challenge is to define disease stages where therapy is more likely to be effective as well as optimizing the sub retinal AAV injection technique and dosing the most efficient vector titer. Of note, efforts are made by Spark Therapeutics® to receive FDA and EMA approval for an AAV vector to treat RPE65 deficient patients.

  • Special Session on Zika Virus
Speaker
Biography:

Bruna Ventura graduated from the Medical School of the University of Pernambuco and completed her residency training at the Altino Ventura Foundation, both in Recife, Brazil. Did a postdoctoral fellowship in cataract and refractive surgery at the Baylor College of Medicine, in Houston, USA. Obtained her Master Degree from the Federal University of Alagoas, in Maceio, Brazil, and is currently working on her PhD Degree. Is Head of the Cataract Department of the Altino Ventura Foundation. She has published more than 25 papers in reputed journals, written several book chapters, and serves as an editorial board member of two ophthalmologic journals.

Abstract:

The Zika virus (ZIKV) is a neurotropic flavivirus. It was first identified in a rhesus monkey in 1947, and first isolated in humans from Uganda a year later. However, only in 2007, a ZIKV outbreak was reported outside of Africa. This outbreak was characterized by rash, conjunctivitis and arthralgia. Another ZIKV epidemic occurred in the French Polynesia in 2013 and 2014. In April 2015, the first ZIKV autochthone transmission was confirmed in Brazil, followed by an epidemic scenario in the country. It is estimated that more than one million Brazilians have had ZIKV infection since then, reflecting the virus’ capacity to cause large-scale outbreaks where the vector is present. After the Brazilian ZIKV outbreak, an unexpected 20-fold increase of microcephaly in newborns was identified, with approximately 3,174 new suspect cases until January 2016. For the first time in history, this malformation has been associated with ZIKV intra-uterus infection. Since other vertically transmitted diseases can cause ocular alterations, ZIKV may also affect the eye. Literature is scarce regarding the ophthalmologic findings of infants with clinical diagnosis of ZIKV-related microcephaly. The Altino Ventura Foundation is a tertiary reference center in Ophthalmology in Recife, Pernambuco, Brazil, and has a Rehabilitation Center for patients with multiple disabilities. Since Pernambuco is one of the states with the highest prevalence of ZIKV-related microcephaly, several patients received ophthalmologic care at the Foundation. Thus, we have assessed the ocular findings of infants born with microcephaly during the Brazilian ZIKV epidemic.

  • Refractive Errors & Management
    Pediatric Glaucoma
    Neuro-Ophthalmology
    Dissociated Vertical Deviation
Location: London, UK
Speaker
Biography:

Janardan Kumar, PhD is a Professor of microbiology and chemistry at Becker College. He served as a chair of natural science department from 2011-2014. Prior to joining to Becker College, while a research associate/Assistant Professor at Duke University, he first proposed at the ARVO international conference, Fort Lauderdale, (1999) that the Rho-GTPase activation mediated through LPA and thrombin perfusion caused increase outflow resistance in porcine eyes. In 2001 while at Duke University he filed for intellectual property in the US on RGD-containing peptides as safe therapeutic alternatives for glaucoma therapy. The same molecule has been filed for patent in Japan, with additional international applications to follow.

Abstract:

The emerging evidence on Rho-GTPase studies in the field of glaucoma research has reinforced a growing understanding of the molecular mechanism(s) of aqueous humor outflow resistance and provided new drug targets for glaucoma therapy. Several laboratories including our research team suggested that the increased outflow facility was as a result of the cellular contractions in outflow pathway cells. Even perfusion of thrombin with impurities in porcine eyes, initially misled us to a conclusion that the Rho-GTPase activation with thrombin leading to cellular contraction might increase the outflow facility. Furthermore, investigation of pure thrombin and lysophosphatidic acid (LPA) perfusion in porcine eyes led us to conclude that Rho-GTPase activation, in fact, decreased the outflow facility. A number of studies have focused on to the regulation of outflow, however, very little is known about the regulation of fluid dynamics in the eye and the role of outflow pathway cells for maintaining aqueous humor outflow resistance. The simple reason is that the physiologically compromised fluid dynamics measuring device at constant pressure and the fluid medium for perfusion, similar to the aqueous humor, are not fully developed. Hence, measurement of the fluid dynamics at constant pressure is warranted to determine if aqueous flow is continuous or discontinuous and could be directly correlated with the function of outflow pathway cells. Moreover, we hypothesize that the measurements of LPA and/or thrombin in the aqueous humor of glaucomatous eyes might provide a rationale to the pathophysiology of glaucoma. We anticipate that this new knowledge will ultimately lead to the development of new therapeutic alternatives in the management of glaucoma.

