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AJO Retinal Detachment by mikeholy

VIEWS: 571 PAGES: 148

									                                                                                                                                    Poster Abstracts

Poster Session 1                                                                improvements in this case demonstrates that surgical intervention,
Saturday, 3 March 2007                                                          in long-standing cases of dry retinal folds, which have base-to-base
                                                                                apposition of photoreceptors is worth attempting.
PHAKIC EYES                                                                     204-B4
                                                                                USE OF BONE MARROW MONONUCLEAR CELLS
A. ANG1, N. GLOVER2, C.K. PATEL2                                                FOR THE REHABILITATION OF PATIENTS WITH
 Royal Hallamshire Hospital, Sheffield, UNITED KINGDOM, 2Radcliffe Infirmary,   DEGENERATIVE RETINAL DISORDERS: AIIMS
Oxford, UNITED KINGDOM                                                          EXPERIENCE

Purpose: To report on success rate of non-posturing macular hole                S. MOHANTY, A. KUMAR, R. TANDON, V. K. PAHAWA, L. KUMAR,
surgery in phakic eyes.                                                         S. BOSE, S. SHARMA, P. VENUGOPAL
Methods: A retrospective analysis of all macular hole surgeries since           All India Institute of Medical Sciences (AIIMS), New Delhi, INDIA
April 2005 was performed. Only phakic eyes undergoing primary
vitrectomy, membrane peel and gas (with C3F8) with minimum of 3 months          Purpose: To evaluate the safety, feasibility and then the efficacy of auto-
follow-up were included in the study. Patients were advised not to lie on       logous bone marrow stem cells in retinal degenerative disorders through
their backs for a week post-operation. Face down posturing was not              this pilot study.
advised. The following exclusion criteria applied: secondary macular holes,     Methods: Eight patients of retinitis pigmentosa (RP) and one patient with
previous failed macular hole surgery and combined phacoemulsification           age related macular degeneration (ARMD), with best correct visual acuity
cataract surgery. The primary outcome measure was anatomical closure            <6/60 and at least FCCF with projection accurate were included in the
rate of macular hole.                                                           study after Ethics Committee approval. Autologous BM-MNCs were
Results: Nineteen patients were included in the study. Macular hole             isolated from bone marrow aspirates in aseptic conditions using density
closure rate was 89% with minimum follow-up duration of 3 months.               gradient centrifugation. 100ul of the cell suspension, which contained 2-
Conclusions: Successful macular hole surgery can be achieved without            4X106 MNC, was injected intravitreally. The parameters evaluated before
face down posturing in phakic patients.                                         release of stem cells for clinical use were viability by Trypan Blue dye

                                                                                                                                                               POSTER ABSTRACTS
                                                                                exclusion test, mononuclear cell count by Giemsa staining, and CD 34/45
                                                                                counts by Flow cytometry. Postoperative and preoperative parameters
203-B3                                                                          evaluated included - Visual acuity (Snellens & ETDRS), media clarity,
SURGICAL MANAGEMENT OF A LONG EXISTING                                          detailed anterior and posterior segment evaluation to look for signs of
DRY RETINAL FOLD                                                                toxicity or any side effects. In addition, Electroretinogram (ERG), Electro-
                                                                                oculogram, Optical coherence tomography, Visual fields, Contrast
A. AURORA, D. GREWAL, S. GREWAL                                                 sensitivity, Fundus photograph & Fluorescein angiography and Multifocal
Grewal Eye Institute, Chandigarh, INDIA                                         ERG were performed.
                                                                                Results: Patients were enrolled during September 2005 to September
Purpose: To evaluate if surgical intervention of a long-standing Dry            2006. RP and ARMD patients were from the age group of 22-43 yrs
retinal fold passing through the macula that shows base-to-base apposi-         (average 32.3 yrs) & 56 yrs, male respectively. The male: female ratio
tion of photoreceptors on Optical Coherence Tomography results in visual        was 5:3 in RP group. The average BM aspirate collected was 46.6 ml
improvement.                                                                    (range 30-55ml) and the average MNC recovered was 37.9 x106 /ml (range
Methods: A 24-year old female had earlier undergone scleral buckling            5.6 x106 - 132 x106 /ml). The viability of the MNC at the time of transplan-
with gas-injection for total retinal detachment presented to us with an         tation was 98.7% with average CD 34 count of 1.63% (range 0.39 -
arcuate retinal fold extending across the macula from the nasal periphery.      3.91%). Eight patients had no adverse effect after treatment up to six
Her visual gain in Left Eye had been poor (20/200) and the arcuate retinal      months follow up. One had a temporary blurring of vision, which
fold had been documented elsewhere six-months before she presented              recovered spontaneously. Patients are still under evaluation.
to us. Optical Coherence Tomography of the retinal fold at the macula           Conclusions: The technique of BM aspiration, isolation of MNC &
documented base-to-base apposition of photoreceptors and presence of            intravitreal injection of very small volume of MNCs in human retinal
an epi-retinal membrane. Patient underwent pars-plana vitrectomy with           disorders has been standardized. This technique is safe and feasible at
posterior hyaloid removal. The epi-retinal membrane and internal limiting       our center.
membrane were peeled over the macula.
Results: The retina and the fold were flat at one-month follow-up. OCT
showed no evidence of retinal fold. BCVA improved to 20/60.                     205-B5
Conclusions: Animal experiments have demonstrated that dry retinal folds        FANCONI’S ANEMIA AND RETINAL
represent linear elevation of retina in which the photo-receptors normally      VASCULOPATHY- A CASE REPORT
lying adjacent to the retinal pigment epithelium are lifted and rotated
into a base to base apposition with minimum intervening sub-retinal fluid.      S.M. CHAI, R. MATHUR, S.G. ONG
It has been suggested that in long standing cases, the photoreceptors,          Singapore National Eye Centre, Singapore, Singapore
instead of undergoing atrophy, elongate and probably still remain
functional. The OCT in our case demonstrated an apparent base-to-base           Purpose: To report a rare case of retinal occlusive vasculopathy in a
apposition of the photoreceptor elements. Flattening of the retinal fold        patient of Fanconi’s anemia.
was achieved surgically resulting in significant improvement in patient’s       Methods: A case-report.
vision. Post-operative OCT confirmed retinal fold flattening. The visual        Results: Fanconi’s anemia (FA) is an autosomal recessive heterogeneous

Asian J Ophthalmol. 2007 Vol 9 No 1 Supplement 1                                                                                                         93
Poster Abstracts

syndrome complex characterized by various congenital anomalies                 scans. Baseline median Central Retinal Thickness (CRT) was 256 microns
(skeletal immaturity, facial dysmorphy, short stature), bone marrow failure,   (mean 290, std. dev. 139, range 113 to 635), while median Central Reti-
predisposition to malignancy. Children with FA frequently have endo-           nal Volume (CRV) was 8.35 mm3 (mean 8.27, std. dev. 1.36, range 6.50
crinopathies which manifest as reduced growth hormone secretion,               to 11.01). At 12 months, median change in CRT was -31 microns (mean
hyperglycemia/hyperinsulinism, hypothyroidism and disorders of prolactin       -93, std. dev. 154, range -397 to 111), while median change in CRV
production. Ocular manifestations are rare such as cataract, congenital        was -1.36 mm3 (mean -1.58, std. dev. 1.38, range -5.06 to 0.05). 9 of
glaucoma, post-cataract surgery CME and neovascularization. A 29-year-         18 eyes (50.0%) showed complete resolution of retinal thickening on OCT,
old Chinese male was diagnosed to have Fanconi’s anaemia when he               7 eyes (38.9%) showed partial resolution, and 2 eyes (11.1%) showed
was 12 year old. This was associated with NIDDM, hepatic dysfunction           no improvement or had an increase in retinal thickening.
and aplastic anemia. He had undergone bone marrow transplant at the            Conclusions: Our study showed that 81.3% of eyes undergoing cSLO-
age of 18 and cataract extraction 5 years ago. Currently, he is on oral        ICGA-guided verteporfin therapy avoided VA loss of >3 lines at 12 months.
hypoglycemics, androgen therapy and folic acid. His left eye has been          This compares favorably to results from flash fluorescein angiography-
blind from intractable glaucoma from vitreous hemorrhage secondary to          guided verteporfin therapy. *CR
branch retinal vein occlusion. He had been under regular follow up and
was found to have mild vascular sheathing in the right eye temporally.
Over the next few months despite tight glycemic control and no other           207-B7
new risk factor, he developed blot hemorrhages and a large frond of NVE        A PROSPECTIVE PILOT TRIAL TO COMPARE THE
in superior quadrant. Fluorescein angiography revealed extensive areas         EFFECTS OF PHOTODYNAMIC THERAPY WITH
of capillary non-perfusion. Patient underwent panretinal photocoagulation.     VERTEPORFIN (PDT) AND TRANSPUPILLARY
Conclusions: Our case represents one of the rare cases of bilateral oc-        THERAPY (TTT) ON QUALITY AND FUNCTIONAL
clusive retinopathy with neovascularization.                                   VISION IN CLASSIC AND OCCULT SUBFOVEAL
                                                                               CHOROIDAL NEOVASCULARIZATION (CNV)
                                                                               SECONDARY TO AGE RELATED MACULAR
206-B6                                                                         DEGENERATION (ARMD) IN INDIAN EYES
INDOCYANINE-GREEN FUNDUS ANGIOGRAPHY-                                          R. AZAD1, G. PRAKASH1, S. KAI1, D. TALWAR2, H.K. TEWARI3
GUIDED PHOTODYNAMIC THERAPY WITH                                               1
                                                                                All India Institute of Medical Sciences, AIIMS, Ansari Nagar, New Delhi, India,
VERTEPORFIN FOR TREATMENT OF SUBFOVEAL                                         INDIA, 2Centre for Sight, New Delhi, India; 3Sir Ganga Ram Hospital, New Delhi,
CHOROIDAL NEOVASCULARISATION                                                   INDIA

S. YONG, E.S. GOH, T. LIM                                                      Purpose: To compare the short-term Quality and Functional visual out-
Tan Tock Seng Hospital, Singapore, SINGAPORE                                   comes of PDT and TTT for subfoveal CVN 2o to ARMD.
                                                                               Methods: Sixty-four patients who were age, lesion type and lesion size
Purpose: Photodynamic therapy (PDT) with verteporfin has improved the          matched were included in a pilot clinical comparative prospective trial.
visual prognosis for patients with age-related macular degeneration            BCVA, contrast sensitivity, reading speed, scotoma size were assessed.
(AMD). However, successful treatment is predicated on treatment of the         Fundus color photography and fluorescein angiography were done . The
lesion in its entirety. Confocal scanning-laser ophthalmoscope (cSLO)          patients were grouped according to lesion type and laser used into four
fundal angiography provides better imaging of choroidal neovascularisation     groups of 16 eyes each , Classic CNV undergoing PDT (CL-PDT) & TTT
(CNV) lesions, as the vessel architecture of occult CNV is delineated more     (CL-TTT) and Occult CNV undergoing PDT (OC-PDT) & TTT (OC-TTT) . Fol-
clearly with cSLO indocyanine green angiography (cSLO-ICGA). Our study         low up was carried out 4 weeks, 12 weeks and 6 months after the
investigates the effect of superior imaging afforded by cSLO-ICGA on PDT       treatment. Retreatment, if indicated , was carried out three months after
treatment outcomes.                                                            the initial treatment, using the same treatment regimen.
Methods: Study design was a retrospective case series of all patients          Results: The results of PDT and TTT were compared separately for clas-
undergoing cSLO-ICGA-guided PDT with verteporfin at a single centre            sic and occult lesions, with pre laser parameters being statistically similar.
over an 18-month period (Mar 2004 to Aug 2005). Eligibility criteria fol-      At six months after the treatment:
lowed closely with the published recommendations of the Verteporfin            (a) The BCVA did not show a significant difference between PDT and
Roundtable Participants (2000 & 2001), with the exceptions of guidance              TTT.
method and that all CNV subtypes were included. 20 eyes of 20 patients         (b) Contrast sensitivity showed a significant improvement trend in both
were eligible for this study. Classic CNV was found in 7 eyes (35.0%),              the group comparisons from baseline, but there was no statistically
predominantly classic CNV in 4 eyes (20.0%), minimally classic CNV in               significant difference between the TTT and PDT for either lesion type.
7 eyes (35.0%) and occult CNV with no classic component in 2 eyes              (c) For classic CNV, Reading Speed was significantly better in eyes with
(10.0%). Cause of CNV was AMD in 15 eyes (75.0%), pathological myopia               PDT compared to TTT (p=0.04, Wilcoxon Rank sum test) but was
in 4 eyes (20.0%) and traumatic choroidal rupture in one eye (5.0%).                similar in occult CNV (p >0.05, Rank sum test).
Results: Median pre-treatment logMar VA was 0.71 (mean 0.74, std. dev.         (d) For Classic CNV, scotoma size decreased significantly more with
0.41, range 0.10 to 1.60). Of 16 eyes that underwent follow-up examina-             PDT treated eyes compared to TTT (p = 0.03, Rank sum test) but was
tion at 12 months, median VA was 0.59 (mean 0.66, std. dev. 0.44, range             similar in occult CNV (p >0.05, Rank sum test).
0.00 to 1.60), and the median change in VA at 12 months was -0.01              Conclusions: This pilot trial concludes that the short-term effects
(mean 0.01, std. dev. 0.46, range -0.70 to 0.90). 8 of the 16 eyes             (6 months) of PDT may be better than TTT in improvement of quality of
(50.0%) had VA improvement of 3 lines or more, 5 eyes (31.3%) were             vision in cases with classic subfoveal CNV due to ARMD in Indian
stable (within +/- 3 lines of baseline), and 3 eyes (18.8%) lost 6 or more     eyes, however both laser modalities seem to be equally efficacious for
lines of VA. OCT response was tracked in 18 patients who had baseline          occult CNV.

94                                                                                                  Asian J Ophthalmol. 2007 Vol 9 No 1 Supplement 1
                                                                                                                                    Poster Abstracts

208-B8                                                                          progressive exudative age-related macular degeneration (AMD).
THE BEHAVIOR OF JUXTAFOVEAL CHOROIDAL                                           Methods: The comparative non-randomized retrospective clinical inter-
NEOVASCULARIZATION LESIONS FOLLOWING                                            ventional study included 305 patients with progressive AMD, divided into
PHOTODYNAMIC THERAPY AND THE INFLUENCE                                          a bevacizumab group of 36 patients (1.5 mg bevacizumab) and a triamci-
OF POSTERIOR SUB-TENON TRIAMCINOLONE                                            nolone group of 269 patients (about 20 mg triamcinolone). All patients
DEPOT INJECTION                                                                 were consecutively included, in the first phase of the study for
                                                                                triamcinolone, and in the second phase of the study for bevacizumab.
K.K. PEH, Y.H. THAM, C.M.G. CHEUNG, Y.C. YANG                                   Mean follow-up was 8.5 ± 6.8 months (2-35.7 months).
Wolverhampton & Midland Counties Eye Infirmary, Wolverhampton, UNITED KINGDOM   Results: In the bevacizumab group, best visual acuity increased signifi-
                                                                                cantly (P<0.001) by 3.2±3.4 Snellen lines, with 25 (69%) eyes and 21
Purpose: Verteporfin photodynamic therapy (PDT) is associated with an           (58%) eyes, improving by at least 2 Snellen lines and 3 lines, respectively.
initial lesion growth prior to stabilization. In the setting of a juxtafoveal   In the triamcinolone group, the visual acuity change was not statistically
choroidal neovascularization (CNV), this could result in subfoveal involve-     significant for any specific follow-up examination within the first 3 months.
ment and a decrease in visual acuity. The aim of this paper is to 1) ob-        Maximal increase in visual acuity, the visual acuity change at 2 months
serve the behavior of juxtafoveal CNV following first application of PDT        after injection, and the percentage of patients with an improvement by
and 2) to study whether combination of PDT with Posterior Sub-Tenon             at least 2 Snellen lines and 3 lines were significantly (P<0.001) higher
Triamcinolone Acetonide Depot Injection (PSTA) may reduce the incidence         in the bevacizumab group than in the triamcinolone group. Intraocular
of subfoveal involvement.                                                       pressure increased significantly (p<0.001) in the triamcinolone group,
Methods: A retrospective review of the fluorescein angiogram of patients        and did not change significantly (P=0.47) in the bevacizumab group.
undergoing first PDT application between June 2005 and August 2006              Conclusions: In exudative AMD, intravitreal bevacizumab (1.5mg) com-
was performed. Patients with juxtafoveal CNV were identified and divided        pared with intravitreal triamcinolone acetonide (about 20mg) results in a
into two groups. Lesion classification was verified by an independent           higher improvement of visual acuity and does not markedly influence
assessor (YCY). Group 1 patients had PDT monotherapy, whereas Group             intraocular pressure within 2 months after injection.
2 patients had a PDT and PSTA combination. In both groups, the change
in lesion greatest linear dimension (GLD) was examined, and visual acu-
ity recorded.                                                                   210-B10

                                                                                                                                                                     POSTER ABSTRACTS
Results: 26 eyes of 25 patients were identified from the cohort of 160          INTRAVITREAL BEVACIZUMAB FOR CHOROIDAL
patients treated. The current available data is on 19 eyes of 18 patients.      NEOVASCULARIZATION WITH POOR RESPONSE
Three months after first PDT treatment, Group 1 (n=15) showed mean              TO PHOTODYNAMIC THERAPY
change in GLD from 1612µm to 1849.9µm with the lesion in 4 cases
becoming subfoveal. Whereas patients in Group 2 (n= 4) showed a                 S. MANDAL, S. GARG, P. VENKATESH, N. WADHWA, A. MEHROTRA
mean change in lesion GLD from 1359.5µm to 998µm, with no lesions               Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical
becoming subfoveal. 7 (46.7%) patients from Group 1 showed lesion GLD           Sciences, INDIA
decrease or stability, whereas all 4 (100%) patients in Group 2 showed
lesion GLD decrease. Three month follow up results are awaited on a             Purpose: To evaluate the efficacy and safety of intravitreal bevacizumab
further 3 patients from Group 1 and 4 patients from Group 2. The mean           in patients with choroidal neovascularization (CNV) who had poor response
percentage change in GLD for Group 1 showed a 35.58% increase in                to photodynamic therapy (PDT).
lesion size [95% CI, -10.46 -81.62%] in comparison to Group 2 which             Methods: In this prospective, noncomparative, consecutive, interventional
showed a -26.03% decrease in lesion [95% CI, -115.2 - 63.13%]. No               case series, 20 eyes of 20 patients with CNV of various causes who
significant adverse ocular events were reported in patients who had             had poor response to PDT (at least two sessions) received intravitreal
combination therapy.                                                            bevacizumab (1.25 mg/ 0.05 ml). Ophthalmic evaluation included best
Conclusions: This study showed no lesion size increase when PDT was             corrected visual acuity (BCVA), complete ophthalmic examination, optical
combined with PSTA. Further randomized controlled trials are justified          coherence tomography (OCT) and fundus fluorescein angiography
based on this pilot data. Given the relative safety and simplicity of admin-    (FFA). Intravitreal injection was repeated if OCT showed presence of fluid
istering PSTA, it may be worth evaluating the role of PSTA in combination       in the form of intraretinal edema, subretinal fluid (SRF) and/or pigment
with PDT as an alternative regimen to monotherapy with either PDT or            epithelial detachment (PED) at 4 weeks interval. Patients were followed
intravitreal anti VEGF agents or to combination therapy using PDT plus          up for up to 9 months and those who completed at least 3 months follow
intavitreal injections. *CR                                                     up were included for analysis. Main outcome measures were changes in
                                                                                BCVA, OCT findings including central macular thickness (CMT) and
                                                                                angiographic characteristics and complications.
209-B9                                                                          Results: The patients were followed-up for a mean period of 4.2 months.
INTRAVITREAL BEVACIZUMAB VERSUS                                                 The causes of CNV were age related macular degeneration (10), myopia
TRIAMCINOLONE ACETONIDE FOR EXUDATIVE                                           (3) and idiopathic (7). The average number of intravitreal injection was
AGE-RELATED MACULAR DEGENERATION                                                1.9 injections per eye. At 3 months the mean decimal Snellen BCVA
                                                                                improved from 0.12±0.09 (median 20/200) to 0.25±0.22 (median 20/
J. JONAS, A.K. IHLOFF, U.H. SPANDAU, B. HARDER, I. KREISSIG,                    120) (p<0.05). The mean CMT reduced from 388 µm to 273 µm. At final
F. SCHLICHTENBREDE                                                              visit 15 eyes had an improvement of BCVA of 1 line or more, 3 eyes had
Department of Ophthalmology, Mannheim, GERMANY                                  no change in BCVA whereas 2 eyes lost 1 line or more. No significant
                                                                                ocular or untoward systemic side effects were observed.
Purpose: To compare an intravitreal high-dose injection of triamcinolone        Conclusions: Short-term results suggest that intravitreal bevacizumab
acetonide versus an intravitreal injection of bevacizumab for treatment of      (1.25mg/ 0.05ml) is safe and effective in patients with choroidal

Asian J Ophthalmol. 2007 Vol 9 No 1 Supplement 1                                                                                                              95
Poster Abstracts

neovascularization who had poor response to PDT. Further evaluation          blurring vision to a sudden complete loss of vision. Any ophthalmological
with longer follow up is needed to confirm long term efficacy and safety     features or immunological markers that could differentiate between, pri-
in such cases.                                                               mary retinal vasculitis and retinal vasculitis caused from a systemic
                                                                             inflammation, could greatly aid in a more specific and cost effective
211-B11                                                                      Methods: Individuals with retinal vasculitis visiting the Ophthalmology
BILATERAL VITREOUS HEMORRHAGE                                                and Immunology OPD in M.S. Ramaiah Medical Teaching Hospital from
PRECIPITATED BY HEAD STANDING (YOGA) IN                                      April 1st 2004 till February 28th 2006 were the subjects of the study. This
IDIOPATHIC VASCULITIS- A CASE REPORT                                         was a hospital based prospective study of 50 patients from the above
                                                                             source, diagnosed to have retinal vasculitis and satisfying the selection
R. GUPTA, A.P. JHINJA, R. KUMAR, R. AZAD                                     criteria. These patients were studied in terms of the symptoms they
Dr Rajendra Prasad Centre for Ophthalmic Sciences, New Delhi, INDIA          experienced by detailed questionnaire and old medical records. All
                                                                             patients were subject to a detailed ocular examination including visual
Purpose: To report a case of bilateral vitreous hemorrhage precipitated      acuity testing, slit lamp evaluation, indirect ophthalmoscope, slit lamp
by headstanding (Yoga) in idiopathic vasculitis.                             biomicroscopy with 90D lens, along with fundus photography and fundus
Methods: Here we report a case of a 30 year old male who presented           fluorescien angiographies as and when required.
with history of almost simultaneous sudden visual loss associated with       Results: Out of the 50 patients selected in this study, 22 had Primary
floaters. There is past history of similar event in the left eye one year    retinal vasculitis and 28 had Retinal vasculitis with a systemic immuno-
previously and the vision improved spontaneously after four weeks. Per-      logic disease. These 28 included, Sarcoidosis, Wegener’s Granulomatosis,
sonal history disclosed the practice of yoga with headstanding (inverted     Multiple Sclerosis, VKH Syndrome, Polyarteritis Nodosa and Behcet’s
body posture) - a form of yoga for approximately five minutes prior to       Disease. With regards to the ophthalmological features, in patients with
both these episodes. On examination his visual acuity was hand move-         Primary retinal vasculitis, macular edema (59%) and peripheral vascular
ments close to face with accurate projection of light in right eye and 20/   sheathing (59%) seemed to be prominent features. On Fundus fluorescein
60 with accurate projection of light in left eye. On further examination     angiography (FFA) 68.2% demonstrated capillary leakage. In the other
was found to have bilateral vitreous hemorrhage. No fundus details were      group, i.e. patients who have a systemic inflammatory / immunologic
visible in the right eye and the left eye showed neovascularization and      cause for the retinal vasculitis, the ophthalmological features varied on
sclerosed blood vessels in superotemporal quadrant. Ultrasonography          the disease being studied. On FFA, once again capillary leakage seemed
was done to examine posterior segment of right eye and it revealed low       to be a prominent feature. The immunological markers recorded in these
to medium amplitude spikes in the vitreous cavity suggestive of vitreous     patients were C reactive protein, Rheumatoid factor and Antinuclear
hemorrhage along with incomplete posterior vitreous detachment. Com-         antibodies. These tests did not show any statistical significance with
plete blood counts and peripheral blood smear, erythrocyte sedimenta-        respect to either group.
tion rate, Mantoux test, bleeding and clotting times, Treponema Pallidum     Conclusions: Primary retinal vaculitis showed an increase incidence of
Hemagglutination test, Antinuclear antibody test and chest x-ray were        Peripheral vascular sheathing. All other findings were disease specific.
done. All the tests were unremarkable.                                       For example, Periphlebitis was found to be more prevalent in Sarcoidosis.
Results: Standard 3 port pars plana vitrectomy was done in the right         Branch retinal vein occlusion was associated more with Behcet’s Disease.
eye. Intraoperatively sclerosed blood vessels with neovacularization were    Visual acuity of patients, regardless of disease, seemed to be affected by
noted in superotemporal and inferotemporal quadrants and sectoral            macular edema and vein occlusion.
LASER was done in both these quadrants. Sectoral LASER was done in
left eye. Post-operative visual acuity at the end of 6 months in the right
eye was 20/60.                                                               213-B13
Conclusions: We presume that increased intraocular venous pressure           INTRAVITREAL BEVACIZUMAB AS AN ADJUNCT TO
caused by headstanding led to vitreous hemorrhage from rupture of ves-       PANRETINAL PHOTOCOAGULATION IN DIABETIC
sels of neovascularisation elsewhere (NVE). We recommend that                VITREOUS HEMORRHAGE
headstanding exercises should preferably be avoided in patients with
vasculitis with neovascularisation, and any person planning to begin         A. TOOR, N. VAIDYA, R. LIEBERMAN, R. FISCHER
headstanding exercises should get his/her fundus examined by an              Mount Sinai School of Medicine, New York, NY, UNITED STATES OF AMERICA
ophthalmologist. To best of our knowledge no case of vitreous hemorrhage
associated with headstanding has been described earlier.                     Purpose: Bevacizumab (Avastin, Genentech), a monoclonal antibody de-
                                                                             veloped to target vascular endothelial growth factor (VEGF,) is currently
                                                                             used to treat metastatic colorectal cancer. It has also been shown to
212-B12                                                                      cause regression of retinal neovascularization. We present a long-term
THE STUDY OF OPHTHALMOLOGICAL FEATURES                                       follow up of patients given intravitreal bevacizumab for proliferative
AND IMMUNOLOGICAL MARKERS IN PRIMARY                                         diabetic retinopathy (PDR) complicated by vitreous hemorrhage (VH).
RETINAL VASCULITIS                                                           Methods: A retrospective chart review was done of patients with
                                                                             established, previously treated PDR and new vitreous hemorrhage (VH),
D.G. DIVAKAR, R. REDDY                                                       who were then treated with a single intravitreal injection of bevacizumab
Msr Medical College, Bangalore, INDIA                                        (1.25mg/0.01ml). Data collected included patient demographics, best
                                                                             corrected visual acuity (BCVA) with VH and then at 2wks, 1mth, 2mths,
Purpose: Primary retinal vasculitis is known as a disease which affects      3mths and 6mths post-injection. Fluorescein angiograms (FAs) were
only the eyes and no other organ. It is a sight threatening inflammatory     also performed at the stated intervals. Further treatment with panretinal
eye disease, whose manifestations may vary from mild to moderate             photocoagulation (PRP) and complications were recorded.

96                                                                                               Asian J Ophthalmol. 2007 Vol 9 No 1 Supplement 1
                                                                                                                                 Poster Abstracts

Results: 10 patients (4M, 6F), age 55.3 + 12.8yrs, were included in this     diabetic retinopathy severity, and were less likely to require laser therapy.
cohort. On initial exam, BCVA ranged from 20/30 to CF, and all patients      Selective VEGF blockade with pegaptanib may have a primary role in
had persistent retinal neovascularization with new VH confirmed by           treating ocular complications of diabetes. *CR
FA. Length of follow up ranged between 3mths (n=6) and 6mths (n=4)
post-injection. Percentage of eyes with a 3 or more line gain in BCVA
was 60%, 70%, 70%, and 80% at 2wks, 1mth, 2mths, and 3mths post-             215-B15
injection respectively (n=10). Half the patients followed for 6mths (n=4)    INTRAVITREAL BEVACIZUMAB (AVASTIN) FOR
had a >3 line gain in BCVA. Regression of neovascularization was seen in     CHOROIDAL NEOVASCULARIZATION OF NON-AMD
5 eyes (including the 4 eyes followed for 6mths). Reperfusion occurred in    RELATED CAUSES
1 eye at 1mth, in 1 eye at 2mths and in 3 eyes at 3mths. All eyes had
been previously treated with PRP, and additional PRP (mean 730 spots)        S. MANDAL, S. GARG, P. VENKATESH, A. MEHROTRA, N. WADHWA
was placed in 7 eyes within 4wks post-injection. Recurrence of vitreous      Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical
hemorrhage did not occur in any eyes.                                        Sciences, INDIA
Conclusions: Intravitreal bevacizumab, when used in eyes with persist-
ent PDR and VH, appears to promote a rapid clearance of VH, allowing for     Purpose: To evaluate the short-term efficacy and safety of intravitreal
the ability to place additional PRP more quickly. Although reperfusion of    bevacizumab in choroidal neovascularization of non-AMD related causes.
neovascular vessels was seen in 50% of our patients, none of the eyes        Methods: In this prospective, noncomparative, consecutive, interventional
included had vitreous rebleeds. This pilot study suggests that a long-       case series, 42 eyes of 42 patients with choroidal neovascularization of
term prospective protocol is required to assess the role of bevacizumab      non-AMD related causes were included. Ophthalmic evaluation included
in conjunction with PRP in treating PDR.                                     best corrected visual acuity (BCVA), complete ophthalmic examination,
                                                                             optical coherence tomography (OCT) and fundus fluorescein angiography
                                                                             (FFA). Patients received intravitreal bevacizumab (1.25 mg/ 0.05 ml) after
214-B14                                                                      baseline evaluation and intravitreal injection was repeated if OCT showed
IMPROVEMENTS IN DIABETIC MACULAR EDEMA,                                      presence of fluid in the form of intraretinal edema, subretinal fluid (SRF)
RETINAL NEOVASCULARIZATION, AND SEVERITY                                     and/or pigment epithelial detachment (PED) at 4 weeks interval. Patients
OF DIABETIC RETINOPATHY WITH PEGAPTANIB                                      were followed up for up to 8 months and those who completed at least 3

                                                                                                                                                                  POSTER ABSTRACTS
SODIUM                                                                       months follow up were included in the study. Main outcome measures
                                                                             were changes in BCVA, central macular thickness (CMT) by OCT, angio-
V. RAJADHYAKSHA, MACUGEN DIABETIC RETINOPATHY CLINICAL TRIAL                 graphic characteristics and complications.
GROUP                                                                        Results: Patients were followed-up for a mean period of 4.5 months. The
Pfizer Inc, Mumbai, INDIA                                                    causes of CNV were idiopathic (29), myopia (9), angioid streak (2), post
                                                                             central serous retinopathy (1) and presumed ocular histoplasmosis
Purpose: Pegaptanib, a selective VEGF inhibitor, approved for the treat-     syndrome (1). The average number of intravitreal injection was 1.75
ment of age-related macular degeneration, has been shown in pre-             injections per eye. At 3 months the mean Snellen BCVA improved from
clinical studies to reverse diabetes-induced blood-retinal barrier           20/130 (median 20/200) to 20/50 (median 20/40) (p<0.05). The mean
breakdown. A prospective double-masked, randomized trial was designed        CMT reduced from 318 µm to 232 µm (p<0.05). At final visit 24 eyes
to evaluate safety and efficacy in the treatment of diabetic macular edema   (57%) had an improvement of BCVA of 3 lines or more, 15 eyes (36%)
(DME).                                                                       remained stable and 3 eyes (7%) lost 3 or more lines. No significant
Methods: In this phase 2 trial, 172 subjects with best-corrected visual      ocular or untoward systemic side effects were observed.
acuity between 20/50 and 20/320 and DME were assigned randomly to            Conclusions: Short-term results suggest that intravitreal bevacizumab
receive intravitreous pegaptanib (0.3 mg, 1 mg, 3 mg) or sham injections     (1.25mg/ 0.05ml) is safe, effective and well tolerated in patients with
at study entry, week 6, and week 12, with additional injections and/or       choroidal neovascularization due to various etiologies other than age
focal photocoagulation as needed for another 18 weeks. Final assess-         related macular degeneration. Significant number of patients showed
ments were made at week 36 and included visual acuity, retinal thickness,    improvement in visual acuity and decrease in retinal thickness by OCT.
and need for additional photocoagulation therapy; retrospective analyses     Further evaluation with longer follow up is needed to confirm long term
assessed the effects of pegaptanib on retinal neovascularization and on      efficacy and safety in such cases.
the severity of diabetic retinopathy graded by an independent reading
center employing the ETDRS Severity Scale.
Results: For all endpoints, pegaptanib was superior to sham. With the        216-B16
0.3 mg dose, mean change in visual acuity (VA) was +4.7 vs. -0.4 letters     STUDIES ON PRO-INFLAMMATORY CYTOKINES,
with sham (P=0.04). Significantly more subjects receiving pegaptanib         ANGIOGENIC AND ANTI-ANGIOGENIC FACTORS IN
maintained or gained ≥5 or 10 letters. Fewer subjects receiving the          VITREOUS OF PATIENTS WITH PROLIFERATIVE
0.3 mg dose that those receiving sham required laser (25% vs. 48%;           DIABETIC RETINOPATHY AND EALES’ DISEASE
p=0.042). Regression of neovascularization and/or reduced leakage was
observed in 8/13 subjects receiving pegaptanib and 0/3 receiving sham,       P. MURUGESWARI 1 , D. SHUKLA 2 , R. KIM 3 , A. RAJENDRAN 2 ,
as well as 0/4 in the fellow eye. 33% of subjects receiving pegaptanib       P. NAMPERUMALSAMY2, V. MUTHUKKARUPPAN1
improved from baseline ETDRS severity by at least one step vs. 13%           Aravind Medical Research Foundation, Madurai, INDIA, 2Aravind Eye Hospital,

receiving sham.                                                              Madurai, India, 3Aravind Eye hospital, Madurai, INDIA
Conclusions: Subjects with DME who received pegaptanib had greater
improvement in vision and reduction in central retinal thickness,            Purpose: To quantify the levels of pro-inflammatory cytokines, chemokine,
experienced regression of neovascularization and amelioration of             vascular endothelial growth factor (VEGF) and pigment epithelium

Asian J Ophthalmol. 2007 Vol 9 No 1 Supplement 1                                                                                                           97
Poster Abstracts

derived factor (PEDF) in the vitreous of Proliferative Diabetic Retinopathy   Comparisons of pre-op visual acuity and final visual outcome, improve-
(PDR), Eales’ Disease (ED), Primary Retinal Pigment Epithelial (RPE) Cells    ment in final visual acuity was noted in 68 cases (68%), 22 cases (22%)
and RPE D407 cell line.                                                       showed no change, and only 10 cases (10%) showed worsening.
Methods: Vitreous samples were collected at the time of vitreoretinal         Eighty -six cases required a single fluid-fluid exchange, 11 eyes needed
surgery from 60 eyes of 60 patients with PDR (n=25), ED (n=10) and            two exchanges, and 5 eyes required three exchanges. Eight cases with
macular hole (control group n=25). Primary cultures of RPE were gener-        pre-operative iris rubeosis failed to demonstrate satisfactory results.
ated from normal and diabetic cadaver eyes. The eye cup with RPE              Hypotony and anterior hyalsid fibrovascular proliferation were noted
was trypsinized with 0.25% trypsin centrifuged and resuspended with           post-operatively. Complications that could be directly attributed to the
DMEM containing 10% FBS in T-25 tissue culture flask. At confluence the       volume homeostatic fluid-fluid exchange were infrequent.
primary RPE and D407 cells were trypsinzed and plated into 24 well            Conclusions: One the basis of the results of this study, our conclusion is
plates (104 cell/well). The conditioned medium from primary RPE and           that volume homeostatic vitreous cavity lavage is an excellent method
cell line was collected and stored in -20C until use. The levels of pro-      for treatment of postvitrectomy diabetic vitreous hemorrhage.
inflammatory cytokines (IL-6, IL-8, and IL1-β), chemokine (Monocyte
Chemoattractant Protein-1, MCP-1), VEGF and PEDF in the vitreous and
conditioned medium were measured by sandwich enzyme-linked                    218-B18
immunosorbant assay.                                                          GLYCAEMIC CONTROL IN PATIENTS WITH TYPE 1
Results: IL-6, IL-8, MCP-1, VEGF levels in the vitreous were significantly    AND TYPE 2 DIABETES MELLITUS FOLLOWING
higher in PDR (P<0.0001) and ED (P<0.0001) than in MH patients. Lower         LASER PHOTOCOAGULATION FOR PROLIFERATIVE
levels of PEDF was observed in PDR (P<0.0001) when compared to MH.            DIABETIC RETINOPATHY
In normal and diabetic primary retinal pigment epithelium and D407 RPE
cell line there was constitutive secretion of IL6, IL-8, VEGF and PEDF in     G.A. REEKS, O. HERLIHY
the condition medium.                                                         Borders General Hospital, Melrose, UNITED KINGDOM
Conclusions: The elevated levels of proinflammatory cytokines and
chemokines in PDR strongly support the possibility of considering PDR as      Purpose: To study whether the glycaemic control in patients with type 1
an inflammatory disease. Further, VEGF may be involved in retinal             and type 2 diabetes mellitus improves following the onset of sight threat-
neovascularization in ED and lower levels of PEDF suggest its role in the     ening proliferative retinopathy (PR).
angiogenesis of PDR. The in vitro expression of these cytokines and growth    Methods: Glycosylated hemoglobin (HbA1C) levels of patients with
factors in the normal and diabetic primary RPE indicates the involvement      type 1 and type 2 diabetes mellitus who had undergone initial laser
of RPE in the inflammatory cascade.                                           retinal photocoagulation for newly diagnosed PR from 2003 to 2005
                                                                              were retrieved. All patients at our hospital with PR receive laser retinal
                                                                              photocoagulation. HbA1C levels were recorded before and after initial
217-B17                                                                       laser retinal photocoagulation at an interval of 6 months.
MANAGEMENT OF POSTVITRECTOMY DIABETIC                                         Results: Forty-one consecutive patients were included in the study. Mean
VITREOUS HEMORRHAGE WITH VOLUME                                               pre-laser and post-laser retinal photocoagulation HbA1C were 8.71%
HOMEOSTATIC FLUID-FLUID EXCHANGER                                             (SD 1.74) and 8.28% (SD 1.47) respectively. There was no statistically
                                                                              significant difference between the comparative groups (p= 0.063, CI
W.C. WU, J.Y. CHEN, Y.C. CHEN                                                 -0.023, 0.882). Thirty-five patients (85.4%) had an initial HbA1C of greater
Kaohsiung Medical University, Kaohsiung, TAIWAN                               than 7%. This patient group showed a statistically significant improve-
                                                                              ment in HbA1C levels (p= 0.044, CI 0.014, 1.054) following laser retinal
Purpose: The incidence of recurrent vitreous hemorrhage of proliferative      photocoagulation.
diabetic retinopathy following posterior vitrectomy ranges from 29% to        Conclusions: The onset of sight threatening proliferative retinopathy does
75% in reported series. Fluid-gas exchange and vitreous cavity lavage         not improve glycemic control in patients with type 1 and type 2 diabetes
are the popular methods of teating this kind of recurrent hemorrhage.         mellitus. Patients with suboptimal glycemic control prior to laser retinal
The fluid gas exchange cannot offer clear vision immediately after the        photocoagulation show significant improvement in glycemic control.
procedure. Although classic vitreous cavity lavage has the potential to
improve vision immediately after the procedure, it has two drawbacks:
unstable intraocular pressure and the need to use larger caliber needles.     219-B19
Methods: To improve the function of classic vitreous cavity lavage, we        OFF LABEL USE OF BEVACIZUMAB FOR THE
design a volume homeostatic fluid-fluid exchanger-Chen’s Infusion/            TREATMENT OF COMPLICATIONS FROM RETINAL
Aspiration (Chen’s I/A) device. This device consists of an infusion double    VASCULAR DISEASES
syringe, aspiration double syringes, and a connecting tube that inter-
connects one syringe of each of the two double syringes to form a closed      M.W. LEE, S.Y. LEE, D. WONG, S.G. ONG, C.L. ANG
hydraulic system and establish a synchronized action between the two          Singapore National Eye Centre, Singapore, SINGAPORE
double syringes. When the plunger of one double syringe acts, the plunger
of the other double syringe moves simultaneously in the opposite direc-       Purpose: To report our initial experience of using Avastin (Bevacizumab)
tion with equal displacement due to the synchronized hydraulic action.        for the treatment of neovascular complications and macular edema
Results: From August 1999 to March 2006, 100 eyes of postvitrectomy           secondary to diabetes and venous occlusive disease.
diabetic vitreous hemorrhage (PDVH) were collected. In each case, vitre-      Methods: This is an interventional, consecutive case series of patients
ous cavity lavage was performed with Chen’s I/A device. After a minimum       with macular edema, retinal or iris neovascularization who had intravitreal
of 6 months of follow up, 80 of 100 eyes (80%) experienced immediate          injection of Avastin (1.25mg/0.1ml). Baseline evaluation included best
clearing of the vitreous, which was maintained for at least three weeks.      corrected visual acuity (BCVA), optical coherence tomography (OCT) and

