2009 Final Program PAAO Papers

FinalProgram.
book Page 189 Monday, September 21, 2009 5:53 PM

American Academy of Ophthalmology
PAAO Original Papers

Sunday – Tuesday, Oct. 25 – 27
9:00 AM – 5:30 PM
A panel discussion will follow each paper presentation.
Selection Committee
The Pan-American Association of Ophthalmology Scientific
Program Committee selected all Original Papers.
See page 33 for committee details.

P.O. Box 7424, San Francisco, CA 94120-7424 Tel: 415-561-8500 Fax: 415-561-8533
© 2009 American Academy of Ophthalmology. All rights reserved.

No portion may be reproduced without express consent of the American Academy of Ophthalmology
Academy staff are available at the Academy Resource Center (North, Booth 3569) to answer any Academy-related questions you may have. 189
PA107 12:00 PM
Cataract
Prevalence of Blindness and Cataract Surgery in
Lumbini Zone, Nepal
Sunday, Oct. 25 Presenting Author: Anil Sherchan SR DO
11:30 AM - 12:30 PM Co-Author(s): Pradeep Bastola SR MD, Manoj Kumar Sharma**, Ram Prasasd
SOUTH, Room 236 Kandel JR MPH**, Kent L Bassett MD**
Purpose: To estimate the impact of the Lumbini Eye Institute in the prevalence of
PA104 11:30 AM blindness in Lumbini Zone Nepal. Methods: People aged 50 years and over were
Bi-axial Prechopping With Two 25-Gauge Cannulas enrolled in the study using stratified cluster randomization designed in Lumbini Zone.
Presenting Author: Arturo Perez Arteaga MD Subjects in the 32 selected clusters were recruited through door-to-door visits. Each
recruited subject was examined by an ophthalmologist. Results: Out of 5916
Purpose: To compare the new method of biaxial prechop with two 25G cannulas selected subjects, 86.9% were examined, mean age being 60 years. The percent-
(BAPC25G) with traditional forceps prechop. Methods: 100 eyes were operated by age of those presenting with total blindness was 4.6%, of which 5% were male and
one surgeon utilizing the BAPC25G technique and the results were compared with a 4.3% were female. Cataract was the principal cause for bilateral blindness (48%).
previous group (retrospective revision) of 100 eyes operated by the same surgeon Conclusion: The finding suggests the need to focus on cataracts more.
with forceps-prechop technique. Results: No differences between gropus in cor-
neal edema, visual outcome, surgical time and phaco power and time. Significative 12:07 PM
difference was found in posterior capsule rupture (1/100 vs 4/100). Conclusion: Panel discussion of previous paper
BAPC25G is a safe and effective technique. It can decrease the risk of damage to
the capsular bag during prechop maneuvers. PA108 12:10 PM
11:37 AM Refractive and Aberrometric Results of Aspheric IOL:
Panel discussion of previous paper a Multicentric Study
Presenting Author: Fabrizio I Camesasca MD
PA105 11:40 AM
Co-Author(s): Paolo Vinciguerra MD*, Damien Gatinel MD*, Burkhard Dick MD**
700 Micron Technology for Lens Extraction Without Purpose: A prospective, multicentric study on the aspheric Zeiss Invent ZO IOL,
Ultrasonic Power providing the same spherical aberration as the natural lens. Methods: Sixty eyes
Presenting Author: Arturo Perez Arteaga MD enrolled through 3 different European centers received complete ophthalmological
evaluation and Nidek OPD aberrometry preoperatively and at 1- and 6-month inter-
Purpose: To demonstrate the safety and efficacy of 700 micron technology for lens
vals. Modulation transfer function (MTF) and aberrometric results were compared
extraction (micro-biaxial) with no ultrasonic power for soft nucleus. Methods: 50
with a sample of 97 healthy, phakic eyes. Results: No significant loss of BSCVA
eyes were operated with microbiaxial technique utilizing the phaco hand-piece and
was noticed. At the 6-month interval, high-order aberration MTF and spherical aber-
compared with the results of 50 eyes with soft nucleus, operated by the same sur-
ration were similar in both the operative and control groups. Conclusion: Invent ZO
geon with microbiaxial technique without phaco handpiece (utilizing only irrigation/
maintains aberrations at the level of healthy, unoperated eyes.
aspiration). Results: No differences were found in visual outcome, inflammatory
process and perioperative complications. Significative differences were found in 12:17 PM
phaco time, total surgical time and speed of visual recovery. Conclusion: Micro-
Panel discussion of previous paper

biaxial technique with no-ultrasonic power is a safe ans effective technique for lens
extraction in soft nucleus cases and can improve the time of visual recovery. PA109 12:20 PM
11:47 AM Posterior Capsule Rupture During
Panel discussion of previous paper Phacoemulsification: Comparison With
Uncomplicated Cases on Long-Term Follow-Up
PA106 11:50 AM
Presenting Author: Daniel A Badoza MD
Reduction in Preexisting Astigmatism by Limbal
Purpose: To compare phacoemulsification with intraoperative rupture of the poste-
Relaxing Incisions in Patients Undergoing rior capsule (RPC) with uncomplicated cases. Methods: We retrospectively
Phacoemulsification compared visual acuity (VA) and refraction in 13 cases with RPC to 126 controls.
Presenting Author: Rakesh Kumar Bansal FRCS(ED) Minimum follow-up was 24 months. Results: Preoperatively, mean VA was 0.38 in
the RPC group and 0.40 in the control group (P = .72), changing to 0.875 for RPC
Co-Author(s): Anamika Garg MBBS**, Sunandan Sood MS**, Arun K Jain MD and 0.95 for controls (P = .14) after surgery. Mean preoperative refraction was -
Purpose: To study the role of limbal relaxing incisions (LRI) in reducing preexisting 0.03 D for the RPC group vs. -1.49 D for controls (P = .18); postoperative refrac-
astigmatism in patients undergoing phacoemulsification. Methods: Selected tion was -0.875 D in the RPC group vs. -0.13 D in controls (P = .009). No retinal
patients were subjected to LRI if the preexisting astigmatism was ≥ 1 D. AMO online detachment occurred after RPC. Conclusion: Phacoemulsification with rupture of
calculator was used to determine the extent of LRI with depth kept fixed at 0.6 mm. the posterior capsule with no significant vitreous in anterior chamber achieved visual
Results: In 25 eyes average preexisting astigmatism was 1.85 ± 1.41 D. Average results similar to those of uncomplicated cases.
postoperative astigmatism after a minimum follow-up of 1 month was 0.93 ± 0.37
D, with average reduction in cylindrical power of 0.92 D, which was found to be sta- 12:27 PM
tistically significant (P < .5). Two eyes developed micro leak during the procedure. Panel discussion of previous paper
Conclusion: LRI is safe and effective in reducing moderate amount of astigmatism
in patients undergoing phacoemulsification.
11:57 AM
* The presenter has a financial interest. ** The presenter has not submitted financial interest disclosure information as of press date. No asterisk indicates that the presenter has no
190 financial interest. Up-to-date information is available in the Online Program on the Academy's Web site: www.aao.org.
Monday, Oct. 26 PA141 10:45 AM
10:15 - 11:15 AM Role of Gender in Patient Satisfaction After Cataract
SOUTH, Room 238 Extraction and Multifocal Intraocular Lens (MIOL)
PA138 10:15 AM Implantation
Presenting Author: Helga P Sandoval MD*
Aphakia Correction With the Retroiridally-Fixated
Artisan IOL Co-Author(s): John W French MD, Mohamed A Guenena MD*, Kerry D Solo-
mon MD*
Presenting Author: Vitor R Fernandes MD
Purpose: To evaluate the role of gender in patient satisfaction after multifocal IOL
Co-Author(s): Tiago P T Monteiro MD, Ricardo A Pereira MD**, Manuel Fer- (MIOL) implantation. Methods: 112 patients following bilateral MIOL implantation
nando Lopes Domingues MD**, Fernando M Falcao-Reis MD PHD** were divided by gender: females, n =76 and males, n = 36. Overall (OS), distance
Purpose: To evaluate the efficacy, safety, and stability of secondary implantation of (DS), intermediate (IS), near (NS), and night vision satisfaction (NS) were assessed
retroiridally fixated Artisan IOL to correct aphakia. Methods: Ten aphakic eyes/10 using a scale from 0 (very dissatisfied) to 10 (highly satisfied). Results: No signifi-
patients (median age: 69.4 years) underwent secondary retroiridial fixation of Artisan cant differences in age, residual refractive error, postoperative visual acuity
IOL. Results: All surgeries were performed without complications. Mean postopera- (uncorrected or best corrected) at distance, intermediate, and near were found
tive refraction was -0.75 D (range: -1.75 to + 1.0 D). Preoperative BSCVA varied between groups. OS was significantly higher in females than males (8.9 vs. 8.4, P =
from hand motions to 0.3 Snellen. Median postoperative BSCVA was 0.4 (range: .040), as well as intermediate (8.3 vs. 7.4, P = .021). Conclusion: Multifocal IOL
0.1–0.9). There were no cases of IOL dislocation. Conclusion: In selected cases, implantation provides high patient satisfaction, with females being more satisfied than
the implantation of a retroiridally fixated Artisan IOL is an effective, safe, and stable males.
method to correct aphakia.
10:52 AM
10:22 AM Panel discussion of previous paper
PA142 10:55 AM
PA139 10:25 AM Analysis of Re-used Blades Used in
Congenital Cataract Surgery in Relative Anterior Phacoemulsification by Scanning Electron
Microphthalmos: A Case Report Microscopy
Presenting Author: Arturo J Ramirez-Miranda MD Presenting Author: Priscila da Rosa Camaratta
Co-Author(s): Ingrid Urrutia-Breton MD**, Eduardo Ayup-Arguijo MD**, Eduardo Co-Author(s): Luciano Albuquerque MD**, Claudia Faganello ScD**, Mauricio
Chavez-Mondragon MD Grillo**, Luciana Freitas**, Fabiana Quartiero**, Ana Veiga**, Joao A Pigatto
Relative anterior microphthalmos (RAM), the condition of eyes with normal axial PhD**
length but a small anterior segment, is responsible for a high incidence of complica- To evaluate by scanning electron microscopy the sharpness of the edge of brand
tions after cataract surgery. A 49-year-old man complaining of decreased photopic new surgical blades and consecutively used surgical blades in phacoemulsification.
visual acuity. On evaluation, best corrected visual acuity was 20/30 in both eyes, Twenty-five angled ophthalmic knife were evaluated after corneal incision in rabbits.
small and steep corneas, shallow chamber and fetal nucleus congenital cataract; he The subjects were divided in five groups: G 1 (control), G 2, blades used once; G 3,
underwent anterior segment analisys by Pentacam`s Scheimpflug images and axial blades used twice; G 4, blades used four times; G 5, blades used six times. Blade