Speaker
Biography:

Samantha Harding was a chemist, polymer scientist and journalist before entering medicine. She was a resident and fellow at Great Ormond Street Hospital, London where she developed her interest in pediatric ophthalmology. She was the first in the history of the American Association of Pediatric Ophthalmology and Strabismus to win best of show twice as first author for posters in 2008 and 2011 and was the first to publish a series of pediatric deep anterior lamellar keratoplasty cases with Ken Nischal. She is a fellow of the Royal College of Ophthalmologists.

Abstract:

The diagnosis of papilloedema can be elusive at the best of times but in children it can present particular challenges. Children are often sent to the eye clinic because "blurry disc margins" are visualised on direct ophthalmoscopy or retinal photography but these can represent normal structural variants. Ultrasound can be helpful, quickly distinguishing an obvious drusen and autofluorescence and enhanced depth imaging can be helpful in a buried druse. Can electrophysiology also be of assistance? This talk will look at some of the challenges diagnosis of true papilloedema can present and clinical and imaging modalities that can assist in making a diagnosis of swelling of the optic nerve head due to raised intracranial pressure.

Speaker
Biography:

Celso Cunha has completed his specialization at the age of 27 at Hospital Regional – Santa Catarina - Brazil. He is a member of the Refraction Department SOBLEC – Brazil, and a Medical consultant for Hoya Vision Care. He has published more than 10 papers which were published in Brazilian journals and Meetings. He is a new member of the editorial national board of Arquivos Brasileiros de Oftalmologia and Revista Brasileira de Oftalmologia.

Abstract:

PURPOSE: To compare the efficacy of 0.025% atropine eye drop in children for the control of myopia with and without photosensitive lens. METHODS: This was a prospective study of sixty children, aged 6 to 12, with spherical equivalent refractive error of -1.00 to -6.00 diopters (D) and astigmatism of -1.00 D or smaller. Children were randomly assigned into two groups in a 1:1 ratio of either anti-reflective coating lens (group 1) or photosensitive lens (group 2). Both groups used 0.025% atropine, once-nightly dosing to both eyes for 1 year. Cycloplegic refraction, axial length, and keratometry were noted at the baseline and 1 year later. In terms of corneal topography, only regular astigmatism was accepted. Student's t test was used to compare the two groups. RESULTS: The age mean and SD for the two groups were 8.2 +/- 1.7 and 8.3 +/- 1.7 years; the initial refractive errors were -3.63 +/- 1.21 D and -3.60 +/- 1.38 D in groups 1 and 2, respectively. Myopic progression was significantly less (P = 0.0007) in group 1 (-0.19 +/- 0.14 D) than in group 2 (-0.32 +/- 0.13 D). Axial length increase was also significantly smaller (P = 0.001) in group 1(0.11 +/- 0.08 mm) than in group 2 (0.21 +/- 0.11 mm). There were no significant statistical differences in relation to keratometry between groups. CONCLUSION: Topical 0.025% atropine eye drops is more effective without photosensitive lens for retarding myopic progression in moderate myopia. However, it is necessary the usage of multilayer anti-refrective coating lens for preventing glare. Furthermore, a larger scale randomized controlled study with longer follow-up seems warranted.

Speaker
Biography:

Anna Laura Giacomin has completed her Medical degree in 1986 at the Padua University. She has joined as the Ophthalmological Specialist at the Padua University in 1991. In 1996, she joined in the Ophthalmology Unit of the Camposampiero PD Civil Hospital, responsible for the Ophthalmoplastic Service. She has obtained Homeopathy clinic course and in 2011, Master 2° level in Ophthalmoplastic Surgery from Naples Federico II University. From 2005, she is a full Member of the European Society of Ophthalmic Plastic and Reconstructive Surgery.