98                                                                                                Asian J Ophthalmol. 2007 Vol 9 No 1 Supplement 1
                                                                                                                                 Poster Abstracts

fluorescein angiography (FA) in certain cases. We report the change           epithelium, and choroid. The angiograms were evaluated for evidence
in BCVA at 1 week and at 1 month follow up. There were 13 eyes from 13        of focal or diffuse macular edema, capillary non-perfusion, intraretinal
patients who received injection; 4 eyes with macular edema secondary          microvascular abnormalities, neovascularization, and other abnormal
to central retinal vein occlusion (CRVO), 1 from a branch retinal vein oc-    findings. Patients requiring ablative therapy for peripheral ischemia were
clusion (BRVO) and 3 with clinically significant macular edema (CSME).        re-imaged after treatment.
3 eyes had rubeosis and 2 eyes had proliferative diabetic retinopathy         Results: High resolution, clinically useful macular and retinal peripheral
(PDR).                                                                        images were acquired in all eyes studied. Previously unrecognized, rarely
Results: The mean pre-injection BCVA was 2.05, 1.72 at one week and           appreciated, and/or clinically meaningful peripheral angiographic
1.28 at one month. 4 eyes had stable vision at 1 month (loss of less than     findings upon which treatment decisions were based were observed in a
0.3 logMAR units) and 9 eyes had improved vision (gain of > 0.3 logMAR        number of cases. Patients treated with directed scatter laser photo-
units). In eyes with macular edema, there was significant improvement in      coagulation to areas of peripheral ischemia identified by the widefield
clinical appearance of the macula at 1 month and in eyes where OCT was        angiography had good clinical response with preservation of non-ischemic
done, the reduction in central retinal thickness was evident even as early    retina.
as 1 week after injection. In all 3 eyes with rubeosis, the new vessels had   Conclusions: The Optos Panoramic200A™ Ultrawidefield Angiography
regressed completely and in the 2 eyes with PDR and vitreous hemorrhage,      System exceeded expectations in terms of image quality and peripheral
the new vessels and hemorrhage had cleared significantly by 1 month.          angiographic data. Rarely appreciated peripheral angiographic features
Conclusions: The use of intravitreal Avastin for the management of macu-      and clinically meaningful data were routinely acquired. This panoramic
lar edema and neovascular complications appears to be efficacious in          angiographic system may become an important diagnostic imaging
this series of patients with a short follow up period. We hope to present     technique in the evaluation and treatment of vitreoretinal diseases and
the 6 month follow up data for these patients at the meeting in March         may offer a distinct advantage over standard 30 degree fluorescein angi-
2007. Currently there is a clinical trial protocol which is awaiting          ography by allowing simultaneous evaluation of the retinal periphery
approval from our Institutional Review Board.                                 through all phases of the fluorescein angiogram. *CR

220-B20                                                                       222-B22

                                                                                                                                                                  POSTER ABSTRACTS
MELLITUS                                                                      AN ALTERNATIVE TREATMENT OF MACULOPATHY
                                                                              IN SYSTEMIC LUPUS ERYTHEMATOSUS
M. DATTANI, S.A. ANSARI                                                       I. WAHYUNI1, R. PRASTYANI2, MOESTIJAB3, Y. DIANY2
M.G.M.M.C & M.Y.H, Indore, INDIA                                               Dept. of Ophthalmology - Airlangga Univercity / Dr. Sutomo Hospital, Surabaya,
                                                                              East Java, INDONESIA, 2Dept. of Ophthalmology - Airlangga Univercity / Dr. Sutomo
Purpose: To report an interesting case series of 2 patients with Diabetes     Hospital, Surabaya, East Java, INDONESIA, 3Dept. of Ophthalmology - Airlangga
Mellitus presenting with opticociliary shunt.                                 Univercity / Dr. Sutomo Hospital, Surabaya, East Java, INDONESIA
Methods: Out of 245 self reported diabetics who were examined at
our eye opd, two diabetics were found to have opticociliary shunt. These      Purpose: To report an alternative treatment of maculopathy in Systemic
patients underwent detailed ophthalmic evaluation including Fundus            Lupus Erythematosus (SLE) with triamcinolone intravitreal.
fluorescein angiography and thorough systemic examination.                    Methods: A case report, 32 years old woman referred from internist with
Results: On FFA, both of these patients revealed moderate NPDR with           SLE and reduced vision. She had noticed with reduced vision in both eyes
one having additional bilateral diabetic maculopathy. The opticociliary       one month before referred from internist. Underlying disease was SLE
shunt vessels didn’t leak till late phase. Systemic examination did not       and diagnosis establish from ARA criteria, she had discoid rash,
reveal any secondary cause of opticociliary shunt.                            photosensitivity, arthralgia, laboratory test Antinuclear Antibodies (ANA)
Conclusions: Opticociliary shunt vessel may be associated with diabetic       titer were 109,7 units (Strong > 60 units) and Anti ds-DNA titer were 253,
retinopathy and this does not need over investigation if there is good        2 units / ml (Moderate positive: 138.9 - 370 units / ml). Ophthalmologic
vision and healthy optic disc rim.                                            examination showed visual acuity in right eye were hand movement and
                                                                              one meter counting finger in left eye. Anterior segment in normal limit
                                                                              and posterior segment showed “cottons wool spots” and maculopathy.
221-B21                                                                       We have done injection of triamcinolone intravitreal.
DIAGNOSIS AND TREATMENT OF PERIPHERAL                                         Results: Visual acuity in both eye were improve as it become two meter
RETINAL ISCHEMIA IDENTIFIED WITH THE OPTOS                                    counting finger in right eye and five meter counting finger in left eye,
PANORAMIC200A™ IMAGING SYSTEM                                                 maculopathy showed good progressivity.
                                                                              Conclusions: In SLE maculopathy condition, Triamcinolone intravitreal
A. GUPTA, C.R. GONZALES, A.E. KREIGER, S.D. SCHWARTZ                          could be considered as an alternative therapy so that could maintain and
UCLA, Los Angeles, CA, UNITED STATES AMERICA                                  improved existing visus and preferred reduced of vision.

Purpose: To assess the utility of the 200 degree Optos 200A Widefield
Angiography System in the evaluation and response to treatment of
patients with peripheral retinal ischemia.
Methods: The Optos Panoramic200A™ was used to simultaneously
image the posterior pole and retinal periphery angiographically in
conditions affecting the vitreous, retinal vasculature, retinal pigment

Asian J Ophthalmol. 2007 Vol 9 No 1 Supplement 1                                                                                                           99
Poster Abstracts

223-23                                                                              225-B25
EDEMA DUE TO INTERMEDIATE UVEITIS                                                   MANAGEMENT OF MACULAR EDEMA

J. Biswas1, S. Maru2, A. Nagpal2                                                    S. PUSHPOTH1, A. EL GENDY2, A. MAINO2, S. ABUGREEN2
1                                        2                                          1
    Vision Research Fndtn, Chennai, INDIA, Medical Research Fndtn, Chennai, INDIA       Wolverhampton and midlands eye infirmary, Wolverhampton, UNITED KINGDOM,
                                                                                        East Lancashire Hospitals NHS Trust, Burnley, UNITED KINGDOM
Purpose: To report a prospective study of intravitreal triamcinilone
acetonide (IVTA) injection for refractory cystoid macular edema (CME)               Purpose: Triamcinolone Acetonide either as intravitreal or posterior
due to intermediate uveitis.                                                        subtenon injection has provided an additional tool for ophthalmologists in
Methods: Propsective study of nine eyes of eight patients who had been              the treatment of macular edema due to various causes. The purpose of
given IVTA for refractory CME due to intermediate uveitis were analyzed             the study is to compare the effectiveness of posterior subtenon injection
All patients had a prior course of oral and periocular steroids and immu-           of triamcinolone acetonide in the treatment of cystoid macular edema.
nosuppressive agent. The duration of uveitis, the duration of CME,                  Methods: All new patients with persistent cystoid macular edema due to
pre and post treatment visual acuity, fundus fluorescein angiogram (FA),            branch retinal vein occlusion (BRVO) or secondary to posterior uveitis who
optical coherence tomogram (OCT) before and after treatment, complica-              attended the East Lancashire Hospital NHS Trust, United Kingdom, be-
tions were studied. Intravitreal injection 0.1 ml (4 mg) of triamcinolone           tween November 2003 and July 2005 were eligible for this study. Exclu-
acetonide was given by pars plana route.                                            sion criteria were: previous macular laser treatment, glaucoma, known
Results: The average age was 47.17 years with 3 males and 5 females.                steroid responders and refusal to participate. A total of 12 eyes of 13
The average duration of uveitis 29.33 months (range 15 to 55 months).               patients were included in the study. 4 eyes had macular edema second-
The average duration of CME was 20.55 month (range 1.5 to 5.2 month).               ary to BRVO and 8 eyes had macular edema secondary to uveitis. All
Patients were followed up for 8.55 months (range 2 to 16 months). Seven             patients received a single dose of 40mg/1ml of posterior subtenon triam-
of 9 eyes showed resolution of CME. Two eyes did not show resolution.               cinolone acetonide injection (PSTI). Main outcome measures included best
Three eyes had improvement of vision more than 2 lines, 3 eyes had                  corrected visual acuity (BCVA) expressed in LogMAR, intraocular pressure,
improvement of one Snellen line. One eye had same vision. The intraocular           presence of macular thickening on clinical examination, area and stain-
pressure was increased only in one eye. This eye did not respond with               ing on fluorescein angiography, measured preoperatively and 1 week,
antiglaucoma medications and required antiglaucoma surgery.                         4 week and 3 months postoperatively. Data were compared with repeated
Conclusions: IVTA is useful in the resolution of refractory CME due to              measures ANOVA and Student’s t-test.
intermediate uveitis.                                                               Results: Mean BCVA in the BRVO group improved from 1.55 ± 1.17 to
                                                                                    0.69 ± 0.36 at 4 weeks and to 0.68 ± 0.35 at 3 months (p=0.27).
                                                                                    The mean BCVA in the uveitis group improved from 1.54 ± 1.6 to 0.66 ±
224-B24                                                                             0.65 at 4 weeks and to 0.50 ±0.69 at 3 months (p=0.047). At 3 months,
SAFETY AND EFFICACY OF INTRAVITREAL                                                 two patients BRVO group and six patients in the uveitis group had com-
TRIAMCINOLONE                                                                       plete resolution of cystoid macular edema. None of the patients had raised
                                                                                    intraocular pressure during this period.
P. VARMA, U. SRIVASTAVA, S. SINGH, S. AGARWAL, M. DATTANI,                          Conclusions: Administering corticosteroid via a posterior subtenon
A. NAYAK, A. KAG                                                                    injection is an effective treatment modality in the management of macu-
M.G.M.M.C & M.Y.H, Indore, INDIA                                                    lar edema due to different causes. The advantages of posterior subtenon
                                                                                    injections are decreased risk of intraocular infection, decreased risk of
Purpose: To evaluate the role of intravitreal triamcinolone in reduction of         immediate raised IOP requiring paracentesis and the possibility to per-
posterior segment inflammation.                                                     form the procedure in outpatient department.
Methods: A prospective study of 8 patients presenting with bilateral pos-
terior segment inflammation of noninfectious etiology was done between
February’06 and Aug’06. Five patients had noninfective idiopathic uveitis           226-B26
and three had Eales disease. 0.4mg/1ml intravitreal triamcinolone was               POSURDEX® INHIBITS RETINAL VASCULOPATHY
administered in one eye of each patient under full aseptic condition. Other         AND NEUROPATHY INDUCED BY INTRAVITREAL
eye of each patient was kept as control. Outcome was measured in terms              VASCULAR ENDOTHELIAL GROWTH FACTOR
of V/A, IOP, cataract progression and resolution of inflammation.                   (VEGF) IN MONKEYS
Results: At 2 months follow up, V/A improved in all 8 eyes with resolution
of posterior segment inflammation. Increase in IOP was noted in 2 eyes              J.A. BURKE, T. LIN, K.M. ZHANG, W. ORILLA, C. SPADA, M. ESCOBAR,
which was controlled by topical Beta -Blockers. No progression of cata-             C. GHOSN, L.WHEELER
ract was evident.                                                                   Allergan, Inc., Irvine, CA, UNITED STATES OF AMERICA
Conclusions: IVTA is effective and safe in reducing intraocular inflammation.
                                                                                    Purpose: There is growing evidence that corticosteroids are efficient at
                                                                                    treating a variety of retinopathies in which VEGF plays a putative role. In
                                                                                    this study, the efficacy of 700µg dexamethasone posterior segment drug
                                                                                    delivery system (Dex PS DDS; Posurdex®; Allergan, Inc., Irvine, CA) at in-
                                                                                    hibiting intravitreal VEGF-induced retinal changes was examined in monkeys.
                                                                                    Methods: Six cynomolgus monkeys weighing 3.0 to 4.5 kg were
                                                                                    randomized to receive either unilateral Dex PS DDS or sham injection.

100                                                                                                       Asian J Ophthalmol. 2007 Vol 9 No 1 Supplement 1
                                                                                                                                 Poster Abstracts

One week later, the treated eyes were given 1.25µg VEGFh165. Follow-            228-B28
up measurements were made up to 4 weeks post-VEGF and included                  CENTRAL RETINAL VEIN THROMBOSIS AS THE
intraocular pressure (IOP), anterior chamber slit-lamp examination, optic       PRESENTING SYMPTOM OF ANESSON’ SYNDROME
nerve head topography with HRT, retinal vessel integrity by fundus
photography and fluorescein angiography, retinal thickness with OCT,            T. AGGERMANN, P. HAAS, S. BINDER
and retinal neurosensory function with simultaneous bilateral flash ERG         Rudolf Foundation Clinic, Vienna, AUSTRIA
using the Espion® electrophysiology system.
Results: VEGF-induced vascular and neuronal effects peaked at _ to 1            Purpose: To report a case of Sneddon´s syndrome in a 61 year-old male
week, and resolved by 2 weeks. Dex PS DDS reduced VEGF-induced an-              patient presenting with a central retinal vein occlusion (CRVO). Sneddon’s
terior segment flare, retinal vein tortuosity, dilation and leak, macular       syndrome is a systemic disease characterized by generalized livedo
edema, and optic nerve head swelling (P <. 05). ERG deficits were also          racemosa and cerebrovascular disease. One of the known vascular com-
reduced (e.g., -54 ± 13% to 11 ± 16%, b-wave @ 1 cd-s/m2; P =. 03).             plications of Sneddon Syndrome is venous thrombosis or aneurysm
Conclusions: 700µg Dex PS DDS significantly reduces VEGF-induced                formation. We report, herewith, a patient with a central retinal vein throm-
retinal vasculopathy, neuropathy, and anterior segment inflammation in          bosis in his right eye who was subsequently diagnosed with a Sneddon
monkeys. *CR                                                                    Syndrome. To our knowledge, this is the first report of a central retinal
                                                                                vein thrombosis in association with generalized livedo racemosa and
                                                                                cerebrovascular disease.
227-B27                                                                         Methods: A 61-year-old man presented with sudden and painless
HEMI-CENTRAL RETINAL ARTERY OCCLUSION: A                                        decrease of visual acuity of his right eye. Indirect ophthalmoscopy
CASE SERIES OF FOUR EYES                                                        revealed a central retinal vein occlusion. History, clinical examination,
                                                                                magnetic resonance imaging and laboratory serologies were performed.
E. RISHI, P. RISHI, T. SHARMA, S.V. MAHAJAN                                     Results: By dermatohistopathology and magnetic resonance tomography
Medical Research Foundation, Chennai, Medical Research Foundation, Chennai,     of the brain, Sneddon syndrome could be confirmed. Magnetic resonance
INDIA                                                                           imaging showed old cerebral infarction in the left basal ganglia. Labora-
                                                                                tory serologies including vasculitis parameter, antiphospholipid antibod-
Purpose: To describe patient profile, clinical features, etiopathogenesis       ies and lupus anticoagulant were negative. Antiphospholipid antibody

                                                                                                                                                               POSTER ABSTRACTS
and natural history of ‘Hemi-central retinal artery occlusion’.                 negative Sneddon´s Syndrome was diagnosed. Aspirin was recommended
Method: Observational case series.                                              to reduce the risk of future thromboses.
Results: Four young patients (Table 1) presenting with acute monocular          Conclusions: We describe a rare association between central vein occlu-
loss of vision, on exhaustive investigations were detected to be harboring      sion and Sneddon’s Syndrome. Ophthalmologists should be aware of the
systemic conditions such as polycythemia vera, factor V leiden mutation,        existence of Sneddon´s syndrome presenting with a retinal vein occlusion.
Eisenmenger syndrome and a prosthetic mitral valve. All patients were
young adults, less than 40 years of age. Clinical features were sugges-
tive of involvement of superior hemitrunk of bifurcated central retinal         229-B29
artery. This was confirmed with fluorescein angiography and was a strik-        COATS’ DISEASE DIAGNOSED IN ADULTHOOD - A
ing feature in all cases. Electroretinogram revealed ischemic changes           REVIEW OF 33 EYES
and corresponding visual field defects. Ocular color Doppler was diag-
nostic of unusual proximal, post-lamina cribrosal branching of central          P. RISHI, E. RISHI, M. UPARKAR, L. GOPAL, T. SHARMA, P. BHENDE, M. BHENDE
retinal artery, in two cases. Remarkable visual recovery of 6/18 or better      Medical Research Foundation, Chennai, Medical Research Foundation, Chennai,
was a hallmark feature in all, unlike devastating visual loss in central        INDIA
retinal artery occlusion. Mean follow-up was 3.5 months.
Conclusion: We hypothesize that rare anatomical variation of proximal,          Purpose: To describe the patient profile, clinical features, treatment and
post-lamina cribrosal branching of central retinal artery may predispose        outcome of Coats’ disease diagnosed in adults aged 35 years or more.
these hemitrunks to development of an acute occlusion with underlying           Methods: Retrospective analysis of patients diagnosed to have Coats’
systemic factors in young adults.                                               disease between Jan 1996 and Jan 2006 and aged 35 years or more
                                                                                were included. Eyes with a secondary cause for exudation like inflam-
                                                                                mation, infection, retinal degeneration or systemic disease were excluded.
                                                                                Patient profile, presenting features, treatment rendered and outcomes
                                                                                were analyzed.
                                                                                Results: At presentation, 31 of 280 patients (11%) diagnosed to have
                                                                                Coats’ disease in the last 10 years, were 35 years of age or more. 74.19%

Table 1 Abstract 227-B7. Clinical Profile of Hemi-CRAO
  NO      Age (yrs)        Sex         Eye          VA at presentation        Systemic condition              Hemitrunk involvement          Final VA
  1          26             M          OD                      6//6           Prosthetic mitral valve                 Superior                 6//6
  2          36             M          OS                No perception of       Polycythemia vera                     Superior                 6//6
  3          28             F          OD                     6//18             Factor V Leiden                       Superior                6//18
                                                                               Mutation, mild MR
  4          22             M          OS                      6//6              Eisenmenger                          Superior                 6//6

Asian J Ophthalmol. 2007 Vol 9 No 1 Supplement 1                                                                                                        101
Poster Abstracts

were males. 93.54% had unilateral disease. Mean age at presentation           respectively, while those treated with sham had lost an average of -3.2
was 46.72 years (range 35 to 80 years). Insidious, painless loss of vision    letters (P=0.09 and P<0.02 for 0.3 mg and 1 mg vs. sham). Fewer than
was the predominant presenting feature (90%). Average duration of             10% of those receiving either dose of pegaptanib but 31% of sham-treated
complaint(s) was 17.72 months (range 15 days to 15 years). Retinal exu-       subjects lost ≥15 letters by week 30 (P<0.05 for both comparisons
dation (93%) and telangiectatic vessels (87%) were hallmarks of the           with sham). Approximately 90% of pegaptanib-treated subjects had
disease. However, localized telangiectasia and exudation (< 2 quadrants)      visual acuities ≥20/200 at week 30 vs. 63% of those treated with sham
were seen more often in the adult form unlike the predominantly diffuse       (P<0.05 for both comparisons with sham). Mean change from baseline in
involvement in the classic childhood disease. Mean LogMAR visual              retinal thickness was greatest in the 0.3 mg pegaptanib group and small-
acuity was 1.54 + 1.19. Visual acuity of 6/12 or better was seen in 5 eyes    est in the sham group at both the center point (-253µg and -151µg) and
(15.2%) while 11 eyes (33.3%) had visual acuity <6/12 but >6/60 and           the center subfield (-251µg and -144µg). Retinal or iris neovascularization
17 eyes (51.5%) had visual acuity worse than 6/60. Anterior segment           developed in 3%, 6%, and 9% of those in the 0.3mg, 1 mg, and sham
involvement was seen in 8 of 33 (24.24%) eyes - aqueous flare and a           groups, respectively. No serious ocular adverse events, endophthalmitis,
significant cataract in 4 eyes each. Mean follow up was 41.5 months +         traumatic cataract, or retinal detachment were reported. No evidence of
52.3 months (Range of 1 to 168 months). Favorable structural out-             a sustained effect on intraocular pressure was noted.
come was seen in 87% eyes. Epiretinal membrane formation was the              Conclusions: Selective VEGF blockade may have a significant role in the
commonest complication (19%). There was statistically significant             management of macular edema in retinal venous occlusive diseases such
improvement in the visual acuity of the treated group of eyes from their      as CRVO. *CR
pre-operative status (p = 0.04). None of the eyes developed neovascular
Conclusions: Important differences exist between the classic, childhood       231-B31
form of Coats’ disease and its adult onset presentation. Patients diag-       THE STUDY OF RETINOPROTECTIVE EFFECT OF
nosed with Coats’ disease in adulthood have a less pronounced male            SYNTHETIC RETINAL PEPTIDE ON EXPERIMENTAL
predominance (74.19%), more benign natural course and treatment is            MODEL OF RETINITIS PIGMENTOSA IN CAMPBELL
rewarding in selected cases. Occasional bilateral presentation (6.46%),       RATS
presence of anterior segment abnormalities (24.24%), retinal detachment
and vitreous hemorrhage at presentation, less frequent macular edema,         S.V. TROFIMOVA, V.K. KHAVINSON, M.I. RAZUMOVSKY
and relatively poor visual acuity at presentation were seen in contrast to    St. Petersburg Institute of Bioregulation and Gerontology, St. Petersburg,
their western counterparts. While presence of systemic disease appeared       RUSSIAN FEDERATION
to be coincidental, hypercholesterolemia and thyroid disease were not
seen in any of these patients.                                                Purpose: To estimate the retinoprotective effect of synthetic retinal pep-
                                                                              tide in Campbell rats with pigmented retinal degeneration.
                                                                              Methods: The study was performed on 120 animals from 42 female rats.
230-B30                                                                       The experiment consisted of two stages. During the first stage experi-
PEGAPTANIB SODIUM IN TREATING MACULAR                                         mental group females (n=25) were intramuscularly treated with synthetic
EDEMA SECONDARY TO CENTRAL RETINAL VEIN                                       retinal peptide in the dose of 1.0µg per animal for 3 weeks before mating
OCCLUSION (CRVO)                                                              and throughout the whole period of pregnancy. Control group females
                                                                              (n=17) received sterile 0.9% NaCl solution according to the same schedule.
M. HOSSAIN, PEGAPTANIB IN CENTRAL RETINAL VEIN OCCLUSION                      The second stage of the experiment was conducted with the offspring of
STUDY GROUP                                                                   these females. Baby rats of the experimental group (n=70) received the
Pfizer Inc, West Ryde, AUSTRALIA                                              peptide intramuscularly beginning from the 5th day of their postnatal
                                                                              life, in the dose of 0.5µg up to the 35th day, and in the dose of 1.0µg
Purpose: Results of a phase 2 randomized clinical trial suggest that          up to the 81st day in the volume of 0.2ml per animal. The injections were
selective VEGF inhibition with pegaptanib safely and effectively treats       performed 5 days a week with a subsequent week interval. The control
diabetic macular edema. The same approach was evaluated for the               animals (n=50) received 0.2 ml of sterile 0.9% NaCl solution according to
macular edema secondary to CRVO.                                              the same schedule. Retinoprotective effect of the peptide was estimated
Methods: Subjects with recent vision loss from macular edema second-          basing on the results of electrophysiological and morphological studies
ary to CRVO were enrolled in a randomized, dose-ranging, double-masked,       conducted only in the offspring.
sham-controlled, multicenter phase 2 trial. Those with best-corrected         Results: By the 23rd day the summary bioelectric activity in both groups
visual acuity in the study eye of 65 to 20 ETDRS letters inclusive and        made no statistic difference. However, beginning from the 35th day the
better than or equal to 35 letters in the fellow eye were eligible. Macular   control rats showed a drastic decrease in the bioelectric activity of the
edema was determined by ocular coherence tomography (OCT). Subjects           retina, and by the 53rd day all control animals showed no activity on
received either intravitreal pegaptanib sodium (0.3 or 1 mg) or sham in-      electroretinograms. In experimental rats the ERG amplitude remained
jections every 6 weeks for 24 weeks and were followed for 30 weeks.           high up to the 41st day, beginning to gradually decline only after the
Photocoagulation for neovascularization was permitted in accordance with      70th day of their ontogenesis. Morphologic data confirmed the results of
the Central Vein Occlusion Study protocol. Fluorescein angiography, OCT,      electrophysiological study. So, the control showed complete destruction
and color photography were performed.                                         of all retinal layers by the 41st day, while in the experimental group all
Results: In all, 98 subjects entered the study (33 in both the 0.3 mg and     retinal layers survived. Thus, the peptide prolonged the period of retinal
1 mg pegaptanib groups; 32 in sham group). Baseline visual acuity             morphologic structure survival.
was well balanced across study arms. Both doses of pegaptanib had an          Conclusions: It was found, that this method of peptide administration
early and sustained effect on vision. At week 30, subjects receiving          enables to double the period of functional activity of the retina as
0.3 and 1 mg pegaptanib had gained averages of +7.1 and +9.9 letters,         compared to the control. Thus, the synthetic retinal peptide reveals a

102                                                                                               Asian J Ophthalmol. 2007 Vol 9 No 1 Supplement 1
                                                                                                                              Poster Abstracts

protective effect on the eye retina of Campbell rats, which suffer from       Methods: Heterozygous transgenic P23H-3 rats, a model of autosomal
genetically predetermined retinal degeneration.                               dominant retinitis pigmentosa, were raised to young adulthood in
                                                                              scotopic light (12 h 5 lx ‘daylight’, 12 h dark). The brightness of the day
                                                                              part of the cycle was increased to 300 lx (low end of the daylight range)
232-B32                                                                       for 1 week and then reduced to 5 lx for 5 weeks. Using a double flash
UNUSUAL CLINICAL ASSOCIATIONS WITH                                            protocol, the electroretinogram (ERG) was used to assess cone function
RETINITIS PIGMENTOSA                                                          after 1 week of 300 lx light exposure and after 2 and 5 weeks recovery
                                                                              in dim light.
L. GOPAL, M. BHENDE, T. SHARMA, K. K                                          Results: Exposure of dim-reared rats to 300 lx cyclic light for 1 week
Medical Research Foundation, Chennai, INDIA                                   reduced the cone-associated ERG b-wave. Returning animals to 5 lx con-
                                                                              ditions for 2-5 weeks resulted in substantial recovery of the cone b-wave
Purpose: To describe three unusual associations with Retinitis Pigmentosa     amplitude from 57% to 77% of control values.
(RP).                                                                         Conclusions: The degenerative P23H-3 retina shows significant recov-
Methods: We report three rare clinical associations seen in patients          ery of cone function in response to a reduction in ambient light. These
diagnosed with RP.                                                            findings suggest that, in humans suffering visual loss due to comparable
Results: Subfoveal choroidal neovascular membrane in a female patient         genetic mutations, light management should improve retinal function.
successfully treated with photodynamic therapy. Optic nerve head              Specifically, improvement should be seen in daytime and high-acuity
neovascularization of the disc in a non diabetic male patient treated with    vision that is mediated by the cone system.
laser photocoagulation. Scattered retinal hemorrhages seen in a young
male who was diagnosed to have chronic myeloid leukemia on laboratory
investigations.                                                               235-B35
Conclusions: The management and literature review of rare clinical            PILOT STUDY OF RETINAL VASCULAR NETWORK
associations with RP will be discussed.                                       GEOMETRY IN GLAUCOMA

                                                                              A. TEY1, N. PATTON2
233-B33                                                                        Ninewells Hospital and Medical School, Dundee, UNITED KINGDOM, 2Princess

                                                                                                                                                             POSTER ABSTRACTS
AVASTIN AS A TREATMENT OPTION IN CENTRAL                                      Alexandra Eye Pavilion, Edinburgh, UNITED KINGDOM
                                                                              Purpose: To explore the relationship between parameters of retinal
D. REEVES                                                                     vascular geometry and visual field indices in glaucoma.
Omni Eye Specialists, Denver, CO, UNITED STATES OF AMERICA                    Methods: We performed a prospective study in a group of glaucoma
                                                                              patients (n=20). Parameters of retinal vascular geometry (vessel widths,
Purpose: To present our unique experience of treating a CSCR patient          bifurcation angles and branching coefficients) were correlated with meas-
with a pan-VEGF inhibitor (Avastin).                                          ures of visual field change (mean visual field defect and pattern standard
Methods: 42 y.o.male patient with recurrent CSCR requested treatment          deviation).
to speed up recovery from recent re-activation of the disease in the foveal   Results: Mean visual field deviation correlated with venular caliber
zone. 2.5 mg of Avastin was injected intravitreally.                          (R=0.46, p=.04). No other associations between retinal vasculature and
Results: Over the course of two months, the subretinal fluid resolved.        visual fields were detected.
Three months later the fluid re-occured from a different leakage area.        Conclusions: These results lend further evidence of glaucoma as a
The patient requested a second injection of Avastin. Again, over the course   vascular disease. Future studies exploring this association are planned.
of two months the subretinal fluid resolved, rendering a visual acuity
of 20/20.
Conclusions: Avastin had a transient beneficial effect in drying out          236-B36
the subretinal fluid in a patient with recurrent CSCR. This should trigger    PREFERENTIAL HYPERACUITY PERIMETRY FOR
further investigation in what the role of a pan-VEGF inhibitor could play     DETECTION OF AGE-RELATED MACULAR
in the physiopathology of CSCR.                                               DEGENERATION

                                                                              B. MAHESHWAR, E. ROSDI, A.M. WAGLE, K.G. AU EONG
234-B34                                                                       Alexandra Hospital, Singapore, SINGAPORE
P23H-3 RETINA BY MANAGEMENT OF AMBIENT                                        Purpose: To evaluate the ability of preferential hyperacuity perimetry (PHP)
LIGHT                                                                         to detect age-related macular degeneration (AMD) and to compare the
                                                                              results with that of conventional Amsler grid.
V. CHRYSOSTOMOU, K. VALTER, J. STONE                                          Methods: A retrospective analysis of 213 eyes of 109patients, with and
The Australian National University, Canberra, AUSTRALIA                       without AMD, who underwent a conventional supervised Amsler grid (AG)
                                                                              examination, PHP test, and macular color photographs were studied.
Purpose: Our group has recently reported a recovery of function in the        The color photographs were graded and categorized into 5 groups. All
retina of the rhodopsin-mutant P23H-3 rat in response to the manage-          patients with late AMD (choroidal neovascularisation (CNV) and geographic
ment of ambient light. Here, we extend the study to specifically examine      atrophy) underwent fluorescein and indocyanine green angiography.
the effect of light restriction on cone photoreceptors in the degenerative    Results: Of the 28 eyes with CNV (Group 5), 28 (100%) and 26 (92%)
retina.                                                                       were positive on the PHP and AG respectively. Twelve eyes had geographic

Asian J Ophthalmol. 2007 Vol 9 No 1 Supplement 1                                                                                                     103
Poster Abstracts

atrophy (Group 4), and of them, 11 (91%) and 7 (58%) were positive on           progressed to Acute Threshold ROP. Cryotherapy was applied and the
the PHP and AG respectively. Forty-five eyes had AMD with high-risk char-       retinopathy regressed uneventfully. Case II revealed funduscopic and
acteristics (HRC) (Group 3), 17 (38%) and 7 (16%) were positive on the          echographic features of Stage II ROP which regressed spontaneously in
PHP and AG respectively. Thirty-five eyes with of AMD without HRC (Group        both eyes. It was noted that echographic features of Stage II and III were
2), 14 (40%) and 10 (29%) were positive on the PHP and AG respectively.         seen well and corresponded consistently with funduscopic features.
Ninety-three eyes had no AMD (Group 1), 7 (7.5%) and 10(11%) were               Conclusions: Echographic features of Stage I ROP and normal fundus
positive on PHP and Amsler respectively. The sensitivity to detect CNV          findings in premature babies were not able to be differentiated. Progres-
using PHP was 97.5% and 82.5% using AG, and the specificity to differ-          sion and regression features of ROP stages II and III were well detected
entiate it from group 3 lesions was 62% and 84% using PHP and AG                by ultrasound. To the best of our knowledge these are the first reports of
respectively.                                                                   ultrasonic zoning of ROP.
Conclusions: For late AMD (Groups 4 and 5) and intermediate AMD (Group
3) PHP has a higher sensitivity and a lower specificity compared to AG.
This may be due to small sample size in our study and a larger study is         239-B39
warranted.                                                                      OPTICAL COHERENCE TOMOGRAPHY IN OPTIC
                                                                                DISC PIT AND ASSOCIATED MACULOPATHY

237-B-37                                                                        D. CHAUHAN1, S. DAS2, R. ARORA2, D. SHROFF2, R. NARULA2, R. SACHDEV2,
NEAR-INFRARED SPECTROSCOPIC EXAMINATION                                         M. SACHDEV1
OF AQUEOUS HUMOR                                                                1
                                                                                    Centre For Sight, Delhi, INDIA, 2Guru Nanak Eye Centre, Delhi, INDIA

J. JONAS1, D. WEISSBRODT2, R. MUELLER2, J. PERRIN2, J. BACKHAUS2                Purpose: To report 5 patients with an optic disc pit and associated
 Department of Ophthalmology, Mannheim, GERMANY, 2Mannheim University of        maculopathy evaluated by optical coherence tomography (OCT) for
Applied Sciences, Institute for Instrumental Analysis, Mannheim, GERMANY        delineation of structural retinal changes and to understand the patho-
                                                                                physiology of this entity.
Purpose: To report on a new technique for examining aqueous humor.              Methods: Patients were evaluated by biomicroscopy, fluorescein angi-
Methods: Aqueous humor samples obtained from 198 patients (cataract:            ography (FA) and OCT.
n=66 eyes; age-related macular degeneration: n=66; diabetic macular             Results: Fundoscopy revealed a central serous detachment in all eyes.
edema: n=66) were in vitro examined by mid infrared spectroscopy.               Contrary to previous reports horizontal line scans showed a direct
After training and validating the technique, 66 samples were taken for          communication between subretinal space and the pit.
the final test.                                                                 Conclusions: OCT proved to be a useful tool in the evaluation of optic
Results: In computerized analysis of the spectrometric data, 22 (100%)          disc pit. Larger studies are required to confirm our new findings regard-
cataract eyes were diagnosed as cataract group, 17 (77%) diabetic macu-         ing the pathogenesis via a direct communication between the detached
lar edema eyes were diagnosed as diabetic macular edema group, and              sensory retina and the pit.
14 (64%) eyes with age-related macular degeneration were diagnosed
as age-related macular degeneration group. Mid infrared spectrometry
could statistically significantly (p=0.004) differentiate between the three     240-B40
study groups.                                                                   INTRAVITREAL DOING WITH POSURDEX®
Conclusions: Mid infrared spectroscopic examination of aqueous humor            (DEXAMATHASONE IN A SLOW-RELEASE
may be able to in vitro differentiate eyes with cataract, age-related macular   BIODEGRADABLE DEVICE) SUPPRESSES
degeneration or diabetic macular edema. It may merit further evaluation.        EXPERIMENTAL ANTERIOR UVEITIS IN RABBITS

                                                                                J.A. BURKE, C. GHOSN, Y. LI, W. ORILLA, T. LIN, N. LINKE, B. DEBROSSE,
238-B38                                                                         M. ROBINSON, L. WHEELER, S.M. WHITCUP
ULTRASONOGRAPHIC FINDINGS OF RETINOPATHY                                        Allergan, Inc., Irvine, CA, UNITED STATES OF AMERICA
                                                                                Purpose: Chronic non-infectious uveitis describes a group of ocular
R. NORAMAZLAN                                                                   inflammatory diseases that can result in permanent vision loss if left
Hospital Tuanku Fauziah, Kangar, Perlis, MALAYSIA                               untreated. Corticosteroids (topical, periocular, systemic) are the main-
                                                                                stay of uveitis therapy, but are associated with several drawbacks. Eye
Purpose: This poster describes the ultrasonographic findings of ROP             drops require frequent administration, periocular dosing can cause scle-
using an Ultrasonic ROP Zoning system.                                          ral thinning and systemic dosing can cause numerous adverse effects.
Methods: Two premature babies were randomly selected for ultrasound             An intravitreal steroid that distributes to the anterior segment is one
examinations from premature babies attending the eye clinic. Ultrasound         mechanism that can potentially overcome these hurdles. This study evalu-
examinations were performed during their visits to our clinic from the          ated the efficacy of intravitreal Posurdex®, a polymer-based biodegrad-
first screening examination and on subsequent follow-ups. A 10 MHz              able system that slowly releases the corticosteroid dexamethasone, on
ophthalmic ultrasound probe of the Humphrey B scan machine was used.            suppressing experimental anterior uveitis in rabbits.
All the sonograms and medical records were reviewed retrospectively.            Methods: Anterior uveitis was induced by an intracameral injection of
Results: A total of 4 eyes (2 patients) were examined. Case I revealed          20ug Mycobacterium Tuberculosis H37 RA (Mbt) in one eye of 19 rabbits
funduscopic appearances and echographic features of ROP Stage I in the          pre-immunized 20 days previously with 2 subcutaneous doses of 10mg
right eye and stage II ROP in the left eye. On follow-up, the Stage I ROP       Mbt. Animals were divided into 2 groups and dosed intravitreally with
of the right eye had regressed but the Stage II ROP of the left eye had         either Posurdex® 700ug (n=10) or a 22-gauge sham injection (n=9)

104                                                                                                      Asian J Ophthalmol. 2007 Vol 9 No 1 Supplement 1
                                                                                                                                      Poster Abstracts

4 days after disease induction. Follow-up consisted of anterior chamber           visual acuity of 6/36 or worse. Cataract, posterior segment complications
cell scoring (0-4+) with a slit-lamp using the Standard of Uveitis Nomen-         and glaucoma compromised the final visual outcome.
clature (SUN) method and gross ocular observations, and were made prior           Conclusions: Screening for uveitis to detect uveitis in all cases of
to induction of uveitis, at the time of drug dosing and 3, 7 and 13 days          juvenile arthritis can help to prevent blindness.
after drug dosing. Eyes were enucleated at 4 and 13 days for histology
(H&E, CD3, Ram11, tunnel staining).
Results: Histological assessment show that this model induces inflam-             243-B43
matory infiltrates (lymphocytes, macrophages) and edema at the level of           CLINICAL EVALUATION AND OUTCOMES OF
the iris, ciliary processes, anterior chamber and cornea, but not the vitre-      DENGUE CHORIORETINITIS AND MACULOPATHY
ous or retina. At the 13 day time-point, there was a marked decrease of           WITH OPTICAL COHERENCE TOMOGRAPHY (OCT)
inflammatory cells and tunnel staining in eyes treated with Posurdex®
compared to the sham-treated eyes. Clinical assessment showed that                S.C. TEOH1, C.K.L. CHEE2
there was marked anterior segment inflammation in all subjects at the             1
                                                                                   The Eye Institute, Singapore, SINGAPORE, 2National University Hospital, Singapore,
time of drug dosing. Baseline randomization show that 89 ± 11% of sham            SINGAPORE
eyes (n=9) had a SUN severity score of ≥ 3 compared with 90 ± 10% of
Posurdex® eyes (n=10); p>0.05. Three days after dosing, 100 ± 0%                  Purpose: To characterize and correlate OCT findings with visual outcomes
(n=9) in the sham group had SUN score of ≥ 3 or not evaluateable (NE)             in dengue maculopathy.
due to corneal edema vs. 40 ± 16% of eyes in the Posurdex® group                  Methods: Consecutive non-interventional series of 35 patients with
(n=10); p<0.05. Thirteen days after dosing, 100 ± 0% (n=4) in the sham            dengue fever and impaired vision from posterior uveitis and maculopathy
group had SUN scores of ≥ 3 or NE vs. 20 ± 20% (n =5) in the Posurdex®            over 4 months. Visual acuity and fields were correlated with angiography
group; p<0.05.                                                                    and OCT findings.
Conclusions: Intravitreal dosing with Posurdex® appears to be an effi-            Results: OCT showed 3 patterns of maculopathy: (1) diffuse thickening,
cient way of treating anterior uveitis. *CR                                       (2) macular edema with subfoveal debris and (3) cystic separation of
                                                                                  subfoveal retinal pigment epithelium layer. Visual outcome was independ-
                                                                                  ent of amount of edema but scotomata persisted longest in pattern (3)
241-B41                                                                           and shortest in (1).