lenght measured by IOL master which confirmed the diagnosis. Phacoemulsification body irregularities and organic material were observed on all used surgical blades (G
was performed with acrilyc lens implantation in both eyes. There are just a few 2, 3, 4 and 5), but not on new surgical blades (G 1). In addition, G 5 revealed more
reports of RAM with congenital cataratc, confirmed diagnosis by Pentacam and irregularities. Reusing blades for phacoemulsification may produce structural
adjusted IOL power predicted by Hoffer Q formula in the IOL master allowing visual changes and its clinical implications need to be evaluated due to the possible relation
improvement with postoperative complications.
10:32 AM 11:02 AM
Panel discussion of previous paper Panel discussion of previous paper
PA140 10:35 AM PA143 11:05 AM
Microincision Cataract Surgery (2 mm) With the Surgical Technique for Implantation of the
Acri.Comfort 646 Toric IOL for the Management of Synchrony Dual Optic IOL, Five Years Evolution
Astigmatism Presenting Author: Ricardo Alarcon MD*
Presenting Author: Bassam Elkady MD** Co-Author(s): Victor Manuel Bohorquez MD**, Luis G Vargas MD**
Co-Author(s): Cláudia D Costa-Ferreira MD, Jorge L Alio MD PhD*, Vanessa Purpose: The key surgical steps required for successful implantation of the Syn-
Pongo MD** chrony dual optic IOL. Methods: The five year evolution of the surgical technique
Purpose: Evaluate toric IOL (Acri comfort 646 TLC) for the correction of corneal for implantation of the Synchrony IOL will be presented.Insights gained during the
astigmatism. Methods: Astigmatism was studied using 3 vectors: target induced developmental process of this unique lens will be discussed. Results: A summary
astigmatism (TIA), surgically induced astigmatism (SIA), and difference vector (DV), of the techniques used during surgery will be given. Videos showing the delivery of
described by the Alpins method of 21 eyes with corneal astigmatism. Results: the lens into the capsular bag using a newly developed preloaded injector. Conclu-
Mean pre- and post-operative cylinder was -4.46 1 2.23 D and -0.45 10.63, sions: A focused, methodical surgical technique assures optimal results and a highly
respectively. Arithmetic mean difference vector was 0.47 1 0.61. 91% of astigma- satisfied patient.
tism was corrected. Mean toric EOL axis rotation was -1.75 1 2.93. Conclusion:
Acri.comfort 646 TLC is precise, safe and effective to correct moderate and high 11:12 AM
astigmatic defect. Panel discussion of previous paper
10:42 AM
financial interest. Up-to-date information is available in the Online Program on the Academy's Web site: www.aao.org.
191
Tuesday, Oct. 27 PA159 9:30 AM
9:00 - 10:00 AM Long-term Performance of Dual-Optic
SOUTH, Room 238 Accommodating IOLs
PA156 9:00 AM Presenting Author: Andrea Galvis MD*
Functional Vision in Presbyopia-Correcting IOLs: A Co-Author(s): Ivan L Ossma-Gomez MD**
Randomized Comparison Between Accomodating Purpose: Long-term visual function and capsular biocompatibility were assessed
>4 years after implantation with a dual optic accommodating IOL. Methods: Pro-
Dual Optic and Diffractive Multifocal IOLs spective non-controlled longitudinal study; testing included visual acuities measured
Presenting Author: Ricardo Alarcon MD* at different distances; slit lamp exam, reading speed and UBM to demonstrate
Co-Author(s): Victor Manuel Bohorquez MD**, Luis G Vargas MD** mechanism of action. Results: Uncorrected visual acuity (UCVA) was 20/40 or bet-
ter for distance and intermediate for all subjects while 88% achieved 20/40 near
Purpose: To compare visual performance between a diffractive multifocal IOL and a
UCVA. Yag rates were 5.8%. Ultrasound biomicroscopy analysis showed evidence
dual optic accommodating lens Methods: Prospective double-masked randomized
of movement after accommodative stimuli. Conclusion: The dual optic accommo-
study. Fifty patients were implanted with each IOL binocularly. After 1 year, Visual
dating IOL provides patients with adequate near, intermediate and distance vision
acuity and reading speed measured with full distance correction were evaluated at
that is maintained for over 4 years.
40, 60, 80, 100, 200 and 400 cm. Results: Visual acuities and reading speed
(with distance correction) were similar at distance and near (P>0.05 ANOVA). At all 9:37 AM
intermediate distances Synchrony was significantly better than ReSTOR (P<0.05, t-
test). Conclusion: Synchrony IOL provides a better range of functional vision, with
similar performance at near PA160 9:40 AM
9:07 AM Functional Range of Vision After Binocular
Panel discussion of previous paper Implantation of Multifocal or Dual Optic
Accommodating IOLs
PA157 9:10 AM
Presenting Author: Ivan L Ossma-Gomez MD*
Three-Year Results With Synchrony Dual-Optic
Co-Author(s): Andrea Galvis MD**, Victor Manuel Bohorquez MD**, Ricardo
Accommodating IOL Alarcon MD**
Presenting Author: Victor Manuel Bohorquez MD* Purpose: To compare range and quality of vision after binocular implantation with
Co-Author(s): Ricardo Alarcon MD**, Luis G Vargas MD** two intraocular lens (IOL) technologies. Methods: Multicenter randomized prospec-
Purpose: Evaluation of 3 year visual outcomes of the Synchrony IOL. Methods: tive double masked clinical trial comparing patients binocularly implanted with dual
14 patients implanted with the Synchrony IOL were evaluated at 12, 24 and 36 optic accommodating IOLs (N = 44) or diffractive apodized multifocal IOLs (N = 48).
months. Uncorrected and distance corrected visual acuity for far, intermediate and Results: There were statistically significant differences in mean acuities at 60
near were assessed. Results: After 3 years, the mean uncorrected visual acuity through 200 cm. Contrast sensitivity showed differences at all frequencies in all light-
(logMAR) remains stable: -0.125 distance, 0.165 intermediate and -0.030 near. ing conditions (P<0.01). Conclusions: Patients implanted with a dual optic
DCNVA remains stable over time. After 36 months, over 100% of patients can read accommodating IOL achieve better intermediate visual acuities compared to similar
20/40 or better. Conclusion: Synchrony showed comparable visual outcomes at patients implanted with multifocal diffractive apodized IOLs with higher levels of visual
all visits. Visual stability is maintained with this dual-optic accommodating IOL 3 years quality.
after implantation
9:47 AM
9:17 AM Panel discussion of previous paper
PA161 9:50 AM
PA158 9:20 AM Real Life Performance of Dual Optic Accommodating
How to Teach Phacoemulsification in a Secure Way and Multifocal IOLs
Presenting Author: Felipe Torres MD Presenting Author: Andrea Galvis MD*
Co-Author(s): Monica C Mendoza MD**, Silvio Arellano MD**, Julio Blanco Co-Author(s): Ivan L Ossma-Gomez MD**
MD**, Johnny Zumaeta MD**, Ivan Cornejo MD** Purpose: To describe reading speed and visual function under different lighting
Purpose: To describe a way to teach phacoemulsification. Methods: Our hospital conditions comparing 4 intraocular lens (IOL) technologies. Methods: Non-concur-
is the main teaching center in Peru. We had 2 PGY-3 residents who participated in rent comparative study of 4 patient groups implanted with Synchrony (N = 29),
1710 cataract surgeries. Using a protocol and an objective evaluation form to assess Tecnis Multifocal (MF) (N = 34), ReSTOR (N = 27) and ReZoom (N = 30). Reading
residents’ skills in cataract surgery, we measured the surgical difficulty of each case speed was measured under photopic and mesopic conditions. Results: Mesopic
for residents. Tutors were aware of any surgical complications and solved them. reading speeds were higher in the Tecnis MF (164.3 ± 27.6) and Synchrony
Results: Of the 1710 surgeries, PGY-3 residents participated in 799 surgeries groups (159.6 ± 19.8) compared to ReZoom (86.9 ± 11.5) and ReSTOR (75.2 ±
(511 ECCE and 288 phaco). We measured the security of the tutorials through the 12.1) (P < .0001). Contrast sensitivity function was highest in Synchrony group.
complication rate (posterior capsule rupture and vitreous loss), which in this group of Conclusion: Dual optic accommodating IOLs showed high performance in reading
residents was 6.9% during phacoemulsification. Conclusion: Teaching ophthal- speed while providing higher quality of vision when compared to MF IOLs.
mology residents phacoemulsification must be done in a secure way in order to get a
learning curve with few complications. 9:57 AM
9:27 AM
decreased to 10.93 ± 3.52 mm Hg (P < .001). Conclusion: Small but statisti-
Cornea, External Disease cally significant reductions in IOP measurements with GAT were found after CXL in
patients with keratoconus. The rationale for this effect might be the reduction in ker-
atometric values after CXL.
Sunday, Oct. 25 3:42 PM
3:15 - 4:15 PM Panel discussion of previous paper
SOUTH, Room 236
PA127 3:45 PM
PA124 3:15 PM
Bacterial Resistance to Moxifloxacin Prophylaxis in
Conjunctival vs. Limbal-Conjunctival Autograft in
Photorefractive Keratectomy (PRK) Patients
Primary Pterygium Surgery: Do Limbal Cells Make a
Presenting Author: Maria C Leoratti MD
Difference?
Presenting Author: Olga Alvarez-Bulnes MD Co-Author(s): Mauro S Campos MD
Purpose: To evaluate moxifloxacin prophylaxis in patients submitted to PRK.
Co-Author(s): Maria Teresa F Sellares MD**, Alfons Casale MD**, Xavier Nunez Methods: 80 eyes were randomized to receive topical moxifloxacin 0.5% (MOX)
MD**, Josep Visa Nasarre MD**, Manuel Alejandro Romera MD**, Josep Gracia (G1) or hipromelose (G2) qid during 3 days before and MOX for7 days after surgery.
Martinez MD** Conjunctival scrapings were collected before surgery (TI-3days and TII-30 minutes)
Purpose: To determine whether limbal cells have a role in the prevention of recur- and postoperatively (TIII-7 and TIV-30 days) for cultures. Results: Cultures were
rence after primary pterygium surgery. Methods: Revision of 36 eyes with primary similar at TI. At TII, a significant number of eyes from G1 had negative cultures (P <
pterygium. 18 underwent excision with conjunctival autograft, whereas the rest .001) but no differences were found at TIII or TIV (P > .005),3 eyes from G1 dis-
underwent excision with limbal-conjunctival autograft. All of them were followed for closed methicillin-resistant Staphylococcus during the study. Conclusion: MOX
one year. Results: 2 patients in the conjunctival graft group (11%) presented recur- reduced the conjunctival bacterial flora but its prolonged use may facilitate the selec-
rence after 12 months, while none of the patients in the other group had recurrence. tion of resistant microorganisms or to induce bacterial mutation.
However, no statistical difference was found between the two types of autograft (P =
0.2). Conclusion: The results suggest that the barrier effect of the graft, not the 3:52 PM
limbal cells themselves, plays a role in reducing recurrences after primary pterygium Panel discussion of previous paper
surgery.
PA128 3:55 PM
3:22 PM
Automated Lamellar Disc Keratectomy for the
Treatment of Disabling Symptoms in Bullous
PA125 3:25 PM Keratopathy
Microbial Keratitis in the Elderly: A 32-Year Review Presenting Author: Eliana D Goncalves MD**
Presenting Author: Renato Passos Co-Author(s): Fabiana Paris**, Ricardo Kanecadan MD**, Jose Gomes MD*,
Co-Author(s): Angelino Julio Cariello MD**, Maria Cecíia Zorat-Yu PhD**, Ana Mauro S Campos MD
Hofling-Lima MD MBA Purpose: To evaluate the effects of automated lamellar disc keratectomy (ALDK) for
the treatment of painful bullous keratopathy (BK). Methods: Twenty nine patients