Abstract:

Infective and inflammatory eyelid disorders (blepharitis, chalazion, allergy, viral infections) have a frequent manifestation in pediatry. Usually they are treated with therapeutic local procedures to resolve itching and ocular reddish to reduce the risk of bacterial infection due to a minor control of the hygiene in this age. If the pathology has recurring aspects, or has an aesthetic expression, other examinations are performed to place the problem in a general health contest. In fact disorders of immune system are revealed in eyelid disorders, in particular in mucous membrane immune system (lung, intestine, liver). The environment, nutrition and of family life style, play an important rule in eyelid disorders. Prophylaxis, conventional and unconventional therapies (homeopathy) are proposed to prevent chronicity, avoid lid surgery and reduce the risk of sight problem due to corneal damage.

Speaker
Biography:

Sevinj Salmanova has completed her PhD from Azerbaijan State Medical University. She is chief of Pediatric Department at National Center of Ophthalmology. She has published more than 25 papers in reputed journals.

Abstract:

To trace the state of adrenergic-cholinergic relationship in the recovery stage of sensomnestic and pupil-accommodative mechanisms 2000 children suffered from pre-, perinatal encephalopathy aged 3-12 months and further in ages 1-3 years, followed by catamnesis 5-7 years old were examined. The state of sensomnestic indicators was assessed by the adequacy of fixation of visual attention, by flash visual evoked potential and the reaction of "assimilation" of photostimulation rhythm in the EEG. They were grouped by diagnosis of neonatologists; pre-, perinatal encephalopathy (PPE) – 1000 children, perinatal acute cerebrovascular stroke (PACVS) - 400 children, perinatal toxic-hypoxic encephalopathy - 600 children. We found that 85% of children with PACVS and 50% of children with PPE in the early neonatal period have marked catecholamine excite dumping syndrome. We have had a direct positive correlation between this syndrome and the duration of unstable fixation of visual attention in children with PACVS and with PPE, examined of a periods of life up to 3 and 3-6 months, even – up to 1st year. In more than one third of these children up to age of 1 year, there was a tendency to strengthen of dysregulation of the visual analyzer vascular providing mechanisms, related to cholinergic irritation. However, we have worked out the treatment plan, including Prednisolone 1 mg - in the morning, 2 ml of Bio-Ritmo – in the afternoon, Vasobral 10 mg - in the evening, Semax - 1 drop in each nostril (1 time a day) carry through 3 weeks, minimizes the risk of exacerbation of the consequences of catecholamine excite dumping syndrome.

Speaker
Biography:

Caroline Mvilongo Tsimi has completed MD degree from Yaounde faculty of Medicine and biomedical sciences. She is an ophthalmologist at Yaounde Central Hospital and has published some papers in reputed journals.

Abstract:

The management of strabismus in Cameroon is not well developed and the average age of first consultation is beyond the age amblyopia reversal. It is with the aim of improving strabismus management that we undertook this prospective and descriptive study which spanned 11 months. The objective was to describe amblyopia in patients with comitant strabismus at their first visit. Data collected included the age at the first visit, past history, refractive error, the characteristics of strabismus, amblyopia and strabismus-associated factors.Forty patients were included amongst whom there were 21 females and 19 males. The mean age was 5.5±4.6 years, with extremes of 3 months and 24 years. The hospital prevalence of amblyopia was 1.02%. Esotropia was the most common form of strabismus in 52.5 % of cases. In 37.5% of cases, the onset of strabismus was before the age of six months. Amblyopia was present in 63.7% of cases. It was classified as severe in 29.41% of cases, moderate in 21.57% of cases, and mild in 49.02% of cases. Head tilt was present in 27.5% of cases and nystagmus in 25% of cases. In conclusion, the prevalence of amblyopia is high in our milieu with a higher prevalence amongst esotropic patients. The management of strabismus relies on the wearing of the full cycloplegic correction and requires the full cooperation of the parents.