                                                                                                                                                                        POSTER ABSTRACTS
VOGT KOYANAGAI HARADA DISEASE WITH DISC                                           Conclusions: OCT patterns in dengue maculopathy are useful for
AND RETINAL HEMORRHAGES - REPORT OF FOUR                                          characterization, monitoring and prognosis of the visual defect.

R. AGRAWA                                                                         244-B44
Shri Ganapati Netralaya, Jalna, INDIA                                             PATHOLOGICAL STUDY AND TREATMENT
                                                                                  OUTCOME OF IMMUNE RECOVERY UVEITIS IN A
Purpose: To report a series of cases of VKH disease with retinal and/or           PATIENT WITH ACQUIRED IMMUNODEFICIENCY
disc hemorrhages.                                                                 SYNDROME (AIDS)
Design: Observational case series, Clinical science - scientific report.
Methods: Clinical evaluation of four patients of VKH disease at a tertiary        M. NAKAJIMA, M. IWATA, M. ARAKAWA, M. UCHIYAMA, M. SAWA
referral eye care center in central India in the period between April 2002        Nihon University School of Medicine, Department of Ophthalmology, Tokyo, JAPAN
to March 2003.
Results: Incidental finding in the form of optic disc hemorrhage in one           Purpose: To present the clinical features and management outcome
patient, peripapillary hemorrhage in two patients and retinal hemorrhages         of immune recovery uveitis (IRU) with cystoid macular edema (CME),
at posterior pole in one patient was noted at presentation or during the          epimacular membrane and traction retinal detachment in a patient with
course of VKH disease in this case series.                                        AIDS, and to analyze the functional cell components in proliferative
Conclusions: Optic disc or retinal hemorrhages can be included as an              fibrovascular membrane and vitreous in IRU.
additional occasional ocular finding in the patients with VKH disease.            Methods: A 43-year-old Thai woman was diagnosed as having cytome-
                                                                                  galovirus (CMV) retinitis with AIDS. After receiving highly active anti-
                                                                                  retroviral therapy, IRU occurred in her left eye without recurrence of CMV
242-B42                                                                           retinitis. Pars plana vitrectomy was performed to treat CME and traction
JUVENILE ARTHRITIS AND UVEITIS                                                    retinal detachment. Proliferative fibrovascular membrane was studied
                                                                                  immunohistochemically for CD3, CD4, CD8, CD20 and CD68. CMV-DNA
S. CHOWDHURY, A. PATTANAYAK                                                       in vitreous was studied by PCR.
Bokaro General Hospital, India, Bokaro Steel City, Jharkhand, INDIA               Results: CME decreased within 1 week after operation, but recurred two
                                                                                  months later. Two sub-Tenon injection of triamcinolon acetonide amelio-
Purpose: Study of uveitis in juvenile arthritis.                                  rated the recurred CME, and visual acuity was improved in 1-year follow-
Methods: Observational case study emphasizing ocular morbidity related            up. Immunohistochemistry revealed CD3+, CD8+ and CD68+ cells in the
to patient’s sex, age at diagnosis of arthritis and uveitis.                      proliferative fibrovascular membrane. CMV-DNA was undetectable.
Results: 42 cases, 24 females, median age at diagnosis: JRA 7 years,              Conclusions: Repeated sub-Tenon injection of triamcinolon acetonide is
uveitis 9 yrs (14 cases), positive relation between antinuclear antibody          effective to ameliorate recurrent CME. Fibrovascular membrane contains
positivity and the development of uveitis (p < 0.05). 50% of uveitis cases        predominantly macrophages and T-lymphocytes.
had mild inflammation without any sequel. All the patients without uveitis
had a final visual acuity of 6/9 or better. 6 patients with uveitis had a final

Asian J Ophthalmol. 2007 Vol 9 No 1 Supplement 1                                                                                                                105
Poster Abstracts

245-B45                                                                          lens implantation. Bevacizumab (Avastin) 2.5mg in 0.1 cc was given
ADALIMUMAB; ACTIVE AND CONVENIENT                                                intravitreally and a dramatic regression of iris neovascularization
THERAPY FOR PATIENTS WITH SEVERE BEHçET’s                                        was observed one week after injection and the keratic precipitations
DISEASE                                                                          disappeared after topical corticosteroid treatment.
                                                                                 Conclusions: Fulminant intraocular inflammation caused by virulent
J.A.M. VAN LAAR1, P.M. VAN HAGEN1, J.H. KAPPEN1, P.L.A. VAN DAELE1,              pathogens will resulted in intraocular neovascularization formation.
T. MISSOTTEN2, G.S. BAARSMA2                                                     Anti-VEGF agent may be one of the adjuvants in the treatment of severe
 Erasmusmc university hospital, Rotterdam, THE NETHERLANDS, 2Eye hospital,       endophthalmitis.

Purpose: anti-TNF-α therapy with infliximab or etanercept is effective           247-B47
in patients with autoimmune diseases such as Behçet’s disease (BD).              OPTICAL TOMOGRAPHY FINDINGS IN CENTRAL
Recently a new anti-TNF-α agent (adalimumab) has been introduced in              CHOROIDITIS
rheumatoid arthritis. Adalimumab is administered more conveniently sub-
cutaneously once every two weeks. So far only one case series of three           D. CHAUHAN 1 , S. DAS 2 , R. ARORA 2 , R. ARORA 2 , D. SHROFF 2 ,
patients with BD uveitis successfully treated with adalimumab has been           R. NARULA2, R. SACHDEV2
published.                                                                       1
                                                                                     Centre For Sight, Delhi, INDIA, 2Guru Nanak Eye Centre, Delhi, INDIA
Methods: a case series of 8 BD patients with active, mostly severe sys-
temic refractory disease now treated with 40 mg adalimumab and previ-            Purpose: To describe the morphologic characteristics of macular lesions
ously treated with infliximab (75%) were analyzed retrospectively.               and in central choroiditis by optical coherence tomography (OCT) and
Infliximab was given in the past and terminated because of responses             to investigate the correlation between topographic features and visual
(mean 128 days, range 136-1093 days). Hereafter adalimumab was                   acuity (VA).
started if symptoms required anti-TNF-α therapy. Symptoms included               Methods: Thirty consecutive patients with a clinical diagnosis of active
uveitis, colitis, esophageal, oral and genital ulcers, central nervous sys-      central choroiditis in at least one eye. Main Outcome Measures were
tem involvement, erythema nodosum and arthritis and were refractory to           Best-corrected Snellen VA and topographic features of the macula,
most non-anti-TNF-α immunosuppressive drugs. BDCAF was included in               including macular thickness and macular volume measurements, and
5 of the evaluations.                                                            correlation of macular thickness with VA.
Results: adalimumab yielded swift objective responses and tapering of            Results: Macular edema was noted in all patients. Epiretinal membrane
current immunosuppressive therapy in all patients. Improvement of eye            was detected by OCT in 10 eyes (23%). Six eyes (14%) demonstrated
symptoms included disappearing of vitreous cells and improvement of              vitreomacular traction. Lamellar macular hole was seen in 2 eyes (4.6%).
the visual acuity from 20/32 and 20/320 to 20/20 and 20/250 (patient             The mean retinal thickness at the central fovea was 333 microns.
# 2) and 0.16 to 0.6 (in patient # 4). Symptoms were less severe if reap-        Macular edema was located mainly in the outer retinal layers. Eyes with
pearing during adalimumab and were not correlated with anti-adalimumab           cystoid macular edema (CME) had significantly greater retinal thickness
antibodies. The mean BDCAF decreased from 35.8 to 9.2. Duration of               measurements than eyes with diffuse macular edema (P_0.001).
therapy was more than 370 days (range 80-625 days) and 7 patients                Different patterns of cystoid macular edema (several distinguished cysts,
(88%) are still treated. The therapy was well tolerated and no significant       partially or completely confluent cysts and in few cases just one marked
side effects were noted.                                                         cyst) were observed. Multivariate analysis revealed that visual acuity was
Conclusions: adalimumab constitutes a well-tolerated and effective               negatively correlated with increased macular thickness.
modality in therapy refractory BD patients including those with active           Conclusions: Optical coherence tomography (OCT) as an objective and
uveitis.                                                                         reliable test is useful for studying the retina and is especially useful in
                                                                                 evaluation of macular status in central choroiditis. It provides quantita-
                                                                                 tive measurements of retinal thickness that are useful for follow-up.
ENDOGENOUS STERNOTROPHOMONAS                                                     248-B48
MALTOPHILIA ENDOPHTHALMITIS                                                      PATTERNS OF RETINAL VASCULITIS IN A
                                                                                 REFERRAL CENTER IN SOUTH INDIA
Dep. of Ophthalmology, Taipei Veterans General Hospital and National Yang-Ming   M. KUMARAN1, S. RATHINAM2, S. MANOJ3
University, Taipei, TAIWAN                                                       Hindu Mission Hospital, Chennai, Chennai, INDIA, 2Aravind eye hospital, Madurai,
                                                                                 Madurai,TN, India, 3Chaitanya Eye Hospital, Trivandarum,Kerala, INDIA
Purpose: To report the neovascularization suppressing effect of
Bevacizumab (Avastin) in Gram negative endophthalmitis.                          Purpose: To report the pattern of retinal vasculitis in a South Indian
Methods: Interventional case report.                                             tertiary eye care center.
Results: One 41 year-old healthy male presented with hypopyon in                 Methods: A retrospective analysis of the case records of 76 consecutive
the left eye. He has been treated as uveitis with systemic and topical           patients with retinal vasculitis was done to analyze the pattern of retinal
corticosteroid for a week. Aqueous and vitreos tapping yielded                   vasculitis in a South Indian tertiary eye care center from June 2000 to
Sternotrophomonas Maltophilia, a Gram negative bacillus. Intravitreal in-        June 2003. A standard clinical protocol, with appropriate laboratory
jection of antibiotics, lensectomy and vitrectomy had silenced down the          investigation, was followed for the final clinical diagnosis.
intraocular inflammation but massive neovascularization of iris with much        Results: 76 patients were included in the study; 58 males (76.7%) and
keratic precipitates on cornea precluded the plan of secondary intraocular       18 females (26.3%) were identified for the study. Mean age group 26 ±

106                                                                                                       Asian J Ophthalmol. 2007 Vol 9 No 1 Supplement 1
                                                                                                                               Poster Abstracts

5.9 years (Mean age±2SD), (Range 10 to 55 years). A specific diagnosis          function can occur within one week after trauma and permanent dam-
was established in 63 cases (82.89%). Infectious etiology was seen in 46        ages in two weeks, suggesting that timing of vitrectomy be 1~2 weeks
cases (60.52%), of which Leptospirosis was the commonest cause, seen            after injury. Our clinical practice also showed that some visual recovery
in 21 patients (27.6%) followed by Tuberculosis (11 patients, 14.47%)           can be achieved in selected traumatized eyes after operation.
and Viral (CMV, V. Zoster, ARN) etiology (7 patients, 9.16%). Non-infec-
tious etiology was seen in 17 patients (22.36%), of which Sarcoidosis
was the commonest cause in 12 patients (15.78%) followed by Behcet’s            250-B50
disease (4 patients, 5.26%) and VKH syndrome (1 patient). Idiopathic            THE CLINICAL APPLICATION OF CT OCULAR
Retinal vasculitis was seen in 13 patients (17.1%). Pan-uveitis at presen-      FOREIGN BODY LOCALIZATION DIAGRAM
tation was seen in 49 patients (64.47%) of which non-granulomatous
anterior uveitis occurred in 41 patients (83.67%). Granulomatous ante-          H. ZHANG
rior uveitis was seen in 8 patients (16.32%). Bilateral disease was seen        Baoan People’s Hospital, Shenzhen, Guangdong, China, Shenzhen, CHINA
in 41 patients (53.9%) and 50 patients (65.8%) presented within 4weeks
of the onset of the disease process.                                            Purpose: to describe the role of CT ocular foreign body localization
Conclusions: Leptospirosis, viral and tuberculosis were the commonest           diagram (CT OFBLD) in the detection and localization of foreign bodies
form of retinal vasculitis in the infectious group, while Sarcoidosis           in intraocular foreign body after perforated trauma.
was common in the non-infectious group. The appearance of Leptospiral           Methods: in a prospective study, CT examination was performed in sixty-
retinal vasculitis in endemic areas has changed the way we approach             eight eyes of fifty-seven consecutive patients with suspected intraocular
the diagnosis and management of Retinal vasculitis in our Tertiary eye          foreign body. After CT scanning, drawing the foreign body shadow on the
care center.                                                                    CT intraocular foreign body localization diagram. Intraocular foreign bod-
                                                                                ies were precisely detected and eliminate the disturbance of extraocular
                                                                                foreign bodies in actinography. And then we can translate from the shadow
249-B49                                                                         on CT photograph to the CT OFBLD. Finally, we can got the data that we
TRAUMATIC HEMORRHAGIC RETINAL                                                   need for an operation to remove the ocular foreign body.
DETACHMENT                                                                      Results: in all forty-seven eyes, CT scan detected and precisely localized
                                                                                small foreign bodies (metallic in 40 eyes, others 7 eyes). Operative pro-

                                                                                                                                                             POSTER ABSTRACTS
Y.N. HUI, Z.F. ZHANG, W. LIU, L. WANG                                           cedures to remove the intraocular foreign bodies (especially for metallic
Eye Institute, Xijing Hospital, Xi’an, CHINA                                    foreign body) were guided by the information of the CT OFBLD.
                                                                                Conclusions: CT scan is a noninvasive method for detecting intraocular
Purpose: To review the pathological changes, timing of vitreous surgery         foreign bodies after perforated trauma. It can be used to accurately
and outcome in eyes with traumatic hemorrhagic retinal detachment (HRD)         diagnose foreign bodies and assist in surgical management, particularly
based on histopathology, animal model and clinical practice.                    when direct visualization is obscured because of the trauma in eyes with
Methods: The sections of eye globes enucleated shortly after rupture            partial-thickness corneoscleral lacerations or sealed full-thickness
were examined with light microscopy. To establish a rabbit model of HRD,        corneoscleral laceration and suspected very tiny foreign bodies that
autologous anticoagulated blood (0.2 ml) was transvitreally injected into       common X-ray can not be found, CT is a safe and effective method for
the subretinal space. The model was evaluated by means of ultrasound            detecting and localizing foreign bodies in the eyeball.
A and B scan, OCT, ERG and VEP, light microscopy and transmission elec-
tron microscopy in the subsequent 28 days after injection, to explore the
changes in absorption of blood, retinal structural and functional damage        251-B51
with time.                                                                      PROGNOSTIC FACTORS FOR OPEN GLOBE
Results: The pathological examination of ruptured eye globes revealed           INJURIES - ANALYSIS OF FIVE HUNDRED &
that the retina was in part morphologically intact, and blood clots were        TWENTY THREE EYES
under the retina and choroid, or in the stroma of choroid. After injection of
blood, HRD formed and extended from 10 to 12 disc diameters in rabbit           R. AGRAWAL
eyes. The obvious elevation of the retina maintained for 14 days and the        Shri Ganapati Netralaya, Jalna, INDIA
residual subretinal hemorrhage was still noted till 28 days. The ampli-
tudes of ERG a and b waves decreased to the lowest levels on day 3,             Purpose: Ocular trauma is one of the leading causes of ocular morbidity
slightly recovered on day 7 and then remained stable at about 50% of the        in children and young adults. It can have a significant impact on socio-
normal level thereafter. The implicit time of the waves was prolonged           economic status of the individual. Successful surgical repair and sub-
mostly at 3-7 days and partially recovered but still 5%- 30% longer than        sequent visual rehabilitation of open globe injury is a topic of great
controls. The implicit time and amplitude of VEP were prolonged or de-          significance and challenge to all the practicing ophthalmologists. One of
creased respectively. Histopathologically, the outer and inner segments         the important components in management of open globe injury is the
of photoreceptors broke within one week, and the cell numbers in the            counseling of trauma victim and his family. Even though, with advent of
outer and inner nuclear layers decreased obviously at 14 days. TEM              new modalities and improved technology the management of penetrat-
revealed karyopyknosis of the photoreceptors which were then totally            ing ocular injuries has changed, we need to prognosticate any patient
disappeared in the center area. HRD caused by intraocular foreign bodies,       with ocular trauma before and even after the repair of open globe injury.
penetrating injury, and open or close blunt trauma in 39 eyes, all with         Just repairing the open globe injury under very guarded visual prognosis
NLP, was treated with vitreous surgery. 19 eyes had LP or better after          in each and every case may not prove to be right rationale in today’s
operation.                                                                      world of evidence based medicine. To support the prognosis in ocular
Conclusions: The retina can be partially intact shortly after severe trauma.    trauma patient there have been numerous literature till date. This study
The HRD model revealed that severe damages of retinal structure and             is also based on the same ground wherein numerous variables affecting

Asian J Ophthalmol. 2007 Vol 9 No 1 Supplement 1                                                                                                       107
Poster Abstracts

the prognosis of ocular trauma patient is analyzed by univariate and          variables: the number of injuries in which the product was involved (NB),
multivariate analysis and by logistic regression analysis.                    the hospitalization rate (HR) and the mean duration of the hospitalization
Methods: Retrospective case analysis of 523 eyes of open globe                (MDH), ratio of initial and final visual acuity. A score ranging from 1 to 20
injuries wherein preoperative variables were correlated with final visual     is assigned to each of these variables according to which percentile the
outcome. Exclusion criteria were patients with less than four months          product is classified as belonging to (classified by increments of 5). Thus
follow up, previous ocular surgery, presence of intraocular foreign body,     a higher score is assigned to an object that is more frequently involved in
endophthalmitis.                                                              injuries (and which is therefore more dangerous).
Results: Factors influencing final visual outcome were presence of rela-      Results: The SSRD is calculated every year and this makes it possible to
tive afferent papillary defect, length of laceration, presence of vitreous    track the dangerousness of an object over time and adopt preventive
loss, laceration posterior to rectus muscle & retinal detachment. Initial     measures .In our study, tennis ball, unexploded cracker, assault and steel
visual acuity at time of presentation and time elapsed between surgery        foundry had the highest SSRD. This was also calculated for the children.
and injury had no statistically significant impact on post operative final    Conclusions: The results obtained contribute to establishing priority
visual outcome. Blunt trauma was found to have 3.9 times higher risk of       actions at the community level. The methodological weaknesses of this
poor visual outcome as compare to penetrating trauma.                         score are linked to the way the information is gathered (specific features
Conclusions: Identifying poor prognostic factors prior to surgical repair     of the hospital collecting data), its quality and exhaustiveness. The
contributes toward patient counseling and surgical strategy.                  advantages of this score are the fact that it is easy to calculate and per-
                                                                              form and that it can be used over time and at national level. The results
                                                                              obtained match the ‘impressions of seriousness’ about which there is a
252-B52                                                                       consensus in the field of home and leisure injuries.
WITHOUT SEDATION                                                              254-B54
                                                                              NEAR INFRARED PHOTON THERAPY FOR RETINAL
R. AGRAWAL                                                                    INJURY AND DISEASE
Shri Ganapati Netralaya, Jalna, INDIA
                                                                              J.T. EELLS
Purpose: To report the utility of topical anesthesia for surgical repair of   Uinv of Wisconsin - Milwaukee, Milwaukee, WI, UNITED STATES OF AMERICA
open globe injuries in selected patients.
Methods: In this non-comparative interventional case series, out of 289       Purpose: Far red to near-infrared (NIR) light treatment has been shown
eyes of open globe injuries, sixty three eyes with open globe injury were     to stimulate mitochondrial respiration and improve functional recovery of
repaired under topical anesthesia.                                            the retina and optic nerve following toxic insult and injury. Recent studies
Results: Six patients had mild discomfort during surgery. No patient          in our laboratories have provided evidence for the therapeutic benefit of
had surgical or anesthesia related adverse effects. The pre- and post-        NIR-LED treatment in the survival and functional recovery of the retina
operative clinical photographs document the prototype case for which          and optic nerve in vivo after acute injury by the mitochondrial toxin, for-
corneal wound repair was done under topical anesthesia.                       mic acid generated in the course of methanol intoxication. In these studies,
Conclusions: Topical anesthesia is safe and effective and could be            3 brief 670 nm LED treatments (4 J/cm2), administered at 5, 25, 50 h of
reasonable alternative for less severe open globe injuries. However,          methanol intoxication, significantly attenuated the retinotoxic actions of
surgical training & patient preparation are the keys to the safe use of       formate during intoxication and protected the retina from histopathologi-
this technique.                                                               cal changes. We hypothesize that the therapeutic effects of NIR light result,
                                                                              in part, from intracellular signaling mechanisms triggered by the interac-
                                                                              tion of NIR light with the mitochondrial photoacceptor molecule cytochrome
253-B53                                                                       oxidase which culminate in improved cellular mitochondrial energy me-
A TOOL TO CHARACTERIZE THE RELATIVE                                           tabolism and antioxidant production.
SEVERITY OF EYE INJURIES: THE SYNTHETIC                                       Methods: To test this hypothesis we compared gene expression profiles
SCORE OF RELATIVE DANGEROUSNESS                                               in the neural retina of untreated rats with those from the neural retina of
                                                                              methanol-intoxicated rats and LED-treated methanol-intoxicated rats using
A. PATTANAYAK, S. CHOWDHURY                                                   Code Link Rat 3D Bioarray (Amersham Biosciences).
Bokaro General Hospital, India, Bokaro Steel City, INDIA                      Results: Methanol intoxication and LED treatment altered the retinal
                                                                              expression of nearly 80 genes. Several functional subcategories of genes
Background: The epidemiological data regarding eye injuries are very          regulated by NIR-LED were identified in retinal samples including those
scarce in India. Most of the data are taken from the hospital records,        encoding DNA repair proteins, antioxidant defense enzymes, molecular
which show only the clinical patterns and visual outcome lacking vital        chaperones, protein biosynthesis enzymes, and trafficking and degrada-
epidemiological clues. Prevention being the best way for tackling any         tion proteins. Striking differences were observed in genes from cytochrome
injury the analysis of dangerousness of the offending object could be         oxidase family, peroxiredoxin family and genes involved in cell growth
an important step.                                                            and maintenance. Differential expression of selected genes was confirmed
Purpose: To study the dangerousness of offending object by developing         at the level of RNA. *CR
a decision-making tool the Synthetic Score of Relative Dangerousness
Methods: This is part of ongoing prospective study on eye injuries
occurring in a steel township. SSRD is calculated for all the eye injuries
attending eye OPD during 2004-2005. It is calculated empirically using 4

108                                                                                               Asian J Ophthalmol. 2007 Vol 9 No 1 Supplement 1
                                                                                                                                  Poster Abstracts

255-B55                                                                          Results: SLO analysis has shown that HC Ad EGFP was toxic at high
TREATMENT OF CHOROIDAL NEOVASCULAR                                               doses (>107 iu) because the fluorescence has disappeared within 3 days
MEMBRANES IN PARAFOVEAL TELANGIECTASIA                                           after injection. At lower doses (5.104 -5.106 iu) the fluorescence was
WITH TRANSPUPILLARY THERMOTHERAPY: A                                             detectable during 1 month. Moreover the injection of HC Ad EGFP has
CASE SERIES                                                                      induced a depigmentation of the retina at the injection site and this was
                                                                                 not observable after injecting HC Ad VEGFs demonstrating an intrinsic
N. KASINATHAN, T. SHARMA                                                         toxic property of EGFP and not of the HC adenoviral vector. In SLO imaging
Sankara Nethralaya, Chennai, INDIA                                               at different time-points after the injection of different doses of the two
                                                                                 different HC Ad VEGFs, changes of the retinal or choroidal vascular
Purpose: To report the role of transpupillary thermotherapy (TTT) for            structures in the subretinal space were not clearly discernible. The in
the treatment of choroidal neovascular membranes (CNV) secondary to              vitro analysis is now under investigation and will eventually permit to
parafoveal telangiectasia (PFT).                                                 detect the presence of endothelial cells in the subretinal space.
Methods: Retrospective analysis of 13 eyes of 12 patients diagnosed to           Conclusions: The development of CNV in our model is still under in-
have parafoveal telangiectasia with choroidal neovascular membranes              vestigation and our future results may represent a helpful model for the
and treated with transpupillary thermotherapy between January 2000 to            development of new therapeutic strategies for angioproliferative diseases
January 2004. Laser settings included power between 150 to 550 mW,               of the eye since the advantages of the HC Ad VEGF used are low toxicity,
duration 1 minute. End point was no visible burn or slight graying of retina.    low immunogenicity and long-term expression of VEGF. Further work
Outcome was assessed with snellen visual acuity, clinical and angiographic       correlating SLO and histological results is in progress to address the
examination.                                                                     difference in the detection of early stage CNVs.
Results: Nine eyes had predominantly classic subfoveal CNV. Four eyes
had predominantly classic juxtafoveal CNV. Regression of the choroidal
neovascular membrane occurred after single treatment in 11 eyes (84%)            257-B57
and after 2 sittings in 2 eyes (15%). Following treatment, vision improved       THE ROLE OF NICOTINE IN THE PATHOGENESIS
in 4 eyes (31%), maintained in 8 eyes (62%) and decreased in 1 eye               OF AGE-RELATED MACULAR DEGENERATION
(7%). Mean follow-up was 8.8 months.
Conclusions: TTT may have a role in managing CNVs due to parafoveal              L. YANG, Y. WANG, Y. WANG, H. YIN, H. GONG, Y. WANG

                                                                                                                                                               POSTER ABSTRACTS
telangiectasia.                                                                  Shandong Eye Institute, Qingdao Eye Hospital, qingdao, CHINA

                                                                                 Purpose: To study the effect of nicotine, the important component in to-
256-B56                                                                          bacco on the biological properties of cultured RPE cells to explore the
COMPARISON OF DOSE-RESPONSE AND TIME-                                            possible mechanism of smoking in AMD development.
COURSE EFFECTS OF TWO HUMAN VEGF FAMILY                                          Methods: Fetal RPE cells were cultured in monolayer in HA filters, treated
MEMBERS (VEGF-A165 AND VEGF-DαNαC) AND                                           with different concentrations of nicotine, and the transepithelial resist-
EGFP IN RABBIT EYE AFTER SUBRETINAL                                              ance (TER) were measured. Expression change of complement factor H,
ADENOVIRAL GENE TRANSFER: A NEW MODEL OF                                         IL-6, IL-8 in nicotine treated RPE cells was determined at 72h using real
CHOROIDAL NEOVASCULARIZATION IN THE                                              time-PCR. Matrix metalloproteinase (MMP)-1, -2, -9 expressions were
RABBIT?                                                                          assayed using reverse transcription PCR and analyzed using Image J
                                                                                 software. The effect of nicotine on the morphology of cultured RPE cells
S. JULIEN1, F. KREPPEL2, S. BECK3, S. KOCHANEK2, M. SEELIGER3,                   was assayed using scanning electron microscope (SEM).
K.U. BARTZ-SCHMIDT4, U. SCHRAERMEYER1                                            Results: After treatment with different concentrations of nicotine, the TER
 Department of Experimental Vitreo-Retinal Surgery, University Eye Hospital of   of RPE cell layers decreased. The expression of CFH and IL-6 of RPE cells
Tuebingen, Tuebingen, GERMANY, 2Division of Gene Therapy, University of Ulm,     increased but the expression of IL-8, MMP-1, -2, -9 decreased in nico-
Ulm, GERMANY, 3Retinal Diagnostics Research Group, University of Tübingen,       tine treated RPE cells. SEM displayed that RPE cells treated with nicotine
Tuebingen, GERMANY, 4Department I, University Eye Hospital of Tuebingen,         became irregular and the cell-cell junction is less tight than control.
Tuebingen, GERMANY                                                               Conclusions: Nicotine can change the morphology, destroy the barrier
                                                                                 function, and affect the gene expression of RPE cells, indicating that
Purpose: The aim of this study was to determine dose-response and                nicotine might participate in the pathogenesis of AMD through changing
time course-effects of vascular endothelial growth factor (VEGF) A165,           the physiological function of RPE cells.
DαNαC and enhanced green fluorescent protein (EGFP) as delivered                 Confirmation: The animals or fetus used in this research was conducted
using a high capacity adenoviral vector (HC Ad) on vascular growth and           in compliance with the “ARVO Statement for the Use of Animals in
pathological changes in the rabbit eye. Moreover, we wanted to develop           Ophthalmic and Vision Research” and the “Declaration of Helsinki”.
a new rabbit model for choroidal neovascularization (CNV) and to
compare different detection methods of VEGF-A165 and VEGF-DαNαC
over expression-induced neovascularization in the rabbit.
Methods: High-capacity adenoviral vectors encoding VEGF-A165, VEGF-
DαNαC and EGFP were constructed and injected at different doses
(5.104 -109 infectious units (iu)) into the subretinal space of rabbits.
The development of neovascularization and the expression of HC Ad-
transduced VEGF-A165, DαNαC and EGFP proteins were followed up to 3
months in vivo by scanning laser ophthalmoscopy and angiography (SLO),
and in vitro by electron microscopy and immunohistochemistry.

Asian J Ophthalmol. 2007 Vol 9 No 1 Supplement 1                                                                                                       109
Poster Abstracts

258-B58                                                                              rats, we were surprised by our preliminary findings of attenuated ERG
THE EFFECTS OF LIGHT MANAGEMENT ON THE                                               responses in the P23H rats. We hypothesize that a longer period of 670
CONES OF DEGENERATING P23H-3 RETINA                                                  nm light treatment may be required to protect the P23H retina from
DURING DEVELOPMENT                                                                   degeneration.

ARC Centre of Excellence in Vision, Canberra City, AUSTRALIA                         260-B60
                                                                                     VITREOUS HUMOR ENHANCES THE
Purpose: Present study aimed to establish if light management can                    PROLIFERATION OF RETINAL PRECURSOR CELLS
modify the progress of the degeneration in the P23H-3 transgenic rat and
especially its effects on cone function and morphology.                              J. YANG1, H.J. KLASSEN1, M. PRIES2, W. WANG3, M.H. NISSEN2
Methods: All animals were raised in cyclic ambient light (12h dark/12h               1
                                                                                      University of California, Irvine, Orange, CA, UNITED STATES OF AMERICA, 2Univer-
light) with the light phase at either 5 lux or 40 lux conditions. One group          sity of Copenhagen, Copenhagen, DENMARK, 3Peking University, Beijing, CHINA
of animals was raised to P (postnatal days) 120 at 5 lux (scotopic group),
another group was raised in 40 lux from P3 to P120 (mesopic group) Two               Purpose: To evaluate the potential effects of vitreous humor on retinal
other groups were raised in either of these conditions to P30 and then               precursor cell (RPC) proliferation.
were transferred to the other light levels (scotopic/mesopic group and               Methods: RPCs were isolated from SD rats on embryonic day 19 and
mesopic/scotopic group) Single and double flash full field ERG recordings            cultured in DMEM:F12 including N2 supplement and 20ng/ml EGF in the
were performed and tissue samples were collected at P30, 40, 60,                     absence or presence of porcine vitreous humor at different concentrations.
80, 100, 120. TUNEL labeling was used to detect cell death, histological             Cell proliferation was quantified on days 0-4 using 3H-thymidine incorpo-
and immunohistological stainings were performed to examine cone                      ration assay. Potentially active components of vitreous humor were sepa-
morphology, and to measure outer segment and retinal layer thickness.                rated by gel filtration chromatography (GFC) and the effect on RPC
Results: Mesopic light decreased a-wave amplitude and cone b-wave of                 proliferation determined.
the ERG. The scotopic light after mesopic-rearing increased both rod and             Results: Addition of 20% vitreous humor to primary RPC cultures increased
cone functions.                                                                       H-thymidine incorporation by as much as 481%, as compared to growth
Conclusions: Light restriction can slow the progress of degeneration in              medium without aqueous supplementation. Using gel filtration and in vitro
the P23H-3 rat strain.                                                               proliferation assay, one of the growth promoting activities of vitreous humor
                                                                                     was localized to the 176Da molecular weight range, consistent with ascor-
                                                                                     bic acid.
259-B59                                                                              Conclusions: These results show that vitreous humor can enhance the
EFFECT OF 670 NM PHOTON THERAPY ON THE                                               proliferation of RPCs and ascorbic acid appears to contribute in part to
ERG OF NON-DEGENERATIVE AND DEGENERATIVE                                             this function.