Purpose: To describe 1545 cases of microbial keratitis in the elderly in a reference
were randomized to ALDK alone (G1) or with adjunctive intra operative 0.02% mito-
service. Methods: Revision of files from elder patients with microbial keratitis that
mycin C (G2). All patients were followed for 6 months and 23 completed one year of
underwent corneal scraping for microbiological analysis. Results: Most prevalent
follow up. Pain was quantified by means of a 1 (less) to 10 (maximum) grading sys-
age group was 60–69 years (46.8%). There were 681 males (45.8%). Associated
tem, number and duration of episodes and insomnia due to night pain. Results:
factors were: past ocular surgery (25.1%), ocular trauma (7.2%), and contact lens
Mean pain reduced from 8,2 (G1) and 7,4 (G2) preoperatively to 1,8(G1, P= .001)
usage (3.0%). Bacterioscopy was positive in 40.5% of cases. Culture positivity for
and 1,0 (G2, P< .001) at one year. Of the 12 patients with preoperative insomnia,
any agent was 53.5% (bacteria 47.0%, fungi 6.1%, Acanthamoeba 0.4%). Con-
none presented this symptom during the study. Conclusion: ALDK is an effective
clusion: The most important associated factor was past ocular surgery, especially
therapy for controlling pain in BK.
penetrating keratoplasty. The most frequent causative agents were bacteria: Gram-
positive cocci (coagulase negative Staphylococcus) and Gram-negative bacilli (Pseu- 4:02 PM
domonas,Proteus, and Moraxella).
3:32 PM
PA129 4:05 PM
Trends on Gram Positive Microbial Keratitis in South
PA126 3:35 PM Florida
Analysis of Intraocular Pressure After Corneal Presenting Author: Roberta de Ventura Urbano MD
Collagen Crosslinking in Patients With Keratoconus Co-Author(s): Eduardo C Alfonso MD*, Darlene Miller MPH
Presenting Author: Maria Jose Cosentino MD Purpose: to evaluate the trends on the gram positive microbial keratitis infectious on
Co-Author(s): Daniel A Badoza MD South Florida. Methods: laboratory records of patients examined at our institution
between 1990 and 2008 , were divide in four periods separated by years. Data was
Purpose: To analyze changes in IOP in eyes with keratoconus after corneal cross-
extracted on culture positive rates, pathogen frequency , emerging antibiotic resis-
linking (CXL). Methods: We studied retrospectively 45 cases operated on with
tance. Results: the culture positive rate was stable through all four periods. On
CXL. IOP was measured with Goldmann applanation tonometry (GAT) before and 12
period C an increase on the resistance profile was shown. Conclusion: It is not only
months after CXL. Preoperative flattest K was 47.61 ± 6.48 D, steepest K was
important to monitor the resistance profile of microbial keratitis , but it is also impor-
51.10 ± 8.48 D, and IOP was 12.5 ± 2.96 mm Hg. Results: Twelve months
tant to establish the trends on the microbial pathogen profile and to update the trends
after CXL, flattest K was 45.33 ± 6.35 D and steepest K was 48.79 ± 7.91 D; IOP
related to the risk factors.
193
4:12 PM PA153 2:30 PM
Panel discussion of previous paper Cambios Refractivos a 4 Años en Pacientes con
Queratocono Operados con Anillos de Ferrara/
Monday, Oct. 26 Keraring (AF)
2:00 - 3:00 PM Presenting Author: Francisco Segura-Lozano MD
SOUTH, Room 238 Co-Author(s): Gabriela Bustamante MD**, Laura Elena Valencia MD**, Leonard
PA150 2:00 PM Zuniga**
Objetivo: Ver la eficacia de los AF a 4 años de control en pacientes con ectasias
Cirugía Corneal de Adición en Ectasia Post-LASIK corneales. Método: 75 pacientes con Queratocono QC y otras ectasias fueron
Presenting Author: Pedro-Ivan Navarro MD implantados con AF midiéndoles la agudeza visual sin y con corrección (AVSC,
Objetivo: El implante de segmentos intracorneales podría ser una opción quirúrgica AVCC) refracción y queratometrías (Q1,Q2) preoperatorias y a 1,2,3 y 4 años.
novedosa y segura para tratar la ectasia post-lasik. Métodos: Presentamos el resul- Resultados: Todas las variables mejoraron significativamente a 1 año. AVSC
tado de doce ojos tratados con intacs que fueron seguidos durante 36 meses para mejoró de 20/180 a 20/60, AVCC de 20/40 a 20/30, Esfera de -8.7 a -3.6,
observar su efectividad terapeútica. Resultados: El tiempo promedio de diag- Astigmatismo de 5.6 a 2.8, Q1 de 54.1 a 47.9, Q2 de 47.9 a 45.9 P < 0.001).
nóstico de la enfermedad fue 42.33 meses, la agudeza no corregida acumulada Al comparar estos resultados con las mediciones subsecuentes no hubo diferencias
preoperatoria mostró que el 100% de los pacientes tenía una visión de 20/400 o significativas (P > 0.1) Conclusión: Los AF mejoran significativamente la visión de
peor y de 20/70 o mejor en el post-operatorio a 3 años. Todos los pacientes pacientes con QC, disminuyendo la refracción y aplanando Q1 y Q2. A 4 años de
mostraron aplanamiento corneal y reducción en el defecto refractivo desde un mes control estos cambios siguen estables.
de operados, los cuales se mantuvieron en el tiempo. Conclusión: Cirugía corneal 2:37 PM
de adición con intacs puede ser un procedimiento novedoso y mínimamente invasivo
para tratar la ectasia corneal post-lasik. Panel discussion of previous paper
2:07 PM PA154 2:40 PM

Panel discussion of previous paper Vision-Related Quality of Life in Keratoconus
Patients Treated for Corneal Collagen Crosslinking
PA151 2:10 PM
Presenting Author: Ricardo Gomes dos Reis MD
Resultados de Queratoplastia Penetrante en el
Co-Author(s): Ricardo Lamy MD*, Bruno M Fontes MD*, Camila F Netto MD**,
Centro Cristiano de Servicios Medicos Mariana G Pecego MD**, Lorena Vianna**, Haroldo V Moraes Jr MD, Adalmir M
Presenting Author: Robin A Rios MD Dantas MD**
Objetivo: Evaluar los resultados de queratoplastías penetrantes realizadas entre el Purpose: Evaluate the vision-related quality of life in keratoconus patients treated
año 2000 al 2007. Método: Estudio retrospectivo de 103 pacientes sometidos a with riboflavin and ultraviolet radiation for Corneal Collagen Cross-linking (CXL).
queratoplastía, valorando indicaciones preoperatorias, resultados visuales, edad del Methods: The National Eye Institute Visual Function Questionnaire 25 (NEI-VFQ-25)
donante y complicaciones. Resultados: Los principales diagnósticos etiológicos was applied in twenty-one patients with progressive keratoconus treated by CXL. The
fueron queratitis microbiana (33.3%) y queratopatía bullosa (22.2%) Los mejores questionnaire was applied before and after the procedure, with ranges of 3, 6 and
resultados visuales fueron queratocono (86%) y distrofia de Fuchs (80%). Hubo 12 months. Results: The NEI-VFQ-25 composite score increased 5.3 points after
rechazo del injerto en 16 ojos (14.8%). No hubieron diferencias significativas por 3 months (P < .05); 4.2 points after 6 months (P < .05) and 5.4 points after 12
edad del donante. Conclusión: La queratitis microbiana activa cursa con pobre months (P < .05). Conclusion: The vision-related quality of life had a general
recuperación visual después de trasplante corneal. Es válido usar tejidos de improvement after crosslinking treatment.
donantes mayores de 65 años.
2:47 PM
2:17 PM Panel discussion of previous paper
PA155 2:50 PM
PA152 2:20 PM Effects of Corneal Collagen Crosslinking on Visual
Segmentos en Ectasias Secundarias a Cirugia Acuity and Contrast Sensitivity
Refractiva Presenting Author: Ricardo Lamy MD*
Presenting Author: Ricardo L Escobar Cuartas SR MD Co-Author(s): Camila F Netto MD**, Ricardo Gomes dos Reis MD, Bruno M
Objetivo: Demostrar las bondades de una técnica mínimamente invasiva, de rápida Fontes MD*, Mariana G Pecego MD**, Lorena Vianna**, Haroldo V Moraes Jr
recuperación y de alta satisfacción para el médico y el paciente. Con mejoría evi- MD, Adalmir M Dantas MD**
dente de la AV, del patrón topográfico y estable en el seguimiento. Métodos: Purpose: Assess the effects of corneal collagen crosslinking (CXL) on visual acuity
Pacientes con ectasias posteriores a cirugías incisionales y / o excimer láser. Utili- and contrast sensitivity. Methods: Sixty-two eyes of 31 patients were enrolled. One
zando una Z.O. de 5 mm y los segmentos de Ferrara y / o keraring. Resultados: eye was treated and the fellow served as control. Pelli-Robson contrast sensitivity test
Se muestra la mejoría de la AV sin y con corrección, la seguridad de la técnica, las (PR) and best corrected visual acuity (BCVA) were compared preoperatively and 40,
topografías pre y pos operatorias con seguimientos de 6 meses a 5 años. Conclu- 90, 180 and 365 days after cross-linking Results: In the treated group, BCVA (log-
sión: Los segmentos intraestromales son una excelente alternativa en el manejo de MAR) improved (P < .05) after 40 days (-0.08); 90 days (-0.14); 180 days (-016);
las diferentes ectasias, con muy baja tasa de complicaciones, estable y no contrain- 365 days (-0.18) and PR decreased -0.13 points (P = 0.34) after 40 days and
dica otras cirugías en el futuro. increased +1.23, +1.81 and +2.35 points after respectively 90, 180 and 365
days (P < .05). Conclusion: CXL was efficacious in improving visual acuity and con-
2:27 PM trast sensitivity
2:57 PM
Tuesday, Oct. 27 10:42 AM
10:15 - 11:15 AM Panel discussion of previous paper
SOUTH, Room 238 PA196 10:45 AM
PA193 10:15 AM Effect of Crosslinking on Corneal Thickness in
Amniotic Membrane: Its Effect on the Expression of Patients With Corneal Edema
IL-8 Cytokine Through TLR3 Pathway on Human Presenting Author: Manuela M Cordeiro Barbosa MD**
Limbocorneal Cells Co-Author(s): Ana Hofling-Lima MD MBA, Jose Bonifacio Barbosa JR MD**,
Presenting Author: Jonathan U Quevedo Martinez MD Flavio Hirai MD
Co-Author(s): Yonathan Garfias MD PhD**, Veronica Zaga MD PhD**, Maricar- Purpose: To investigate the effects of collagen crosslinking in corneal thickness of
men Jimenez-Martinez MD PhD** patients with corneal edema. Methods: Clinical interventional case series included
25 eyes of 25 consecutive patients with corneal edema for at least 4 months. The
Purpose: The aim of the study is to identify whether amniotic membrane (AM) is
corneal thickness was measured in microns before and 1, 3, and 6 months after the
capable of inhibiting the synthesis and secretion of IL-8 in human limbocorneal cells
treatment utilizing ultrasound pachymetry (UP) and OCT. Results: The media of
(HuLC). Methods: Primary cultures of HuLC were stimulated with specific patho-
pretreatment for UP 712 μm and OCT 773 μm, reduction of corneal thickness, was
gen-associated molecular patterns (PAMPs) to each toll-like receptor (TLR).
measured in all postoperative data; 1 month: 618 μm, 712 μm; 3 months: 657 μm
Synthesis and secretion of IL-8 was measured by reverse transcription polymerase
and 746 μm. Conclusion: Collagen crosslinking may be an alternative to reduce
chain reaction and ELISA. Experiments were performed in the presence or absence
corneal edema.
of AM. Results: There was significant increase in IL-8 synthesis in cells incubated
with Poly (I:C) and ODN2006. A significant reduction in the expression of IL-8 was 10:52 AM
observed in the presence of AM. To determine protein expression of TLR3, intracel-
lular flow cytometry on HuLC was performed, and there was no significant change in
its expression. Conclusions: We can conclude that AM did not affect the expres- PA197 10:55 AM
sion of TLR3.
Hypertonic Saline Solution Versus Diluted Alcohol-
10:22 AM Histological, Ultra-microscopical and
Panel discussion of previous paper Immunohistochemical Study of Corneal Epithelium
PA194 10:25 AM Presenting Author: Rossen M Hazarbassanov MD
Evaluation of Conjunctival Flora in Patients With Co-Author(s): Myrna Santos MD**, Edna Freymuller MD**, Jose Gomes MD*
Tear Film Dysfunction Purpose: To determine alterations on keratoconus corneal buttons (KCB) epithelium
exposed to ethanol 20% (ET) or 5%, 10%, 20% hypertonic saline (HS). Methods:
Presenting Author: Melissa Tomimatsu** Ten KCBs were exposed to ET or HS for 30 seconds and evaluated by microscopy,
Co-Author(s): Ana Hofling-Lima MD MBA, Flavio Hirai MD, Manuela M Cordeiro ultramicroscopy (UM), and immunohistochemistry (caspase-3). Results: Corneas
Barbosa MD** exposed to ET and 20% HS showed epithelium and basal membrane damage. UM
Purpose: To evaluate the conjunctival flora of patients with tear film dysfunction and revealed uniform desmosomal junctions and low electronic density between epithelial
its modification after silicon plug insertion. Methods: Cross-sectional study of 41 cells and epithelium and BL for ET-treated samples. On 10% HS treatment there