Speaker
Biography:

Coming soon

Abstract:

The incidence of uveitis in children (between 4-7/100,000/year) is lower than that of adults, but it is more likely to cause vision impairment. Unlike adults, the onset is mostly insidious in normal looking white eyes, whilst slowly allowing inflammation to damage the structures of the eyes until vision is compromised, often permanently. In the developed economies the proportion of infectious cases is declining but idiopathic uveitis stubbornly persists. Screening of children at high risk, such as those with arthritis, allows earlier treatment, which can save vision. However treatment with steroids topically, regionally or systemically leads to delayed causes of vision loss that may not be manifested until late adolescence or even adulthood. Promptly initiating steroid sparing immunomodulatory therapy can avoid these problems, but management is complicated potentially dangerous and is independent of the status of any systemic condition and uveitis often smoulders on long after the arthritis has completely resolved. Use of biological agents is effective but is expensive and needs to be prolonged increasing the risk of systemic side effects, including cancer. The challenges of early diagnosis, appropriate referral and control of inflammation are ever present and despite best modern care children still lose vision in one or both eyes as a consequence of uveitis.

Speaker
Biography:

Arturo Maldonado-Junyent is a Medical doctor and surgeon, graduated from the National University of Cordoba, Argentina, specialist and master in ophthalmology. He is head of the anterior segment department of the Clinica de Ojos Maldonado Bas in Córdoba, Argentina. He is also Assistant Professor of the Postgraduate specialization in Ophthalmology in the Catholic University of Córdoba and Director of the Postgraduate in Ophthalmology of the Ophthalmology Society of Córdoba, Argentina.

Abstract:

Penetrating keratoplasty is rarely used in children due to the high rate of rejection. But manual lamellar keratoplasty requires a level of surgical skill that limits its performance. And the visual results in conventional femtosecond assisted lamellar keratoplasty are not good. In order to solve this, we have developed a hybrid lamellar keratoplasty technique with high replicability, since its performance is almost entirely automated, thus guaranteeing a significant percentage of surgery completion. It is named FEHLK (Femto Excimer Hybrid Lamellar Keratoplasty). Indications: This technique is indicated for any corneal pathology in which the endothelium is unharmed, including keratoconus, superficial and deep corneal opacities and scars. Technique: This involves making a lamellar cut with a femtosecond laser, with the lamellar keratoplasty program, without completing the central three millimeters, which will later be dissected manually. This makes possible an interface zone in the visual axis of much higher quality than that made by the femtosecond laser. We then make a photoablation with an excimer laser to regularize further the surface of the corneal bed. Finally, the donor tissue is sutured. Conclusion: With this technique, we can make a reproducible lamellar keratoplasty in children and adults with a very low complication rate, which allows us to maintain the endothelium and extend the life of the graft and decrease rejection, achieving better visual results. This is the best option for pediatric patients.

Speaker
Biography:

Professor Mohamed Mostafa Kamel Diab has completed his Ph.D. at age of 29 years from Ain Shams University and postdoctoral studies from Ain shams university school of medicine Cairo Egypt. He is professor of ophthalmology Ain shams university Cairo Egypt and consultant ophthalmology Magrabi hospital KSA. He has published 16 international papers in reputed ophthalmology journals.

Abstract:

Introduction: Dissociated vertical deviation (DVD) is a poorly understood vertical deviation which may remain latent (compensated) or manifest (decompensated). The deviation may be symmetrical or asymmetrical Objective: we compare 3 different surgical approaches in patients with DVD without IO over-action. Methods: This is prospective study include 48 consecutive patients with dissociated vertical deviation without inferior oblique overaction subdivided into three groups, 16 patients each Group I patients was subjected to bilateral inferior rectus tucking (plication), and Group II patients were subjected to combined bilateral superior rectus recession and Faden procedure (posterior fixation), lastly Group III bilateral superior rectus recession is the procedure for management. Results: It was found that DVD had significantly improved in all cases of group inferior rectus tucking with correct11±3pd of vertical deviation and 4±2pd of asymmetry with exception one patient needed retucking of unilateral IR for residual manifest DVD. GroupSR Faden procedure revealed moderately improved DVD with correct 9±2pd of vertical deviation 2±2pd of asymmetry with 4 patients needed resection of unilateral IR for residual manifest DVD. Group SR recession corrected to10±3pd of vertical deviation and 3±1pd of asymmetry. Conclusion: Various treatment modalities as a primary procedure for management of dissociated vertical deviation without inferior oblique overaction revealed still superior rectus recession combined with faden procedure is the best line of treatment nevertheless inferior rectus tucking procedure is safe easy respectable substitute, further studies is recommended in this field.