D.K. KIRK1, J.T. EELLS2, V. CHRYSOSTOMOU1, J. STONE1, K. VALTER1                     261-B61
The Australian National University, Canberra, AUSTRALIA, 2University of Wisconsin-   GLIAL CELL LINE-DERIVED NEUROTROPHIC
Milwaukee, Milwaukee, WI, UNITED STATES OF AMERICA                                   FACTOR REGULATES THE VASCULAR
                                                                                     PERMEABILITY OF THE BLOOD-RETINAL BARRIER
Purpose: Treatment with 670 nm light emitting diodes (LED) is effective
in diabetic wound healing, ischemic heart injury and is retinoprotective in          N. NISHIKIORI 1, M. OSANAI 2, H. KAWATA 3, H. CHIBA 2, T. KOJIMA 2,
acute toxic injury. This lab has shown previously that treating Sprague-             N. SAWADA2, H. OHGURO3
Dawley (SD), P23H-3 and Royal College of Surgeons (RCS) rats to 670 nm               1
                                                                                      Department of, Ophthalmology and Pathology, Sapporo Medical University School
N-IR during the critical period of postnatal retinal development has                 of Medicine, S-1, W-16, Chuo-ku, Sapporo, JAPAN, 2Department of Pathology,
decreased the mean number of TUNEL positive cells in the outer nuclear               Sapporo Medical University School of Medicine, S-1, W-16, Chuo-ku, Sapporo,
layer (ONL) of the P23H-3 and produced no significant change in the mean             JAPAN, 3Department of Ophthalmology, Sapporo Medical University School of
number of TUNEL positive cells in the ONL of the SD and RCS rats. This               Medicine, S-1, W-16, Chuo-ku, Sapporo, JAPAN
study was undertaken to determine the effects of 670 nm LED treatment
on retinal function as measured by the electroretinogram (ERG).                      Purpose: We have previously demonstrated that glial cell line-derived
Methods: Pups for each of the strains were treated with 4 J/cm2 of 670               neurotrophic factor (GDNF), a member of the neurotrophic factors, was
nm N-IR LED once per day for five days from P16 to P20. Sham treated                 secreted from glial cells such as astrocytes in retina. In addition, we
animals were exposed to the same protocol with no light. ERGs were                   showed that the capillaries of blood-retinal barrier (BRB) are positive for
performed on days P22, P30, P40, P60, and P80. Results were analyzed                 GDNF receptor alpha 1 (GFR alpha 1) and GFR alpha 2, whereas the effect
to determine the a-wave and cone b-wave response to an intensity series.             of GDNF on BRB functions remains to be clarified. BRB is a biological unit
Results: 670 nm LED treatment had no effect on the ERG responses                     composed of capillary endothelial cells and glial cells, and is essential for
in SD and RCS rats. Our preliminary findings indicate that 670 nm LED                maintaining retinal microenvironment and low permeability. Early event
treatment attenuated the a-wave and b-wave in P23H rats up to P40.                   of diabetic retinopathy (DR) is an increase in permeability of the BRB and
Conclusions: Our data indicate that the retina of the SD rat is unaffected           a certain molecule that modulates BRB function will meet considerable
in the long-term by the 670 nm N-IR treatment administered during the                promise, however, there have no evidences to show the significant
critical period of retinal development. Our findings in the RCS rats indi-           effects in blocking DR. Therefore, we examined the possibility whether
cate that that 670 nm light treatment is unable to prevent degeneration.             GDNF expression in glial cells regulates BRB function in DR.
Given the protection against apoptotic cell death observed in the P23H               Methods: We performed double-immunofluorescent staining assay to

110                                                                                                       Asian J Ophthalmol. 2007 Vol 9 No 1 Supplement 1
                                                                                                                                  Poster Abstracts

detect GDNF and GDNF receptors expression in retina from mice. We                 263-B63
performed reverse transcriptase (RT)-PCR, real-time PCR and Western               SALICYLATE-BASED ANTI-INFLAMMATORY DRUGS
blot analysis in order to quantitate the GDNF mRNA and protein expres-            INHIBIT THE EARLY LESION OF DIABETIC
sions. For the assessment of permeability, we measured transendothelial           RETINOPATHY
electrical resistance and flex of [14C]-inulin of capillary endothelial cell
monolayers on semipermeable filters after 7days treatment with GDNF               L. ZHENG, T.S. KERN
recombinant protein. In addition, to further demonstrate in the clinical          Case Western Reserve Univeristy, Cleveland, OH, UNITED STATES OF AMERICA
setting, we examined in vivo trials using diabetic mice.
Results: Immunohistochemically, GDNF was detected in the cells posi-              Purpose: It has been reported by our lab that aspirin can inhibit the
tive for glial fibrillary acidic protein, which is a differentiation marker for   development of diabetic retinopathy in a 5-year study of diabetic dogs,
glial cells such as Muller cells and astrocytes. GFR alpha 1 and GFR alpha        raising a possibility that anti-inflammatory drugs may have beneficial
2 were localized in von Willebrand factor-positive cells such as capillary        effects on diabetic retinopathy. We administrated three salicylate-based
endothelial cells comprising of BRB. In addition, we showed that GDNF,            drugs (aspirin, sodium salicylate and sulfasalazine) on the development
which reduces the vascular permeability of BRB, was increased in the              of early stages of diabetic retinopathy in rats.
glial cells by treatment with retinoic acid receptor alpha stimulants as          Methods: Lewis rats were randomly assigned to be made diabetic or
previously described. Furthermore, this phenotypic transformation of              remain as non diabetic controls. Experimentally diabetic rats were treated
glial cells is sufficient for significant reductions of vascular leakage and      with or without aspirin, sodium salicylate and sufasalazine. NF-κB nuclei
angiogenesis in the DR.                                                           translocation was investigated by immunochemistry, and transcription
Conclusions: These findings reveal that the GDNF regulate BRB function,           factor binding to DNA assessed by EMSA or transcription factor array.
implying that glial cells could be a possible therapeutic target in DR.           ICAM-1, VCAM, iNOS, COX-2 protein levels were assessed by Western
                                                                                  blots. Retinal thickness and ganglion cell loss were evaluated by
                                                                                  microscopy. The retinal vasculature was isolated using the trypsin digest
262-B62                                                                           method, and used for TUNEL assay to assess vascular cell apoptosis and
ASSOCIATION BETWEEN SORBITOL                                                      degenerate (acellular) capillaries.
DEHYDROGENASE GENE POLYMORPHISMS AND                                              Results: Diabetes of 9-10 months duration significantly increased the
TYPE 2 DIABETIC RETINOPATHY                                                       number of TUNEL-positive capillary cells and acellular (degenerate) cap-

                                                                                                                                                                  POSTER ABSTRACTS
                                                                                  illaries in the retinal vasculature. All three salicylate-based drugs inhib-
J. BLASIAK1, M. KOWALSKI2, I. MAJSTEREK1, J. SZAFLIK2, A. BORUCKA2,               ited this cell death and capillary degeneration without altering the severity
J. SZAFLIK2                                                                       of hyperglycemia. In 2-4 month studies, all three salicylates inhibited the
University of Lodz, Lodz, POLAND, 2Medical University of Warsaw, Warsaw, POLAND   diabetes-induced loss of neuronal cells from the ganglion cell layer. Oral
                                                                                  aspirin (as a representative of the salicylate family) inhibited the diabe-
Purpose: Diabetic retinopathy (DR) may affect 98% of diabetic patients,           tes-induced alteration in DNA binding affinity of NF-κB and selected other
but its etiology is poorly understood. Besides glycemic exposure, genetic         transcription factors. All three salicylates inhibited the diabetes-induced
factors are likely contribute to the onset of DR. Polyol pathway, including       translocation of p50 (a subunit of NF-κB) into nuclei of retinal vascular
aldose reductase and sorbitol dehydrogenase (SDH), can be activated               endothelial cells, and of p50 and p65 into nuclei of cells in the ganglion
under hyperglycemic conditions. In our work we searched for an associa-           cell layer (GCL) and inner nuclear layer (INL). Sulfasalazine (also as
tion between the C-1214G and G-888C polymorphisms of the promoter                 a representative of the salicylates) inhibited the diabetes-induced up-
of the SDH gene and the occurrence and progression of type 2 diabetic             regulation of several inflammatory gene products that are regulated by
retinopathy.                                                                      NF-κB, including VCAM, ICAM-1, iNOS and COX-2.
Methods: 221 unrelated individuals with type 2 diabetes mellitus (T2DM)           Conclusions: Salicylates, in doses administrated in our experiments, in-
were divided into three groups: without DR, with non-proliferative (NPDR)         hibited diabetes-induced degeneration of retinal capillaries and NF-κB
and proliferative (PDR) DR. Genotypes of the C-1214G and G-888C                   activation in the retina. These salicylates were well tolerated, and offer
polymorphisms of the SDH gene were determined in DNA from peripheral              new tools to investigate and inhibit the development of diabetic retinopathy.
blood lymphocytes of patients by restriction fragment length polymor-
phism and allele-specific PCR, respectively. The distributions of the geno-
types were contrasted by the χ2 test and the significance of polymorphism         264-B64
was assessed by multiple logistic regression producing odds ratios (ORs)          THE EFFECT OF GLUCOSE OF HIGH
and 95% confidence intervals (95% CIs).                                           CONCENTRATION ON BARRIER FUNCTION OF
Results: We found an association (OR 1.73, 95% CPI 1.06-2.83) between             HUMAN RETINAL CAPILLARY ENDOTHELIAL CELLS
the occurrence of NPDR and the G allele of the G-888C polymorphism.
There was a lack of any association between NPDR and the other poly-              G. YUAN, X. DONG
morphism of the SDH gene. No differences were found in the distribu-              Shandong Eye Iinstitute, Qingdao, CHINA
tions of these polymorphisms between patients with proliferative or
non-proliferative retinopathy. Analysis of combined genotypes (haplotypes)        Purpose: To establish the method of culturing human retinal capillary
of both polymorphisms revealed an association between the C/G-C/G                 endothelial cells (HRCEC ) in vitro. To detect the effect of glucose of high
genotype and NPDR (OR 2.95 CPI 1.07-8.13).                                        concentration on the barrier function of cultured HRCEC, and to discuss
Conclusions: The G-888C polymorphism of sorbitol dehydrogenase gene               the mechanism in it.
may be associated with the onset of diabetic retinopathy rather than with         Methods: Take the normal human retina from eye bank, through washing,
its progression and its effect may be strengthen by the interaction with          cutting, digesting, filtering and isolating by magnetic beads to get the
the C-1214G polymorphism. Therefore, these polymorphisms may be                   purified HRCEC. Then identify the cells of serial subcultivation by immu-
considered as markers of DR in diabetic patients.                                 nohistochemistry and FCM. Passage the cells and divide to 3 groups in

Asian J Ophthalmol. 2007 Vol 9 No 1 Supplement 1                                                                                                          111
Poster Abstracts

random, and change the media to DMEM containing glucose of 5.6mmol/L,           assay and immunohistochemistry analysis were carried out.
15.6mmol/L and 25mmol/L respectively when the cells proliferate                 Results: So far, TUNEL assay showed that light preconditioning decreased
confluently. On the 3rd day and 1, 2, 3 and 4 weeks after changed               the rate of photoreceptor death induced in the C57BL/6J retina by
the media, survey the endothelial cell activity of each group by MTT,           hyperoxia, by ~50%. By contrast, hyperoxic preconditioning did not cause
and measure TER by cell resistometer, and detect the express of tight           a significant decrease in the rate of photoreceptor death induced in the
junction protein Occludin and ZO-1 by western blot, and detect the gene         BALB/c retina by bright light. In C57BL/6J retinas, bright cyclic light ex-
transcription of Occludin and ZO-1 by RT-PCR.                                   posure did not increase the expression of stress-related molecules in-
Results: The HRCEC could form stable monolayer. And the content                 cluding GFAP, FGF-2 and CNTF.
percentage was more than 95% by immunohistochemistry and FCM. The               Conclusions: This is the first demonstration that light preconditioning
differences of cell activity were not significant statistically among the 3     can have general effects; i.e. it can protect the retina from a different
groups. TER ascended gradually after the cells subcultured, and get peak        form of stress, such as hyperoxia. The mechanism by which light-condi-
value of 29.83±2.49Ω·cm2. After change media glucose concentration,             tioning protects C57BL/6J photoreceptors from hyperoxic damage is not
TER fluctuated between 27.25±4.22Ω·cm2~30.00±2.98Ω·cm2 and the                  known, but appears not to involve FGF-2 or CNTF. The failure of hyperoxic
differences were not significant in group L; TER descended in group M,          conditioning to protect BALB/c photoreceptors from light damage sug-
which descended rapidly between 1 to 3 weeks especially; in group H,            gests that hyperoxic stress does not induce the same protective mecha-
TER descended to 15.75±3.30Ω·cm2 rapidly on the 3rd day, and the                nisms at light stress. It is possible that the retinal mechanism for protection
difference was significant, and descended continuously thenceforth. The         against bright light is active and evolved than the protective mechanisms
express of Occludin and ZO-1 descended along with the concentration of          evoked by hyperoxia.
glucose ascending. In group L, the expression of Occludin didn’t change
along with the time, but groups M and H, the expression of Occludin
descended evidently; the change of the expression of ZO-1 along with            266-B66
the time was not obvious. The gene transcription of Occludin descended          LNK DELETION IMPROVES ISCHEMIC
along with glucose concentration ascending, but ZO-1 was not correla-           RETINOPATHY AUGMENTING BONE MARROW-
tion with it. Along with the time, the gene transcription of Occludin changed   DERIVED ENDOTHELIAL PROGENITOR CELL
inconspicuously in each group, but the gene transcription of ZO-1 de-           RECRUITMENT IN NEOVASCULARIZATION
scended conspicuously in group H and inconspicuously group L and M.
Conclusions: The human retinal endothelial cells could be purified,             T. SUZUKI 1, S.M. KWON 2, Y. NAKAGAWA 1, K. KAWAI 1, S. TAKAKI 3,
cultured and subcultivated successfully. The activity of human retinal en-      T. ASAHARA2
dothelial cells could not be decreased by glucose of high concentration,        1
                                                                                 Tokai University School of medicine, Isehara, JAPAN, 2 Kobe Institute of
but TER of them could be decreased along with concentration of glucose          Biomedical Research Innovation / RIKEN Center for Developmental Biology, Kobe,
ascending. It maybe related with the gene transcription and protein             JAPAN, 3Tokyo University School of medicine, Tokyo, JAPAN
express of Occludin and ZO-1.
                                                                                Purpose: Lnk is known to be an essential inhibitory signaling molecule
                                                                                for self-renewality of stem cells by the finding of enhanced hematopoietic
265-B65                                                                         reconstitution in Lnk-deficient mice. Lineage negative hematopoietic stem
PROTECTIVE MECHANISMS IN THE RETINA:                                            cells (HSCs) have recently been shown to contain a population of
COMPARISON OF THE PROTECTION INDUCED BY                                         endothelial progenitor cells (EPCs) capable of forming blood vessels,
LIGHT STRESS AND BY HYPEROXIA                                                   and EPCs are mobilized from the bone marrow in response to a variety
                                                                                of factors and can target sites of angiogenesis in ischemic tissue. We
Y. ZHU, K. VALTER, J. PROVIS, J. STONE                                          have previously demonstrated that Lnk deletion restores postnatal
The Australian National University, Canberra, AUSTRALIA                         neovascularization in a hind limb ischemia model regulating EPC-medi-
                                                                                ated signaling cascade. We then tested the hypothesis that Lnk deletion
Purpose: Previous studies have shown that bright light can precondition         improved ischemic retinopathy restoring angiogenesis in a mouse oxy-
the retina, upregulating protective mechanisms which increase resist-           gen-induced retinopathy (OIR) model.
ance to subsequent light challenge. The present study was designed to           Methods: OIR was induced by 5 days 75% oxygen exposure and then
test whether preconditioning with another photoreceptor-lethal stimulus,        incubation under room air condition (21% oxygen) in postnatal day 7 (P7)
hyperoxia, can provide similar protection against light-induced death           C57BL/6J wild type (WT) and Lnk-/- mice. First, we evaluated the angio-
of photoreceptors. We also tested whether condition with bright light is        genesis both in WT and Lnk-/- mice. Secondary, we examined the effects
protective against hyperoxia-induced damage.                                    of Lnk gene deletion on EPC population in bone marrow and peripheral
Methods: Protection against light-induced damage was tested in the              blood by FACS analysis and EPC colony-forming assay. Furthermore, we
BALB/c mouse, which is light-sensitive. Protection against hyperoxia-           performed transfusion study with isolated GFP+ Sca1+ lineage- cells in
induced damage was tested in the C57BL/6J strain, which is hyper-               OIR mice to examine the homing capacity of bone marrow-derived EPCs.
oxia-sensitive. BALB/c and C57BL/6J mice were born and raised in                Results: Lnk deletion significantly reduced avascular area and retinal
dim cyclic light (12h 5 lux, 12h dark). At age P (postnatal day) 79-165,        hemorrhage area at P17 by 52% and 60% compared with control.
mice of each strain were divided into two groups. One group of BALB/c           Neovascular tufts quantified from whole mounts were significantly re-
was placed in 75% O2 for 2w and the other group was maintained in               duced by 51%. The number of EPCs both in bone marrow and peripheral
normoxia. Both groups were then exposed bright (1000 lux) cyclic light          blood was increased in Lnk-/- mice, and Lnk-/- EPCs formed vasculogenic
for 1w. For the C57BL/6J mice, one group was exposed to bright light            colonies in culture. In addition, transfused Lnk-/- EPCs had more homing
(1000 lux) for 5-7 days while the other group was maintained in dim light,      capacity compared to WT EPCs.
before both groups placed into 75% O2 for 2w. Eyes from these animals           Conclusions: In this study, we demonstrated that Lnk deletion not only
were collected and cryosectioned. TUNEL labeling, gene expression               enhanced physiological angiogenesis but also improved pathological

112                                                                                                  Asian J Ophthalmol. 2007 Vol 9 No 1 Supplement 1
                                                                                                                                  Poster Abstracts

angiogenesis with EPC contribution. Therefore, inhibition of Lnk expres-          Methods: The viral vector construct (AAV-Trx1) for Trx-1 gene expression
sion may provide an effective target for the treatment of retinal neovascular     was made by subcloning Trx-1 fused to a fluorescent protein into an
diseases as well as ischemic retinopathy.                                         adeno-associated virus vector cassette. The AAV-Trx1 vector particles were
                                                                                  produced in 293T cells based on the helper free system. ARPE-19 cells
                                                                                  infected with the AAV-TRX1 (ARPE-Trx1) were maintained with DMEM
267-B67                                                                           containing 10 % of fetal bovine serum (FBS). ARPE-Trx1 cells plated onto
EFFECT OF MUSCARINIC AGENTS ON MAMMALIAN                                          96 well culture dishes for the cell viability test. One day after plating the
RETINAL PIGMENT EPITHELIAL (RPE) CELLS                                            medium were exchanged to the medium containing 40 µM C2-ceramide
                                                                                  and 1% FBS or cysteine free medium for the induction of oxidative
S.R. WEON1, V.A. BARATHI1, R.W. BEUERMAN2                                         stress. Cell viabilities were assessed at 24 hours after the oxidative stress
 Singapore Eye Research Institute, Singapore, SINGAPORE, 2Singapore Eye           exposure using the cell Titer 96 aqueous non-radioactive cell prolifera-
Research Institute, Yong Loo Lin School of Medicine, National University of       tion assay. The mitochondrial membrane potentials were analyzed using
Singapore, Singapore, SINGAPORE                                                   the membrane-potential-sensitive dye, JC-1.
                                                                                  Results: Cell viabilities of ARPE-19 cells were about 40 % and 70 % of
Purpose: The retinal pigment epithelium (RPE) is critical to retinal function.    survival induced by 40 µM of C2-ceramide and cysteine free (cys-free)
The purpose of this study was to investigate muscarinic acetylcholine             medium, respectively. Mitochondrial depolarization was observed in
receptors (mAChRs) on the RPE cells and the effect of muscarinic agents.          each treatment. Increased cell viability was observed in ARPE-Trx1 cells
Methods: Primary cells were harvested by trypsinization from non-                 exposed to oxidative stress by cysteine free medium but not C2-ceramide.
human primate, Balb/c mouse, and human donors and we used the ARPE                The membrane depolarization in ARPE cells was observed in each oxidative
19 cell line. Cultured RPE cells were used at passage 2-4. Luminescent            stress. The rate of membrane depolarization in ARPE-Trx1 cells exposed
ELISA assays for proliferation were carried out with atropine or pirenzepine      to Cys-free medium was decreased while those in C2-ceramide treat-
at 0,0.1,1.0,10,100µM and MT7 at 0,0.005,0.05,0.5,5 µM. The m1 ago-               ment were not changed.
nist MT1 and carbachol were used at 0,0.005,0.05,0.5,5 µM and 0,0.1,              Conclusions: Trx-1 protects RPE cells from oxidative stress by inhibiting
1.0,10,100µM respectively. RPE primary cells were confirmed by                    the loss of mitochondrial membrane potential, suggesting an important
immunohistochemisty (anti-cytokeratin KG 8.13 antibody). Presence of              role of Trx system in protecting these cells.
mAChRs was investigated by immunobloting.

                                                                                                                                                                  POSTER ABSTRACTS
Results: RPE explant primary cells and early stage outgrowth took ap-
proximately 1week. RPE primary cells were identified by anti-cytokeratin          270-B70
KG 8.13, which is specific for RPE cells. Western blots confirmed the             CURCUMIN MODULATES SDF-1α/CXCR4-INDUCED
presence of m1-m5 on RPE cells. Pirenzepine and MT7 antagonists in-               MIGRATION OF HUMAN RETINAL ENDOTHELIAL
hibited proliferation of RPE cells in a dose dependent manner (p<0.05,            CELLS (HRECS)
n=4, ANOVA). Atropine, a general muscarinic receptor antagonist, also
inhibited proliferation of RPE cells in a dose dependent manner (p<0.05,          M. SAMEER, M. BALASUBRAMANYAM, M. REMA
n=4, ANOVA). In contrast, the muscarinic receptor agonist MT1 and car-            Madras Diabetes Research Foundation, Chennai, INDIA
bachol increased cell proliferation in a dose dependent manner (p<0.05,
n=4, ANOVA). Atropine and the M1 specific antagonist pirenzepine com-             Purpose: The α-chemokine stromal derived factor (SDF-1α) and G-
pletely blocked carbachol stimulated proliferation.                               protein-coupled seven span transmembrane receptor CXCR4 axis regu-
Conclusions: Our results show that we have cultured pure RPE cells and            lates the trafficking of various cell types and plays a pivotal role in cell
all 5 subtypes of mAChRs are expressed in RPE cells. mAchR receptor               migration, proliferation and survival. The aim of this study was to assess
participates in the control of cell proliferation in monkey, mouse and            whether Curcumin inhibits Human Retinal Endothelial Cell migration by
ARPE 19 RPE cell.                                                                 interfering with SDF-1α/CXCR4 signaling.
                                                                                  Methods: HREC were isolated and cultured in endothelial growth medium.
                                                                                  The HRECs viability and proliferation was assessed by MTT and thymi-
268-B68                                                                           dine uptake assays respectively. The effect of SDF-1 induced HRECs migra-
STABLE EXPRESSION OF THIOREDOXIN-1                                                tion (chemotaxis) in the presence and absence of curcumin was observed
DECREASES THE CYTOTOXICITY CAUSED BY                                              using boyden chamber migration assay. Intracellular Ca2+ entry (Fura-
OXIDATIVE STRESS IN RETINAL PIGMENT                                               2AM) was measured using fluorimetric analysis. Immunofluorescence and
EPITHELIAL CELLS                                                                  western blotting was performed to quantify CXCR4, phosphorylated AKT
                                                                                  and PI3-Kinase expression levels.
E. SUGANO 1 , H. TOMITA 1 , W. CAO 2 , H. ISAGO 1 , M. YOSHIOKA 1,                Results: HRECs migration was increased dose-dependently (1, 10, 50,
S. NARIKAWA1, M. TAMAI1                                                           100 ng/ml) in SDF-1α treated cells. In contrast, AMD3100 an inhibitor of
Tohoku University Biomedical Engineering Research Organization, Sendai, JAPAN,    CXCR4 reduced HREC migration dose-dependently (0.1, 0.5, 1, 10 µmol/l).
Oklahoma University Health Sciences Center, Dean McGee Eye Institute, Oklahoma,   Cell migration was decreased when cells were exposed to EGTA, a
OK, JAPAN                                                                         chelator of Ca2+. Curcumin also blocked Ca2+ influx, an important signal
                                                                                  for cell migration. In addition curcumin significantly decreased SDF-1α
Purpose: Thioredoxin-1 (TRX-1) is an endogenous redox-active multi-               induced HRECs migration. Curcumin down regulated SDF-1α induced
functional protein participating in the control of numerous physiological         CXCR4, phospho-AKT, phospho phosphotidylinositol-3-Kinase (PI3-K)
processes including cell growth, survival/apoptosis. To investigate the           and eNOS.
crucial role of Thioredoxin-1 (Trx-1) against oxidative stress, we trans-         Conclusions: This study indicates that the inhibitory effect of curcumin
ferred Trx-1 gene into RPE cells using an adeno-associated virus (AAV)            on SDF-1α induced HREC migration could be caused by an upstream
vector and monitored cell viabilities during oxidative stress.                    blockage of Ca 2+ influx and the subsequent downstream decreased

Asian J Ophthalmol. 2007 Vol 9 No 1 Supplement 1                                                                                                          113
Poster Abstracts

expression of phospho-AKT and phospho-PI3-K expression which are vi-             Results: We examined the morphology of the RGCs at several time points
tal proteins responsible for migration.                                          with developmental significance. At P0, the dendritic morphologies of the
                                                                                 RGCs were very different from adult, and most cells were diffusely strati-
                                                                                 fied in the IPL. At P3, when synaptogenesis started, the dendritic
271-B71                                                                          morphologies of most RGCs were still very different from adult, however,
ABERRANTLY EXPRESSED RECOVERIN ENHANCE                                           the stratification at this stage was significantly narrower. A few cells at
SENSITIVITIES TO ANTICANCER DRUGS IN A                                           this early stage showed adult like morphology, especially some bistratified
CANCER CELL LINE                                                                 cells. At P8, when the axon terminals of bipolar cells started expressing
                                                                                 VGluT1, but the ribbon synapses were not formed, more than 80% of
S. MATSUO, H. OHGURO, I. OHGURO, N. NISHIKIORI, K. MATSUO,                       RGCs already displayed adult-like dendritic morphology, and almost
H. KAWATA                                                                        every single subtype identified in adult was already present. Before eye
Dept. of Ophthalmology Sapporo Medical University School of Medicine, Sapporo,   opening at P13, more than 97% RGCs exhibited adult-like dendritic mor-
Japan, sapporo, JAPAN                                                            phology and stratification. These findings showed that the adult-like mor-
                                                                                 phology emerge much earlier than eye opening, indicating a corresponding
Purpose: Cancer-associated retinopathy (CAR) is an ocular manifesta-             process of circuitry formation. Electrophysiological experiments supported
tion of a paraneoplastic syndrome whereby immunological reactions to-            the indication and revealed that some of the neural circuitries were con-
ward recoverin, a retina-specific calcium binding protein, and other retinal     nected several days before eye opening. Despite some immature signs,
antigens aberrantly expressed in tumor cells lead to the degeneration of         such as low firing rate, fewer spikes and easily fatigued light responses,
retinal photoreceptor cells. To elucidate pathological role of the aberrantly    robust direction selectivity can be detected from P11 RGCs. The degree
expressed recoverin, we studied rates of expression of recoverin in              of directionality measured by the half width of direction tuning curves
malignant tumors and effects of aberrantly expressed recoverin on sen-           and the index of directionality was already very similar to adult. The den-
sitivity to anticancer drugs.                                                    dritic morphology of these RGCs was identical to their adult counterparts.
Methods: Rates of aberrant expression of recoverin was determined by             Conclusions: Most RGCs exhibit adult-like dendritic morphologies within
immunohistochemistry of multiple tissue arrays obtained from several             a week of birth, and some complicated retinal processing emerge almost
cancers of lung, stomach, colon and others by anti- human recoverin              as soon as the RGCs acquire ability to respond to light, suggesting
mAb. In the presence of several anticancer drugs, including antitumor            the circuitry may already connected before the RGCs receive inputs from
antibiotics, plant alkaloid and antimetabolites, cell proliferation assay was    bipolar cells.
performed using recoverin positive or negative A549 cells originated from
human lung adenocarcinoma.
Results: Immunofluorescence labeling revealed that immunoreactivities            273-B73
toward recoverin were detected at approximately 10-40% of malignant              POTENTIAL OF RAT MüLLER GLIAL CELLS TO
tumor tissues. Proliferation of recoverin-positive A549 cells was signifi-       CONVERT TO A NEURONAL LINEAGE IN VITRO
cantly suppressed in the presence of anti-cancer drugs as compared               AND TO BE A SOURCE OF PHOTORECEPTORS BY
with that of recoverin-negative cells.                                           AN AGGREGATE-CULTURE
Conclusions: The present data may correlate with the previous observa-
tion that recoverin expressing cancer cells induced tumor immunity and           A. KUBOTA1, K. NAKASHIMA2, Y. TANO3, K. NISHIDA1
a favorable prognosis for primary cancer in CAR patients.                        1
                                                                                  Tohoku University Graduate School of Medicine, Sendai, JAPAN, 2Nara Institute of
                                                                                 Science and Technology, Ikoma, JAPAN, 3Osaka University Medical School, Osaka,
DEVELOPMENT OF GANGLION CELLS IN THE                                             Purpose: It has been reported that mammalian glial cells can be
MOUSE RETINA                                                                     redirected towards a neuronal lineage in vitro. So we investigated
                                                                                 that mammalian Müller glial cells which are glial cells in retina, can be
S. HE                                                                            redirected towards a neuronal lineage in vitro.
Chinese Academy of Sciences, Beijing, CHINA                                      Methods: Rat Müller glial cells were obtained from 2-week-old Long-
                                                                                 Evans rats. We made aggregate-spheres (Müller-spheres) by culturing
Purpose: The function of the nervous system depends on precise con-              them on non-adhesive culture dishes in serum-free medium. Then Müller-
nections between neurons in different brain regions. These connections           spheres were transferred to the chamber slides coated with ornithine
are formed during development and can be dynamically remodeled to a              and laminin, and cultured for additional 7 days. Müller-spheres obtained
certain degree even in adulthood. In this study, we investigated develop-        from GFP-transgenic rats were transplanted into the subretinal space of
ment of morphologies of the ganglion cells in the mouse retina, and the          2 weeks-old rats and sectioned after a week.
emergence of capability of a subtype of retinal ganglion cells (RGCs) to         Results: Rat Müller glial cells became to express an immature neuronal
code motion directions.                                                          marker β-III tubulin through an aggregate culture. They also became
Methods: We used a gene gun to propel tungsten particles coated with a           to express a photoreceptor specific marker, opsin (RET-P1) when trans-
lipophilic dye (DiI) into the whole mount retinal preparations to label reti-    planted into subretinal space.
nal ganglion cells. We measured soma size, dendritic field size, level of        Conclusions: Mammalian Müller glial cells can be redirected towards a
dendritic stratification in the inner plexiform layer (IPL), together with       neuronal lineage in vitro and express photoreceptor specific marker,
the dendritic branching patterns, we were able to classify the RGCs into         opsin (RET-P1) when transplanted into subretinal niche. This result
different subtypes. We also performed cell-attached and voltage clamp            indicate that mammalian Müller glial cells could be a source of neuronal
recordings to examine the light responses, excitatory and inhibitory             cells and may contribute to treat degenerative retinal diseases such as
inputs to RGCs on isolated whole-mount mouse retinas.                            retinitis pigmentosa.

114                                                                                                   Asian J Ophthalmol. 2007 Vol 9 No 1 Supplement 1
                                                                                                                                   Poster Abstracts

274-B74                                                                        Conclusions: The use of surgical treatment of retinal detachment in
RISK FACTORS FOR RHEGMATOGENOUS RETINAL                                        children allowed to achieve the attachment of retina in 80.4% cases and
DETACHMENT (RRD) AFTER CATARACT SURGERY                                        increasing of visual field and visual acuity.

A. MEHROTRA, P. VENKATESH, S. MANDAL, S. GARG                                  276-B76
AIIMS, New Delhi, INDIA                                                        COMPARATIVE EVALUATION OF BIMATOPROST
                                                                               MONOTHERAPY IN PRIMARY CHRONIC ANGLE
Purpose: To determine the risk factors for rhegmatogenous retinal              CLOSURE AND PRIMARY OPEN ANGLE
detachment (RRD) after cataract surgery in India.                              GLAUCOMA EYES: A THREE YEAR STUDY
Methods: A retrospective study of 111 consecutive patients of
rhegmatogenous retinal detachment (RRD) after cataract surgery was             V. GUPTA, G. SRINIVASAN, A. SHARMA, T. DADA, R. SIHOTA
performed. Patients younger than 40 years, with history of trauma and          Dr RP Centre for Ophthalmic Sciences, New Delhi India, All India Institute of Medi-
those having cataract surgery combined with other ocular procedures            cal Sciences, INDIA
such as glaucoma drainage surgery and keratoplasty were excluded from
the study.                                                                     Purpose: To compare the long term efficacy of bimatoprost 0.03% mono-
Results: The mean age of the patients at presentation was 56.50 years.         therapy in primary open angle glaucoma (POAG) versus primary chronic
The median interval between cataract surgery and development of                angle closure glaucoma (PCACG) eyes.
retinal detachment was 29.52 months.68.47 % of the patients were men           Methods: A total of 55 consecutive primary adult glaucoma patients who
and 31.53% were women. 72.97% had a total RRD and 27.03% had a                 were started on bimatoprost monotherapy were prospectively evaluated
subtotal RRD. ECCE was the most common type of cataract surgery and            in this 3-year open labeled uncontrolled study. The primary outcome
had been done on 61.26% of the patients, 18.92% had surgery by                 was to evaluate if there was a difference in the response to therapy of
phacoemulsification, 16.22% by ICCE and 3.60% by SICS. Complicated             POAG eyes as compared to PCACG eyes over a follow up of 3 years. The
cataract surgery was present in 48.65% of the cases with RRD.                  probability of IOP control to <18mmHg was compared in both groups
Conclusions: Most cases with RRD presented within 3 years of cataract          with survival analysis technique.
surgery. ECCE was the predominant cataract surgery procedure.                  Results: In POAG group the mean IOP at 36 month follow up in compari-

                                                                                                                                                                     POSTER ABSTRACTS
Complicated surgery was significant risk factor for RRD.                       son with the mean IOP at 1 month follow up was found to be increased
                                                                               by 2.10 (+3.90) mmHg [CI -0.975 -4.185]. In PCACG group, the mean IOP
                                                                               at 36 month follow up in comparison with the 1-month follow up was
275-B75                                                                        increased by 3.66(+3.34) mmHg [CI -6.241 -1.092] Patients with pri-
EFFECTIVENESS OF VITREORETINAL SURGERY IN                                      mary open-angle glaucoma and primary chronic angle closure glaucoma
7-12 AGE CHILDREN WITH DETACHMENT OF                                           showed a 50% and 40% chance of having IOP reduction< 18mmHg with
RETINA                                                                         bimatoprost monotherapy (p =0.23), respectively at 3-year follow up.
                                                                               Conclusions: This study shows that bimatoprost 0.03% monotherapy
Z. MEERMANOVA, S. AHANOVA, L. ORAZBEKOV                                        significantly lowers IOP in both POAG and PCACG eyes over a period of 3
Kazakh eye disease research institute, Almaty, KAZAKHSTAN                      years though its efficacy decreases over time, more in PCACG compared
                                                                               to POAG eyes.
Purpose: To analyze the effectiveness of treatment of retinal detachment
in children from 7 to12 years old.
Methods: 41 eyes have been operated by use vitreoretinal surgery. Among        277-B77
patients prevailed boys - 69.5%.The main reasons of retinal detachment         THE USE OF A FIXED COMBINATION OF
were - high myopia- 47.8%, eye traumas - 39.2 % (especially contusion),        BRIMONIDINE 0.2% AND TIMOLOL 0.5%
idiopathic reason detachment of retina - 13.04%. During examination of         (COMBIGAN) IN A REAL LIFE GLAUCOMA CLINIC
second eye at 30.5% patients with high myopia detected detachment of
retina. Inheritance diseases were in 21.7% patients. Proliferative             K.C.S. FONG1, C.J. BRITTAIN2, M. SUBASH2, I.H. GILLESPIE2
vitreoretinopathy (PVR) stage «B» was observed in 68.2% cases, PVR stage       1
                                                                                Moorfields Eye Hospital, London, UNITED KINGDOM, 2Kingston Hospital, London,
«C» posterior - in 19.5%, PVR stage «C» anterior-posterior - in 12.3%          UNITED KINGDOM
patients. The process was old in 87% of all cases.
Results: Episcleral buckling with giant retinal tears was done at              Purpose: To study the intraocular pressure (IOP) lowering efficacy
rhegmatogenous detachment of retina (43.3%). Subtotal vitrectomy with          and safety of a fixed combination of brimonidine 0.2% and timolol 0.5%
silicone oil tamponade was done at rhegmatogenous detachment of                (Combigan) in a variety of clinical settings.
retina with large and macular holes and tractional detachment of retina        Methods: In a single center glaucoma clinic setting, patients with
(24.4%). The combination of circular indentation of sclera with episcleral     primary open angle glaucoma were treated with Combigan either as
buckling and subtotal posterior vitrectomy with introduction of silicon oil    monotherapy or in combination with other glaucoma medications and
and endolaser coagulation of retina was done in 26.3% cases. Average           their clinical course prospectively followed. The primary measure was
visual acuity before operation was 0.048±0.02 and after operation in-          decrease from baseline IOP. Secondary outcome measures were adverse
creased to 0.2±0.15. Visual field increased in average 2.2 times. Attach-      events.
ment of retina was received in 80%. In 4 patients after episcleral buckling,   Results: 35 patients were started on Combigan and followed up for a
3 patients after vitrectomy and one patient after combined operation           mean period of 6 months. The mean age was 78 years (range 48 to
was recurrence of retinal detachment. Most of them were patients after         87 years). An overall mean IOP reduction of 19% (4 mm Hg) was found.
eye injuries.                                                                  For further analysis, patients were divided into the following sub-groups:

Asian J Ophthalmol. 2007 Vol 9 No 1 Supplement 1                                                                                                             115
Poster Abstracts

1. Combigan combined with hypotensive lipid (n= 13, mean IOP                        controls adults were recruited through students, staff of the school.
     reduction 22.7 to 15.3 mm Hg).                                                 Fundus photographs were taken with Topcon TRC-NW6S camera and were
2. Timolol 0.5% switched to Combigan (n=5, mean IOP reduction 21.8                  assessed if glaucomatous signs were presence or not by two observers
     to 15.8 mm Hg).                                                                separately. IOP were measured by the I-care tonometer. Corneal thick-
3. Brimonidine 0.2% switched to Combigan (n=4, mean IOP reduction                   ness and curvature were measured by the Oculus Pentacam system.
     25.8 mm Hg to 17.0 mm Hg).                                                     Results: No glaucoma was detected on the basis of the fundus photo-
4. Fixed combination of Trusopt and Timolol 0.5 % (Cosopt) switched to              graphs. No significant difference in measured IOP was found between DS
     Combigan (n=7, mean IOP reduction 19.2 to 16.0 mm Hg).                         subjects and controls. IOP and CCT were only associated highly in control
     5. Brimondine 0.2 % and Timolol 0.5% used separated switched to                adults (r=0.528, p=0.017). No significant correlation was found for IOP-
     Combigan (n=6, mean IOP reduction 19.0 mm Hg to 18.7 mm Hg).                   CCT and IOP-CR in adult subjects with DS.
     2 patients (5.7%) had ocular allergy and 3 patients (8.5%) had                 Conclusions: People with DS may carry risk factors including ageing
     shortness of breath.                                                           earlier, higher refraction and thinner cornea. By contrast, certain factors
Conclusions: Combigan shows effective IOP lowering effects in the short             may be protective including low blood pressure and true low IOP. However,
term in a variety of settings whether as monotherapy or in combination              the questions still remain: Is glaucoma missed in people with DS and do
with other glaucoma medications. Switching from Cosopt to Combigan                  people with DS develop glaucoma or not?
gave an additional 17% (3.2 mm Hg) additional IOP lowering. The inci-
dence of ocular allergy is lower than that reported for when brimonidine
is used alone.                                                                      281-B81
                                                                                    RETINITIS PIGMENTOSA AND ITS ASSOCIATION
                                                                                    WITH ANGLE CLOSURE GLAUCOMA
CLINICAL TRIAL RESULTS OF TOPICAL                                                   M. YANG, L. ANG, T. AUNG
PILOCARPINE, BETAXOLOL, BRIMONIDINE,                                                Singapore National Eye Centre, Singapore, SINGAPORE
OF PRIMARY OPEN ANGLE GLAUCOMA                                                      Purpose: To report the anatomical characteristics and long-term
                                                                                    intraocular pressure outcome of 9 patients with primary angle-closure
I. KAUR, S. BHAGAT, P. KAUR, G. KAUR                                                glaucoma (PACG) and retinitis pigmentosa, and to compare these with
Govt Medical College, Amritsar, INDIA                                               PACG patients without retinitis pigmentosa.
                                                                                    Methods: The presenting ocular features and long-term intraocular
Purpose: 5 randomized trials conducted to compare the IOP lowering                  pressure outcome after laser peripheral iridotomy were analyzed. A-scan
efficacy and safety of 2% pilocarpine, 0.5% betaxolol, 0.2% brimonidine,            biometry and ultrasound biomicroscopy (UBM) was performed. These
2% dorzolamide, 0.005% latanoprost in patients of primary open angle                results were compared retrospectively with 120 consecutive PACG pa-
glaucoma.                                                                           tients that presented from 1989 to 1994.
Methods: 5 groups of 20 patients each were randomly taken. Each group               Results: The median age of the patients was 53 years (range, 46-
was administered one of the above mentioned drugs in appropriate                    62 years), with the majority (88.9%) being males. The mean follow-up
dosage. IOP was measured weekly for a period of 12 weeks.                           period was 51.8 + 31.5 months. Twelve eyes of 9 patients had PACG,
Results: IOP reduction in 12 weeks was maximum with Latanoprost fol-                of which 10 eyes had acute angle-closure, and 2 eyes had chronic angle-
lowed sequentially by Brimonidine, Dorzolamide, Betaxolol and pilocarpine           closure glaucoma. Biometry showed a mean axial length of 22.38 ±
.6 patients of pilocarpine required adjunctive therapy by 3rd -4th weeks.           1.18 mm, a lens thickness of 5.23 ± 0.25 mm, an anterior chamber depth
Conclusions: In the present study in order of efficacy of control of IOP—           of 1.9 ± 0.16 mm, and a relative lens position of 0.20 ± 0.01. Five eyes
Latanoprost -Brimonidine-Dorzolamide- Betaxolol -Pilocarpine, but                   (41.7%) were treated successfully with laser peripheral iridotomy alone,
Brimonidine was concluded as the best therapeutic option as it effec-               while 7 eyes (58.3%) required additional medication or trabeculectomy
tively lowered the IOP, was cost friendly and had minimum side effects.             to control the intraocular pressure. The biometric and UBM features were
                                                                                    similar to that of PACG patients without retinitis pigmentosa.
                                                                                    Conclusions: Patients with retinitis pigmentosa and PACG were predomi-
280-B80                                                                             nantly male, and developed an acute attack at an earlier age compared
TO CONSIDER THE DETECTION OF GLAUCOMA IN                                            to PACG patients without retinitis pigmentosa. Despite a patent iridotomy,
PEOPLE WITH DOWN’s SYNDROME                                                         the majority of eyes required medication or surgery for intraocular
                                                                                    pressure control.
 Optometry & Vision Sciences school, Cardiff University, Cardiff, UNITED KINGDOM,
 Department of Ophthalmology, University of Wales College of Medicine, Cardiff,     282-B82
UNITED KINGDOM                                                                      RISK FACTORS FOR FIRST PRESENTATION OF
                                                                                    GLAUCOMA WITH SIGNIFICANT VISUAL FIELD LOSS
Purpose: There is a high prevalence of ocular defects in people with
Down’s syndrome (DS). However, several investigators who have studied               N.C. DEVA, H.V. DANESH-MEYER, E. INSULL, G. GAMBLE
large numbers of DS patients did not report glaucoma, probably due                  University of Auckland, Auckland, NEW ZEALAND
to the detection of glaucoma. This study aimed to consider the detection
of glaucoma among our subjects with DS.                                             Purpose: To evaluate factors associated with severity and pattern of visual
Methods: Nineteen adults with DS were recruited from the patients                   field loss on first presentation of glaucoma to ophthalmologists.
attending the university clinic, and through local community. Sixteen               Methods: 106 consecutive newly diagnosed patients were enrolled. All