patients, from UNIFESP, São Paulo, from 2005 to 2007. Samples were taken from was shrinking and detachment of all epithelium layers. No condition showed staining
conjunctival sac and tested for the presence of microorganisms before and after plug for caspase-3. Conclusion: Cornea exposure to HS (5%, 10%) causes less dam-
insertion. Results: Coagulase-negative Staphylococcus was the most prevalent age to epithelium than similar exposure to 20% HS or 20% ET.
microorganism in eyes with or without plug. Susceptibility to oxacillin before and after 11:02 AM
plug insertion was 87.5% and 73.7%, respectively. Conclusion: Conjunctival flora
of eyes with tear film dysfunction was similar to that in normal eyes. Specific prophy- Panel discussion of previous paper
laxis before intraocular surgery in patients with plugs might not be necessary.
PA198 11:05 AM
10:32 AM Predictive Model to Calculate Glaucoma
Panel discussion of previous paper Development Risk in Penetrating Keratoplasty
PA195 10:35 AM Presenting Author: Blanca Domingo-Gordo MD PhD**
Endothelial Cell Loss (ECL) in Busin Glide (BG) vs. Co-Author(s): Beatriz Paredes-Garcia MD PhD**, Dolores Martin MD**, M Jesus
Herrero-Lluch MD**, Carlos Salvador Fernandez Escamez MD, Nicolas Tole-
Forceps-Assisted (FA) Donor Lenticule Insertion dano Fernandez MD**
Technique for DSEK Purpose: To determine glaucoma postkeratoplasty incidence and risk factors.
Presenting Author: Dominika Anna Janiszewska MD** Methods: 348 patients were analyzed prospectively with univariate and multivariate
Co-Author(s): Dariusz Dobrowolski MD**, Dorota Tarnawska MD, Edward A methods to reach a predictive model. Results: Glaucoma incidence was 25%,
Wylegala MD PhD** increased in perforation (RR: 1.9), trauma (RR: 1.8), bullous keratopathy (RR: 1.7),
prior glaucoma (RR: 4.1), pseudophakia with anterior chamber IOL pre-PK (RR:
Purpose: To compare endothelial cell loss (ECL) after Descemet-stripping endothe-
3.9), pseudophakia with posterior chamber IOL post-PK (RR: 2.3), IOL removal (RR:
lial keratoplasty (DSEK) with 2 graft insertion techniques. Methods: Cross sectional,
3.3), aphakia post-PK (RR: 3), interrupted sutures (RR: 1.9), and peripheral syn-
longitudinal retrospective analyses of 86 patients after DSEK, 40 operated using
echiae (R: 10.8). We reached a predictive model with a accuracy of 83.8% to
Busin glide (BG) and 46 with forceps-assisted (FA) technique. Endothelial cell density
detect probability of glaucoma development. Conclusion: A predictive model
was measured with Topcon SP 3000 and CSO SP-02 (agreement assessed with
might calculate individual risk to develop glaucoma that causes important visual
Bland-Altman method). Measurements obtained preoperatively and at 6 and 12
impairment.
months postoperatively were compared. Results: There was no statistical difference
between ECL from BG and FA at 6 months (P = .76). ECL was significantly greater 11:12 AM
than BG at 12 months (P = .011). Conclusion: There is an acceleration of ECL
from 0.5 to 1 year postoperatively, significantly lower in the BG technique.
195
años). La presentación más frecuente fue 52.9% panuveitis, seguida de posterior
Intraocular Inflammation, Uveitis (26.5%) y anterior (20,6%) Se documentó curso agudo en 70%, unilateralidad en
91.2% y 56% causadas por toxoplasmosis. Conclusión: La incidencia de uveítis
en Costa Rica en un centro terciario es 2.5%.
Sunday, Oct. 25 2:32 PM
SOUTH, Room 236
PA123 2:36 PM
PA110 2:00 PM
Intravitreal Bevacizumab (IVTB) for Inflammatory
Bevacizumab Intravitreo Versus Acetonida de
Choroidal Neovascularization (CNV): Results From a
Triamcinolona Intravitrea Para el Edema Macular
Collaborative Study Group
Cistoideo Uveitico Refractario (EMCUR)
Presenting Author: Juan V Espinoza-Garcia MD
Presenting Author: Andr Francisco Lasave MD
Co-Author(s): Maria H Berrocal MD*, Mauricio Maia MD, Lihteh Wu MD, Jose A
Co-Author(s): Juan G Sanchez MD, Lihteh Wu MD, Mauricio Maia MD, Arturo A Roca MD, Hugo Quiroz-Mercado MD*, Jose M Ruiz-Moreno MD PhD, Andr
Alezzandrini MD**, Miguel E Brito MD**, Humberto Contreras-Brandt MD**, Francisco Lasave MD, J Fernando Arevalo MD FACS
Sergio Bonafonte**, Silvio M Lujan MD**, Manuel Diaz Llopis MD PhD**, Natalia
Purpose: To evaluate the safety and efficacy of intravitreal bevacizumab (IVTB) in
Restrepo MD**, Francisco J Rodriguez MD*, Patricia Udaondo MD**, Juan V
inflammatory CNV. Methods: Retrospective, multicenter, interventional, noncom-
Espinoza-Garcia MD, J Fernando Arevalo MD FACS
parative study of 11 eyes (10 patients) with CNV secondary to chorioretinal
Objetivo: Reportar la eficacia de la inyección intravítrea única de bevacizumab (BIV) inflammatory diseases treated with IVTB (1.25 mg or 2.5 mg) and followed for 24
versus acetonida de triamcinolona intravitrea (TIV) para tratar el EMCUR no infecci- months. Results: At 24 months after IVTB, logMAR BCVA improved from 0.82 to
oso. Métodos: 28 pacientes (36 ojos) recibieron una inyección de BIV 2.5 mg (16 0.53 (P < .05), and central macular thickness (CMT) decreased from 344.3 μm to
ojos) o 4 mg de TIV (20 ojos). Resultados: Seguimiento fue de 6 meses. El Grupo 201.2 μm (P = .004). BCVA remained stable (± 1 lines) or improved 2 or more
TIV tenia una agudeza visual (AV) basal logMAR 1.1 ± 0.2 y 0.7 ± 0.4 (P < .001) lines in 9 eyes (81.8%). Reinjections were necessary in 5 eyes (45.5%). Conclu-
a los 6 meses. El Grupo BIV tenia una AV basal logMAR 1.2 ± 0.4 y 0.8 ± 0.4 (P sion: IVTB seems to provide functional and anatomic stability or improvement in
= .02) al final del seguimiento. El Grupo TIV presento una reducción significativa del inflammatory CNV at 24 months.
EMC por OCT desde 454.8 ± 238.9 μm a 296 ± 134.4 μm en 6 meses (P <
.001). El Grupo BIV no presento diferencias significativas. Conclusión: Una inyec- 2:44 PM
ción única de TIV fue más efectiva que el BIV en 6 meses en EMCUR. Panel discussion of previous paper
2:08 PM
Panel discussion of previous paper Ocular Tumors and Pathology
PA111 2:12 PM
Toxocariasis Ocular en Costa Rica 1998–2008: Una Sunday, Oct. 25
Revisión de 10 Años 10:15 - 11:15 AM
SOUTH, Room 238
Presenting Author: Roberto Jimenez MD**

Co-Author(s): Lihteh Wu MD, Joaquin Martinez MD PA168 10:15 AM
Objetivo: Describir las características clínicas de la toxocariasis ocular en Costa Infiltración del Cristalino por Melanomas Uveales.
Rica. Métodos: Revisión retrospectiva de todos los casos diagnosticados con toxo- Características Inmunohistoquímicas e
cariasis ocular durante los años 1998-2008 en el Hospital Nacional de Niños.
Resultados: 80 casos fueron identificados. En promedio, los pacientes se exam- Implicaciones Clínicas
inaron 6.7 meses después del inicio de síntomas. Los síntomas de presentación Presenting Author: David E Pelayes MD
más comunes eran estrabismo, pérdida visual y leucocoria. A la presentación el Co-Author(s): A Martin Folgar MD**, Jorge Zarate MD**
92.5% tenía una AV menor o igual que 20/200. Al finalizar el seguimiento, el
18.5% de los ojos obtuvo una AV mayor o igual que 20/40, 13% entre 20/50 y Objetivo: Reportar la infiltración del cristalino por los melanomas intraoculares.
20/100 y 68.5% tenían menor o igual que 20/200. Conclusión: En Costa Rica, Describir las características inmunohistoquímicas e implicancias clínicas. Materia-
el diagnóstico de una toxocariasis ocular es muy tardío por lo cual los resultados les y metodos: Se estudiaron 4 casos que en el momento del diagnóstico clínico,
visuales son pobres. ecográfico, mostraban compromiso del cristalino. Todos fueron evaluados mediante
técnicas convencionales e inmunohistoquímicas. Resultados: Dos pacientes
2:20 PM mostraron compromiso capsular y del epitelio del cristalino. Los otros 2 casos com-
Panel discussion of previous paper prometían las fibras periféricas y lo rodeaban totalmente. En los 4 casos, el tipo
histológico era mixto, de predominio epiteloide. Conclusión: Los melanomas intra-
PA112 2:24 PM oculares raramente infiltran el cristalino. Esto depende fundamentalmente de su
ubicación y de su agresividad histológica.
Incidencia de Uveítis en Costa Rica
Presenting Author: Ana Maria Munoz Barrionuevo MD 10:23 AM
Co-Author(s): Lihteh Wu MD
Propósito: Determinar la incidencia y características clínicas de uveítis en un centro
oftalmológico terciario en Costa Rica. Métodos: Se evaluaron prospectivamente los
nuevos pacientes en el Consultorio de Emergencias de Oftalmología del Hospital
México de Abril 2008 a Marzo 2009. Resultados: Se evaluaron 1368 pacientes,
de los cuales 34 (2.5%) presentaron uveítis de nueva presentación, 22 pacientes
eran masculinos y 12 femeninas con edad media de 35.2 años (rango de 15 a 82
PA169 10:27 AM
Orbit, Lacrimal, Plastic Surgery
Conjunctival Tumor in Hispanic Population: 100
Chilean Patients Clinical Series
Presenting Author: Maria E Manquez Hatta MD Sunday, Oct. 25
Co-Author(s): Pablo Vigorena MD** 4:30 - 5:30 PM
Purpose: To describe a series of conjunctival tumors in Hispanic population. SOUTH, Room 236
Methods: Clinical follow up in 100 consecutive patients sent to a referral center.
Chile from April 2006 to April 2009. Results: Of the 100 hispanic patients 90% PA130 4:30 PM
were adults, there was no difference by sex. Bening lesions were 67% mostly con- Tratamiento Con Dosis Bajas de Radioterapia en la
junctival nevus, malignant lesions were 33% including squamous cell carcinoma, Orbitopatía Tiroidea
melanoma, lymphoma, sebaceous carcinoma. Melanocytic lesions were 71 %, non
melanocytic lesions were 29%. Conclusion: The conjunctival tumors are present in Presenting Author: Virginia Bautista Ruescas**
hispanic patients from different ages. Most of the tumors are benign lesions. The Co-Author(s): Maria Mercedes Lopez Molina, Jose Manuel Ortiz Egea MD**,
presence of malignant tumors is not an exception. Maria Mercedes Lopez Molina, Maria Jose Carrilero Ferrer MD**
Métodos: Presentamos una serie de diez pacientes con oftalmopatía activa mod-
10:35 AM
erada-severa tras tratamiento radioterápico externo con megavoltaje y
Panel discussion of previous paper fraccionamiento de 1 Gy/semanal 20 semanas. Utilizamos una escala de satisfac-
ción entre 1 nula y 5 excelente. Resultados: El 80% dio una respuesta superior o
PA170 10:39 AM igual a 4 tras finalizar y a los 6 meses. La clínica inflamatoria disminuyó en todos y
Expression of Hipoxia Inducible Factor-1 in Uveal se normalizó la motilidad ocular en los casos afectos. Los efectos secundarios
Melanoma Animal Model Treated With COX-2 fueron en tres casos edema palpebral, dos casos de alopecia en cejas, y tres casos
con leves molestias retro-oculares desapareciendo a la semana. Conclusión: La
Inhibitor motilidad ocular, la pérdida de agudeza visual y la inflamación es mejorada con
Presenting Author: Alexandre Nakao Odashiro MD radioterapia y corticoides. Administrando 1 Gy por semana, se logra una respuesta
Co-Author(s): Patricia Odashiro**, Sebastian Di Cesari MS**, Daniel Abourbih similar con menos efectos secundarios.
MS**, Emilia Antecka MD PhD**, Priscila Inacio Fernandes MD**, Bruno Franco
Fernandes MD PhD**, Miguel N Burnier Jr MD PhD**
4:38 PM
Purpose: To describe differences of HIF-1  expression in uveal melanomas (UM)
treated and nontreated with COX-2 inhibitors. Methods: Paraffin blocks from intra- PA131 4:42 PM
ocular UM of the COX-2 animal model were selected. Four tumors from the treated
and 7 from the control group were immunostained for HIF-1- protein. Tumors Sphenoid Wing Meningioma Resection Through an
were classified 0, 1, 2, or 3 according to the staining. Results: In the control Extended Eyelid Crease Approach to the Temporal
group, 85.7% of tumors presented a score of 3, and 14.3% presented a score of Cranial Fossa
2. In the treated group, 75% presented a score of 1, and 25% presented a score of
2 (P = .000216). Conclusion: The effect of COX-2 inhibitors in UM can be related Presenting Author: Alfio P Piva MD**
to the reduction of the hypoxia. Purpose: To demonstrate that sphenoid orbital meningioma (SOM) resection is