116                                                                                                     Asian J Ophthalmol. 2007 Vol 9 No 1 Supplement 1
                                                                                                                                     Poster Abstracts

patients had a complete clinical assessment, Heidelberg Retinal Tomog-           284-B84
raphy (HRT) and reliable visual field testing (VF) testing (SITA- Standard       DIURNAL INTRAOCULAR PRESSURE PROFILES IN
24-2, Humphrey Visual Field Testing). VF grading was based on Advanced           CHRONIC OPEN-ANGLE GLAUCOMA
Glaucoma Intervention Study (AGIS) scoring and classified for the
presence of a nasal step, paracentral scotoma and/or arcuate scotoma.            J. JONAS 1, W.M. BUDDE 1, A. STROUX 2, I. OBERACHER-VELTEN 3,
Demographic data and reasons for referral were collected.                        A. JUENEMANN3
Results: Demographic parameters at first diagnosis were: median age              1
                                                                                  Department of Ophthalmology, Mannheim, GERMANY, 2 Dept. of Medical
59 (range 35-90) years, mean deviation -4.37 ±4.52 dB (mean ± SD),               Informatics, Biometry and Epidemiology, Berlin, GERMANY, 3Department of
pattern standard deviation 4.52 ± 3.52 dB, intraocular pressure 21.4 ±           Ophthalmology, Erlangen, GERMANY
6.6 (mean ± SD), and C:D ratio 0.69 ± 0.12 (mean ± SD). 37% of all
study participants had a positive family history of glaucoma. Of the rea-        Purpose: To evaluate day-and-night intraocular pressure (IOP) profiles in
sons for referral, the most common were suspicious discs (69%), elevated         normal and glaucomatous eyes.
IOP (52%) and abnormal visual fields (43%). Increasing age was associ-           Methods: The hospital-based clinical observational study included 3561
ated with a visual field defect on first presentation (mean of 54 years          day-and-night profiles of IOP measurements performed on 1408 eyes of
with no VF defect, compared with 63 years for mild, moderate or severe           720 normal Caucasian subjects or chronic open-angle glaucoma patients.
defect visual field defect, p=0.0018). Of the reasons for referral, an ab-       Results: For all except the secondary open-angle glaucoma group,
normal screening visual field test was significantly associated with a VF        IOP was highest at 7 a.m., followed by the measurements at noon, and
defect at presentation identified by SITA- Standard testing (p=0.015).           5 p.m., and finally at 9 p.m. or midnight. In the secondary open-angle
Multivariate logistic regression analysis identified age (OR 1.15, [1.06-        glaucoma group, mean measurements did not vary significantly during
1.26], PSD (OR 18.91[1.71-75.92]) and positive family history (OR 10.43          day and night. The profile amplitude (5.5±2.8 mm Hg) was significantly
[1.67-67.49] are independent risk factors for an AGIS score of greater           (p<0.001) higher in the secondary open-angle glaucoma group than
than zero at presentation. 69% of patients that present with glaucoma-           in the normal-pressure glaucoma group and the normal group. The two
tous VF defects have symmetrical damage between the two eyes, with               latter groups did not vary significantly (p=0.47) in profile amplitude.
the inferior visual field being involved twice as frequently. No patient char-   Expressed as percentage of the mean IOP, the IOP amplitude did not
acteristics were identified to predispose to the development of a para-          vary significantly between any of the study groups. The inter-eye IOP
central scotoma at initial presentation.                                         difference for any measurement time was significantly (p<0.001) smaller

                                                                                                                                                                      POSTER ABSTRACTS
Conclusions: Patients who have a positive family history of glaucoma             than the IOP profile amplitude.
are ten times more likely to have a visual field defect at the time of glau-     Conclusions: Treated secondary open-angle glaucoma eyes may not ex-
coma diagnosis. An increased focus on family history may help identify           hibit the normal day-and-night pressure profile, which is usually shown
these patients earlier and prevent permanent irreversible visual loss            in normal eyes and treated eyes with other types of chronic open-angle
at the time of first presentation.                                               glaucoma. The day-and-night IOP amplitude in absolute terms is highest
                                                                                 in secondary open-angle glaucoma. In relative terms, the IOP amplitude
                                                                                 may not vary significantly between various types of chronic open-angle
283-B83                                                                          glaucoma. Inter-eye IOP differences are significantly (p<0.001) smaller
COMPARISON OF DYNAMIC CONTOUR                                                    than the IOP profile amplitude.
Dong-A University Hospital, Busan, KOREA                                         ABNORMALITIES AFTER PARS PLANA VITRECTOMY
                                                                                 AND SILICONE OIL ENDOTAMPONADE
Purpose: To compare dynamic contour tonometry(DCT) and Goldmann
applanation tonometry(GAT) and investigate the influence of central cor-         T. DADA, D. AGARWAL, S. GARG, S. MANDAL, R. GADIA, Y.R. SHARMA,
neal thickness(CCT) to intraocular pressure.                                     R. SIHOTA
Methods: In a prospective study of 165 eyes with glaucoma(135 eyes),             Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical
glaucoma suspect(14 eyes), and ocular hypertension(16 eyes), intraocular         Sciences, Ansari nagar, New Delhi, INDIA
pressure was measured with DCT and GAT, and followed by measure-
ment of CCT with ultrasound pachymetry. Statistical analysis were                Purpose: To evaluate the intraocular pressure (IOP) abnormalities after
performed with simple linear regression analysis and t-test using SPSS           pars plana vitrectomy (PPV) and silicone oil endotamponade with or with-
(Statistical software, ver. 10; SPSS Inc., Chicago, IL).                         out encirclage.
Results: A clear correlation between DCT and GAT was found(r = 0.733,            Methods: A prospective study was done in 60 eyes of 60 patients with
p < 0.001). The average intraocular pressure was 14.92±2.28 mmHg                 primary rhegmatogenous retinal detachment (RRD) and proliferative
with DCT and 13.97±3.12 mmHg with GAT, and intraocular pressure                  vitreoretinopathy (PVR). Pre-operative evaluation included IOP measure-
with DCT was 0.95±2.49 mmHg higher than with GAT on the average.                 ment by applanation tonometry, gonioscopy, optic disc evaluation, indi-
A meaningful correlation between GAT and CCT was showed(r2 = 0.145,              rect ophthalmoscopy and ocular biometry including anterior chamber
p < 0.001), but was not showed between DCT and CCT(r2 = 0.012, p =               depth, lens thickness and axial length. All the eyes underwent PPV,
0.081). And the difference of intraocular pressure between GAT and               air-fluid exchange and silicone oil endotamponade as a primary procedure.
DCT(GAT-DCT) shows a significant correlation with CCT(r 2 = 0.145,               Encirclage (2.5 mm) with or without buckle (10 mm asymmetric) were
p < 0.001).                                                                      used depending on location of breaks and severity of PVR. At the end
Conclusions: DCT seems to be a reliable method for intraocular pressure          of surgery silicone oil (1000 cs) was injected till it regurgitated into the
measurement, which is not influenced by CCT unlike GAT.                          infusion cannula. Last scleral port was closed with air pressure kept at

Asian J Ophthalmol. 2007 Vol 9 No 1 Supplement 1                                                                                                              117
Poster Abstracts

10 mmHg. Volume of silicone oil injected into the eye was noted.                   Results: Both groups had similar baseline characteristics for gender, age,
Postoperatively IOP was recorded at 24hrs, 1 wk, 4 wks, 8 wks, and 3               years since diagnosis and number of eye drops prescribed. The change
months. Patients were divided into two groups: group 1 with encirclage             in patients’ self-reported compliance was +0.05±0.54 in the interven-
(n=34) and group 2 without encirclage (n=26).                                      tion group and +0.13±0.41 in the control group (p = 0.02). Changes in
Results: Mean age (years) of the patients in group 1 and group 2 was               the glaucoma assessment test scores were +10±12% in the intervention
47.7±16.2 and 45.81±17.30 respectively (p= 0.65). Mean preoperative                group and +1±14% in the control group (z= 2.99, p = 0.003). The glau-
IOP (mmHg) was 12.6±3.6 and 12.8±3.7 respectively (p= 0.71). Twenty                coma assessment test score increased with decreasing IOP in the inter-
two eyes in group 1 and 21 eyes in group 2 were phakic whereas 12 eyes             vention group (correlation coefficient r = -0.301, p = 0.053), whereas no
in group 1 and 5 eyes in group 2 were pseudophakic. Mean axial length              correlation was found in the control group (r = +0.031, p = 0.85).
(mm), anterior chamber depth (mm) and lens thickness were comparable               Conclusions: Clinic-based patient education using the AAO glaucoma
between two groups. Mean volume of oil (ml) injected was 4.7±0.8 and               video is a practical and effective method to improve glaucoma aware-
5.1±1.3 in group 1 and 2 respectively (p=0.16). Mean IOP (mmHg) at day             ness and increase patient compliance with medication use. It may also
1 was 22.4±6.5 and 20.6±3.9 in group 1 and 2 respectively (p=0.22).                enhance the quality of care provided to glaucoma patients. Despite limi-
At day 1, 10 eyes in group 1 and 7 eyes in group 2 had an IOP of more              tations of a short follow-up period, small sample size and a brief glau-
than 22 mmHg (range 24-37 & 24-32 respectively) and all were control-              coma knowledge-assessment test, our study serves as a founding
led with topical medications. At 1wk, 4wks and 3 months follow-ups there           framework for future studies to better address the role of physicians in
was no difference in IOP between two groups (p>0.05). At 3 months fol-             improving drug compliance in glaucoma.
low-up mean IOP (mmHg) was 17.4±2.8 and 16.4±2.5 in group 1 and 2
respectively (p=0.17). At 3 months all except 5 eyes in group 1 and 3
eyes in group 2 were off anti-glaucoma medication. There was a positive            287-B87
significant correlation between axial length and amount of oil injected            EVALUATION OF GLAUCOMA AWARENESS
(r=0.893 and p<0.001).                                                             BETWEEN NEW AND ESTABLISHED GLAUCOMA
Conclusions: Proper titration of volume of silicone oil injected at the end        PATIENTS
of surgery avoids development of glaucoma in the post operative period.
Post-operative increase in IOP can be controlled with topical medication           N.C. DEVA1, H.V. DANESH-MEYER1, Y. TAN1, S. CARROLL1, K. TARR2,
most of the time. Encirclage with or without buckle has no effect on post          C. SLIGHT3, G. GAMBLE1
operative IOP.                                                                     1
                                                                                    University of Auckland, Auckland, NEW ZEALAND, 2Southern Eye Specialists,
                                                                                   Christchurch, NEW ZEALAND; 3Greenlane Clinical Centre, Auckland City Hospital,
                                                                                   Auckland, NEW ZEALAND
PATIENT EDUCATION AND ITS EFFECTS ON DRUG                                          Purpose: To assess and compare glaucoma knowledge between patients
COMPLIANCE IN GLAUCOMA THERAPY                                                     with established glaucoma, newly diagnosed glaucoma, and the general
Y. QAZI1, A. LIN2, S. ORENGO-NANIA2                                                Methods: A validated self-administered true/false questionnaire assess-
 Department of Biological and Biomedical Sciences, Aga Khan University, Karachi,   ing glaucoma knowledge was distributed to 408 participants (208 estab-
PAKISTAN, 2Baylor College of Medicine, Houston, TX, UNITED STATES OF AMERICA       lished glaucoma patients, 100 newly diagnosed glaucoma suspects, 100
                                                                                   controls). Demographic data were also recorded.
Purpose: To study the effects of patient education on drug compliance in           Results: Established glaucoma patients had (median 17/22, IQR 15, 19)
glaucoma therapy.                                                                  marginally but significantly (P<0.05) greater glaucoma knowledge scores
Methods: We designed a randomized prospective controlled trial with                than new patients (median 16/22, IQR 13, 18). Both of these groups scored
IRB approval. A sample size of 37 patients per group was calculated                significantly better than the control population (median 13/22, IQR 10,
using pooled two-sample t-test (p= 0.05, α= 0.80), with an assumed                 14, P<0.05). Significant misconceptions include: 80% of all participants
average intraocular pressure (IOP) of 16 mmHg ± 3 mmHg. 81 patients                thought that topical medications could not have systemic side-effects,
were included with informed consent at the eye clinic in the Veterans              48% of established glaucoma patients felt that they would have symp-
Affairs Medical Center in Houston, and randomized into intervention (42)           toms warning them of disease progression. One-third of new patients
and control (39) groups. Patients included had to be diagnosed with glau-          considered blindness to be a common outcome of having glaucoma. For
coma and be on at least one topical medication. The American Academy               established patients, factors associated (p<0.05) with a lesser likelihood
of Ophthalmology (AAO) educational glaucoma video was our intervention.            of scoring in the lowest quartile of the total score included having family
Self-reported compliance score and IOP were the subjective and objec-              (OR 0.33, CI 0.11-0.98) or friends (OR 0.28, CI 0.06-0.97) with glaucoma,
tive primary outcomes, respectively. A glaucoma assessment test was                being referred by an optometrist compared to general practitioner (OR
designed to quantify patients’ knowledge of glaucoma and a change in               0.21, CI 0.08-0.57), speaking English at home (OR 0.13, CI 0.04-0.49)
score was our secondary outcome. Measurements and scores were taken                and being seen in the private healthcare sector (OR 0.13, CI 0.04-0.42).
at initial and 1-month follow up visits. Patients reported self-compliance         Conclusions: Patients with established glaucoma have only slightly greater
by checking a box that best represented their use of glaucoma eye drops,           knowledge than newly diagnosed patients. Misconceptions amongst es-
which was scaled on a 4-point system. The Mann-Whitney test was used               tablished patients include a belief that symptoms will warn them of dete-
to compare the changes in self-reported compliance scores and glau-                rioration and failure to realize that glaucoma drops may have systemic
coma assessment test scores between the two groups. Whereas inde-                  side-effects. New patients erroneously believe that glaucoma commonly
pendent samples t-test was performed to compare the changes in IOP.                leads to blindness and certain life-style changes may modify this. Educa-
Correlation between a change in glaucoma assessment test score and                 tional programmes and material should be tailored to address these
(average) change in IOP was analyzed using Spearman rank correlation.              misconceptions.
A p-value < 0.05 was considered to be statistically significant.

118                                                                                                     Asian J Ophthalmol. 2007 Vol 9 No 1 Supplement 1
                                                                                                                                    Poster Abstracts

288-B88                                                                            290-B90
DEALING WITH?                                                                      TRANSPUPILARY THERMOTHERPY IN RAT
                                                                                   RETINAL ISCHEMIA-REPERFUSION MODEL
Kothari Eye Clinic, Mumbai, INDIA                                                  L. ZHANG, N. WANG
                                                                                   Beijing Tongren Hospital, Beijing, CHINA
Purpose: To reclassify Normal Tension Glaucoma (NTG) into the vascular
and nutritional deficiency related Optic Neuropathy Group.                         Purpose: To investigate whether Transpupilary Thermotherpy(TTT) has
Methods: 156 patients with primary diagnosis of NTG with IOP < 20mm                protective effect on retina ganglion cells with the expression of inducible
Hg, gonioscopically open angles and classical glaucomatous field defects           HSP72 and HSP 27 .
and no systemic illness were treated with:                                         Methods: Adult Brown Norway Rats(BN rats) are used in this study.
1. Timolol maleate 0.5% BD -To decrease the fluctuation of diurnal                 HE staining is used to observe morphologic change of retina. Immunohis-
     variation of IOP to minimum                                                   tochemical staining for HSP27, HSP72 were performed after the laser
2. Vasodilators- To take care of vascular insufficiency                            treatment. RGC survival and TDT-mediated biotin dUTP nick end labeling
3. Vitamin B1, B6 ,B12 as neuroprotectants                                         (TUNEL) were used to evaluate RGC protection.
Repeat fields were done for all patients at 3 months, 6 months and yearly          Results: There were increased expression of HSP72 in RGCs at 1, 3 and
thereafter.                                                                        30 days after TTT treatment . With high laser dose, injury configuration
Results: Reversal of signs and symptoms and significant improvement in             change occurs on the retina. TTT pretreatment can reduce apoptosis RGC
fields were noted.                                                                 cell number in rat retinal ischemia-reperfusion model. The difference has
Conclusions: Vascular, nutritional deficiencies and diurnal variation of           statistic significance(p= 0.035 <0.05). While, compared apoptosis RGC
IOP are responsible for this disease entity. IOP is not the primary cause of       cell of TTT group with control group, there is no significant difference
its pathogenesis. The authors feel that this clinical entity should be re-         (p= 0.564>0.05). TTT pretreatment can increase the living RGC cell
classified to the vascular and nutritional deficiency related Optic Neu-           number in rat retinal ischemia-reperfusion model , The difference has
ropathy Group. This clinical trial recommends further studies to determine         statistic significance(p= .009 <0.01).Mean while, compared TTT group
the etiopathogenesis of the disease at the molecular level. This would             with control group, the living RGC cell number of TTT interfered group is

                                                                                                                                                                    POSTER ABSTRACTS
offer a fresh perspective on the disease entity and aid in redefining its          declined, The difference has statistic significance(p= .000 <0.01).
clinical management.                                                               Conclusions: TTT pretreatment protects retina ganglion cells from
                                                                                   glaucomatous damage in rat glaucoma model and suggest a novel path-
                                                                                   way for neuroprotection in glaucoma patients. Meanwhile, TTT also does
289-B89                                                                            injury to normal rat retinas.
P. HUANG, L. WU                                                                    ESTIMATION OF MITOMYCIN-C CONCENTRATION
Peking University third hospital, Peking University Eye Center, Beijing, 100083,   IN THE TENON’S FOLLOWING
China, Beijing, CHINA                                                              SUPRACONJUNCTIVAL APPLICATION

Purpose: To determine the necessity of neuroradiologic examination                 V. GUPTA, V.T, A. SINHA, R. SIHOTA
before giving the diagnosis of Normal tension glaucoma (NTG).                      Dr RP Centre for Ophthalmic Sciences, New Delhi India, All India Institute of
Methods: In the first case a 62-year-old female patient with tubular               Medical Sciences, INDIA
visual field in the right eye and superior arcuate scotomas in the left eye,
associated with bilateral normal intraocular pressure (IOP), glaucoma-             Purpose: Estimation of Mitomycin C (MMC) concentration in the tenon’s
tous cupping of the optic disks was suspected to have NTG. In the second           capsule following application over the intact conjunctiva before routine
case a 66-year- old male patient has been diagnosed as NTG for 6 years             trabeculectomy.
with glaucomatous disk cupping and arcuate scotomas in the left eye.               Methods: In 41 eyes, of 41 patients, MMC (0.4mg/ml for 3 minutes) was
Magnetic resonance imaging (MRI) was performed on both patients to                 applied over the intact conjunctiva before beginning trabeculectomy.
exclude occult pathology.                                                          A part of tenon’s capsule directly beneath the site of application was excised
Results: Two positive scans were obtained. A mass lesion in sella turcica          during trabeculectomy. Tenon’s was homogenized, centrifuged and MMC
area was detected in the patient described in case 1 which destroyed the           concentrations were analyzed using high-performance liquid chromatography.
normal form of the sella turcica, sinus sphenoidalis and suprasellar cistern.      Results: The average weight of the sample of Tenon’s tissue excised
A pituitary adenoma without chiasmal compression was noted in the                  was 5.51± 4.42 mg (range 0.9-17.1) and the average estimated MMC
patient of case 2.                                                                 concentration found to be present in the Tenon’s tissue using HPLC
Conclusions: Careful clinical examination alone is helpful in distinguish-         18.67±32.36 x 10-6 M (Range 0.38 - 197.05 x 10 -6 M). In 36 of the 42
ing NTG from nonglaucomatous optic atrophy, but may be not enough.                 patients (85.71%) the MMC concentration reached above 2 x 10-6
Neuroradiologic screening in NTG patient is important and necessary.               (Concentration required to inhibit human conjunctival fibroblasts).
                                                                                   Conclusions: Mitomycin does permeate into the subconjunctival tissue
                                                                                   after supraconjunctival application for 3 minutes. Application of MMC
                                                                                   over the conjunctiva may be a useful alternative to sub-conjunctival or
                                                                                   sub-scleral application during routine trabeculectomy and as an adjunct
                                                                                   during needling of failing blebs.

Asian J Ophthalmol. 2007 Vol 9 No 1 Supplement 1                                                                                                            119
Poster Abstracts

292-B92                                                                              293-B93
EVALUATION OF ALOE VERA GEL FOR ITS                                                  OCULAR HYPOTENSIVE ACTIVITY OF
EXPERIMENTAL MODELS                                                                  MODELS OF GLAUCOMA

S.K. GUPTA, N.D. GALPALLI, S.S. AGRAWAL, R. AGAR WAL,                                S. SRIVASTAVA1, P. CHAHAR1, A. NAGPAL1, N. KUMAR1, S.S. AGRAWAL1,
S. SRIVASTAVA, R. SAXENA                                                             S.K. GUPTA1, R. SAXENA2
Delhi Institute of Pharmaceutical Sciences and Research, New Delhi 110017, New           Delhi Institute of Pharmaceutical Sciences and Research, New Delhi, INDIA,
Delhi, INDIA                                                                             Dr R P Centre, All India Institute of Medical Sciences, New Delhi, INDIA

Purpose: Presently available antiglaucoma drugs suffer from the                      Purpose: Glaucoma is one of the major causes of blindness. Till date, no
drawbacks of high cost, side effects and poor patient compliance due to              systematic scientific study has been done to explore the possible role of
shorter duration of action. Present study is an attempt to explore the               herbal therapy for treatment of glaucoma. Present study is an attempt to
ocular hypotensive activity of Aloe vera gel from natural origin. Its use in         explore the ocular hypotensive activity of Andrographis panniculata.
glaucoma and other eye diseases is mentioned in folklore medicine                    Methods: New Zealand white albino rabbits of either sex weighing 1.5 -
(WHO monograph).                                                                     2 kg were used for study. All animal procedures performed in this study
Methods: New Zealand white albino rabbits of either sex weighing 1.5 -               complied with the ARVO Statement for the Use of Animals in Ophthalmic
2 kg were used for the study. Antiglaucoma activity of Aloe vera gel was             and Vision Research. Antiglaucoma activity of Andrographis panniculata
tested using non-contact tonometer (NCT-2000, Nidek, Japan). To stand-               eye drops (0.3%) was tested using non-contact tonometer (NCT-2000,
ardize the technique of measuring IOP using NCT a comparative study                  Nidek, Japan) and Shiotz Tonometer for measurement of IOP in rabbits.
was conducted with Non Contact Tonometer and Shiotz Tonometer for                    The two methods showed a good linear correlation coefficient. Andro-
measurement of IOP in rabbits, which showed a good linear correlation                graphis panniculata eye drops (0.3%) were evaluated in normotensive
coefficient. The effect of Aloe vera gel was compared with standard drug             and water loading model. The effect of Andrographis panniculata eye
pilocarpine 2%. In normotensive, water loaded and steroid induced models,            drops (0.3%) was compared with standard drug timolol (0.25%). In
test drug (50 µl) was applied topically to one eye and the other eye was             normotensive and water loaded models, test drug (50 µl) was applied
treated with saline, which served as control. Paired student’s t test was            topically to one eye and the other eye was treated with saline, which
used for data analysis (p<0.05).                                                     served as control. After drug application, measurements of IOP with NCT
Results: The % fall in IOP in normotensive rabbits after topical applica-            and Shiotz Tonometer were done at different time intervals. Student’s
tion of pilocarpine in treated eye were 13.30, 14.14, 13.21 and 13.46%               paired t test was used for data analysis (p<0.05).
at 2, 2.5, 3 and 4 hours respectively and corresponding values for Aloe              Results: Timolol (0.25%) and Andrographis panniculata (0.3%) eye
vera gel were 13.75, 15.04, 16.02 and 10.18% (n=10). In water-loaded                 drops significantly (p< 0.05) lowered IOP in our study. The % fall in IOP in
rabbits, the % difference in IOP between treated and control eye after               normotensive rabbits after topical application of timolol in treated eye
topical administration of pilocarpine were 25.84, 28.05 and 28.48% at                were 16.08, 19.51, 19.78 and 20.81% at 1, 1.5, 2 and 3 hours respec-
15, 30 and 45 minutes respectively and the corresponding values for                  tively and corresponding values for Andrographis panniculata eye drops
Aloe vera gel were 22.78, 20.34 and 25.18% (n=8). In steroid induced                 were 14.46, 18.73, 20.43 and 12.23 % (n=12). In water-loaded rabbits,
model, Aloe vera gel showed maximum lowering of IOP in test eye at 2                 the % difference in IOP between treated and control eye after topical
hours with a fall of 12.42% from baseline, but pilocarpine did not affect            administration of timolol were 22.99, 28.71 and 31.72% at 15, 30 and 45
intraocular pressure significantly (n=6). Table 1 shows the peak IOP low-            minutes respectively and the corresponding values for Andrographis
ering effect of pilocarpine and Aloe vera gel in different experimental              panniculata eye drops were 23.19, 29.95 and 23.86% (n=12).
models.                                                                              Conclusions: The results of the present study suggest that, Andrographis
Conclusions: These results indicate that Aloe vera gel is comparable to              panniculata eye drops have potential of being used as antiglaucoma agent,
pilocarpine and has the potential of being used as antiglaucoma agent                which is comparable to standard drug timolol. Further studies on mecha-
in clinical practice. However, more work on the mechanism of action,                 nism of action and regulatory toxicities are in progress.
regulatory toxicology and formulation development are needed before
it is subjected to clinical trials.
Table 1 Abstract 292-B92. Comparative fall in IOP of Pilocarpine and Aloe vera gel   SULPHONAMIDE INDUCED GLAUCOMA
  Glaucoma Model                   Pilocarpine 2%            Aloe vera gel
                                    (Maximum %               (Maximum %              A. NARAYANASWAMY, M. ANTROLIKAR, L. VIJAYA
                                  lowering of IOP)         lowering of IOP)          Medical Research Foundation, Chennai, INDIA
  Normotensive rabbits                  14.14                    16.02
  Water-loaded rabbits                  28.48                    25.18               Purpose: Report unusual idiosyncratic response of Sulphonamide drugs
  Steroid induced Glaucoma               9.83                    12.42               (Acetazolamide, Topiramate and Co -Trimoxazole) resulting in bilateral
                                                                                     secondary angle closure glaucoma masquerading as malignant glaucoma.
                                                                                     Methods: Observational Case Series.
                                                                                     Results: Idiosyncratic reaction following administration of Sulphonamide
                                                                                     drugs precipitates bilateral choroidal effusion and shallow anterior cham-
                                                                                     bers along with raised intraocular pressures. UBM evaluation confirms
                                                                                     the presence of choroidal effusion.
                                                                                     Conclusions: Ophthalmologists are generally aware of the common
                                                                                     side effects and idiosyncratic reactions of acetazolamide and other

120                                                                                                         Asian J Ophthalmol. 2007 Vol 9 No 1 Supplement 1
                                                                                                                               Poster Abstracts

sulphonamide agents. However awareness about the rare “allergic reac-        was observed between these plasma ET-1 concentrations and glaucoma
tion” of bilateral choroidal effusion masquerading as malignant glaucoma     stages in NTG and POAG.
is low .A conservative approach by simple withdrawal of instigating agent    Conclusions: These results indicate that plasma ET-1 may be involved in
is effective in these cases.                                                 the pathogenesis of glaucomatous optic neuropathy.

295-B95                                                                      297-B97
TISSUE                                                                       R.S. KUMAR1, M. BASKARAN1, P.T.K. CHEW2, H.T. WONG3, T. AUNG4
                                                                               Singapore Eye Research Institute, Singapore, SINGAPORE, 2National University
H. OHGURO, I. OHGURO, M. NISHIKIORI, S. MATSUO, K. MATSUO,                   Hospital, Singapore, SINGAPORE, 3Tan Tock Seng Hospital, Singapore, SINGAPORE;
H. KAWATA                                                                    4
                                                                               Singapore National Eye Center, National University of Singapore, Singapore,
Sapporo Medical University School of Medicine, Sapporo, JAPAN                SINGAPORE

Purpose: To study the effects of anti-glaucoma drugs on metabolism           Purpose: To investigate the prevalence of plateau iris in primary angle
within the extracellular matrix (ECM) of ocular surface including cornea,    closure suspects (PACS) before and after laser iridotomy (LI).
conjunctiva and subconjunctival tissues.                                     Methods: Ultrasound biomicroscopy (UBM) was performed with the
Methods: Several anti-glaucoma drugs including β-blockers, α/β-blockers,     patient supine and under dark adaptation in the superior, nasal, inferior
α1-blocker, α2-agonist and prostaglandin derivative were topically           and temporal quadrants. UBM images were graded before and after LI
administrated to rat eyes daily for two weeks or incubated with human        using standardized criteria in 119 Asian subjects with PACS. Subjects
corneal cells or human fibroblasts for 72 h. Thereafter, expressions and     with at least 180 ° occludable angles with IOP ≤ 21 mm Hg and no
enzymatic activities of the matrix metalloproteinases (MMPs), a group        synechiae and healthy optic nerves were classified as PACS. Plateau iris
of enzymes proteolyzing ECM and their inhibitors, TIMPs (tissue inhibitors   configuration was defined as presence of occludable angles with flat iris

                                                                                                                                                              POSTER ABSTRACTS
of metalloproteinase) were evaluated.                                        plane and anteriorly placed ciliary processes.
Results: Quantitative RT-PCR and biochemical enzymatic assay revealed        Results: 14/119 (11.9%) subjects were diagnosed to have plateau iris con-
significantly up-regulated and down-regulated expressions of MMPs and        figuration before LI. Plateau iris syndrome was identified in all except one
TIMPs, respectively, in rat conjunctival and subconjunctival tissues upon    subject after LI. 6/119 (5%) subjects who did not have plateau iris con-
administration of α/β-blockers, α1-blocker, α2-agonist and prostaglan-       figuration before LI were diagnosed to have plateau iris syndrome after LI.
din derivative, suggesting that these drugs may enhance ECM degradation.     Conclusions: There was a low prevalence of plateau iris in the Asian
However in contrast, β-blocker administration caused reverse effects,        PACS population studied. Some cases of plateau iris were manifest only
that is, up-regulation and down-regulation of expressions of TIMPs and       after LI.
MMPs, respectively.
Conclusions: The present experimental observations suggest that some
of α/β-blockers, α1-blocker, α2-agonist and prostaglandin derivative         298-B98
stimulate ECM degradation of ocular surface tissues by modulating MMPs       A NEW SOFTWARE FOR ANALYZING IRIS SHAPES
and TIMPs balance.                                                           IN UBM IMAGES

                                                                             R. KRISHNA KUMAR, U. SEKAR, B. SHONRAJ, A. VIJAYA, M. SHWETA,
296-B96                                                                      S. SATHISH, S.VARADHARAJAN
STUDY OF CONTRIBUTION OF LOW LEVEL OF                                        Elite School of Optometry, Unit of Medical Research Foundation, Chennai, INDIA
PATHOGENESIS OF GLAUCOMATOUS OPTIC                                           Purpose: To analyze iris shapes utilizing Ultrasound Biomicroscopy (UBM)
NEUROPATHY                                                                   images of normal and narrow angled subjects by developing a software
                                                                             using MATLAB 7.2.
I. OHGURO, H. OHGURO, M. NISHIKIORI, S. MATSUO, K. MATSUO,                   Methods: A software in Matlab 7.2 was developed to trace the anterior
H. KAWATA                                                                    iris surface in UBM images. The software first flips the images to the left
Sapporo Medical University School of Medicine, Sapporo, JAPAN                side. It then enhances and denoises these images. These images were
                                                                             then resized to 500 x 500 pixels using nearest neighbor interpolation.
Purpose: To study of contribution of plasma endothelin-1 (ET-1) concen-      They were then rotated to a standard position and then binarized. The
tration to pathogenesis of glaucomatous optic neuropathy.                    user is then asked to choose the iris insertion in the binary image. In
Methods: We examined plasma ET-1 concentrations in 102 patients with         case of images of narrow angled eyes, the iris insertion is chosen before
normal-tension glaucoma (NTG), 90 patients with primary open-angle           binarization. The software then automatically traces the anterior surface
glaucoma (POAG) and 100 age-matched non-glaucomatous subjects                of the iris to 2.5 mm horizontally. The area under the traced iris surface
(CONT). In addition, the relationship between the plasma ET-1 concentra-     was calculated. This was carried out on UBM images of 11 normal eyes
tions and glaucoma stages were also studied.                                 and 11 narrow anterior chamber angle (narrow angled) eyes. A student
Results: Plasma ET-1 concentrations of patients with NTG (3.34±              unpaired t-test was carried out on these two sets of images.
1.27 pg / ml, P < 0.01) and POAG (3.80±1.40 pg / ml, P < 0.05) were          Results: The average area in the normal eyes was found to be 0.4645mm2
significantly lower than those of CONT (4.39±1.34 pg / ml). No relation      ± 0.1607mm2 and in narrow angles to be 1.1241mm2 ± 0.3288mm2.

Asian J Ophthalmol. 2007 Vol 9 No 1 Supplement 1                                                                                                       121
Poster Abstracts

Significant difference was found between the area of normal and narrow            5.6 mmHg at 1 week and 17.6 ± 4.5 mmHg at 4 weeks postoperatively.
angles (p<0.000) using student’s unpaired t-test.                                 Preoperative superior TIA was 0.0 degrees, AOD at 250µm and at 500µm
Conclusions: The significant difference found between the areas of the            was 0 mm. Inferior TIA, AOD 250µm and AOD 500µm were 0 mm, 0.015
two group shows that the iris shapes differ between the normal and                ± 0.03 mm, 0.024 ± 0.05 mm respectively. Postoperative mean superior
narrow angled eyes.                                                               TIA was 15.21 ± 9.37 degrees, AOD at 250µm and at 500µm was 0.1 ±
                                                                                  0.09 mm and 0.22 ± 0.16 mm respectively. Postoperative Inferior TIA,
                                                                                  AOD 250µm & 500µm were 22.92 ± 8.33 degrees, 0.43 ± 0.28 mm and
299-B99                                                                           0.51 ± 0.28 mm respectively. Anterior chamber depth changed from
DEGREE OF ANGLE CLOSURE AND THE RISK OF                                           1.762 ± 0.267 mm to 3.036 ± 0.243 mm in postoperative period. There
PERIPHERAL ANTERIOR SYNECHAIE: AN                                                 was a significant increase in TIA, ACD and AOD at 250µm and 500µm
ANTERIOR SEGMENT OCT STUDY                                                        after cataract surgery (p<0.0001).
                                                                                  Conclusions: Phacoemusification cataract surgery leads to opening up
D.H.W. SU1, P.J. FOSTER2, J. SEE3, P.T.K. CHEW3, T. AUNG1                         of the peripheral iridocorneal angle and significant lowering of IOP in the
 Singapore National Eye Center, Singapore, SINGAPORE, 2Moorfields Eye Hospital,   early post operative period in eyes with chronic PACG.
London, United Kingdom; 3National University Hospital, Singapore, SINGAPORE

Purpose: To evaluate the relationship between angle width determined              301-B101
by anterior segment optical coherence tomography (AS-OCT) and the                 IMAGING AND QUANTIFICATION OF RETINAL
presence of peripheral anterior synechiae (PAS).                                  NERVE FIBRES IN NORMAL AND OCULAR
Methods: Images of the nasal, temporal and inferior angles were                   HYPERTENSIVE INDIAN EYES USING STRATUS
obtained with AS-OCT. The angle opening distance (AOD), trabecular-iris           OCT 4
space area (TISA), and area of recessed angle (ARA) in the nasal, tempo-
ral and inferior quadrants measured 500µm and 750µm from the scleral              M. BHADAURIA
spur were calculated. Gonioscopy was performed for each quadrant to               Indian Army, Armed force’s Medical College Pune- 40, Pune 40, Maharashtra India,
determine the presence of PAS.                                                    INDIA
Results: The mean values of AOD, TISA, and ARA in the nasal, temporal
and inferior quadrants were significantly less in eyes with PAS compared          Purpose: Measure the thickness of retinal nerve fiber layer in peripapil-
to those without PAS (p<0.001). Analysis by quadrant showed that these            lary area in normal and ocular hypertensive Indian eyes and find out the
parameters were also less in the nasal and temporal quadrants in eyes             difference if any in two groups.
with PAS (p<0.001), but for the inferior quadrant, only ARA (500) was             Methods: 50 patients of general OPD who were found to be normal after
significantly less (p=0.02). AOD, TISA and ARA were significantly corre-          complete ophthalmic evaluation and 50 patients of ocular hypertension
lated with clock hours of PAS (Pearson’s correlation coefficient 0.24, 0.31       were subjected to measurement of RNFL thickness by Stratus OCT 4
and 0.17 respectively, p<0.05).                                                   using Fast RNFL thickness protocol between Jan 2004 to Oct 2005 at a
Conclusions: Angle width determined using AS-OCT was significantly                tertiary care center of armed forces.
reduced in eyes with PAS. There was a significant correlation between             Results: RNFL thickness was significantly lower in Ocular hypertension
angle width and degree of PAS.                                                    group compared to normal group. In the normal group RNFL thickness
                                                                                  was more in < 50 years of age compared to above 50 years of age.
                                                                                  Conclusions: OCT 4 can detect RNFL loss objectively before it can be
300-B100                                                                          detected ton standard automated perimetry and may be useful tool in
ULTRASOUND BIOMICROSCOPY STUDY ON THE                                             deciding treatment strategy in ocular hypertensive patients.
G. SRINIVASAN, V. GUPTA, R. SIHOTA                                                PERIMETRICALLY NORMAL “DISC SUSPECT” AND
Glaucoma Research Facility, Dr. Rajendra Prasad Centre for Ophthalmic Sciences,   THE INFLUENCE OF PLANIMETRIC
All India Institute of Medical Sciences, Ansari nagar, New Delhi, INDIA           CHARACTERISTICS ON RECLASSIFICATION

Purpose: To study the changes in anterior segment parameters on                   S.V. RAMESH, M.M. PREETHA, P.RAJU, R.GEORGE, M.BASKARAN,
ultrasound biomicroscopy (UBM) and intraocular pressure (IOP) after               L.VIJAYA
phaco-emulsificaion in eyes with Chronic Primary angle closure glau-              Medical and Vision Research Foundation, Chennai, INDIA
coma (PACG).
Methods: Twenty three eyes of 23 patients with Chronic PACG were                  Purpose: To assess the performance of HRT II and planimetry in diagnos-
included. All patients underwent phacoemulsification with in the bag IOL          ing glaucoma among optic disc suspects with normal standard automated
implantation. Pre and post operative IOP was measured by applanation              perimetery results and SWAP defects (SAP).
tonometry at 1 and 4 weeks. Ultrasound biometric parameters were                  Methods: Patients clinically diagnosed to be optic disc suspects with
measured at 4 weeks on UBM P40 (Paradigm Medical Industries Ltd.                  normal standard automated perimetery were enrolled in the study. All the
USA) machine and included the trabecular iris angle (TIA), Angle opening          enrolled subjects underwent HRT II, SWAP and stereo photography of the
distance (AOD), and anterior chamber depth.                                       optic disc. Subjects were classified as those with defects on short wave-
Results: The mean age was 54.6 ±12.9 years. Mean preoperative base-               length automated perimeter (SWAP) and those without any defects on
line IOP was 38.67 ± 6.05 mmHg. The post operative IOP was 13.5 ±                 SWAP. SWAP was used as a gold standard for comparison of HRT II

122                                                                                                    Asian J Ophthalmol. 2007 Vol 9 No 1 Supplement 1
                                                                                                                                     Poster Abstracts

parameters. The diagnostic efficacy of non disc size dependent HRT II            Methods: Forty four eyes of 29 ocular hypertensives and 46 eyes of 24
parameters like Cup shape measure (CSM) and linear discriminant func-            age-matched subjects with normal perimetry were included from an epi-
tions developed by Mikelberg et al (FSM) and the other by Burk et al (RB)        demiological study. Ocular hypertensives (OHT) were those with intraocular
in these subjects were studied. HRT II and planimeric disc measurements          pressure (IOP) > 21 mm Hg with normal ocular examination and perimetry.
were compared.                                                                   Complete ophthalmic examination with ultrasound pachymetry, stereo
Results: Sixty six eyes of 39 subjects with a mean age of 43.65 (SD:             disc photos, Humphrey perimetry and optical coherence tomography (OCT
13.58) yrs were analyzed, 32 eyes had defects on SWAP. FSM had the               - RNFL program) were performed in all subjects. Disc area calculated by
highest sensitivity (81.2%) in detecting subjects with defects on the            computerized planimetry was categorized as small (area less than the
SWAP. Among the combination of parameters analyzed, “FSM or RB” had              33rd percentile - 2.4 mm2), large (more than 66th percentile - 2.74 mm2)
the best sensitivity (81.25%). All the parameters showed low specificity         and medium (between 33rd and 6th percentiles) in the normal sample
values. There was a significant difference between the HRT and plani-            studied. Average RNFL thickness was derived from RNFL analysis of OCT
metric measurements of disc area (p=0.0001) and rim area (p=0.002).              images. Pearson’s correlation coefficient was used for correlation
The ISNT rule on disc planimetry had 100% sensitivity in subjects with           between disc area and RNFL thickness. Logistic regression analysis
large disc size.                                                                 was used to assess the association of disc area, mean central corneal
Conclusions: No single parameter or combination of parameters had                thickness (CCT) and RNFL thickness.
adequate sensitivity and specificity in detecting early glaucoma among           Results: The mean disc area for normal subjects was 2.62 ± 0.44 (1.87
glaucoma suspects.                                                               - 3.90) mm2 and in OHT was 2.53 ± 0.48 (1.66 - 3.68) mm2 (p=0.36). The
                                                                                 mean IOP was significantly higher among the OHT subjects, mean diff
                                                                                 ±SE: 9.82 ± 0.43 mm Hg, p= 0.0001 (95% CI of the diff = 8.95, 10.69).
303-B103                                                                         The mean RNFL thickness was different between the normals (104.56 ±
OPTIC DISC SIZE IN A POPULATION-BASED STUDY                                      9.36 µ) and OHTs (98.79 ± 10.99 µ), p= 0.009 (95% CI of diff = -10.04,
IN CENTRAL INDIA. THE CENTRAL INDIA EYE AND                                      -1.50). Average RNFL thickness showed positive correlation with disc
MEDICAL STUDY                                                                    area among normals (r = 0.480, p = 0.001) while OHTs had weak corre-
                                                                                 lation (r = 0.129, p = 0.405). Logistic regression analysis showed that
J. JONAS 1, V. NANGIA 2 , A. MATIN 2, K. BHOJWANI 2 , M. YADAV 2,                OHTs had significantly thinner RNFL thickness after adjusting for mean
M. KULKARNI2                                                                     CCT and disc area (OR = 0.947, 95% CI = 0.903, 0.994).

                                                                                                                                                                      POSTER ABSTRACTS
 Department of Ophthalmology, Mannheim, GERMANY, 2Suray Eye Institute, Nagpur,   Conclusions: Disc area did not correlate with average RNFL thickness
INDIA                                                                            among ocular hypertensives. Ocular hypertensives had thinner RNFL thick-
                                                                                 ness compared to age-matched normals after adjusting for CCT and disc
Purpose: To determine the optic disc size in the adult Indian population         area.
in Nagpur / Maharashtra in Central India.
Methods: The interim analysis of the population-based, cross-sectional
cohort study included 603 subjects. Mean age was 49.13 ± 13.49 years             305-B105
(range, 30 - 95 years), mean refractive error was -0.23 ± 1.78 diopters          EVALUATION OF RETINAL NERVE FIBER LAYER
(range, -20.0 diopters to +6.00 diopters). Color optic disc photographs          THICKNESS IN MYOPIC POPULATION USING
were morphometrically examined. Main outcome measure was optic                   SCANNING LASER POLARIMETRY (GDXVCC)
disc area. Only one randomly selected eye per subject was included into
the statistical analysis.                                                        T. DADA, A. AGGARWAL, R. MURALIDHAR, R. GADIA, S. MOHAN,
Results: Optic disc photographs were available for 585 (97%) subjects.           V. GUPTA, R. SIHOTA
Using planimetry of photographs, mean optic disc area measured 2.79 ±            Dr. Rajendra Prasad Centre for Ophthalmic Sciences, AIIMS, Ansari nagar, Newdelhi,
0.56 mm2 (range: 1.73 mm2 - 5.50 mm2). Optic disc area was not related           INDIA
to gender (p=0.51) (optic disc area, males: 2.83 ± 0.58 mm2 versus
females: 2.76 ± 0.53 mm2) (P=0.12;95%CI: -0.02, 0.17).                           Purpose: To evaluate the retinal fiber layer (RNFL) thickness in low,
Conclusions: Compared with data of preceding studies, mean optic disc            moderate and high myopia and compare it with emmetropes using scan-
size was larger in Indians from Central India than in Caucasians. Central        ning laser polarimetry with variable corneal compensation (GDxVCC).
Indians and Chinese did not markedly differ in optic disc size. These data       Methods: The nerve fiber layer assessment was performed using the
may be of importance of the optic nerve head analysis in glaucoma.               GDx VCC 82 eyes of emmetropes, 30 eyes of low myopes (0 to -4 D SE),
                                                                                 45 eyes with moderate myopia (-4 to -8D SE), and 29 eyes with
                                                                                 high myopia (-8 to -15D SE). The TSNIT global average and Nerve Fiber
COMPARISON OF OPTIC DISC AREA AND RETINAL                                        Table Abstract 305-B105. Correlation of RNFL thickness and myopic refractive error
                                                                                   Ref error       TSNIT Average        p value            NFI         p value
OCULAR HYPERTENSIVES AND AGE-MATCHED                                                                                  (mean + SD)
                                                                                   Emmetropes       54.21 + 3.95                     17.08 + 6.16
                                                                                   Low myopes       53.25 + 4.24         0.21        20.06 + 8.36       0.11
M. BASKARAN, S.V. RAMESH, R.J. GEORGE, R. PREMA, L. VIJAYA                         (0 to -4D)
Sankara Nethralaya, Chennai, INDIA                                                 Moderate         52.03 + 5.30         0.0097      24.38 + 9.04       0.0000
Purpose: To analyze the association of optic disc area and retinal nerve           (-4 to -8D)
fiber layer thickness (RNFL) in ocular hypertensives and comparison to             High myopes      63.58 + 16.01        0.0000      19.58 + 12.32      0.0400
                                                                                   (-8 to -15D)
normal eyes.

Asian J Ophthalmol. 2007 Vol 9 No 1 Supplement 1                                                                                                               123
Poster Abstracts

Indicator (NFI) were analyzed, compared and correlated with the axial             glaucomatous and healthy eyes based on AROCs.
length and refractive error (spherical equivalent-SE).                            Results: NFI (nerve fiber layer index) is the best single parameter for
Results: There was no significant difference in the mean age between              differentiating glaucoma from normal eyes (AROC, 0.795). With LDA
the myopes and emmetropes. There was no statistically significant dif-            method, the AROC for glaucoma detection was 0.845 with four input
ference in the NFI and TSNIT values between emmetropes and low myopes.            parameters (TSNIT, Superior, Inferior, and Inferior maximum).
The TSNIT average was significantly lower (p=0.0097), while the NFI               Conclusions: Compared with NFI, LDA with stepwise selection method
was higher (P < 0.0001) in moderate myopes as compared to emmetropes.             improved the ability to differentiate between normal and glaucomatous
In high myopia the RNFL showed supranormal values, the TSNIT average              eyes in Taiwan Chinese population using GDx VCC measured data.
was significantly higher (p < 0.0001 ) as compared to emmetropes.
Conclusions: The RNFL measurements on scanning laser polarimetry
are affected by myopic refractive error. Moderate myopes show a signifi-          308-B108
cant thinning of the RNFL. In high myopia due to peri-papillary chorioretinal     EVALUATION OF DISC AREA AND AXIAL LENGTH
atrophy and contribution of scleral birefringence, the RNFL thickness             INFLUENCE ON RETINAL NERVE FIBER LAYER
values are abnormally high. These findings need to be taken into account          THICKNESS
while assessing and monitoring glaucoma damage in moderate-high
myopes on GDxVCC.                                                                 R. JAIN, S.S. PANDAV, A. GUPTA
                                                                                  Post Graduate Institute of Medical Education ad research, Chandigarh, INDIA

306-B106                                                                          Purpose: To evaluate the influence of disk area and axial length on
OCT PARAMETERS IN GLAUCOMA -A SOUTH                                               Retinal nerve fiber layer thickness as measured on Optical coherence
INDIAN STUDY                                                                      tomography.
                                                                                  Methods: Fifteen normal subjects were enrolled for this prospective, non-
M.Y. DHAR, H. SUJITHRA, I. JAYACHANDRAN, A. KHAKE                                 comparative, non-interventional study complying with Helsinki Declaration.
Amrita Institute of Medical Sciences and Research Centre, Cochin, Kerala, INDIA   Normal subjects had unaided visual acuity of 20/20 and no other ocular
                                                                                  pathology. After taking an informed consent the optic disks were imaged
Purpose: To evaluate the usefulness of Optical Coherence Tomography               on Heidelberg’s Retinal Tomogram (HRT-I) for optic disk analysis and
for glaucoma in Indian Population.                                                disk area (DA) as well as Optical Coherence Tomography (OCT) for retinal
Methods: All patients undergoing OCT for glaucoma [which included                 nerve fiber layer thickness (RNFL). The axial length was measured using
Fast RNFL, Fast Optic Disc, and Fast Macular thickness] at our speciality         ultrasound A scan. RNFL measurements included the Fast RNFL scan
hospital were included in the study. This included glaucoma suspects              (at 3.46mm) in each eye, RNFL measurements at the disc margin, RNFL
and patients on treatment or prior to starting treatment. The findings were       at 1.2mm, 1.5 mm around the disc margin. The descriptive analysis of
correlated to results of other tests for glaucoma evaluation i.e. Optic nerve     disk area and axial length; disk area and RNFL thickness at varying
head evaluation and visual fields to see if they correlated.                      distances form disk margin and axial length and RNFL at increasing
Results: OCT changes in the Indian population follow trends similar to            distance form disc margin was done.
the western studies in glaucomatous patients.                                     Results: Mean age was 32±1.55 years. The variation of RNFL at disc
Conclusions: OCT is a useful tool for confirming and supplementing the            margin parallels the RNFL at 3.46 mm. The RNFL increase with disc area
diagnosis of glaucoma. It also helps in excluding glaucoma where optic            till 2.8mm2 and thereafter it decreases with increase in disc area with
nerve head changes mimic glaucoma as in optic nerve head pits with                RNFL at disc margin remaining higher than RNFL at 3.46mm. Similarly,
arcuate scotomas.                                                                 the RNFL both at disc margin and 3.46 mm increases with increase in
                                                                                  axial length till 23mm and thereafter a gradual decrease with increase in
                                                                                  axial length was observed. The disk area increases with increase in axial
307-B107                                                                          length and thereafter, it stabilized till 24mm wherein it again started
LINEAR DISCRIMINATION ANALYSIS FOR                                                increasing.
GLAUCOMA DIAGNOSIS USING GDX VCC                                                  Conclusions: RNFL on OCT alone without considering the disc size and
PARAMETERS IN TAIWAN CHINESE POPULATION                                           axial length may lead to false positive reporting of thin RNFL as RNFL
                                                                                  varies with increasing disc size and axial length.
 China Medical University Hospital, Taichung, TAIWAN, 2Department of Industrial
Engineering & Management, National Chin-Yi Institute of Technology, Taichung,     309-B109
TAIWAN                                                                            ASSESSMENT RETINAL NERVE FIBER LAYER
                                                                                  THICKNESS BY SCANNING LASER POLARIMETRY
Purpose: To investigate the diagnostic performance of linear discrimi-            (GDXVCC) IN NORMALS, POAG SUSPECTS AND
nant analysis (LRA) applied to multi-dimensional information on glaucoma          EARLY POAG PATIENTS
disease and to determine the area under the receiver operating charac-
teristic curves (AROCs) for differentiating between normal and glauco-            T. DADA, A. SHARMA, R. GADIA, A. AGARWAL, G. SRINIVASAN, V. GUPTA,
matous eyes based on the measured data from the GDx VCC.                          R. SIHOTA
Methods: One randomly selected eye from 82 patients with early glau-              Glaucoma Research Facility. Dr. Rajendra Prasad Centre for Ophthalmic Sciences,
coma and 62 age- and sex- matched normal subjects were included                   All India Institute of Medical Sciences, New Delhi, INDIA
in the study. Each patient received GDx VCC measurement. Fourteen
parameters were included in a LDA with stepwise selection method to               Purpose: To evaluate the ability of scanning laser polarimetry with
determine the best combination of parameters for discriminating between           variable corneal compensation (GDxVCC) to detect differences in retinal

124                                                                                                    Asian J Ophthalmol. 2007 Vol 9 No 1 Supplement 1
                                                                                                                                      Poster Abstracts

nerve fiber layer (RNFL) thickness between normal, Primary Open Angle                Results: The TSNIT average (µm) normal vs. POAG suspects vs. POAG at
Glaucoma (POAG) suspects and early POAG eyes.                                        the 3 different diameter circles was 54.17 ± 4.6 vs 49.96 ± 6.5 vs 46.92
Methods: This study included 100 eyes of normal subjects (normal disc                ± 6.2 (small); 47.17 ± 4.8 vs 43.79 ± 5.7 vs 41.48 ± 6.5 (medium);
with normal visual fields), 50 eyes with suspected POAG (suspicious disc,            41.57 ± 4.6 vs 39.77 ± 5.9 vs 38.33 ± 7.1 (large). All parameters of all
normal fields) and 50 eyes with early POAG (glaucomatous disc and visual             circles showed significant difference between normal and early POAG
field defects). All patients underwent 30-2 SITA standard visual fields, slit        eyes (p<0.001). AUC was 0.911 for NFI at all circles (p<0.001). All
lamp biomicroscopy, gonioscopy, applanation diurnal IOP recording and                parameters at small and medium circle and all except TSNIT average at
GDxVCC. The main outcome measures included TSNIT average, superior                   large circle showed significant difference between normal and glaucoma
and inferior average and NFI.                                                        suspect eyes (p<0.001), AUC being highest (0.801) for NFI at large circle
Results: Mean age in all the 3 groups were comparable. The TSNIT aver-               (p<0.001). All parameters except inferior average at small circle,
age (µm) in normal subjects, POAG suspects and early POAG were                       superior average and NFI at medium circle and NFI at large circle showed
54.17±4.60, 49.76±6.54 and 46.92±6.23 respectively. All the para-                    significant difference between glaucoma suspect and early POAG
meters of GDxVCC showed significant difference between POAG and                      eyes (p<0.05), with AUC being highest (0.731) for NFI at small circle
normal subjects (p<0.001) with NFI having highest AUC of 0.920 and                   (p<0.001). All RNFL parameters progressively decreased significantly
specificity and sensitivity of 90% and 83% at a cut off of >26.5. All the            with increasing observation circle diameter. There was significant differ-
parameters showed significant difference between POAG suspects and                   ence between small vs. medium (p<0.001), medium vs. large (p<0.001)
normal subjects (p<0.001) with NFI having highest AUC of 0.793 and                   and small vs. large circle results (p<0.001) of all the groups and for all
specificity and sensitivity of 80% and 60% at a cut off of >24.5.All the             the parameters except NFI. There was no significant difference in NFI
parameters except inferior average showed significant difference between             with different measuring circles.
POAG and POAG suspects p=0.049, p=0.01 and p<0.001 for TSNIT                         Conclusions: The RNFL thickness decreases with an increasing scan
average, superior average and NFI respectively with NFI having highest               radius on GDxVCC. Medium and large circle scans can also be used for
AUC of 0.730 and specificity and sensitivity of 80% and 56% at a cut off             detection of RNFL damage in POAG in addition to the conventional small
of >33.                                                                              circle scan. This will be especially useful in RNFL measurements in eyes
Conclusions: GDxVCC has good sensitivity and specificity to differentiate            with significant peripapillary atrophy.
between normal and early POAG. The discriminating ability of the instru-
ment between normals vs POAG suspects and POAG suspects vs early

                                                                                                                                                                      POSTER ABSTRACTS
POAG is poor.                                                                        311-B111
                                                                                     ASSESSMENT OF RETINAL NERVE FIBER LAYER
                                                                                     THICKNESS BY OCT3 AT FOUR SCAN DIAMETERS
310-B110                                                                             AND GDXVCC IN NORMALS, POAG SUSPECTS AND
MEASUREMENT BY SCANNING LASER                                                        T. DADA, P. GARG, R. GADIA, R. SIHOTA, A. SHARMA, S. KHOKHAR,
POLARIMETRY (GDXVCC) IN NORMALS, GLAUCOMA                                            V. GUPTA, G. SRINIVASAN
SUSPECTS AND EARLY GLAUCOMA PATIENTS                                                 Glaucoma Research Facility Dr. Rajendra Prasad Centre for Ophthalmic Sciences,
                                                                                     All India Institute of Medical Sciences, New Delhi, INDIA
Glaucoma Research Facility, Dr. Rajendra Prasad Centre for Ophthalmic Sciences,      Purpose: To assess retinal nerve fiber layer (RNFL) thickness by Stratus
All India Institute of Medical Sciences, New Delhi, INDIA                            OCT 3 and Scanning laser polarimetry (GDx VCC) in normal subjects,
                                                                                     Primary Open Angle Glaucoma (POAG) suspects and early POAG and to
Purpose: To study the ability of retinal nerve fiber layer thickness at 3            find the effect of different scan radius on RNFL assessment by OCT.
scan diameters using GDxVCC in discriminating between healthy, glau-                 Methods: This study included 200 eyes of normal subjects, 50 eyes
coma suspects and early perimetric glaucomatous eyes.                                with suspected POAG and 50 eyes with early POAG. All patients under-
Methods: One hundred eyes of normal subjects (normal disc with normal                went detailed glaucoma workup along with GDxVCC and OCT. OCT was
visual fields), 50 eyes of primary open angle glaucoma (POAG) suspects               performed along a concentric circle with a radius of 1.2 mm, 1.4 mm,
(suspicious disc, normal fields) and 50 eyes of early POAG patients                  1.6 mm and 1.73 mm. Main outcome measures were average NFL thick-
(glaucomatous disc and early visual field defects according to Hodapp                ness over 360°, TSNIT average, average NFL thickness in superior and
Anderson, Parrish criteria) were evaluated using GDxVCC and SITA                     inferior quadrant and NFI.
standard 30-2 visual fields. Retinal Nerve Fiber Layer Thickness (RNFL)              Results: Average RNFL thickness in normals, POAG suspect and early
parameters were measured on GDxVCC at 3 different observation                        POAG by OCT of different radius scan and GDxVCC is given in Table 1. All
circles- conventional small circle, medium and large circle. The TSNIT               the studied parameters of both GDxVCC and OCT showed significant
average, superior average, inferior average and NFI were evaluated.                  difference between early glaucoma and normals (p<0.001). AUC being

Table Abstract 311-B111. Average RNFL thickness by OCT at different Scan Diameter and GDxVCC
  Parameters                    Normals        POAG suspect           p value between normal                  Early POAG          p value between normal
                                                                         and POAG suspect                                             and Early POAG
  OCT RNFL 1.2 mm                114.10            102.80                         0.083                          94.97                      0.005
  OCT RNFL 1.4 mm                101.43            104.16                         1.000                          92.65                      0.001
  OCT RNFL 1.6 mm                 99.56             94.25                         0.482                          82.29                      0.000
  OCT RNFL 1.73 mm                92.31             93.30                         1.000                          77.36                      0.002
  GDxVCC TSNIT Average            56.02             47.26                         0.000                          46.08                      0.000

Asian J Ophthalmol. 2007 Vol 9 No 1 Supplement 1                                                                                                              125
Poster Abstracts

0.817 for OCT at 1.73 mm scan of inferior quadrant with sensitivity of       313-B113
71% at specificity of 85%. AUC of NFI being 0.86 with sensitivity of 77%     MANAGEMENT OF CATARACT & GLAUCOMA WITH
at specificity of 90%. OCT (1.2 mm radius scan of superior quadrant) and     SMALL INCISION CATARACT SURGERY &
GDxVCC parameters showed significant difference between glaucoma             SUTURELESS TRABECULECTOMY WITH MINIMAL
suspects and normals (p<0.001), AUC being 0.729 for OCT 1.2 mm scan          COST-A 3RD WORLD SCENARIO
of superior quadrant with sensitivity of 35% at specificity of 80%. AUC of
TSNIT average by GDxVCC was 0.888 with sensitivity of 80% at specificity     M. RATHI, C.S. DHULL, S. SACHDEVA
of 85%. There was significant positive correlation (p <0.001) between all    Regional Institute of Ophthalmology, PGIMS, Rohtak,Haryana, INDIA
RNFL parameters by GDxVCC and OCT at various diameters at respective
quadrants. RNFL thickness at 1.2 mm radius was 20% more than RNFL            Purpose: To evaluate the efficacy of sutureless cataract & glaucoma
thickness at 1.73 mm radius on OCT in normals. GDxVCC RNFL thickness         surgery in a single-eyed patient with failed trabeculectomy.
values were nearly half of OCT RNFL values.                                  Methods: A 58 year old lady presented with absolute glaucoma in the left
Conclusions: Both OCT and GDxVCC has good sensitivity and specificity        eye & failed trabeculectomy with cataract in the right eye, with a vision of
to differentiate between normal and early POAG. The discriminating           2/60.The IOP in the right eye was 28mm of Hg. The patient was blind for
ability between normals vs POAG suspects is poorer with OCT than             all practical purposes, but could not afford any medical or surgical
GDxVCC. There was a high degree of correlation between all OCT and           treatment. We undertook SICS with sutureless trabeculectomy (with the
GDxVCC RNFL thickness. RNFL thickness increases with decreasing scan         Kelly’s descemets membrane punch) in the right eye, through a temporal
diameter on OCT.                                                             frown shaped tunnel (6.5mm),as there was a filtering bleb at 12 o’clock
                                                                             & there was against-the-rule astigmatism.
                                                                             Results: The visual outcome was 6/9, with a with-the-rule induced astig-
312-B112                                                                     matism of 0.25D. The cost of the surgery was less than 10 US Dollars,
COMPARISON OF GLAUCOMA SURGERIES FOR                                         which was borne by the hospital.
THE TREATMENT OF REFRACTORY POST-                                            Conclusions: It is worthwhile to undertake this surgery in 3rd world
KERATOPLASTY GLAUCOMA                                                        countries where locally manufactured rigid IOL can provide good post-
                                                                             operative results.
Singapore National Eye Centre, Singapore, SINGAPORE
Purpose: To compare the intraocular pressure control (IOP) and graft         MANAGEMENT OF INTRA OPERATIVE
survival between trabeculectomy, glaucoma drainage device (GDD) and          CONJUNCTIVAL BUTTONHOLES - A NEW
diode transscleral cyclophotocoagulation procedures (TCP) in manage-         APPROACH
ment of refractory post-keratoplasty glaucoma.
Methods: A retrospective review of clinical records of patients with         S. PUSHPOTH, S. MURTHY, P. CORRIDAN
penetrating keratoplasty and refractory post-keratoplasty glaucoma           Wolverhampton and Midlands eye infirmary, Wolverhampton, UNITED KINGDOM
requiring glaucoma surgery which were both performed at Singapore
National Eye Center was conducted. The patients were seen at the             Purpose: To report a new technique in the management of conjunctival
Singapore National Eye Centre from July 1991 to September 2004 and           button holes, during trabeculectomy with atraumatic, 11- 0 nylon suture.
were identified from the cornea and glaucoma databases. Two primary          Methods: A series of four patients, who developed conjuntival button
outcomes were evaluated: IOP control and graft status.                       holes or tear, during routine planned trabeculectomy was managed using
Results: 70 eyes of 68 patients were identified. 2 patients had bilateral    the new technique.
ocular involvement. Number of eyes with trabeculectomy, GDD and TCP          Results: All four patients could be successfully managed using the new
were 42, 15 and 13 respectively. There were no differences between the       technique.
3 groups in terms of age of patients, history of penetrating ocular trauma   Conclusions: Conjunctival button holes, tears or post operative bleb leak
and pre-existing glaucoma. Trabeculectomy had both better IOP control        can be successfully managed using 11 - 0 nylon sutures, without shifting
(p=0.04) and graft survival (p=0.01) than GDD and TCP which were sta-        the bleb site.
tistically significant.
Conclusions: Trabeculectomy is superior to GDD and TCP in terms of
both IOP control and graft survival in surgical management of refractory     315-B115
post-keratoplasty glaucoma.                                                  PANRETINAL CRYOPEXY IN YOUNG ADULT
                                                                             WOMAN WITH BILATERAL NEOVASCULAR

                                                                             D. DHARMAWIDIARINI, S. BOENGAS, E. KOMARATIH, W. SASONO
                                                                             Airlangga University, Surabaya, INDONESIA

                                                                             Purpose: A case report management of Neovascular Glaucoma.
                                                                             Methods: A 26 years woman complained about painful and blurred
                                                                             vision since three days on left eye (LE) and five months on right eye (RE).
                                                                             Visual acuity (VA) was two meters finger counting (LE) and hand move-
                                                                             ment (RE) with intra ocular pressure (IOP) 37,2mmHg (LE) and 43,4 mmHg
                                                                             (RE). We found Cupping disc ratio were 0,4 (LE) and 0,7 (RE). There were

126                                                                                               Asian J Ophthalmol. 2007 Vol 9 No 1 Supplement 1
                                                                                                                                     Poster Abstracts

peripapilary hemorrhage and sheeting. In Gonioscopy, anterior chamber              317-B117
angles were closed on both eyes with peripheral anterior synechiae at              RETROSPECTIVE EVALUATION OF SHALLOW
3-6-9 o’clock (LE) and at 4-5 o’clock (RE) , new vessels at 360° (LE).             ANTERIOR CHAMBER FOLLOWING
Timolol Maleate 0,5% eye drop two times daily, Acetazolamide 250 mg                TRABECULECTOMY IN PRIMARY OPEN ANGLE
three times daily, Kalium Slow Release once a day and Atropin 1% eye               GLAUCOMA EYES
drop two times daily were given for both patients. We performed Panretinal
Cryopexy in both eyes.                                                             P. SONY, A. SOOD
Results: Ten days after treatment, IOP became 31,8mmHg on left eye                 Venu Eye Institute and Research Centre, New Delhi, INDIA
and 27,2mmHg on right eye. Rubeosis iridis and new vessels on anterior
chamber angle were regressed.                                                      Purpose: Shallow anterior chamber is a well-documented postoperative
Conclusions: Panretinal Cryopexy was beneficial in the management of               complication of trabeculectomy. This study was conducted to evaluate
Neovascular Glaucoma to regress new vessels and decrease IOP                       the cause of shallow anterior chamber following uncomplicated
Keywords: Panretinal Cryo-pexy, Neovascular Glaucoma.                              trabeculectomy in eyes with primary open angle glaucoma.
                                                                                   Methods: Retrospective analysis of the patients records who had under-
                                                                                   gone trabeculectomy during a period of six months (July 2005-December
316-B116                                                                           2005) collected and analyzed for the incidence, management and seque-
ANTERIOR SEGMENT OPTICAL COHERENCE                                                 lae of post-operative shallow-anterior chamber. The time of occurrence
TOMOGRAPHY IMAGING OF TRABECULECTOMY                                               of shallow anterior chamber, severity of iridolenticular touch, bleb details,
BLEBS BEFORE AND AFTER LASER SUTURE LYSIS                                          fundus findings, intraocular pressure and B-scan ultrasound findings were
                                                                                   noted. In addition response to conventional management and timing and
M. SINGH 1 , T. AUNG 2, D. S. FRIEDMAN 3 , C. ZE 1, P. J. FOSTER 4,                method of anterior chamber reformation if needed were also recorded.
W. P. NOLAN5, J. L. SEE1, S. D. SMITH6, P. T.K. CHEW1                              Results: A total of 146 trabeculectomies were performed on 120 patients
 National University Hospital, Singapore, SINGAPORE, 2Singapore National Eye       with the diagnosis of primary open angle glaucoma. Thirty-two eyes (21%)
Centre, Singapore, SINGAPORE, 3Wilmer Eye Institute and Johns Hopkins Bloomberg    were found to have shallow anterior chamber during the immediate post-
School of Public Health, Baltimore, MD, UNITED STATES OF AMERICA, 4Moorfields      operative period. Six patients had grade I, 11 had grade II and 15 eyes
Eye Hospital and Institute of Ophthalmology, London, UNITED KINGDOM, 5Moorfields   had grade III shallow anterior chamber. Three eyes had a conjunctival

                                                                                                                                                                     POSTER ABSTRACTS
Eye Hospital, London, UNITED KINGDOM, 6Cole Eye Institute, Cleveland, OH, UNITED   leak and required resuturing. Twenty six eyes shallow AC with over-
STATES OF AMERICA                                                                  filtration. In 12 eyes of the anterior chamber became deep with pressure
                                                                                   patch for 24 hours and 6 eyes it deepened in 48 hours. Eight patients
Purpose: To image trabeculectomy blebs before and after laser suture               required AC reformation and bleb revision. In three eyes the AC failed to
lysis (LSL) using anterior segment optical coherence tomography                    reform even after two surgical attempts. These patients were sent home
(AS-OCT).                                                                          for two days and were asked to return to us after two days. At 2 days
Methods: This was a prospective observational study of patients who                follow-up all three of these eyes exhibited well formed anterior chamber
underwent LSL after trabeculectomy from August 2004 to August 2005.                with normal IOP. Four eyes had a slightly flat bleb, along with shallow
All blebs were imaged with a prototype of the AS-OCT (Carl Zeiss Meditec           anterior chamber. Ten eyes showed choroidal detachment on B-Scan
Inc, Dublin, CA, USA) before and after LSL. Standardized color mono-               Ultrasonography. One eye that had shallow AC with increased IOP showed
photographs of blebs were also obtained at each visit. Blebs were                  presence of hemorrhagic choroidal detachment.
assessed for the following qualitative features: bleb height, thickness of         Conclusions: Over-filtration is one of the common causes of shallow AC
the conjunctiva in the bleb wall, apposition of the scleral flap to underly-       following trabeculectomy. Almost half of such patients require AC refor-
ing sclera and patency of the internal ostium. High blebs were defined             mation and resuturing. Timely management of shallow AC may prevent
as total bleb height (TH) exceeding twice scleral thickness S (i.e. TH>2S),        long-term untoward sequelae.
moderate height blebs as S<TH<2S and low blebs as TH<S.
Results: 7 blebs in eyes of 7 patients were imaged. There were 4 men
(57.1%) and the mean age of patients was 66.0 ± 12.0 years. Pre LSL,              318-B118
5 blebs were low and 2 were of moderate height. After LSL, 6 out of 7              TRYPAN BLUE STAINING OF FILTERING BLEBS TO
eyes (85.7%) showed an increase in total bleb height. In these 6 eyes,             ASSESS TRABECULECTOMY FUNCTION DURING
the bleb wall thickness increased and the scleral flap was found to                PHACOEMULSIFICATION AND
have separated from sclera with the formation of a hyporeflective area             PHACOTRABECULECTOMY
between scleral flap and sclera, suggestive of an aqueous filled space. In
one eye, there was no discernable change in bleb height, cavity height or          T. DADA, S. MOHAN, A. AGGARWAL, R. GADIA, V. DAVE, V. GUPTA,
wall thickness.                                                                    R. SIHOTA
Conclusions: AS-OCT was able to demonstrate features of bleb mor-                  Glaucoma Research Facility, Dr. Rajendra Prasad Centre for Ophthalmic Sciences,
phology that changed after LSL. The results of this study support the              All India Institute of Medical Sciences, Ansari nagar, New Delhi, INDIA
potential use of AS-OCT in imaging blebs after trabeculectomy. *CR
                                                                                   Purpose: To report the use of trypan blue staining of filtering bleb to
                                                                                   assess filtration function in eyes with operated trabeculectomy under-
                                                                                   going phacoemulsification cataract surgery and during phacotrabeculectomy.
                                                                                   Methods: Seventeen eyes of 17 patients with operated trabeculectomy
                                                                                   and cataract undergoing phacoemulsification and ten eyes under-
                                                                                   going phacotrabeculectomy were included in the study. Trypan blue
                                                                                   (0.6 mg/ml) was used to stain the anterior capsule to aid visualization of