possible through a pure orbital route. Methods: Prospective, noncomparative 6-
10:47 AM patient case series description of surgical technique. Study included SOM limited to
Panel discussion of previous paper the sphenoid wing with or without adjacent intradural infiltration or compressive optic
neuropathy (CON). SOM resection was accomplished through extended eyelid
PA171 10:51 AM crease incision using standard microsurgical drilling techniques. Meningioma infil-
15-Lipoxygenase Expression in Uveal Melanoma trated bone was directly drilled out, exposing duramater and periorbita. Results:
Gross total meningioma resection was possible in all cases. Average reduction of
Presenting Author: Andresson M Figueiredo MD PhD exophthalmos = 3.66 mm (3–5 mm), SD ± 0.81. Improved CON: 3/4. Conclu-
Co-Author(s): Paulo C Ferreira MD PhD, Gustavo S Lima MD**, Fernando Ram- sion: The herein described procedure is a suitable way to resect limited SOM with or
alho Lopes MD without CON.
Purpose: To investigate the expression of the platelet isoforms of 15-Lipoxygenase
5:00 PM
(15-LOX) in uveal melanoma and its correlation with histopathological prognostic
factors. Methods: Immunohistochemistry for 15-LOX was done in 20 cases of Panel discussion of previous paper
uveal melanoma. The 15-LOX expression was related to histopathological prognostic
markers, such as cell type, the presence of lymphocytic infiltration and vascular
PA132 5:04 PM
closed loops in the tumour. Results: 15-LOX expression was found in 13 (65%) of Correlation Between Refractive Error, Axial Length
the cases, and it correlated with markers of poor prognosis. such as epithelioid cell and Exophthalmometry in Chinese Graves Disease
type and the presence of lymphocytic infiltration and vascular closed loops. Conclu-
sion: The role of 15-LOX in uveal melanoma should be further elucidated, and the
Patients and Normal Subjects
use of 15-LOX inhibitors warrants investigation as therapeutic target for chemopre- Presenting Author: Jonathan C H Ho MRCP
vention of melanoma metastasis. Co-Author(s): Simon T C Ko MBBS FRCS**, Edwin Chan MBBS**, Clement W
N Chan MBBS FRCOphth**
10:59 AM
Purpose: To study the correlation between refractive error (spherical equivalent [SE]
Panel discussion of previous paper during analysis), axial length (AL), and exophthalmometry (EV) in Chinese Graves dis-
ease (GD) and normal subjects. Methods: Eighty-two GD and 82 normal, sex- and
age-matched subjects were recruited with measurements obtained. Results: EV in
GD group (24.11 mm) was higher than that in the normal group (21.70 mm). Cor-
relations between EV and AL were 0.45 (Pearson r) for normal; 0.33 for GD; EV vs.
197
SE: r = 0.29 for normal; 0.19 for GD. Correlation between AL and SE was good in PA177 3:39 PM
both groups: r = 0.94, normal; 0.77, GD. Conclusion: A lower level of correlation
is found between EV vs. AL and EV vs. SE in normal subjects, as compared to previ- Is There an Increased Incidence of Higher Order
ous literature. The correlations are even less in GD individuals. Aberrations in Young Patients With Unilateral
Amblyopia?
5:12 PM
Presenting Author: Alberto Lopez Miguel
Co-Author(s): Miguel J Maldonado MD PhD, Juan C Nieto DO, Arnaldo Bel-
zunce MD**, Jesus Barrio MD**
Pediatric Ophthalmology, Strabismus
Purpose: To investigate the whole eye’s higher-order aberrations (HOAs) in patients
with unilateral strabismic or anisometropic amblyopia. Methods: Ocular HOAs were
measured with a Hartmann-Shack wavefront sensor over a 6mm pupil in 47 ambly-
Sunday, Oct. 25 opic eyes (36 anisometropic and 11 strabismic) and were compared with sound
3:15 - 4:15 PM fellow eyes. Results: Mean total third-order aberration root mean square (RMS) val-
SOUTH, Room 238 ues were statistically significantly higher in amblyopic eyes (P = .04), but no
difference could be found in fourth-order or fifth-order RMS values. Conclusion:
PA175 3:15 PM The correction of third-order aberrations may be a therapeutic target in the visual
Evolution of Hyperopia in Accommodative Esotropia rehabilitation of eyes with anisometropic and strabismic amblyopia.
Patients 3:47 PM
Presenting Author: Ofelia M Brugnoli De Pagano MD Panel discussion of previous paper
Co-Author(s): Myriam Berman MD, Gabriela Lucia Pagano
PA178 3:51 PM
Purpose: To study the evolution of hyperopia in children with accommodative eso-
tropia. Methods: 56 eyes of 28 patients were examined under cycloplegia with A Study of Complex Strabismus by MRI Using the
cyclopentolate hydrochloride 1% and measured with autorefractor annually. Mean (± IMAGE J Programme
SD) starting age was 3.86 (1.86) years old. Mean (± SD) finishing age was 9.64 Presenting Author: Marlene Vogel**
(2.77) years old. Mean follow up period: 5.75 (2.65) years. Mean uncorrected eso-
tropia was 28.04 (6.98) DP. Results: Mean Initial Hyperopia was 4.40 (1.70) D Co-Author(s): Galia Gutierrez**, Carolina Valenzuela**, Alejandra Torres MD**,
and mean Final Hyperopia 4.42 (1.76) D. No statistically significant difference was Dario Vasquez MD**, Patrica Orellana MD**
noted for the group (P > .05). Conclusion: In the light of our study, we believe that Introduction: MRI image analysis by the IMAGEJ program has allowed us to study
hyperopia in patients with refractive accommodative esotropia remains stable through the extraocular muscles (EOM) in complex strabismus. Objective: To study EOM
time, in contrast to common belief. with Image J. Methodology: We have calculated and compared area, position,
and angle of EOM from MRI orbit images from healthy patients, those with acquired
3:23 PM strabismus in high myopia (MAPE), and those with craniosynostosis (CS). Results:
Panel discussion of previous paper MAPE patients had displacement of the rectus lateral muscles (RLM) and their angles
were higher than the healthy eyes and more severe cases. Patients with CS and V
PA176 3:27 PM pattern had a displacement in both RLM. Conclusion: This study allowed us to
Early Lensectomy With PC IOL and Capsular Tension develop a surgical plan appropriate to the anatomical alteration. This program
allowed measurements of positions of orbital structures.

Ring (CTR) in Microspherophakia to Avoid Lens-
Induced Complications 3:59 PM
Presenting Author: Ibrahim A Al-Jadaan MD** Panel discussion of previous paper
Co-Author(s): Ibrahim AlJadaan MD**, Jose Morales MD** PA179 4:03 PM
Purpose: To report the outcome of early lens aspiration (LA) with posterior chamber
IOL (PC IOL) and capsular tension ring (CTR) in microspherophakia (MS) to avoid or Characteristics of Infant Eye Care With Distinct
treat lens-induced complications (LIC). Methods: Twelve eyes of 9 patients with a Socio-Economical Profiles in Two Ophthalmologic
mean age of 18 years (range: 9–35) underwent LA with PC IOL and CTR. All eyes Emergency Centers
had shallow or absent anterior chamber (AC), frequent lens subluxation, glaucoma, Presenting Author: Camila Ventura MD**
iris corneal touch, and lens-induced myopia. Results: Ten of 12 eyes that had early
surgical intervention ended with ≥ 20/40 vision, normal IOP, deep AC, stable IOL, Co-Author(s): Vasco Torres Fernandes Bravo**, Liana O Ventura MD, Carlos
and emmetropia with a mean follow-up of 5 years (range: 0.3–9). Two eyes devel- Teixeira Brandt MD PhD**
oped corneal decompensation due to late presentation and extensive iris corneal Purpose: To describe the characteristics of ophthalmologic care in infants with dis-
touch. Conclusion: Early surgical intervention in MS is recommended to treat LIC tinct socioeconomic profiles treated in two ophthalmologic emergency centers
and prevent corneal decompensation. (OEC). Methods: All patients < 1 year of age cared for at the OEC of the Altino
Ventura Foundation (FAV) and Pernambucos´ s Eye Hospital (HOPE) from January to
3:35 PM December of 2007 had their medical records reviewed. Results: Total patients:
Panel discussion of previous paper 944, FAV; and 432, HOPE. Mean age: 114.0 ± 4.0 days (FAV) and 223.7 ± 8.6
days (HOPE). FAV’s patients took ± 26.8 and HOPE’s took ± 7.1 days to look for
medical care. Conjunctivitis was diagnosed in 58.4% and 71.1%, respectively.
Conclusion: The patients from HOPE were older and looked for medical care
faster. Conjunctivitis was the most frequent diagnosis in both centers.
4:11 PM
Monday, Oct. 26 PA147 2:30 PM
2:00 - 3:00 PM Alteraciones Neurovisuales y Estrabismo en
SOUTH, Room 236 Pacientes con Esclerosis Múltiple
PA144 2:00 PM Presenting Author: Paula Morelos Herrera MD**
Resección y Transposición Anterior Unilateral del Co-Author(s): Silvia Moguel Ancheita, Rosa María Negrete Rodriguez MD**,
Fabiola Ogaz Gonzalez MD**, Luis Porfirio Orozco Gomez MD**, Sandra Qui-
Oblicuo Inferior en el Tratamiento de Hipertropias nones Aguilar MD**
Presenting Author: Claudia L Pabon MD** Objetivo: Demostrar los síntomas neurovisuales y estrabismo en pacientes con
Co-Author(s): Lisleth Gordon MD**, Ana A Gutierrez MD**, Marisabel Andrade esclerosis múltiple (EM). Métodos: Estudio prospectivo de pacientes con EM. Se
MD**, Maria Alejandra Rodriguez MD** realizó exploración oftalmológica incluyendo pruebas de Fansworth y HRR. Resul-
Objetivos: Evaluar el resultado de la corrección de hipertropias mediante la resec- tados: Se incluyeron 14 pacientes, edad: 38.6 ± 9 años. Conclusión:
ción y transposición anterior unilateral del oblicuo inferior. Materiales y Métodos: Capacidad visual: 0.36 logMAR, discromatopsia a línea rojo-verde en 85% de los
Se incluyen 5 pacientes de sexo femenino con hipertropias a quienes se les realizó casos. Estrabismo en 78% incluyendo skew deviation.
resección y transposición anterior unilateral del oblicuo inferior. Todas las pacientes
2:37 PM
tenían cirugía previa de músculos horizontales. Resultados: Todas las pacientes
estaban en ortotropia en posición primaria al año de seguimiento. Conclusión: La Panel discussion of previous paper
resección y transposición anterior del oblicuo inferior unilateral es efectiva en el trata-
miento de hipertropias en pacientes con antecedente de cirugías previas de los
PA148 2:40 PM
músculos horizontales. Estudio Clínico y Genético de Pacientes Mexicanos
2:07 PM con Fibrosis Congénita de los Músculos
Extraoculares
Presenting Author: Naira C Pereyra-Munoz MD**
PA145 2:10 PM Co-Author(s): Claudia Elena Murillo Correa**, Sanjuanita Flores-Limas MD**,
Perfil Epidemiológico de la Retinopatía del Juan Carlos Zenteno-Ruiz MD PhD**
Prematuro en un Hospital Universitario de un País Objetivo: Identificar mutaciones en el gen KIF21A en pacientes mexicanos con
Latinoamericano. En un Periodo de 6 Años fibrosis congénita de músculos extraoculares (FCMEO). Métodos: Se incluyeron 7
pacientes con FCMEO. Se realizó exploración oftalmológica, tomografía compu-
Presenting Author: Alexander Maximiliano Martinez Blanco** tarizada de órbitas y análisis del gen KIF21A mediante PCR y secuenciación
Co-Author(s): Claudia Zuluaga MD**, Milton Guerra Torres MD** automatizada. Resultados: Todos los casos fueron esporádicos. Cuatro pacientes
Objetivo: Determinar el comportamiento epidemiológico de la Retinopatía del Pre- reunían los criterios clínicos para FCMEO tipo1 y los otros 3 no tuvieron una cuadro
maturo (ROP) en un periodo de 6 años. Métodos: Se revisaron historias clínicas de de FCMEO típica, aunque si fueron diagnosticados como FCMEO por hallazgos
prematuros de ≤ 34 semanas de gestación y/o ≤ 1500 gr de peso al nacimiento, tomográficos. Se evidenciaron mutaciones puntuales en sólo 2 pacientes, ambos en
valorados por el programa de ROP entre enero de 2002 y diciembre de 2007, el codón 954 del gen KIF21A(R954W). Conclusión: La FCMEO tipo 1 es la más
revisando presencia de ROP de manejo quirúrgico. Resultados: Se estudiaron común y se encontraron las mutaciones del KIF21A en dos pacientes.
1703 historias clínicas donde el 12% tuvo algún grado de ROP y de estos el 54%

requirieron cirugía. Entre los pacientes de cirugía el 88% tenía menos de 31 sema-
2:47 PM
nas y el 82% menos de 1251 gr de peso al nacimiento. La incidencia de ROP de Panel discussion of previous paper
manejo ablativo disminuyó del 16% en el 2002 al 4% en el 2007 (P < .001).
Conclusión: La incidencia de ROP de manejo quirúrgico mejoró en el periodo de
PA149 2:50 PM
estudio. Factores de Riesgo en Exotropia Consecutiva
2:17 PM Presenting Author: Blanca Domingo-Gordo MD PhD**
Panel discussion of previous paper Co-Author(s): Jose Reche-Sainz**, Carlos Salvador Fernandez Escamez MD
Objetivo: Factores en la génesis de exotropias consecutivas. Métodos: Estudio
PA146 2:20 PM retrospectivo. 270 pacientes con exotropia consecutiva. Evaluando parámetros: lim-
Análisis de las Funciones Visomotoras y el Nivel de itación aducción, defectos refractivos, ambliopía, anisometropía, desviación vertical
disociada (DVD) y síndromes alfabéticos, tiempo tras cirugía de esotropia. Paquete
Inteligencia en Niños con Estrabismo Recurrente estadístico SPSS 12.0. Resultados: Significativamente, 94% de las exotropias se
Presenting Author: Silvia Moguel Ancheita presentó tardíamente (P < .01) , hipermetropía (78%) (P < .01), limitación de
Co-Author(s): Luis Porfirio Orozco Gomez MD**, Susana Ramirez Sibaja**, Ser- aducción (77%), ambliopía (77%) y anisometropía (88%). No significativa DVD, ni
gio Reyes Pantoja** síndromes alfabéticos. Formas X mayoritarias 55%. Conclusión: Exotropias con-
secutivas aparecieron con mayor frecuencia de forma tardía. La existencia de
Objetivo: Analizar las funciones cognitivas posterior al tratamiento de estrabismo.
hipermetropía hipocorregida, se demostró como factor asociado significativamente.
Métodos: Estudio prospectivo en niños con estrabismo recurrente. Se aplicaron
pruebas de inteligencia y visomotoras, previos y posterior al tratamiento de estra- 2:57 PM
bismo. Resultados: Se incluyeron 9 niños, edad: 8.7 años, seguimiento 8 meses.
Inteligencias: verbal: 91.1 ± 11, ejecutiva: (IE): 86.7 ± 8, global (IG): 91.4 ± 10.6.
Coeficiente de Correlación para IE significativa para estereopsis (-0.2), capacidad
visual y Bender (-0.1). La IG posterior (91 ± 10) fue mejor que el valor pronóstico
(88.1, x = 90). Conclusión: Demostramos mejoría de las funciones cognitivas rel-
acionadas a la recuperación de binocularidad.
2:27 PM
199
11 eyes (40.74%). In only 2 cases (18.18%) cyclodialysis was found in the 2nd
Potpourri scan whereas in the other 9 patients cyclodialysis was closed at this time. Conclu-
sion: This is the first report of cyclodialysis incidence after trabeculectomy surgery
performed by residents in Mexican population.
Monday, Oct. 26 3:42 PM
SOUTH, Room 236
PA165 3:45 PM
PA162 3:15 PM
Screening for Causes of Impaired Vision of a
New Considerations on Pupillary Block Mechanism
Geriatric Population in Costa Rica’s National
Presenting Author: Sebastiao Cronemberger MD
Geriatric and Gerontologic Hospital
Co-Author(s): Nassim S Calixto MD**, Andre Oliveira de Andrade MD**, Rafael Presenting Author: Sebastian Salas**
Vidal Merula MD**
Purpose: To investigate the pupillary block in occludable angle eyes. Methods: In
Co-Author(s): Rolando Mora MD**, Teodoro J Evans MD
a pilot study, we first measured by ultrasound biomicroscopy angle amplitude and iris Purpose: To detect causes of low vision and blindness in the geriatric population.
thickness in 13 acute primary angle closure (APAC) eyes under light and dark condi- Methods: Prospective, noninterventional, transversal case series of patients evalu-
tions. Afterward, we measured iris-lens angle (ILA), iris-lens contact distance (ILCD), ated for the first time at the ophthalmology department of the Hospital Nacional de
and anterior chamber depth (ACD) in 32 APAC eyes under light and dark conditions Geriatría from September 2006 to April 2007. Screening included corrected Snellen
and before and after laser peripheral iridotomy (LPI). Results: Significant decrease visual acuity (VA), biomicroscopy, tonometry (Goldmann), and funduscopy.
in the angle and significant increase in iris thickness occurred when comparing light Results: 164 patients; mean age 75.9 ± 8 years; 60.97% were females. Thirty-
to dark conditions. Significant differences were found in ILA and ILCD: before vs. nine percent had impaired vision (49% cataract, 21% AMD), 34.56% had low vision
after LPI in light and dark conditions. ACD did not change. Conclusions: The (53% cataracts, 20% refractive errors), and 4.3% had legal blindness (43% AMD,
decreasing angle amplitude only corresponds to an increase in iris thickness. Follow- 14% cataract). Conclusion: Cataract is by far the leading cause of impaired vision
ing LPI, APAC eyes had an increase of ILCD and a decrease of ILA, contradicting the in the geriatric population.
pupillary block theory.
3:52 PM
3:22 PM Panel discussion of previous paper
PA166 3:55 PM
PA163 3:25 PM Visual Acuity Screening Skill Development Module
Patients’ Reasons for Self-Reported Nonadherence Presenting Author: Alexandre C Taleb MD
to Glaucoma Treatment Co-Author(s): Chao Lung Wen MD PhD**, Marcos P Avila MD**
Presenting Author: Maria L Veronese Rodrigues MD Purpose: To develop a set of educational tools in basic ophthalmology to create a
Co-Author(s): Lucas Ravagnani Silva**, Eduardo M Rocha MD**, Jayter Silva skill development module for visual acuity (VA) screening. Methods: Interactive
Paula MD PhD** material was produced, based on the development of eye anatomy learning objects
(3D computer graphics) and short film contextualization. Results: The VA Module
Purpose: To detect patients’ opinions about the causes for not adhering to glau-
was applied to 428 health professionals from Family Healthcare Groups throughout
coma treatment. Method: Interviews, with application of an open questionnaire, to
Brazil. Knowledge acquisition was assessed by a standardized questionnaire, which
50 patients with primary open-angle glaucoma (POAG). Results: The reported
was answered before and after the training sessions. A statistically significant differ-
causes of noncompliance were side effects of drugs (24%), lack of information
ence (P < .001) was verified in every knowledge group evaluated, suggesting that
about glaucoma (22%), difficulties in understanding information and in patient-doctor
the module improved the knowledge of the course participants. Conclusion: Due
communication (14%), difficulties in administering the treatment (14%), lack of
to its interactive structure, this module can be used as a distance learning tool for VA
financial resources to acquire eye drops (10%), and patients´ beliefs and attitudes
screening skill development.
(10%). Conclusion: Considering the causes reported, adherence may increase
with education about POAG, improvement in the patient-doctor relationship, and 4:02 PM
increased antiglaucoma drug supply.
3:32 PM
PA167 4:05 PM
Human Artificial Vision
PA164 3:35 PM Presenting Author: Jose Luis Ortigoza Velasco
Cyclodialysis Incidence After Trabeculectomy Co-Author(s): Fernando Martinez Castro MD PhD**, Ellery M Lopez Star MD
Performed by Residents Diagnosed by PhD**
Ultrabiomicroscopy Purpose: Since 1960 many attempts have been done in order to develop visual
Presenting Author: Jesus Arrieta-Camacho MD prostheses; most of the devices, supported in the production of phosphenes through
electrical stimulation are incapable to reconstruct a coherent retinotopic map. Meth-
Co-Author(s): Gilberto Islas MD**, Gerardo Eliud Valdes-Casas MD** ods: This paper describes the experimental design and psychophysical data
Purpose: To determine cyclodialysis incidence after trabeculectomy surgery diag- necessary for the construction of a visual sensory substitution prostheses with a
nosed by ultrasound biomicroscopy. Methods: A prospective, observational, vibrotactile system. Results: The system locates different bars over the epdiermis to
descriptive study was realized.31 eyes were included, 17 male (54.48%), 14 reproduce a point by point matrix, allowing the reconstruction of an image with an
female (45.16%). 4 patients were excluded by incomplete follow up. 2 ultrasound external device that doesn’t require invasive procedures. Conclusions: This vibro-
biomicroscopy scans were realized in the 1st and 3rd postoperative weeks. tactile system is capable of reproducing chromatic gammas, depth and movement
Results: We identify cyclodialysis during the first ultrasound biomicroscopy scan in perception in 3D- environments.
4:12 PM Tuesday, Oct. 27
Panel discussion of previous paper 9:00 - 10:00 AM
SOUTH, Room 236
Refractive Surgery
PA185 9:00 AM
Corneal Collagen Crosslinking Under Contact Lens
Sunday, Oct. 25 Molding in Human Donor Eyes
2:00 - 3:00 PM Presenting Author: Rafael I Barraquer Compte MD
SOUTH, Room 238 Co-Author(s): Jose Lamarca MD**, Juan Alvarez de Toledo MD
PA172 2:00 PM Purpose: To test combining corneal crosslinking (CXL) with orthokeratology (OTK)
in human donor eyes (HDE). Methods: Six pairs of HDEs were maintained at 20
Cirugía Refractiva en Niños, Cuándo y Porqué Est á mm Hg IOP. After epithelium removal, an OTK contact lens (11.8 mm diameter and
Justificada 10 mm main radius) was sutured to one cornea of each pair. A standard CXL proto-
Presenting Author: Gabriel Quesada Larez MD col was applied simultaneously to both. Pre- and postoperative IOP, pachymetry,
topography, corneal hysteresis (CH), and resistance factor (CRF) were measured.
Co-Author(s): Rodrigo Quesada MD
Results: Average maximal K and cylinder values did not change significantly in any
Introduction: LASIK en niños es poco conocido y no es totalmente aceptado. En group. Average CH and CRF increased significantly in both groups, without signifi-
este trabajo presentamos 3 casos de niños operados a los 12 años de edad y un cant differences between them. Conclusion: Corneal molding by a sutured OTK
seguimiento de más de 15 años de evolución. Metodo: Niños que no mejoraron su contact lens combined with CXL does not induce permanent changes in corneal cur-
AV con tratamiento convencional, se sometieron a LASIK. Caso 1: microestrabismo, vature parameters in HDE.
ambliopia, fijación excentrica, +7 OU. Caso 2: anisometropía OS -8.75. Caso 3:
estrabismo acomodativo +5 OU. Resultados: Con 15 años de seguimiento, Caso 9:08 AM
1: mejoró una línea de AV, +1 OD, +2 OS. Caso 2: OS -0.75. Caso 3: plano OU. Panel discussion of previous paper
Conclusión: El éxito en esta cirugía lo valoraremos cuando la visión obtenida en la
infancia persiste en el adulto sin complicaciones. PA186 9:12 AM
2:08 PM Prospective, Randomized, Contralateral Eye
Panel discussion of previous paper Comparison of Visual Outcomes in Custom vs.
Conventional (Conv) PRK With VISX S4 Laser
PA173 2:12 PM Presenting Author: Mark D Mifflin MD**
Aberrometría Corneal en Casos Difíciles Co-Author(s): Christopher J Kurz MD, Majid Moshirfar MD
Presenting Author: Ricardo L Escobar Cuartas SR MD** Purpose: To compare visual outcomes after custom and conventional PRK. Meth-
Objetivo: Revisar resultados, explicar la técnica y consejos prácticos en casos de ods: After institutional review board approval, 48 eyes of 24 patients were
pacientes con cirugías previas o con alto grado de aberraciones. Métodos: Todos randomized to custom PRK in 1 eye and conventional PRK in the fellow eye accord-
los pacientes fueron operados con cirugías guiadas por aberrometría corneal y ing to a standardized protocol. Results: At 6 months there was no statistically
excimer láser de Schwind (Esiris y / o Amaris). Resultados: Se demuestran las significant difference between custom and conventional groups in mean uncorrected