Asian J Ophthalmol. 2007 Vol 9 No 1 Supplement 1                                                                                                             127
Poster Abstracts

the anterior capsule prior to capsulorhexis. In eyes undergoing               320-B120
phacotrabeculecomy the dye injected into the anterior chamber after           RETROSPECTIVE EVALUATION OF COMBINED
closure of the scleral flap at the conclusion of surgery.                     PHACOEMULSIFICATION, LENS IMPLANTATION
Results: Four patterns of staining were observed. Diffuse staining of the     AND TRABECULECTOMY PERFORMED USING A
filtering bleb was seen in 7 eyes, patchy staining was seen in 5 eyes,        SINGLE SUPERIOR SITE BY A SINGLE SURGEON
minimal staining in 3 eyes and no staining in 2 eyes. Diffuse staining
occurred in eyes which had undergone trabeculectomy with Mitomycin C          V. NANGIA, A. MATIN, K. BHOJWANI, M. YADAV
and had intraocular pressure (IOP) ranging from 6-12 mmHg pre-                Suraj Eye Institute, Nagpur, INDIA
opoeratively. Eyes with patchy and minimal staining had IOPs ranging
from 14-18 mmHg, while no staining was seen in two cases with IOPs            Purpose: To study the pressure reducing efficacy of a superior, single
ranging from 18-22 mmHg (on timolol). Leakage of trypan blue was seen         site combine phacoemulsification, lens implantation and trabeculectomy
in all eyes undergoing phacotrabeculectomy and there was a diffuse            surgery performed on patients with glaucoma.
staining of the filtering bleb.                                               Methods: 51 eyes of 39 patients with a mean age of 65.08±8.48 years
Conclusions: Trypan blue staining during cataract surgery in eyes             underwent combined surgery of phacoemulsification, lens implantation
with filtering blebs and phacotrabeculectomy can be used to study the         and trabeculectomy performed using a single superior site by a single
patency of the trabeculectomy fistula and assess the amount of filtration.    surgeon. Fornix based conjunctival flap was used in all cases. A triangu-
This can aid in planning intra-operative bleb resuscitation in eyes with a    lar scleral flap was prepared for trabeculectomy. At its base a corneal
failing filtering bleb or intraoperative revision of scleral sutures during   tunnel was prepared for entry into anterior chamber for phacoemulsifi-
phacotrabeculectomy.                                                          cation. Foldable or rigid lens were used. Three sutures were given to the
                                                                              flap and one suture on either side of the base of the flap, when rigid lens
                                                                              was used.
319-B119                                                                      Results: The mean pre-op IOP was 26.25∑±11.61 mm Hg. mean follow
RESULTS OF TRABECULECTOMY PERFORMED                                           up was 172∑±207 days. Mean post-op IOP was 12.52∑± 4.4mm.Hg.
USING A 7 X 3 MM. FILTER PAPER SOAKED WITH                                    The mean reduction in IOP was 13.73mm.Hg. (52.3%) The mean number
MITOMYCIN-C                                                                   of pre-op medications were 1.05∑±1.04 and the mean number of post-
                                                                              op medications were 0.72∑±0.94.
V. NANGIA, A. MATIN, K. BHOJWANI                                              Conclusions: Analysis of data shows that single superior site combined
Suraj Eye Institute, Nagpur, INDIA                                            surgery is effective in achieving a significant reduction of intraocular
                                                                              pressure, as also the need for medications.
Purpose: To assess the pressure reducing efficacy of using a 7x3 mm.
Whatman filter paper moistened with mitomycin-C intraoperatively.
Methods: 22 eyes of 17 patients with a diagnosis of primary open angle        321-B121
glaucoma underwent trabeculectomy. A 7x3 mm. filter paper was held            BIMANUAL MICROINCISION CATARACT SURGERY
vertically and the two drops of mitomycin-C 0.4 mg/ml from a needle tip       COMBINED WITH TRABECULECTOMY AND
were applied to the smaller edge of the rectangle. The filter paper was       IMPLANTATION OF IOL THROUGH THE
placed on the scleral surface -with one long edge reaching the limbus -       TRABECULECTOMY FISTULA - A NEW TECHNIQUE
for 3 minutes intraoperatively. The conjunctiva-tenons layer was draped       FOR COMBINED SURGERY
over the filter paper.
Results: The mean pre-op IOP was 29.86±11.87 mm Hg. The mean                 T. DADA, A. AGGARWAL, S. MOHAN, R. MURALIDHAR, R. GADIA,
post op IOP was 10.85±5.7mm.Hg. A mean reduction in IOP of 19mm.             V. DAVE, V. GUPTA, R. SIHOTA
Hg (63%) was achieved. The mean follow up was 93±90 days. The                Glaucoma Research Facility, Dr. Rajendra Prasad Centre for Ophthalmic Sciences,
number of medicines used post operatively decreased from a pre-op             All India Institute of Medical Sciences, Ansari nagar, New Delhi, INDIA
average of 1.77±1.3 to 0.28±0.64.
Conclusions: Use of 7x3 mm. Filter paper soaked with 2 drops of               Purpose: To report a new technique for performing combined surgery -
mitomycin-C may be an effective means of increasing the pressure              bimanual microincision cataract surgery (MICS) combined with
reducing efficacy of trabeculectomy while standardizing and using a           trabeculectomy.
controlled and minimal dose of mitomycin-C. Limiting the dosage of            Methods: A fornix based conjunctival flap was created, Mitomycin C
mitomycin-C may help to reduce post operative complications associ-           sponges applied for 3 minutes (0.2 mg/ml), and a 5 x 5 mm scleral flap
ated with its use and enable improved judgment of the variable ocular         was dissected. Cataract surgery was performed from two clear corneal
response.                                                                     (1.2 mm) side ports using a bare phaco needle without its sleeve in the
                                                                              right hand and an irrigating sharp chopper in the left hand. Capsulorhexis
                                                                              was performed using a vitreo-retinal forceps and the nucleus was emul-
                                                                              sified with the hyperpulse mode of the phaco machine (50 pulses/second,
                                                                              duty cycle 30:70, power 40-60%, flow rate 35 cc/min and bottle height
                                                                              of 110 cm). After entering the anterior chamber with a 2.75 mm keratome
                                                                              under the scleral flap, a trabeculectomy fistula was created using
                                                                              a Kelly’s Descemet punch and an iridectomy performed. A hydrophobic
                                                                              foldable IOL (6 mm optic) was inserted into the capsular bag through this
                                                                              opening. The scleral and conjunctival flaps were then sutured back.
                                                                              Results: Seventeen eyes of 17 patients (7 with primary open angle
                                                                              glaucoma and 10 with chronic angle closure glaucoma and cataract) were

128                                                                                                 Asian J Ophthalmol. 2007 Vol 9 No 1 Supplement 1
                                                                                                                                 Poster Abstracts

operated. Mean preoperative IOP was 32.6 ± 6.8 mmHg. Mean post-                   323-B123
operative IOP was 12.8 ± 3.2 mmHg at 4 weeks and 14.6 ± 3.4 mmHg at               A STUDY ON THE CAPABILITY OF FREQUENCY
12 weeks follow up. All eyes obtained a best corrected visual acuity of           DOUBLING PERIMETRY IN THE DETECTION OF
20/40 or better at 3 months.                                                      VISUAL FIELD ABNORMALITIES IN PRIMARY OPEN
Conclusions: Bimanual MICS trabeculectomy with insertion of a foldable            ANGLE GLAUCOMA PATIENTS
IOL through the trabeculectomy fistula offers an alternative method
for combined surgery. This technique offers the advantage of smaller              A.J. NORFADZILLAH, S. BAKIAH
corneal incision for cataract removal, separate from the glaucoma filter          Medical Health Campus, Universiti Sains Malaysia, Kubang Kerian Kelantan,
and without the need for the surgeon to change position during surgery.           MALAYSIA

                                                                                  Purpose: To determine the capability of Frequency Doubling Perimetry
322-B122                                                                          (FDP) in the detection of visual field abnormalities in Primary Open Angle
CORRELATION OF STRUCTURE AND FUNCTION OF                                          Glaucoma (POAG) patients.
THE OPTIC NERVE USING HUMPHREY MATRIX 24-                                         Methods: A prospective, comparative cross sectional study which took
2 PERIMETRY, STANDARD AUTOMATED                                                   place in eye clinic Hospital Universiti Sains Malaysia. One eye of 129
PERIMETRY AND NERVE FIBER LAYER ANALYSIS                                          patients POAG patients was studied. Eyes were examined with FDP in
WITH SCANNING LASER POLARIMETRY IN                                                both screening mode (N-30-5) and threshold mode (30-2) and Humphrey
PRIMARY OPEN ANGLE GLAUCOMA                                                       Field Analyzer (HVF) 30-2. Severity of visual field defect was classified
                                                                                  using Glaucoma Scoring system 2 (GSS2) for both FDP in threshold mode
T. DADA, S. KUMAR, R. GADIA, A. AGGARWAL, A. SHARMA,                              and HVF. FDP in screening mode was defined as abnormal when at
G. SRINIVASAN, V. GUPTA, R. SIHOTA                                                least one missed point. The sensitivity, specificity and receiver operating
Glaucoma Research Facility, Dr. Rajendra Prasad Centre for Ophthalmic Sciences,   characteristic (ROC) curve were evaluated.
All India Institute of Medical Sciences, Ansari nagar, New Delhi, INDIA           Results: For FDP in screening test, the sensitivity was 92.4% and
                                                                                  specificity was 54.2% with value under the ROC curve was 76.5% for
Purpose: To study the correlation between Humphrey matrix 24-2 thresh-            abnormal visual field classified by GSS2. In FDP threshold mode, the
old strategy (Matrix), standard automated perimetry 24-2 SITA-strategy            sensitivity was 98.1% and specificity was 37.5% with value under the

                                                                                                                                                                POSTER ABSTRACTS
(SAP) and nerve fiber layer thickness parameters using scanning laser             ROC curve was 67.8%.
polarimetry with variable corneal compensation.(GDxVCC).                          Conclusions: Frequency Doubling Perimetry, which is rapid and easily
Methods: In this cross-sectional observational study, 60 eyes with POAG           administered is effective in detecting visual field abnormalities in POAG
suspect (suspicious disc, normal fields SAP) and 25 eyes with early to            patients.
moderate POAG (glaucomatous disc changes and visual field defects on
SAP and Matrix) were evaluated on Matrix and SAP using the 24-2 strategy,
and GDxVCC. Global indices (MD, PSD) were used for comparison of visual           324-B124
fields. TSNIT average thickness and NFI on GDxVCC were correlated with            THE IMPACT OF LENS OPACITY ON MULTIFOCAL
global indices of the perimetric tests. All eyes had visual acuity better         VISUAL EVOKED POTENTIALS AND HUMPHREY
than 6/9 with correction, refractive error of less than ±5D sphere and            VISUAL FIELD IN GLAUCOMA PATIENTS
±3D cylinder with no media opacities and normal pupils.                           UNDERGOING CATARACT EXTRACTION
Results: Mean age of patients was 55.6 ± 7.3 yrs and 58.6 ± 6.4 yrs in
POAG suspect and POAG group respectively. In POAG suspect, mean MD                C.S. TAN1, C. YU2, B.A. LIM1, F. OEN2, P.T.K. CHEW3
and PSD by SAP vs. Matrix were -2.58±1.89 vs.-3.48±3.50 and 2.02±                 1
                                                                                   The Eye Institute, Singapore, SINGAPORE, 2Singapore National Eye Centre,
1.05 vs.3.28±0.75 respectively. There was a statistically significant             Singapore, Singapore, 3National University Hospital, Singapore, SINGAPORE
difference in both MD and PSD of SAP and Matrix (p<0.001, (p=0.047). In
POAG group, mean MD and PSD by SAP vs. Matrix were -7.31 ± 4.29 vs.               Purpose: To assess the impact of lens opacity on the Accumap severity
-7.73 ± 3.76 and 6.28 ± 4.26 vs.5.65 ± 2.63 respectively. In this group           index (ASI) for multi-focal visual evoked potentials (MFVEP) in patients
there was no significant difference in the MD and PSD using any of the            with glaucoma undergoing cataract surgery and to correlate ASI with the
two techniques of perimetry. By GDxVCC, mean NFI of POAG suspect and              mean deviation (MD) and pattern standard deviation (PSD) of the Humphrey
POAG were 23.89 ± 12.68 and 40.35 ± 19.22 while mean TSNIT average                visual field (HVF).
were 52.42 ± 11.11 and 46.2 ± 6.30 respectively. NFI and TSNIT aver-              Methods: In a prospective, non-randomized study, patients with glau-
age between two groups were significantly different (p=0.001). There              coma had MFVEPs and HVFs performed both before and after cataract
was a significant negative correlation in POAG patients between MD of             extraction with intraocular lens implant. The pre- and postoperative ASI,
both SAP and Matrix with NFI (p= 0.012 and 0.005 respectively) and a              MD and PSD were compared and correlated, and the differences between
significant positive correlation between MD of both SAP and Matrix with           pre- and postoperative ASI, MD and PSD were analyzed.
TSNIT average (p= 0.008 and <0.001 respectively).                                 Results: Of the 22 patients, 13 (59.1%) had primary open angle
Conclusions: There is a good correlation between Humphrey matrix                  glaucoma and 9 (40.9%) had angle-closure glaucoma. Eight patients
perimetry, standard achromatic perimetry and scanning laser polarimetry.          (36.4%) underwent phacoemulsification only while 14 (63.6%) had
POAG suspects may be monitored using Humphrey matrix perimetry and                phacoemulsification and trabeculectomy. The ASI decreased from a mean
GDxVCC.                                                                           of 90.1 (± 54.8) preoperatively to 43.1 (± 36.6) postoperatively
                                                                                  (P<0.001). The MD increased from -12.2 (± 7.8) to -9.6 (± 8.8)
                                                                                  postoperatively (P<0.001). There was no significant difference between
                                                                                  the preoperative and postoperative PSD (6.5 vs. 6.3, P=0.748).
                                                                                  Preoperatively, the ASI and MD were well correlated (Pearson correlation

Asian J Ophthalmol. 2007 Vol 9 No 1 Supplement 1                                                                                                        129
Poster Abstracts

-0.519, P=0.013). Likewise, the postoperative ASI correlated well with         327-B127
the MD (Pearson correlation -0.599, P=0.004). However, there was no            VESICAN AND FIBRELLIN-1 FORM A MAJOR
correlation between either the pre or postoperative ASI and PSD (P=0.          HYALURONAN-BINDING COMPLEX IN THE CILIARY
763 and 0.114 respectively).                                                   BODY OF CHICK
Conclusions: Glaucoma patients who undergo cataract extraction dem-
onstrate significant decrease in the ASI and improvement in the MD. Both       A. OHNO-JINNO1, Z. ISOGAI2, M. YONEDA3, T. KATAOKA1, M. IWAKI1,
the pre- and postoperative ASI correlates significantly with the respective    M. ZAKO1
MD, and may be useful in monitoring of glaucoma progression.                   1
                                                                                Aichi Medical University, Aichi-gun, JAPAN, 2National Center for Geriatrics and
                                                                               Gerontology, Aichi, Japan, 3Aichi Prefectural College of Nursing and Health, Nagoya,
BLOOD AQUEOUS BARRIER AND POSTERIOR                                            Purpose: To examine whether versican interacts with fibrillin-1 in the
CAPSULAR OPACIFICATION                                                         ciliary body and zonules binds to hyaluronan.
                                                                               Methods: The mRNA expression levels of versican and fibrillin-1 were
S. CHOWDHURY, A. PATTANAYAK                                                    analyzed by RT-PCR, while their protein levels were evaluated by
Bokaro General Hospital,India, Bokaro Steel City,Jharkhand,India, INDIA        immunohistochemistry. Isolation of versican with fibrillin-1-containing
                                                                               microfibrils from ciliary bodies was performed by extraction studies. Dot
Purpose: Postoperative inflammation is a known contributory factor             blot analyses and rotary shadowing electron microscopy were applied to
in posterior capsular opacification. Ocular inflammatory response was          identify versican associated with fibrillin-1-containing microfibrils after
studied by measuring microprotein levels in aqueous.                           gel filtration chromatography and density gradient centrifugation.
Methods: Aqueous tap was done during needling for PCO in 25 secondary          Results: Co-expression of all veriscan isoform and fibrillin-1 in ciliary
cataracts. Equal number of age and sex matched cataract surgical cases         body was confirmed by RT-PCR analysis. Immunohistochemical staining
were taken as controls.                                                        using the antibodies showed co-localization of versican, fibrillin-1 and
Results: Aqueous microprotein level was found to be higher in “after           hyaluronan in the ciliary body. Dot blot analyses revealed that the frac-
cataract” cases.                                                               tions around 1.29 g/ml reacted with antibodies against versican and
Conclusions: This inexpensive method to study ocular inflammatory              fibrillin-1 and hyaluronan. we visualized the beads and strings structure
response was found to be helpful in prevention of posterior capsular           representing microfibrils by electron microscopy after rotary shadowing.
opacification by using NSAIDs in all cases of Grade 1 PCO.                     Conclusions: We found that both versican and fibrillin-1 were expressed
                                                                               in the ciliary body, and that versican was securely bound to fibrillin-1-
                                                                               containg microfibrils as a major hyaluronan-binding structure in the
326-B126                                                                       ciliary body.
PROFILE IN RABBIT AQUEOUS HUMOR                                                328-B128
                                                                               EFFECT OF INTRAVITREAL 8-ISOPGF2α ON RABBIT
K.O. CHU, T.C. K. HO, D.S.C. LAM, C.P. PANG                                    ANTERIOR UVEA CATECHOLAMINES, IN VIVO
The Chinese University of Hong Kong, Hong Kong, HONG KONG
                                                                               C.A. OPERE1, H. LIU2, M. ZHAO1, C.J. DESTACHE1, G. ZHAN2, S.E. OHIA3
Purpose: We developed a method using GC-NCI-MS to determine triam-             Creighton University, Omaha, NE, 2University of Nebraska Medical Center, Omaha,

cinolone acetonide (TAA) in aqueous humor (AH) of rabbits following            NE; 3University of Houston, Houston, TX, UNITED STATES OF AMERICA
inntravitreal injection and subconjunctival injections of TAA.
Methods: TAA, 12 mg, was injected intravitreally into each rabbit eye,         There is evidence that isoprostanes can regulate sympathetic
while 4 mg and 12 mg were injected subconjunctivally. Aqueous humor            neurotransmission in isolated bovine irises in vitro (Opere et al., Free
were sampled on days 0, 1, 7 10, 14 and 21, with determination of              Rad Res. 35:2001). It is, however, unclear if isoprostanes can regulate
intraocular pressure (IOP). Aqueous humor mixed with TAA-D7 internal           the release of endogenous catecholamines from mammalian anterior uvea,
standard were spiked into 2 ml ethylacetate/water mixture (1:1) for ethyl      in vivo.
acetate extraction followed by acetylation by acetic anhydride and pyridine,   Purpose: To determine the effect of intravitreally injected 8-isoprostaglandin
and then derivatization by BSTFA. Sample molecules were dissolved in           (PG)F2α on endogenous catecholamine levels in the aqueous humor and
dodecane for injection into GCMS.                                              iris-ciliary bodies (ICB) in rabbits, in vivo.
Results: Only BSTFA at 70 [[Unsupported Character - &#1618;]]C for             Methods: Albino rabbits (New Zealand strain; 2 kg) were sedated with
20 min gave single acetyl-TMS derivative. Other silylating reagents gave       intramuscular ketamine and xylazine, then injected intravitreally with
many TMS forms. Method was validated on detection limit, linearity,            8-isoPGF2α. Control eyes received an equal volume injection of vehicle.
reproducibility, recovery and selectivity. Elimination rate constant, K, and   After four hours, animals were sacrificed painlessly with CO2 gas. Aque-
half life, t1/2, were 0.06 ± 0.02 and 12.3 ± 3.8 days respectively. No         ous humor and ICB were isolated for measurement of catecholamine and
correlation was found between TA concentration in AH and IOP.                  serotonin levels and their metabolites using high pressure liquid chroma-
Conclusions: We have developed a validated method to measure trace             tography with electrochemical detection. DHBA was used as the internal
amounts of TAA in aqueous humor and adequate for pharmacokinetic               standard to integrate peak area of neurotransmitters.
analysis. Non compartmental behavior was found with elimination rate at        Results: In the ICB, 8-isoPGF2α (0.1µM and 10µM) attenuated dopamine
0.06 ± 0.02 and half life at 12.3 ± 3.8 days. In this study no association     levels by 80.45% (p<0.05) and 32.43% (p>0.05), respectively. Similarly,
was found between TAA concentration in aqueous humour and IOP in the           the catecholamine metabolites, 3,4-dihydroxyphenylacetic acid (DOPAC)
rabbits.                                                                       and homovanillic acid (HVA) were attenuated by the isoprostane. For

130                                                                                                  Asian J Ophthalmol. 2007 Vol 9 No 1 Supplement 1
                                                                                                                             Poster Abstracts

instance, 8-isoPGF2α (0.1 µM and 10 µM) decreased DOPAC levels by            serous retinal detachment. BCVA reduced to Hand Movements. However,
81.35 % (p<0.001) and 8.39%, respectively. Although serotonin was not        at 16 weeks subfoveal fluid had nearly disappeared on OCT and BCVA
detected in the ICB, the concentration of its metabolite, 5-hydroxyindole    improved to 6/36.
acetic acid (HIAA) was by decreased by 83.49% (p<0.05) at 0.1µM con-         Conclusion: Preoperative administration of IB helps to reduce the florid
centration of 8-isoPGF2α. Interestingly, 8-isoPGF2α (10 µM) enhanced HIAA    vascularity in advanced cases of PDR with fibro-vascular proliferations
levels by 33.3%. In the aqueous humor, 8-isoPGF2α (0.1 µM and10 µM )         before PPV . The surgery becomes easier with more complete dissection.
had no significant effect on dopamine levels while its metabolite, DOPAC     We did not observe any effects of Bevacizumab on the posterior capsule
was attenuated by 88.41 % (p<0.001) and 90% (p<0.001), respectively.         opacification and IOL material after 3 months.
The serotonin metabolite, HIAA was also attenuated by 99.04% (p<0.01)
at 10 µM concentration of 8-isoPGF2α. In general, changes induced by
intravitreal injections of 8-isoPGF2α on catecholamine levels was more       330-B130
prominent at the lower concentration of 8-isoPGF2α in the ICB.               MICROBIAL CONTAMINATION OF MULTIPLE DOSE
Conclusion: We conclude that exogenously administered isoprostanes           APPLICATION BEVACIZUMAB (AVASTIN®)
can modulate anterior uveal catecholamine concentrations in rabbits,
in vivo.                                                                     K.K. PEH, R. GUPTA, M.A.R. AWAN, Y.C. YANG
                                                                             Wolverhampton & Midland Counties Eye Infirmary, Wolverhampton,
                                                                             UNITED KINGDOM
COMPARISON OF PRE-OPERATIVE INTRAVITREAL                                     Purpose: We aim to examine the feasibility of preparing multiple dose
BEVACIZUMAB COMBINED WITH PARS PLANA                                         applications of 1mL tuberculin syringes in a clinical setting by investigat-
VITRECTOMY AND IOL IMPLANTATION AS A                                         ing the sterility of individual aliquots immediately after the multiple dose
COMBINATION PROCEDURE COMPARED TO PARS                                       applications are drawn up and after 24 hours of storage. 2 methods are
PLANA VITRECTOMY WITH IOL IMPLANTATION                                       proposed.
ALONE IN PROLIFERATIVE DIABETIC                                              Methods: Two 4ml (25mg/ml) single use vials of Bevacizumab (Avastin®)
RETINOPATHY                                                                  were prepared by two methods to potentially treat 20 patients (per vial);
                                                                             each with 4mg/0.2ml. 10 samples per method (Group 1) were immedi-

                                                                                                                                                            POSTER ABSTRACTS
A. AURORA, D. GREWAL, S. GREWAL                                              ately inoculated into Robinson’s Cooked Meat broth and incubated for 48
Grewal Eye Institute, Chandigarh, INDIA                                      hours prior to inoculation onto Blood agar and Chocolate agar plates and
                                                                             10 samples per method (Group 2) were stored for 24 hours at room tem-
Purpose: To report 3 patients of which 2 were administered Intravitreal      perature within the sterile preparation room prior to culture inoculation.
Bevacizumab (IB) as a pre-operative adjunct and subsequently under-          Method 1: An 18G BD® Blunt Fill filter (BD, Franklin Lakes, USA) was
went combined phacoemsulfication, IOL implantation and posterior seg-        attached to a single use vial of Bevacizumab (Avastin®). A 25G needle
ment extensive membrane surgery. One eye of 1 patient underwent              was also inserted as a vent. 20, 0.2ml samples were drawn by attaching
preoperative IB 1 week before Vitreous surgery and subsequently Silicon      consecutive1 ml tuberculin syringes to the filter needle.
oil Removal (SOR), Phacoemulsification, IOL implantation and repeat IB.      Method 2: 1ml of ambient air was drawn into 20 1 ml tuberculin syringes
Methods: 2 eyes of 2 patients with advanced proliferative diabetic retin-    via separate air filters (PALL® PharmAssure® 25 mm syringe filter with
opathy (PDR) with Tractional/combined mechanism retinal detachment           1.2 µm Supor® membrane). An 18G filter needle was attached to a 10ml
and immature senile cataract precluding good surgical view of retina,        syringe and 4ml of Bevacizumab was drawn up against vacuum. 20
underwent preoperative IB 1 week before a combined procedure of              consecutive samples were then prepared by removing the air filter and
Phacoemulsification, foldable Acrylic IOL implantation, Pars plana           injecting 0.2ml of Bevacizumab into each tuberculin syringe.
Vitrectomy (PPV), silicone oil injection (SOI) and laser photocoagulation.   Results: Using Method 1, there were no contaminated samples from Group
One eye of 1 patient underwent preoperative IB 1 week before Vitreous        1(n=9). After 24 hours storage and subsequent incubation and inocula-
surgery and SOI and subsequently SOR, Phacoemulsification IOL implan-        tion onto growth media, Group 2 samples (n=10) also returned no growth.
tation and repeat IB. All eyes were followed for a period of 4-6 months.     With Method 2, there were no contaminated samples from Group 1 (n=10)
At the last follow-up retina was well attached, IOL was clear and            and Group 2 (n=10).
well centered and vision had increased from PL+, PR accurate/ HMCF to        Conclusions: Following a case report in 2005, intravitreal Bevacizumab
20/200- 20/60.                                                               injection has been used increasingly as off-label treatment for Choroidal
Results: 47 year male presented with BCVA in RE of FC at 1-metre and         Neovascularization (CNV) secondary to age-related macular degenera-
in LE at 2 meters. He had earlier undergone PPV with removal of lens         tion (AMD), as well as other ocular angiogenic pathology. It is available in
and SOI in RE. Retina in RE was partially attached and had subretinal        single-use vials, but contains enough volume to provide multiple doses
hemorrhage. In the LE, IB was administered and after 1 week was taken        for multiple patient treatments. The sterility of aliquots extracted in this
up for PPV, extensive membrane surgery, SOI and laser photocoagulation.      study provides an indication of the safety of drawing up multiple aliquots
3 months after surgery BCVA was 20/100, macula and rest of retina            from a single use vial, and storing them for up to 24 hours. Understand-
were flat. A 53-year-old male, presented with BCVA of CF 1 foot in LE and    ing some of the safety issues surrounding the drug preparation could
no PL in RE. Fundus examination of LE revealed a vitreous hemorrhage         pave the way to designing trials of intravitreal Bevacizumab administration.
with TRD. IB was administered in LE and 1 week later patient was taken       *CR
up for PPV, extensive membrane surgery, laser photocoagulation and SOI.
He received second IB at end of fluid air exchange. At 7-Weeks, BCVA in
LE improved to 6/60. Macula was on, with a stable retina. At 12 weeks,
BCVA was stable at 6/60. SOR, Endolaser with Phacoemulsifcation and
IOL implant were performed. Post-surgery patient developed a central

Asian J Ophthalmol. 2007 Vol 9 No 1 Supplement 1                                                                                                    131
Poster Abstracts

331-B131                                                                         assessment whether the
SMOOTH EXTUBATION IN PATIENTS WITH                                               Conclusions: This instrument is very simple, inexpensive, portable and
HYPERACTIVE AIRWAYS AFTER INTRAOCULAR                                            easy to use to diagnose and assess endopthalmitis as well as vitreous
SURGERY: DIFFUSION OF LIDOCAINE BUFFERED                                         hemorrhage.
VIVO STUDY                                                                       333-B133
                                                                                 THE INCIDENCE AND CHARACTERISTICS OF
B. INDERMOHAN, V. JAGADEESH                                                      RETINOPATHY IN PATIENTS WITH CHRONIC
Sankara Nethralaya, Chennai, INDIA                                               HEPATITIS C: A PROSPECTIVE STUDY

Purpose: To determine the optimal pH to maximize diffusion of lidocaine          C.K. CHENG, C.H. PENG
across the endotracheal tube(ETT) cuff and also to assess the in vivo            Shin Kong Wu Ho-Su Memorial Hospital, Taipei, TAIWAN
effect of diffused lidocaine on cough receptors, for smooth extubation in
patients with hyperactive airways undergoing eye surgery under general           Purpose: To determine the incidence and characteristics of retinopathy
anesthesia.                                                                      associated with the use of pegylated interferon (PEG-IFN) alpha-2a in
Methods: For in vitro study fifteen 8.0mm ID portex ETT were divided             patients with hepatitis C.
into three groups. In each group the cuffs were filled with 6ml of 2%            Methods: All participants with chronic hepatitis C and absence of
lidocaine buffered to a pH of 7.4 (Gr I), 7.6 (Gr II) and 7.8 (Gr III). They     diabetic mellitus underwent best-corrected visual acuity testing, slit-lamp
were immersed in 20ml of distilled water in a water bath at 380C. The            examination, indirect ophthalmoscopy and color fundus photography
lidocaine diffused was measured using high performance liquid chroma-            at baseline and 4-week intervals of PEG-IFN treatment up to 6 months.
tography every half hour for up to five hours. To evaluate the in vivo effect,   Optical coherence tomography was evaluated at baseline, month 1, 3, 6.
75 patients either with history of chronic smoking or recently treated           Results: Between July 2005 and August 2006, 28 eyes of 14 patients
RTI, were randomly divided into 3 groups based on the ETT cuff filling as:       were examined after the establishment of diagnosis of hepatitis C. 14
Gr A (Air), Gr B (Saline) and Gr C (Buffered lidocaine, pH 7.40+0.01). Dur-      (50%) eyes developed retinopathy, which consisted of single-to-multiple
ing extubation, a second blinded anesthetist graded the smoothness of            cotton-wool exudates (100%) and retinal hemorrhage (64.3%), and was
extubation as: Grade 0 - No cough, Grade 1 - coughing for <15 secs and           transient in all cases. Mean time of retinopathy development after initia-
Grade 2 - coughing for >15secs.                                                  tion of PEG-IFN treatment was 2.1 months.
Results: Maximum diffusion occurred in both the Groups I (863.94+ 5.08           Conclusions: The incidence of retinopathy associated with the use PEG-
µg/ml) and Group II (856.88 + 22.82µg/ml). Extubation was smooth in Gr           IFN in patients with hepatitis C was high, but this form of retinopathy was
C compared with Gr B and Gr A patients,(P<0.0001).                               relatively benign. Regular ophthalmic monitoring should be performed in
Conclusions: Filling the ETT cuff with 6ml of 2% lidocaine + 0.5ml of            patients undergoing PEG-IFN therapy.
7.5% Sodium bicarbonate causes adequate diffusion of the uncharged
base form across the hydrophobic PVC walls of the cuff, blocking the
cough receptors and thus facilitating smooth extubation in patients with         334-B134
hyperactive airways after intraocular surgery.                                   MEWDS - A DISEASE OF THE INNER OR OUTER

332-B132                                                                         J.Y.C. CHENG, S.P. CHEE, I.Y.S. YEO, C.D. LUU
DIGITAL OCULAR MEDIAMETRY - A NEW CONCEPT                                        Singapore National Eye Centre, Singapore, SINGAPORE

M. GUPTA1, Y. GUPTA2                                                             Purpose: To describe the electrophysiological findings in patients with
JN Medical College, Aligarh, UP, India, INDIA, 2Institute of Ophthalmology, JN   Multiple Evanescent White Dot Syndrome (MEWDS) showing evidence
Medical College, Aligarh, UP, India, INDIA                                       of inner followed by outer retinal involvement, which is contrary to the
                                                                                 current belief.
Purpose: Design and Use of a ‘ Digital Ocular Mediameter’.                       Methods: The retinal function of three subjects with MEWDS was inves-
Methods: We have designed an Ocular Mediameter, where a light sensi-             tigated using full-field electroretinogram (ERG), multifocal ERG (mfERG)
tive sensor (LDR) is placed on the cornea and adjoining sclera during the        and multifocal oscillatory potentials (mfOPs). Signals were recorded
process of transillumination. We can thus record the trans-corneal and           using DTL electrodes. The photopic ERG and mfERG were used to assess
trans-scleral light transmittance objectively. These recordings are made         the outer retinal function. The inner retinal function was determined by
with white, red and green lights of appropriate wavelengths produced by          the oscillatory potentials of the ERG and mfOP.
interposing pure filters on the light source.                                    Results: In 1 patient, the photopic ERGs of the two eyes were very simi-
Results: In normal eyes, the transmittance recorded with these three             lar but the amplitude of the OPs was markedly reduced in the affected
lights is more or less in the same range. In cases of vitreous hemorrhage        eye. In the other 2 patients, the photopic ERGs were grossly reduced in
the white and red light pass through the vitreous but the green wave-            amplitude and as expected the OPs were also diminished. However, the
length gets absorbed by the blood resulting in a very poor transmittance         reduction of the OPs in these 2 cases may be associated with the pres-
of green light. These differential light transmittance readings with             ence of outer retinal dysfunction. With the use of the mfERG, a residual
different lights can be used to diagnose endopthalmitis as well as               area of “normal” retinal function in the affected eye was identified. The
vitreous hemorrhage even in the presence of a cataract or an opaque              local OP (mfOP) within the residual “normal” retinal area was reduced as
cornea. Repeated recordings at regular intervals can give an accurate            compared to the corresponding retinal area of the fellow unaffected eye.

132                                                                                                  Asian J Ophthalmol. 2007 Vol 9 No 1 Supplement 1
                                                                                                                                     Poster Abstracts

The mfERG responses of the “normal” retinal area were subsequently               12.72 (by 30 nmol) {diagram1} and in the second week 5.46(by 10nmol),
diminished.                                                                      28.65 (by 20nmol) and 55.49% (by 30nmol) {diagram2} decrease of
Conclusions: The reduction of the OPs in the area where the outer retinal        b wave was seen.
function is initially normal and the fact that this normal outer retinal area    Conclusions: Increasing the daunorobicine dose frome10 to 20, the
subsequently becomes abnormal suggest that the inner retina may be               decrease of b wave is increased from 5 to 28% and with 30 nanomole
affected prior to the outer retina in MEWDS.                                     increased to 56% that showed the 30 nm would be toxic for the retinal

RETINAL OSCILLATORY POTENTIALS IN ADULTS                                         337-B137
AND CHILDREN WITH MYOPIA                                                         PULSATILE OCULAR BLOOD FLOW IN CENTRAL
                                                                                 SEROUS CHOROIDORETINOPATHY
Singapore Eye Research Institute, Singapore, SINGAPORE                           R. GADIA, V. GUPTA, H.K. TEWARI, P. VENKATESH, S. GARG
                                                                                 Dr. Rajendra prasad Centre for Ophthalmic Sciences, All India Institute of Medical
Purpose: To examine the relationships between the severity of myopia             Sciences, New Delhi, INDIA
and the oscillatory potential (OP) parameters in adults and children
with myopia.                                                                     Purpose: To evaluate pulsatile ocular blood flow (POBF) in eyes with Central
Methods: Sixteen adults and 20 children with various degrees of myopia           Serous Choroidoretinopathy (CSCR) as choroidal hyperpermeability is a
underwent full-field electroretinogram testing using the Espion system.          known factor in pathology of the disease and also it has been seen that
Oscillatory potentials were recorded using DTL electrodes after 20 min-          patients with CSCR exhibits dysfunction of autonomic nervous system
utes of dark adaptation. Pupils were dilated to at least 7mm with 1%             in the form of higher sympathetic tone of autonomic nervous system in
Tropicamide. The oscillations of the OPs were modeled in the time                comparison to normal age matched controls.
domain by a Gabor function (the multiplication of Gaussian envelope with         Methods: Pulsatile ocular blood flow was measured using principle of
a sine wave carrier). The Gabor function describes the OPs in the time           pneumotonometry in 90 eyes of 45 patients with one eye having active
domain by their maximum amplitude, time to peak, spread, frequency               CSCR other eye clinically normal in each patient. Simultaneous intraocular

                                                                                                                                                                      POSTER ABSTRACTS
and phase lag.                                                                   pressure (IOP) and axial length (AL) were also recorded.
Results: None of the OP parameters were significantly associated with            Results: Mean age of the patients was 35.6 ± 4.8 years. There were 41
the severity of myopia either in the adults or children group. However,          males and 4 females. Mean POBF was 1178 ± 357µl and 1115 ± 326µl
there was a significant difference in the peak time of the OP between the        in CSCR and normal eyes respectively. Respective mean IOP (mm of Hg)
adults and children (p=0.0002). Other OP parameters were not found to            and mean axial length (mm) were comparable. The mean values of IOP
be significantly different between the two groups studied.                       (mm of Hg) were 13 ± 4.1 and 14 ± 4.3 and mean axial length (mm)
Conclusions: Significant difference in OPs between the adults and chil-          were 22.8 ± 0.6 and 22.8 ± 0.5 in CSCR and Normal eyes respectively.
dren was found in this study but only limited to the peak time parameter.        The regression analysis for correlated data using generalized estimating
It is postulated that the peak time difference between adults and children       equation by taking IOP and AL as co-variants was used. There was no
may be associated with myopia progression. A cohort study is needed to           significant difference in POBF between the two eyes (p=0.6) whereas
validate this hypothesis.                                                        IOP was negatively correlated with POBF (partial correlation of -64.5)
                                                                                 (p=0.0001) and negative correlation of POBF with AL (partial correlation
                                                                                 of -117.2) (p=0.065) was found.
336-B136                                                                         Conclusions: Pulsatile ocular blood flow, which represents choroidal
INVESTIGATION OF RETINAL TOXICITY OF                                             blood flow predominantly, is same in both eyes of patients with clinical
DAUNOROBICINE IN RABBITS BY                                                      unilateral active CSCR.