grandes ventajas de esta tecnología. Conclusión: Las cirugías personalizadas son logMAR visual acuity (-0.02 ± 0.09 and -0.03 ± 0.08), higher-order aberrations,
indispensables en los casos con alto grado de aberraciones de alto orden. or contrast sensitivity. Neither group had significant haze, complications, or need for
enhancement. Conclusion: Both custom and conventional PRK provide excellent
2:20 PM visual outcomes.
9:20 AM
PA174 2:24 PM Panel discussion of previous paper
Excimer Láser en Hipermetropías Mayores de 3,0 PA187 9:24 AM
Dioptrias
LASIK Flap Thickness Created With the Fifth
Presenting Author: Ricardo L Escobar Cuartas SR MD**
Generation Femtosecond Laser
Objetivo: Mostrar los resultados de una cirugía extraocular en pacientes con hiper-
Presenting Author: Mohamed A Guenena MD*
metropías de 3,0 a 6,50 dioptrías con y sin astigmatismo, utilizando el Láser
SCHWIND ESIRIS y AMARIS guiados por aberrometría corneal. Métodos: Pacien- Co-Author(s): Helga P Sandoval MD*, Kerry D Solomon MD*
tes Hipermétropes con o sin astigmatismo, con un seguimiento de 6 meses a 5 Purpose: To evaluate accuracy and reproducibility of LASIK flap thickness created
años, todos operados por el mismo cirujano, flap de 9,0 mm o mayor y bisagra by a fifth-generation femtosecond laser (iFS Advanced Femtosecond Laser). Meth-
nasal. Resultados: Se Muestra la técnica quirúrgica , el análisis Topográfico y los ods: In a prospective, unmasked study, a total of 24 eyes underwent LASIK. Flap
mapas de aberrometría postoperatorios . Se demuestra ; que se puede incurvar la thickness was intended to a depth of 100 and 110 microns. Measurements using
córnea hasta 50,0 o 51,0 dioptrías sin alteraciones epiteliales y con leves cambios intraoperative pachymetry and postoperative anterior segment OCT were taken at 3
en las aberraciones de alto orden. Conclusión: El Excimer Láser es una alternativa months. Measurements were compared to intended thickness. Results: Pachyme-
mínimamente invasiva en hipermetropía, segura, modificable y con excelentes try measurements were 109 μm (± 9.6), 119 μm (± 11.5) for an intended
resultados. thickness of 100 μm and 110 μm, respectively, while OCT measurements were 117
μm (± 11.2) and 123 μm (± 6.5). Conclusion: High consistency and reproduc-
2:32 PM ibility of flap thickness were seen when the fifth-generation laser system was used to
Panel discussion of previous paper create the flaps.
9:32 AM
201
PA188 9:36 AM phy in 19 (41.2%). Moderate ischemia showed edematous patterns on OCT (72%),
and severe ischemia showed foveal thinning on OCT (75%) (P < .05). Conclu-
Long-term Results for the Treatment of Myopia- sion: As the ischemia progresses, the foveal OCT pattern shifts from edematous to
Presbyopia With the AMO VISX Excimer Laser foveal atrophy.
System
4:50 PM
Presenting Author: Gustavo E Tamayo MD*
Co-Author(s): Claudia Castell MD, Pilar Vargas MD**
Purpose: To demonstrate safety and efficacy in treatment of myopia in presbyopic PA135 4:54 PM
patients with CustomVue ablation and presbyopia multifocal shape to preserve the Association Analysis of LOC387715 Gene
near vision. Material: Sixty eyes (53 years) with myopia and presbyopia underwent
treatment with an AMO Visx Laser with CustomVue for myopia and special multifocal
Polymorphism in Brazilian Population With AMD
ablation (T shape: near periphery). Mean follow-up: 35 months. UCVA, BCVA, and Presenting Author: Marcio B Nehemy MD
contrast sensitivity VA (CSVA) for distance and wavefront changes were recorded. Co-Author(s): Luciana N Almeida MD**, Rachel Melilo-Carolino MBBS**, Diogo
Results: One hundred percent had UCVA 20/30; 75% had 20/20; 100% had Sperandio MBBS FRCOphth**, Luis A Demarco MD**
BCVA of 20/20, and 30% had 20/15. CSVA returned to normal in 4 months. No
Purpose: To investigate the association between LOC387715 gene and AMD in a
loss of BCVA; enhancement rate was 12%. Patient satisfaction was very high. Con-
cohort from Brazil. Methods: We examined 76 affected individuals and 70 sex-age
clusion: The AMO Visx T shape ablation added to a CustomVue myopia treatment
matched controls. Genotyping for the LOC387715 (rs10490924) single nucleotide
to create a multifocal cornea in eyes with myopia and presbyopia is safe, effective,
polymorphism (SNP) was performed. Results: Mean age was 74.4 (± 8.9) years.
and very satisfying for patients.
A prevalence of 72.3% was observed for A69S variant among AMD cases com-
9:44 AM pared with 38.5% among controls (P < .05). Subjects with one copy of this variant
had a 4.17-fold (P < .0001) (95% CI, 2.07–8.36) increased risk of AMD. Con-
Panel discussion of previous paper clusion: The present data provide a strong association of LOC387715
polymorphism among Brazilian AMD patients.
Retina, Vitreous
5:02 PM
Sunday, Oct. 25 PA136 5:06 PM
4:30 - 5:30 PM
SOUTH, Room 238 Wide Field Angiography and Documentation of
Peripheral Perfusion and/or Ischemia in Patients
PA133 4:30 PM With Wet AMD
Anatomical and Visual Acuity Results of Macular Presenting Author: Mike Bennett**
Surgery With 25-Gauge Vitrectomy Co-Author(s): Karl E Waite MD**, Clifton S Otto MD**, Annie Hiller**
Presenting Author: Gopal Pillai Purpose: To utilize wide-field retinal angiography to assess the peripheral vascular
Purpose: To evaluate the anatomical and visual acuity results of macular surgery perfusion and relative ischemia in patients with active wet compared to dry AMD.
with 25-gauge vitrectomy. Methods: Retrospective analysis of OCT patterns, cen- Methods: Fluorescein angiography, OCT, and macular autofluorescence were
tral macular thickness, and visual acuity was evaluated preoperatively and at 1 week, obtained on 128 eyes. Results: Peripheral nonperfusion and resultant late angio-
1 month, and 6 months postoperatively. The data were statistically compared. graphic leakage was found in patients with active AMD. Conclusion: Peripheral
Results: There were macular holes (n = 40), epiretinal membrane (ERM) (n = 25), perfusion or lack thereof may be a key marker for the relative AMD disease state.
and vitreomacular traction (VMT) (n = 15). In 80% of cases, visual acuity improve- Measuring peripheral angiographic perfusion and understanding this potential source
ments of 1 line, 2 lines, and 3 lines were seen in 80%, 50%, and 40%, of VEGF might be important in ongoing AMD therapy.
respectively. OCT showed significant reduction of macular thickness in the ERM and
VMT group (P < .05) Macular hole closure rate was 82.5%. Conclusion: Opti- 5:14 PM
mally performed 25-gauge macular surgery had good visual and anatomical results. Panel discussion of previous paper
OCT helped significantly in patient selection and surgical decision making.
PA137 5:18 PM
4:38 PM Evaluation of a System for Automatic Detection of
Panel discussion of previous paper Neovascular AMD Using Optical Coherence
PA134 4:42 PM Tomography (OCT) Images
Correlation Between Fundus Fluorescein Presenting Author: Rodrigo Abreu MD*
Angiography and Optical Coherence Tomography in Co-Author(s): Pedro Serrano MD PhD**, Cayetano Guerra Artal PhD**, Luis
Diabetic Macular Ischemia Anton Canalis**, Pedro Domingo Abreu Reyes MD**
Purpose: To evaluate sensitivity and specificity of a computer-aided diagnosis
Presenting Author: Mahesh Gopalakrishnan MS FRCS Ed
(CAD) for automated screening of neovascular AMD using macular OCT images.
Co-Author(s): Gopal Pillai Method: Retrospective cross-sectional study of 264 OCT images (155 from
Purpose: To evaluate the patterns of macular edema in cases of diabetic macular healthy subjects and 109 from AMD patients), randomly and blindly assessed by the
ischemia and to correlate the patterns with the severity of ischemia. Methods: The CAD and one retinal specialist. Results: CAD software showed a sensibility of
fundus fluorescein angiograms and OCTs done between January 2005 and Decem- 81.7% and a specificity of 77.4%. Positive predictive value was 71.8% and nega-
ber 2008 were retrospectively analyzed, and cases of diabetic macular ischemia tive predictive value was 88.7%. Conclusion: Automated detection of neovascular
were selected for the study. Results: Forty-four eyes of 26 patients were studied. AMD OCT images could be a valuable tool for complementing , as a second reader,
Ischemia was moderate in 60.2% and severe in 39.8%. The OCT patterns were neovascular AMD screening.
spongy in 12 (27.3%), cystoid in 10 (22.7%), normal in 3 (6.8%), and foveal atro-
5:26 PM
Monday, Oct. 26 PA183 3:51 PM
3:15 - 4:15 PM Flow Chart for Fluorescein Angiography Analysis
SOUTH, Room 238 Presenting Author: Eduardo P Mayorga MD
PA180 3:15 PM Co-Author(s): Ana Gabriela Palis MD
Multiplex Nested Polymerase Chain Reaction for Purpose: To present a flow chart designed to simplify the analysis of fluorescein
angiograms. Methods: Authors describe a flow chart based on 8 key questions,
Bacterial Endophthalmitis Diagnosis which must be answered through the analysis of an angiogram in order to progres-
Presenting Author: Gustavo Barreto De Melo MD** sively arrive at a diagnosis. Results: The flow chart and the questions make
Co-Author(s): Paulo José Martins Bispo MS**, Maria Cecíia Zorat-Yu PhD**, systematic analysis of angiograms easier, allowing users to arrive at a more accurate
Monica Pinanez MD**, Ana Hofling-Lima MD MBA angiographic diagnosis. Conclusion: The flow chart and key questions simplify
angiographic analysis, helping to systematically obtain an accurate angiographic
Purpose: To assess the accuracy of an “in house” multiplex nested polymerase
diagnosis, especially to those initiating in its analysis. It is also a simple educational
chain reaction (PCR) protocol for detection and gram differentiation of bacterial
tool for those teaching interpretation of this ancillary test.
pathogens involved in infectious endophthalmitis. Methods: Eleven vitreous and 10
aqueous samples were evaluated by Gram staining, culture and multiplex nested 3:59 PM
PCR. Results: Gram staining and culture were positive in 44% and 47%, respec- Panel discussion of previous paper
tively. Multiplex nested PCR was positive in 100% of the aqueous and vitreous
samples. Gram classification could be achieved in 88% of these cases. Conclu- PA184 4:03 PM
sion: The presented multiplex nested PCR protocol showed to be highly sensitive in
the identification of bacteria in cases of endophthalmitis. Endophthalmitis Rate After Intravitreal Injections
With or Without Drape
3:23 PM
Presenting Author: Vasiliki Kounali**
Co-Author(s): Theoni D Panagiotoglou MD**, Paraskevi Drakou MD**, Kyriaki
PA181 3:27 PM Raptaki**, George D Pappas MD**
Pediatric Retinal Detachments in Costa Rica Purpose: To evaluate the necessity of using a drape during intravitreal injections.
Methods: One thousand patients were randomly assigned in 2 groups: Group 1
Presenting Author: Erick Hernandez MD** with and Group 2 without drape. The rest of the procedure followed the American
Co-Author(s): Joaquin Martinez MD, Lihteh Wu MD Academy of Ophthalmology guidelines for intravitreal injections. Results: One
Purpose: To describe the clinical features and surgical outcomes of retinal detach- patient in the drape group developed endophthalmitis. Coagulase negative Staphylo-
ments (RD) in the pediatric population. Methods: Retrospective study of patients coccus was isolated. She was treated successfully with vitrectomy, intravitreal
with RD from a tertiary referral center between 1995 and 2009. Results: A total of antibiotics, and silicone oil injection. One patient developed sterile endophthalmitis
134 patients were included. The average age was 7.3 years; 71% were boys. The and 2 more patients developed severe uveitis. Conclusion: The use of a drape
most common type of RD was rhegmatogenous (51%). The main causes were may not be required for intravitreal injections. The participation of greater number of
trauma, 18%; Coats disease, 12%; and toxocariasis, 8%. Retinal reattachment was patients (10,000) is necessary to infer safer results.
achieved in 63%, with an average of 1.7 surgeries; 19.4% were considered nonsur-
4:11 PM
gical. The most commonly performed procedure was scleral buckling (49%).

Conclusion: Rhegmatogenous RD is the most common type of RD in the Costa
Rican pediatric population. Trauma is the main cause.
3:35 PM Tuesday, Oct. 27

Panel discussion of previous paper 10:15 - 11:15 AM
SOUTH, Room 236
PA182 3:39 PM
PA189 10:15 AM
Intravitreal Anti-VEGF Treatment for Radiation
Retinopathy After Plaque Radiotherapy Estudio Prospectivo Randomizado de Tincion de la
Membrana Limitante Interna con Verde de
Presenting Author: Teodoro J Evans MD
Indocianina vs. Triamcinolona en la Cirugia de
Co-Author(s): Filiberto Altomare MD**, E Rand Simpson MD, Hatem A Krema Agujero Macular
MBBS**, David R Chow MD*, Alan R Berger MD*, Louis Robert Giavedoni
MD**, David T Wong MD* Presenting Author: Gonzalo Sepulveda**
Purpose: To evaluate the effect of anti-VEGF treatment on patients with radiation Co-Author(s): Cristian G Carpentier MD**, Luis H Filsecker MD, Juan I Verda-
retinopathy. Methods: Retrospective case series of seven consecutive patients. guer Diaz MD**
BCVA, central foveal thickness (CFT), and fluorescein angiography findings were pri- Objetivos: Evaluar el éxito anatómico y funcional de la cirugía de agujero macular
mary outcomes. Results: Patients received an average of 4 injections of con extracción de la membrana limitante interna (MLI) al utilizar una técnica de tin-
bevacizumab during a mean follow-up of 9.5 months. Mean BCVA was 20/160, ción y una técnica de marcación. Material y Métodos: Estudio clínico
20/100, and 20/80 at baseline and 3 and 6 months, respectively. Five eyes had prospectivo, randomizado. Se realizó vitrectomía pars plana con peeling de la MLI
macular edema with CFT of 413 μm, 360 μm, and 347 μm at baseline and 3 and 6 con Indocianina Verde (ICG) en 20 ojos y Triamcinolona (T) en 20 ojos, según ran-
months. Four eyes presented retinal ischemia and 2 with vasculitis showing FA domización. Resultados: No hubo diferencias entre la tasa de cierre del agujero
improvement. Conclusion: Intravitreal anti-VEGF therapy seems to be effective in macular (ICG 100%, T 94.74%, P > .05), en la agudeza visual final (ICG 0.45 ±
treating complications related to radiation retinopathy. .28 LogMAR, T 0.46 ± .48 LogMAR, P > .05), ni en las incidencias de complica-
ciones entre ambos grupos (P > .05). Conclusión: Ambas técnicas tienen
3:47 PM resultados anatómicos y funcionales similares.
10:23 AM
203
PA190 10:27 AM
Two-Port Pars Plana Vitrectomy Using Indirect
Ophthalmoscopy
Presenting Author: silvio arellano MD**
Co-Author(s): Monica C Mendoza MD**, Felipe Torres MD**, Julio Blanco
MD**, Johnny Zumaeta MD**, Ivan Cornejo MD**
Purpose: To describe our experience performing 2-port pars plana vitrectomy
using indirect ophthalmoscopy as unique light source. Methods: Case series. In
order to obtain data, we reviewed the clinical histories and the operating room report
book. Results: We performed 20 surgeries (11 males and 9 females). The age
average was 63.15 years. The average follow-up time was 147.50 days. The rea-
sons for performing vitrectomy were 35%, proliferative diabetic retinopathy; 30%,
vitreous opacities; 15%, retinal detachment; and 20%, other. The average operative
time was 116 minutes. The visual acuity after surgery improved in 60%, remained
unchanged in 30%, and worsened in 10%. Conclusion: It is possible to perform
2-port pars plana vitrectomy using indirect ophthalmoscopy.
10:35 AM
PA191 10:39 AM
Combined Indocyanine Green-Mediated
Photothrombosis (IMP) with High-Dose Intravitreal
Bevacizumab in Isolated Choroidal Metastasis
Presenting Author: Juan V Espinoza-Garcia MD
Co-Author(s): Andr Francisco Lasave MD, J Fernando Arevalo MD FACS
Purpose: To report indocyanine greenñmediated photothrombosis (IMP) combined
with high-dose intravitreal bevacizumab (IVTB) for the management of choroidal
metastasis (CM) from breast cancer. Methods: Interventional case report of 3 con-
secutive eyes (2 patients). Patients were submitted to 1 session of IMP combined
with high-dose (4 mg/0.16 ml) IVTB. Results: Two female patients (3 eyes), 47
and 70 years old, respectively, were managed with unsuccessful chemotherapy
before presentation. Ophthalmic evaluation demonstrated complete tumor resolution,
reduction of subretinal fluid, and improvement in visual acuity in all eyes at 3 to 5
weeks. Conclusion: IMP combined with high-dose IVTB may be an adjuvant ther-
apy to systemic chemotherapy for the management of isolated CM.
10:47 AM
PA192 10:51 AM
Vitrectomy Without Internal Tamponade in Primary
Retinal Detachment With Mild to Moderate
Proliferative Vitreo-Retinopathy
Presenting Author: Mohamed A Elmalt MD**
Purpose: To achieve permanent reattachment by scleral buckling (SB) of all retinal
breaks and release of all vitreous traction without internal tamponading. Method: All
patients (25 eyes) had complete triamcinolone assisted vitrectomy, fluid -air
exchange, precise localization of breaks with no traction, placement of appropriate
SB, air-fluid exchange and tightening of SB (firm globe), and endolaser to buckled
breaks. Results: Retinal reattachment without reoperations for at least 6 months
(duration of follow-up ) with success rate 96%. Visual outcome depended on preop-
erative visual acuity, macula status, and duration of macular detachment.
Conclusion: Vitrectomy plus SB achieved time-dependant successful results with-
out need for vitreous substitutes and their complications.
10:59 AM

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book Page 189 Monday, September 21, 2009 5:53 PM

PAAO Original Papers

See page 33 for committee details.

© 2009 American Academy of Ophthalmology. All rights reserved.

Panel discussion of previous paper

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2:07 PM PA154 2:40 PM

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Presenting Author: Roberto Jimenez MD**

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allowed measurements of positions of orbital structures.

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3:35 PM Tuesday, Oct. 27

apy to systemic chemotherapy for the management of isolated CM.

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