F. GHASEMZADEH, M. KHALILI                                                       338-B138
Prof. Assistant, Zahedan, ISLAMIC REPUBLIC OF IRAN                               L-CYSTEINE INDUCED RELAXATIONS OF ISOLATED
                                                                                 PORCINE IRIDES: ROLE OF HYDROGEN SULFIDE
Purpose: Investigation of retinal toxicity of daunorobicine in rabbits by
Electrophysiology.                                                               S.E. OHIA1, C.A. OPERE2, E.M. MONJOK1, G.E. KOUAMOU1, M.L.G. MCKOY3
Methods: Experimental intravitreal injection with 3 doses of 10, 20 and          1
                                                                                  University of Houston, Houston, TX, UNITED STATES OF AMERICA, 2Creighton
30 nanomole for evaluating the toxic effect of daunorobicine is done in          University, Omaha, NE, 3University of the West Indies, Kingston, JAMAICA
one of the eye of 10 albino rabbit each weighting nearly 1-2 Kg for each
dose was selected. In addition in 10 rabbit only the BSS (Balanced Salt          Evidence from our laboratories demonstrates that hydrogen sulfide (H2S)
Solution) was injected to remove the effect of injection or pressure. Injec-     donors such as sodium hydrosulfide (NaHS) can produce relaxations of
tion was done after local anesthesia with tetracaine drops and speculum          porcine iris smooth muscles and that this effect is partly mediated through
insertion for lid opening from 2mm of the limbus in the supero temporal          KATP channels (Monjok et al., IOVS 46: E-Abstract 3684, 2005.). The exact
area of globe. Before injection and first and second week after the injection,   role of H2S in mediating relaxation of this smooth muscle is yet to be
ERG (Electroretinogram) was done.                                                determined.
Results: Toxicity is measured from the b wave amplitude decrease in all          Purpose: We investigated the direct relaxant effect of L-cysteine, a
4 groups before and after the injection. The changes of b wave in the first      substrate for the production of H2S from the enzymatic actions of cys-
week after injection were as order 0.96 (by 10 nmol), 3.66 (by 20 nmol),         tathionine γ-lyase and cystathionine β-synthase on carbachol-induced

Asian J Ophthalmol. 2007 Vol 9 No 1 Supplement 1                                                                                                              133
Poster Abstracts

contractions in isolated porcine irides. Furthermore, we studied the role             subtends an angle of 35 to 40 degrees to the previous optic. An air bubble
of intramural generation of H2S and prostanoids in the effects caused by              is entrapped within the material of the sphere at the top which floats
L-cysteine in this tissue.                                                            in the eye fluids and being a part of the optic sphere maintains it in a
Methods: Isolated porcine iris muscle strips were set up in organ baths               vertical position irrespective of the position of the eyes. The sphere is
containing oxygenated Krebs buffer solution at 37°C. Longitudinal iso-                mounted onto a haptic by two horizontal pivot joints which allow vertical
metric tension was recorded via a grass FT03 Force-displacement Trans-                swiveling movements between the optic and haptic. The direction and
ducers and analyzed using the PolyView computer software. An initial                  extent of movements is controlled by miniature locks built into these pivot
load of 150 mg was placed on each tissue after which they were allowed                joints. On distant gaze the visual axis passes through the superior optic.
to equilibrate for one hour. The relaxant action of L-cysteine on carba-              When the eye moves downwards by 30-40 degrees as for conventional
chol-induced tone was studied in the absence and presence of inhibitors               near vision the optic sphere remains vertical by virtue of the entrapped
of cystathionine γ-lyase (propargylglycine, PAG) and cystathionine                    air bubble, thus realigning the visual axis through the near optic. This
β-synthase (aminooxyacetic acid, AOA) and cyclooxygenase (flubiprofen).               behaves like a bifocal spectacle. This IOL was tried in model eyes.
Results: L-cysteine (30 nM - 1 mM) produced concentration-dependent                   Results: The IOL swiveling action was perfect in all model eyes.
relaxations of carbachol-induced tone. Inhibition of cyclo-oxygenase with             Conclusions: The swiveling bifocal IOL holds tremendous promise as a
flurbiprofen (3 µM) produced significant (P < 0.001) enhancement of                   future IOL.
relaxations induced by L-cysteine. In the presence of flurbiprofen, the
inhibitor of cystathionine β-synthase, AOA (30 µM) caused significant
(P < 0.001) rightward shifts in the concentration-response curves to                  341-B141
L-cysteine and attenuated the maximum inhibitory response. Interestingly,             A MEDIA SWITCHING BIFOCAL INTRA-OCULAR
the inhibitor of cystathionine γ-lyase, PAG (1 mM) only blocked relaxa-               LENS IMPLANT- PROTOTYPE
tions caused by high concentrations of L-cysteine (> 100 µM).
Conclusions: The observed inhibitory action of L-cysteine in isolated                 Y. GUPTA1, M. GUPTA2
porcine irides is dependent on endogenous biosynthesis of H2S catalyzed               1
                                                                                       Institute of Ophthalmology, Aligarh Muslim University, Aligarh, India, 2JN Medical
by cystathionine γ-lyase and cystathionine β-synthase. Furthermore,                   College, Aligarh Muslim University, Aligarh, INDIA
prostanoids are involved in the inhibitory action of L-cysteine in this tissue.
                                                                                      Purpose: A new concept in bifocal IOL technology.
                                                                                      Methods: This IOL consists of a coaxial plano-convex lens combination.
339-B139                                                                              The anterior half dumbbell shaped lens, with its convex surface placed
PRESBYOPIA AND PRESBYCUSIS? CAN THEY BE                                               anteriorly, has a power of 20 D within the eye or as required for distant
CORRELATED?                                                                           vision. Posterior to it is a second lens having a power of about 3 D in air
                                                                                      also with its convex surface directed anteriorly. The little space in
I. KAUR, J. SINGH, P. KAUR, S. BALA                                                   between these two lenses is sealed around the periphery and filled to
Govt Medical College, Amritsar, INDIA                                                 about 2/3rd with an appropriate liquid and the top 1/3rd is occupied with
                                                                                      air. The IOL is so designed that when the eyes are directed horizontally
Purpose: To correlate presbyopia and presbycusis as age related entities              for distance vision, the liquid occupies the space in between the optical
and find out other risk factors.                                                      zones of the lenses. This almost neutralizes the power of the convex
Methods: 60 cases in the age group ranging from 40-72 years were                      surface of the posterior lens whereas the power of the plane surface of
selected ,excluding those having visual or auditory impairment due to                 the anterior lens is unaffected. The resultant power for distance is thus
any other cause.                                                                      about 20 D. When the eyes swivel downwards by 30-40 degrees for near
Results: A complete eye check up which included measurement of near                   vision, the fluid level remains horizontal resulting in air to occupy the
point of accommodation and amplitude of accommodation was done                        space in between the optical zones of the lenses leading to the restora-
followed by complete ENT evaluation including pure tone audiometry.                   tion of the power of the posterior lens to 3 D. Thus the total power of the
Conclusions: Both conditions increased gradually with age but no                      lens combination for near is 23 D. The lens prototypes were designed and
relationship could be found with arterial hypertension, blood sugar level,            tried in model eyes.
serum cholesterol and consumption of tobacco/alcohol.                                 Results: The IOL successfully provided power changes for vision for
                                                                                      distance and near.
                                                                                      Conclusions: This IOL holds tremendous promise and may prove to be a
340-B140                                                                              break through in bifocal IOL technology.
Y. GUPTA1, M. GUPTA2                                                                  CORNEAL INLAY IS A REVERSIBLE REFRACTIVE
 Institute of Ophthalmology, Aligarh Muslim University, Aligarh, INDIA, 2JN Medical   PROCEDURE
College, Aligarh Muslim University, Aligarh, INDIA
                                                                                      R. PRAKASAM, P.V. KRISHNA
Purpose: The invention, design and lab trial of a new bifocal intra-ocular            L V Prasad Eye Institute, Hyderabad, INDIA
lens implant.
Methods: A hollow sphere of PMMA or the like which has two anteriorly                 Purpose: To report the reversibility of corneal inlay refractive procedure
mounted functional optical zones of appropriate power for distant and                 when implanted in human corneas.
near vision. The optic for distant vision is mounted on the horizontal axis           Methods: Corneal inlays were implanted in the corneas of 5 eyes of 5
and the optic for near is mounted below it such that its optical center               unsighted patients after creating a LASIK flap with a microkeratome. One

134                                                                                                         Asian J Ophthalmol. 2007 Vol 9 No 1 Supplement 1
                                                                                                                               Poster Abstracts

sham patient was selected, where only LASIK flap was created without           changes induced by implant and tear pooling at the border of central
implantation of the lenticule. Patients were followed up on days 1, 3, 15      steep zone may cause epithelial and sub epithelial pigmentation.
and monthly thereafter for 12 months and at 3 monthly intervals for the
next 12 months. The inlay from patients 006 and 003 had to be explanted
at the 5-month time point and 24-month time point respectively due             344-B144
to a persistent epithelial defect and stromal melts. Detailed slit lamp        IOL POWER CALCULATION TAKING SPHERICAL
biomicroscopic evaluation, refraction, corneal topography, keratometry         ABERRATION INTO ACCOUNT
and other routine ocular examinations were performed in follow-up visits
and any unusual ocular findings, refractive changes, corneal curvature         S. NORRBY
changes were recorded.                                                         AMO Groningen BV, Groningen, THE NETHERLANDS
Results: Immediate post-operative mean differences in refraction values
in implanted eyes were 7.04 D (SD ± 3.93, CI 95%: 10.19,3.89) myopic           Purpose: To highlight how spherical aberration influences IOL power
from base line spherical refraction value (mean 1.21D, SD ± 4.75). Im-         calculation.
mediate post-operative mean differences in keratometry values in im-           Methods: Exact ray tracing allowing aspheric surfaces on both cornea
planted eyes were 5.87 D (SD ± 3.6, CI 95%; -2.99, -8.75) steeper from         and IOL is compared with the thin lens calculation employed in current
base line keratometry value (mean 44.37, SD ± 1.49). The changes in            power formulas such as SRK/T.
corneal curvature and refraction were stable up to two years, (keratometry     Results: Intraocular lenses (IOL) are labeled with their paraxial power.
mean variation: -4.72,SD ± 0.99, CI 95% -4.25, -5.19; refraction mean          An eye implanted with a spherical IOL has positive spherical aberration.
variation: 5.66, SD ± 1.75, CI 95% 6.49,4.83). Reversal of the corneal         Therefore the eye appears more myopic than a paraxial calculation would
curvature and refraction changes was noticed in two patients after lenticule   indicate. The effect in an average eye with a pupil diameter of 4 mm and
removal. Refraction and keratometry values after lenticule removal was         a 20.0 D spherical IOL is -0.53 D of myopia. For a 3 mm pupil the effect is
approximately equal to base line values.                                       -0.29 D and for 5 mm -0.85 D. The same eye implanted with a 20.0 D IOL
Conclusions: Corneal inlay procedure appears to be reversible; it may          correcting the spherical aberration of the cornea has the power expected
not alter the corneal curvature permanently.                                   from its labeled value at all pupil diameters. For a given type of IOL and a
                                                                               fixed pupil size, however, the asphericity of the cornea has negligible
                                                                               influence on the refractive outcome.

                                                                                                                                                              POSTER ABSTRACTS
343-B143                                                                       Conclusions: Spherical aberration has appreciable influence on IOL power
CORNEAL PIGMENT RING DEPOSITS AFTER                                            calculation, in particular for spherical IOLs, depending on pupil size. Cur-
CORNEAL INLAY                                                                  rent formulas, being based on paraxial (thin lens) theory, are incapable of
                                                                               taking spherical aberration into account. Aspherical ray tracing calcula-
R. PRAKASAM, P.V. KRISHNA                                                      tions are required to further refine IOL power calculation and pupil size
L V Prasad Eye Institute, Hyderabad, INDIA                                     must be taken into account. *CR

Purpose: To report the formation of pigment ring deposits following im-
plantation of corneal inlays in human corneas.                                 345-B145
Methods: Corneal inlays were implanted in the corneas of 5 eyes of 5           CAPSULO - SCLERAL FIXATION OF IOL IN A CASE
unsighted patients after creating a LASIK flap with a microkeratome. One       OF COMPLETE ANIRIDIA - AN UNUSUAL INDICATION
sham patient was selected, where only LASIK flap was created without
implantation of the lenticule. Patients were followed up on days 1, 3, 15      P. VARMA, S. SINGH, S. AGARWAL, M. DATTANI, A. NAYAK
and monthly thereafter for 12 months and at 3 monthly intervals for the        M.G.M.M.C & M.Y.H,Indore, Indore, INDIA
next 12 months. The inlay from patients 006 and 003 had to be explanted
at the 5-month time point and 24-month time point respectively due to a        Purpose: To report capsulo scleral fixation of IOL in a case of complete
persistent epithelial defect and stromal melts. Detailed slit-lamp             aniridia.
biomicroscopic evaluation, corneal topography, keratometry and other           Methods: A 35 yrs. old male presented in our OPD with bilateral 360
routine ocular examinations were performed in follow-up visits and any         degree aniridia with cataractous lens. V/A was HM +,shallow anterior
unusual ocular findings, refractive changes, corneal curvature changes         chamber , IOP 17.3mm of Hg and open angle on gonioscopy. Scleral
were recorded.                                                                 fixation of the lens is indicated when there is no posterior capsule for
Results: All five subjects with implant except sham patient had devel-         PCIOL and no iris support for the anterior chamber IOL. We did SICS with
oped brown-colored pigment deposits at time periods between weeks to           capsulo scleral fixation of the IOL in this case.
three months, located in the para central cornea in a ring or line             Results: Postoperative course was uneventful with no complications and
configuration, which encircled the border of central steep zone of corneal     V/A improved to 6/12 at follow up.
implant. Interestingly pigment ring or line disappeared after lenticule re-    Conclusions: Capsulo Scleral fixation of IOL can be considered as treat-
moval in-patient 003 and 006. Immediate post-operative mean differ-            ment option for cases with complete aniridia.
ence keratometry values in implanted eyes were 5.87 D (SD ± 3.6,
CI 95% -2.99, -8.75) steeper from base line keratometry value (mean
44.37, SD ± 1.49). The changes in corneal curvature were stable unto
two years (keratometry mean variation: -4.72,SD ± 0.99, CI 95% -4.25,
-5.19; refraction mean variation: 5.66, SD ± 1.75, CI 95% 6.49,4.83),
which was not parallel to the changes in pigment ring over period of time.
Conclusions: The appearance of the pigment ring pattern is similar to
the iron deposits of the Fleischer ring of keratoconus. Corneal topographic

Asian J Ophthalmol. 2007 Vol 9 No 1 Supplement 1                                                                                                      135
Poster Abstracts

346-B146                                                                              Measurements of working distance were recorded by a Polhemus Fastrak®
SURFACE REFLECTIVITY OF ACRYLIC AND PMMA                                              system, commonly used for near vision recording. Results were analyzed
INTRAOCULAR LENS IMPLANTS                                                             in terms of working distance and relative working distance (working
                                                                                      distance divided by forearm length).
M.K. GEORGE, B.M. DEBROFF                                                             Results: Writing was found to be significantly closer than Reading
Yale University, New Haven, CT, UNITED STATES OF AMERICA                              (p=0.039) and performing both tasks on Chinese text was also signifi-
                                                                                      cantly closer than English text (p=0.002). This was also true for relative
Purpose: To study the surface reflectivity of acrylic and polymethylmetha-            working distance. Mean distance for Writing Chinese (347±50mm) was
crylate intraocular lens implants and to determine the factors that                   significantly closer than Writing English (360±50mm; p<0.001). There
affect it.                                                                            was no significant difference between Reading Chinese and Reading
Methods: The spectral reflectance of four intraocular lens models were                English.
studied using a spectracolorimeter. The IOL models studied included:                  Conclusions: Working distance for Writing (in both Chinese and English)
1. the SA60AT hydrophobic acrylic lens (refractive index, RI =1.55),                  was significantly shorter than Reading among Singaporean Chinese. It
     2. the SN60AT hydrophobic acrylic yellow-chromophore tinted lens                 was also found that performing near work in Chinese was significantly
     (RI = 1.55)                                                                      closer than English and this was also true when the length of the sub-
3. the SN60WF hydrophobic acrylic yellow-chromophore tinted lens with                 ject’s forearm was taken into account. This is perhaps due to the fact that
     a posterior aspheric surface (RI=1.55), and,                                     the Chinese characters have more strokes and are more complicated
4. a polymethylmethacrylate (PMMA) lens (RI=1.49). A steady and                       than English. This could possibly lead to a closer working distance when
     constant white light source was reflected off the IOL surface at 45° in          working on Chinese as it requires more concentration. Furthermore, Writing
     all cases and the surface luminance and photopic reflectivity was                Chinese was significantly closer than Writing English although there
     measured. Independent T-tests and multivariate analyses were used                was no difference between Reading Chinese and Reading English. *CR
     to determine the significant factors influencing surface reflectivity.
Results: The surface luminance of the PMMA group (15.7 cd/m2) was
significantly higher (p=0.000) than the acrylic group (1.53 cd/m2). The               348-B148
photopic reflectivity of the PMMA group was 3.69% and significantly                   INFLUENCE OF AMETROPIA, PRESBYOPIA AND
higher (p=0.000) than acrylic lenses (0.36%). The spectral reflectance                GENDER ON WORKING DISTANCE IN
ratio for the blue end of the visible light spectrum was significantly lower          SINGAPOREAN CHINESE ADULTS
in yellow pigmented lenses (p=0.02) than clear lenses, irrespective of
the IOL material. The presence of yellow pigment did not influence the                B. DROBE1, E.J. SEOW2, F.L. TANG3
surface luminance or photopic reflectivity of acrylic lenses. Multivariate            1
                                                                                          Essilor R&D, Saint-Maur, France, 2 Essilor R&D, Singapore, SINGAPORE;
analysis showed that IOL material alone affects total surface reflectivity            3
                                                                                          Singapore Polytechnic Optometry Centre, Singapore, SINGAPORE
(p=0.013), where as presence of IOL pigment only influences blue reflec-
tion (p=0.069).                                                                       Purpose: To evaluate the influence of ametropia, presbyopia and gender
Conclusions: The refractive index and implant material are determinant                on working distance among non-presbyopic (uncorrected or with single
factors in the total amount of light reflected from the IOL surface. The              vision correction) and presbyopic Chinese adults wearing Progressive
yellow chromophore inside an IOL implant plays a role in decreasing                   Addition Lenses (PALs).
the amount of blue light reflected from the lens; however, it does not                Methods: Working distance was measured by a Polhemus Fastrack® unit
influence the total amount of light reflected from the surface of an acrylic          while performing two reading and two writing tasks. Each task was
lens. Acrylic lenses with or without the yellow chromophore are a better              performed in English and Chinese by 21 non-presbyopes (aged 18 to 39)
choice than PMMA in patients who might be concerned with cosmetically                 and 39 presbyopes wearing PALs (aged 41 to 68). Results were analyzed
unacceptable external reflections from the implant.                                   in terms of working distance and relative working distance (working
                                                                                      distance divided by forearm length).
                                                                                      Results: Ametropia (emmetropia or myopia; repeated measures ANOVA:
347-B147                                                                              p=0.63) and gender (p=0.45) had no statistically significant influence on
INFLUENCE OF LANGUAGE AND TASK ON                                                     working distance. The results for normalization, i.e. relative working
WORKING DISTANCE IN SINGAPOREAN CHINESE                                               distance, were also similar (respectively p=0.95 and p=0.07), even if in
BILINGUALS                                                                            our sample men were taller than women (1.68m vs. 1.58m, p<0.001).
                                                                                      Working distance was greater in presbyopes (372 ± 44 mm) than in
E.J. SEOW1, B. DROBE2, F.L. TANG3                                                     non-presbyopes (331 ± 53 mm; p<0.01). This difference was also
 Essilor Asia Pacific Pte Ltd, Singapore, SINGAPORE, 2Essilor International, Saint-   evident in relative working distance. The value of additions on PALs had
Maur Cedex, FRANCE, 3Singapore Polytechnic Optometry Centre Private, Singapore,       no influence on working or relative working distance.
SINGAPORE                                                                             Conclusions: Working distance was greater in presbyopes than non-
                                                                                      presbyopes. It is unclear if the contributing factor was presbyopia or pro-
Purpose: To measure working distance in young bilingual Asian adults                  gressive lens wear. Myopia or emmetropia and gender had no influence
and Asian presbyopes wearing Progressive Addition Lenses (PALs), in                   on working distance. *CR
order to evaluate the influence of language and task on near tasks
working distance.
Methods: 39 progressive lens wearers (aged 41 to 68) and 21 young
adults (aged 18 to 39) participated in this study. All the subjects were
Singaporean Chinese and bilingual (Chinese and English). Two writing
and two reading tasks were performed, each in Chinese and English.

136                                                                                                         Asian J Ophthalmol. 2007 Vol 9 No 1 Supplement 1
                                                                                                                               Poster Abstracts

349-B149                                                                        of individuals who were hypermetropic (≥+0.5D).
AGE DISTRIBUTION OF TOTAL, CORNEAL AND                                          Conclusions: This comprehensive survey provides the first national
INTERNAL ABERRATIONS OF THE EYE                                                 estimates of the requirements for spectacles in adults in Pakistan. The
                                                                                spectacle coverage was found to be extremely low. With the forecasted
M.P. HOLZER, S. GOEBELS, G.U. AUFFARTH                                          projections in population growth, services for refractive errors need to
University of Heidelberg, Heidelberg, GERMANY                                   be expanded and integrated into eyecare services wherever possible.

Purpose: To investigate and compare the age distribution of total,
corneal and internal optical wavefront errors of the eye.                       351-B151
Methods: Three consecutive measurements with the OPD Scan (Nidek,               THE ALTERNATIVE APPROACH TO VISUAL BLUR:
Japan) were performed in 140 eyes of 140 volunteers. Refraction, topog-         NEUROVISION TREATMENT FOR MYOPIA, POST-
raphy and wavefront aberrations were measured and reliability tested.           REFRACTIVE SURGERY AND PRESBYOPIA
Total, corneal and internal 3rd, 4th, 5th and 6th order aberrations (Zernike)
were calculated for a 5 mm pupil and age correlations analyzed.                 D. TAN1A, A. FONG1B
Results: Six age-decade groups were analyzed (range 17 to 77 years).            A
                                                                                  Singapore Eye Res Institute, 1Singapore National Eye Center, Singapore,
Best corrected visual acuity of all volunteers was at least 20/25 or better     SINGAPORE
and no ocular pathologies were found. The reliability of the measure-
ments revealed mean values of the standard deviations of 0.0266 (total          Purpose: An alternative approach to vision enhancement in patients
Z12), 0.0342 (internal Z12) and 0.0468 µm (corneal Z12). Internal spheri-       with various forms of refractive errors is to improve contrast sensitivity
cal aberrations were even in the age groups > 65 in the negative range          function and hence visual acuity, through a computerized perceptual
but were statistically less negative than in the age group 25-36. However,      learning program. NeuroVision’s NVC technology is a non-invasive, pa-
there was no age correlation found.                                             tient-specific, computerized neural adaptation program based on visual
Conclusions: The OPD scan offers important information regarding                of neural connections at the cortical level to improve contrast sensitivity
refraction, topography and distribution of wavefront errors of the eye          and visual acuity. We evaluated efficacy in enhancing unaided visual
with a good reliability. The data of this study confirms specific aberration    acuity (UAVA) and unaided contrast sensitivity function (UCSF) in low
distributions of the eye. Spherical aberrations however, showed even in         myopes, emmetropic presbyopes and post-refractive surgery patients.

                                                                                                                                                              POSTER ABSTRACTS
higher age groups negative values.                                              Methods: 113 patients with low myopia (mean cycloplegic SE of -1.18D,
                                                                                range 0 -2.50D) underwent NVC treatment. 55 patients (Subgroup-1) have
                                                                                completed 6 months follow up and 16 patients (Subgroup-2) have com-
350-B150                                                                        pleted 6 and 12 months follow up post treatment end. 41 presbyopic
ESTIMATING THE NEED FOR SPECTACLE                                               patients aged 41-55 (mean 46.37± 0.52) with near addition ranged
CORRECTION IN PAKISTAN. THE NATIONAL                                            +1.00D to +2.00D (mean +1.40D ± 0.05D) underwent NVC treatment.
PAKISTAN BLINDNESS AND VISUAL IMPAIRMENT                                        14 post-refractive surgery patients (10 post-lasik, 2 post-PRK and 2 post
SURVEY                                                                          RK+lasik patients)(28 eyes) with mean post-refractive surgery spherical
                                                                                equivalent of -1.33D (range +0.75 to -3.12D) underwent NVC treatment.
S.P. SHAH                                                                       Results: Mean Baseline LogMAR UAVA was 0.41, improving to 0.13, gain
ICEH, London School of Hygiene and Tropical Medicine, London, UNITED            of 2.8 lines. Mean baseline unaided CSF improved at all spatial frequen-
KINGDOM                                                                         cies to within the normal range. Patients with at least 6 months follow-up
                                                                                maintained 85% of the improvement, while those with 12 months follow-
Purpose: To determine the prevalence, magnitude and risk factors for            up maintained 81% of the improvement after 12 months. Presbyopia
uncorrected significant refractive errors in a nationally representative        Group: Mean Near Unaided LogMAR VA improved from 0.33 to 0.17, gain
sample of adults (≥ 30 years) in Pakistan.                                      of 1.6 lines. Mean Low Contrast Near Unaided LogMAR VA improved
Methods: Multi-stage, stratified cluster random sampling survey meth-           from 0.44 to 0.30, gain of 1.3 lines. Post-refractive surgery group: Mean
odology was used. Subjects were interviewed, had their visual acuity            Baseline LogMAR UAVA was 0.32, improving to 0.115, gain of 2.05 lines.
measured, and underwent non-cycloplegic autorefraction, ocular biometry         Mean refractive error in all groups remained unchanged after treatment
and fundus/optic disc examination. Manual refraction was attempted              in all eyes.
in subjects in whom autorefraction was not possible. All subjects               Conclusions: Results to date suggest that NVC treatment improves UAVA
with <6/12 presenting acuity in either eye underwent a more detailed            and CSF in low myopes, emmetropic presbyopes and post-refractive
ophthalmic examination, including corrected distance visual acuity meas-        surgery patients. This improvement appears to be retained for at least 12
urement with trial lenses, and dilated slit lamp examination.                   months after treatment in the low myopia group, and a randomized
Results: A total of 16,507 subjects were examined (95.5% of those               trial for low to moderate myopia is near completion.
enumerated) 1,148 (7.0%) of whom were wearing their distance correc-
tion at examination. Using the age/sex standardized prevalence (14.6%,
95%CI 14.1, 15.1%) we estimate that 5,980,000 visually impaired
adults could improve their visual acuity status by one or more WHO cat-
egory with spectacle correction. 290 adults required a change to their
current prescription. Spectacle coverage using a 6/12 cutoff (i.e. the pro-
portion of individuals with significant refractive errors who had spectacles)
was 16.4%. Men were 50% more likely to be wearing spectacles than
women (95%CI: 1.2, 1.9, p<0.001). 94.3 % of myopic subjects (≤-0.5D,
4,972/5,275) were not wearing spectacles, nor were 94.2% (3696/3,922)

Asian J Ophthalmol. 2007 Vol 9 No 1 Supplement 1                                                                                                      137
Poster Abstracts

352-B152                                                                          auto-refractor, and streak retinoscopy are 0.62D [95% confidence inter-
MYDRIATIC CHANGES IN VAULTING AND                                                 val (CI)-1.86 to 3.09], 0.90 (95%CI -1.29 to 3.09), and 0.90 (95% CI
ANTERIOR CHAMBER DEPTH IN POSTERIOR                                               -1.47 to 3.27), respectively. The mean and standard deviations of the
CHAMBER PHAKIC IOL IMPLANTED EYES                                                 differences between the hand held Retinomax and table mounted auto
                                                                                  refractor are 0.43 (0.40), table mounted auto refractor and retinoscopy
K. SHIMIZU, K. KAMIYA, D. AIZAWA                                                  are 0.39 (0.43), and hand-held Retinomax and retinoscopy are 0.67
Kitasato University, Kanagawa, JAPAN                                              (0.49).
                                                                                  Conclusion: The refractive error results of the table mounted auto
Purpose: In phakic IOL (ICLTM: Version 4, STAAR Surgical Company)                 refractor and hand-held Retinomax are highly correlated. However, the
implantation, ICL vaulting (distance from ICL to anterior surface of crys-        hand-held retinoscopy refractive error results tend to be more hyperopic.
talline lens) is highly important when we predict the rate of ICL-induced
cataract, however, mydriatic changes have not been elucidated. We
investigated changes in ICL vaulting and anterior chamber depth before            354-B154
and after mydriasis in ICL implanted eyes.                                        OPHTHALMOLOGICAL BARRIERS TO IRIS
Methods: Eleven eyes of 7 patients undergoing ICL implantation between            RECOGNITION
August 2002 and March 2005 in Kitasato University Hospital were
included in this study. Mean age was 40.3±10.3 (mean±SD, range: 29 to             S.Z. TAN, T.M. ASLAM, B. DHILLON
58) years old, mean preoperative manifest refraction (spherical equivalent)       Princess Alexandra Eye Pavilion, Edinburgh, UNITED KINGDOM
was -15.0±5.6 (range: -22.8 to -4.0) diopters, and mean follow-up
period was 24.3±10.1 months. Before and after mydriasis under mydri-              Purpose: Iris recognition technology employs real-time, high confidence
atic cycloplegic agent (Mydrin-P: 0.5% tropicamide plus 0.5% phenyle-             recognition of a person’s identity by mathematical analysis of the random
phrine hydrochloride), anterior segment structure was measured with               patterns that are visible within the iris of an eye from some distance. This
Scheimpflug imaging system (PentacamTM: OCULUS) for three times, and              cutting-edge technology is already widely used in access control, con-
vaulting and anterior chamber depth were calculated from the digitally            sumer identification and border management programs. As the eye is an
captured images.                                                                  organ prone to the natural process of diseases, it is important to realize
Results: ICL vaulting was significantly increased from 216.7±114.3 µm             the potential difficulties eye pathologies can impact on the operation of
(before mydriasis) to 411.7±142.9 µm (after mydriasis)(p<0.01, Wilcoxon’s         the technology before its use becomes more widespread. This study aims
signed-ranks test). Anterior chamber depth was also significantly increased       to investigate the potential problems of patients with ophthalmic patho-
from 3033.0±267.1 µm (before mydriasis) to 3149.5±290.6 µm (after                 logies to enroll in the iris recognition technology.
mydriasis)(p<0.01).                                                               Methods: Patients of our institution were randomly selected to take part
Conclusions: Mydriasis induced a significant increase in ICL vaulting and         in the study. A commercial infrared light tripod mount iris recognition
anterior chamber depth in ICL implanted eyes.                                     camera deploying Dougman algorithms® was used to capture images and
                                                                                  create a unique biometric template for each eye. Difficulties in each en-
                                                                                  rolment were investigated.
353-B153                                                                          Results: 50 patients with a total of 100 eyes with and without pathologies
COMPARISON OF THE HAND-HELD RETINOMAX,                                            of the cornea, iris, anterior chamber, lens and retina were photographed.
TABLE-MOUNTED AUTO REFRACTOR AND                                                  Among the 100 eyes, 7 failed to enroll with the iris recognition camera: 2
RETINOSCOPY IN SINGAPORE PRESCHOOLERS                                             were from a patient with diabetic eyes and rubeosis; 2 were from a pa-
                                                                                  tient with patent peripheral iridotomy; 2 were from a frail elderly patient
S. PRABAKARAN1, A. JAURIGUE2, B. TOH3, A. CHIA4, S. LEO5, B.L. QUAH4,             with central venous occlusion and cataract who failed to co-operate and
Y. LING 4, K.G. AU-EONG6, B. CHANG6, P.M. LAM 7, S. FARZAVANDI 7,                 another eye was from a young patient with a diagnosis of visual migraine.
D. KOH1, D. TAN8, T.Y. WONG1, S.M. SAW1                                           Enrolment in patients with partial ptosis and poor vision was found to be
  COFM, National University of Singapore, Singapore, SINGAPORE, 2COFM, National   only possible with positional adjustment of the camera and lifting of the
University of Singapore, Singapore, SINGAPORE, 3COFM, National University of      eyelid.
Singapore, Singapore, SINGAPORE, 4Singapore National Eye Center, Singapore,       Conclusions: Combined eye pathologies and lack of patients’ co-opera-
Singapore, 5Tan Tock Seng Hospital, Singapore, SINGAPORE, 6Alexandra Hospital,    tion had been shown to make the iris registration process substantially
Singapore, SINGAPORE, 7Singapore National Eye Center, Singapore, SINGAPORE,       more difficult. This qualitative study is important as a pilot study to iden-
  Singapore Eye Research Institute, Singapore, SINGAPORE                          tify the potential difficulties of a wide range of eye pathologies in enrol-
                                                                                  ment with the iris recognition technology before studies of a larger scale
Purpose: To compare the cycloplegic refraction measurements using                 looking at specific eye pathology are carried out.
hand-held Retinomax, table-mounted auto refractor, and streak retinos-
copy among Singapore preschoolers.
Methods: Subjects between 24-72 months old Singapore Chinese
children underwent cycloplegic refraction using the hand-held Retinomax,
table mounted auto refractor (Canon FK-1, Tokyo, Japan) and streak
retinoscopy at a central clinic site from July 2006 to September 2006.
The examiner who performed retinoscopy readings was masked to the
auto refractor findings.
Results: There were 19 children; 12 were boys and 7 were girls. The
mean age was 47.05 months and range was 24 to 72 months. The mean
spherical equivalents of the hand-held Retinomax, table mounted

138                                                                                                   Asian J Ophthalmol. 2007 Vol 9 No 1 Supplement 1
                                                                                                                                      Poster Abstracts

355-B155                                                                            BCVA: Rt.6/18 Lt.6/24. No RAPD. Full V/F by confrontation. Full color vision.
TWO-PHOTON EXCITED AUTOFLUORESCENCE                                                 Normal A/S. Vitreous: Clear. Fundus: White centered retinal hemorrhages
IMAGING OF THE HUMAN RETINA-CHOROID                                                 (Roth Spots), blot hemorrhages, intra-retinal macular hemorrhages. No
COMPLEX                                                                             vascular sheathing. No tortuosity. Normal discs. G.Exam: Temp. 35.5 C,
                                                                                    B.P. 119/83, B.M 3.1 mm. No lymphadenopathy, normal chest auscult-
M. HAN 1, G. GIESE 2, S. SCHMITZ-VALKENBERG 3, A. BINDEWALD-                        ation. Investigations: Chest X-Ray; within normal. WBC; 261.44 x10^9
WITTICH3, F. HOLZ3, M. NIEMZ1, J. BILLE4                                            (H); features typical for CML. Referred to Hematology. Bone marrow biopsy:
 Mannheim Biomedical Engineering Labs, University of Heidelberg, GERMANY, 2Max      maximally cellular marrow, consistent with CML. B.M. trephine: keeping
Planck Institute for Medical Research, Heidelberg, GERMANY, 3Department of          with CML. Started Hydroxycarbamide for cytoreduction. Then Imatinib
Ophthalmology, University of Bonn, GERMANY, 4Kirchhoff Institut fuer Physik,        was initiated. Follow-up showed response with WBC reduction.
Heidelberg, GERMANY                                                                 Results: Life-threatening blood dyscrasias can present with isolated
                                                                                    ophthalmic symptoms. Though leukemic retinopathy is frequently
Purpose: The development of age-related macular degeneration (AMD)                  asymptomatic, it was found that almost half of the cases with leukemia
is thought to result from an accentuation of the aging process. A mini-             show retinal manifestations in the form of: venous tortuosity, retinal
mally invasive, high resolution imaging modality is vital to delineate the          hemorrhages, cotton-wool spots, white centered hemorrhages (Roth
age-related structural abnormalities in the retina-choroid complex prior            Spots). These changes are due to secondary hematological abnormalities
to apparent pathological manifestations of AMD. Based on the endog-                 (anemia, thrombocytopenia). Primary leukemic infiltration of the retina is
enous chromophores in the human retina-choroid complex, we employed                 rare and usually associated with poor prognosis. Other findings might
two-photon excited autofluorescence (TPEF) imaging to characterize                  include CRVO.
the morphological and spectral properties of the human photoreceptors,              Conclusions: In conclusion, we can emphasize the importance of having a
RPE and choriocapillaries ex vivo.                                                  high index of suspicion in dealing with cases with atypical retinal
Methods: The human retinas were obtained from four human Caucasian                  vascular findings where a simple further investigation can help in early
postmortem donor eyes (19, 55, 57 and 64 years old, with normal vision).            diagnosis, so further effective treatment of such a life threatening condition.
TPEF imaging was performed with a customized multiphoton laser scan-
ning microscope (Zeiss LSM 510) equipped with a mode-locked
femtosecond Ti:Sapphire laser (Coherent Chameleon XR, λ = 720 - 980                 357-B157

                                                                                                                                                                      POSTER ABSTRACTS
nm). The autofluorescence spectrum of RPE cells was measured with                   EFFECT OF THE GANODERMA LUCIDUM SPORES
a confocal laser scanning microscope (Leica TCS SP2) coupled to a UV                OIL ON THE ELECTRORETINOGRAM AND
argon ion laser (λ = 364 nm).                                                       PATHOLOGIC APPEARANCE OF PHOTORECEPTOR
Results: As age increases, the regularity of the parafoveal photoreceptor           DAMAGE INDUCED BY MNU IN SPRAGUE-DAWLEY
mosaic appears to be preserved. Enlarged lipofuscin granules in the aged            RATS
RPE demonstrate significantly blue-shifted autofluorescence, which co-
incides with the depletion of melanin pigments. Prominent fibrillar struc-          X.G. DENG, J. GE, Z.Q. ZHONG
tures in elderly choriocapillaries may represent age-related structure and          State Key Laboratory of Ophthalmology, Guangzhou, CHINA
permeability alterations in the choroid.
Conclusions: TPEF imaging is an elegant and highly efficient tool to de-            Purpose: To approach the therapeutical effect of the Ganoderma
lineate the thick, fragile and opaque retina-choroid complex. Requiring             Lucidum Spores Oil (GLSO) on the photoreceptor damage induced by
neither slicing nor labeling, the most vital components (photoreceptors,            N-methyl-N-nitrosourea (MNU) in rats and look for a kind of effective mod-
RPE, choriocapillaries, Bruch’s membrane) in the human retina-choroid               ern Chinese Traditional medicine to prevent and treat retinitis pigmentosa.
complex can be examined with high contrast and subcellular resolution,              Methods: After three days of intragastric administration with different
which may provide fresh insights into the pathogenesis of AMD.                      medicine, 25 of Sprague-Dawley (SD) rats were randomly pulled out for
                                                                                    normal group, 100 of SD rats received a single dose 40 mg/kg of MNU
                                                                                    intraperitoneal injection and were randomly divided into four groups: GLSO
356-B156                                                                            group with GLSO intragastric administration, docosahexaenoic acid (DHA)
SUDDEN DROP OF VISION AS AN INITIAL                                                 group with DHA intragastric administration, GLSO combined with DHA
PRESENTATION OF LIFE THREATENING                                                    group with GLSO and DHA intragastric administration and model group
HEMATOLOGICAL DISORDER                                                              with dilution intragastric administration. At different time, 1d, 3d, 5d, 7d
                                                                                    and 10d, five rats were examined with electroretinogram and eyes were
M.S.A. ABU-AIN, O. MAKHZOUM, S. PAGLIARINI                                          enucleated after sacrificing rats for pathological examination.
University Hospital Coventry & Warwickshire, Coventry, UNITED KINGDOM               Results: The results from ocular electroretinogram showed that it was
                                                                                    not significant by comparing a wave latency phase and b wave latency
Purpose: We report a case of sudden reduction of vision due to leukemic             phase of different medical deal group at a different time point, P>0.05.
retinopathy. The loss of vision was the initial presentation of this life threat-   The b wave amplitude of different medical deal group was obviously higher
ening hematological disorder (Chronic Myeloid Leukemia). The presence               than those of model group at different time point, P<0.05 or P<0.01. The
of white centered hemorrhages bilaterally on fundoscopy suggested an                a wave amplitude of GLSO group was higher than those of model group,
underlying hematological disorder where prompt investigations confirmed             P<0.05, but it wasn’t significant by comparing with DHA group and GLSO
the diagnosis of the CML.                                                           combined with DHA group, P>0.05. The results from ocular pathology
Methods: A 28 year-old Afro Caribbean male, presented to the eye casu-              showed that the retinal photoreceptor damage induced by MNU were
alty complaining of 5 days’ history of progressive painless blurring of             obviously relieved in the different group at different time point, compared
vision in both eyes Lt > Rt. No other ophthalmic complaints. No previous            with model group, P<0.05. The relieving intension presented GLSO>DHA>
ophthalmic problems. He had no systemic symptoms. On examination,                   GLSO and DHA>dilution.

Asian J Ophthalmol. 2007 Vol 9 No 1 Supplement 1                                                                                                              139
Poster Abstracts

Conclusions: Our experimental results suggest that GLSO and DHA                  359-B159
can relieve retinal photoreceptor damage induced by MNU and promote              SCREENING AND DIAGNOSIS OF OPTIC PATHWAY
retinal functional recovery.                                                     GLIOMAS IN CHILDREN WITH
                                                                                 NEUROFIBROMATOSIS TYPE 1 USING SWEEP
                                                                                 VISUAL EVOKED POTENTIALS
DISTRIBUTION AND FUNCTION OF L-TYPE CA                                           B.C.M. CHANG1, G. MIRABELLA2, R. YAGEV3, M. BANH2, E. MEZER2,
CHANNEL IS REGULATED BY ACTIN                                                    P.C. PARKIN2, C.A. WESTALL2, R.J. BUNCIC2
CYTOSKELETON IN SALAMANDER RETINA                                                1
                                                                                  Alexandra Hospital, Singapore, SINGAPORE, 2The Hospital for Sick Children,
                                                                                 Toronto, ON, CANADA, 3Soroka University Medical Center, Beer-Sheva, ISRAEL
NYU School of Medicine, New York, NY, UNITED STATES OF AMERICA                   Purpose: Neurofibromatosis type 1 (NF-1) is an autosomal dominant
                                                                                 phakomatosis with a prevalence of 1/2000 to 1/5000. Up to 24% of these
Purpose: Intracellular Ca2+ regulates a variety of neuronal functions            patients develop optic pathway gliomas (OPGs). We investigated the use
including neurotransmitter release, protein phosphorylation, gene                of sweep visual evoked potentials (SVEP) as a screening tool for identify-
expression, and synaptic plasticity. In the vertebrate retina the main           ing NF-1 patients with OPGs by comparing them to NF-1 patients with no
source of Ca2+ for many of these regulatory processes is the influx through      OPGs and to normally developing children.
voltage-gated L-type channels. Earlier we showed that F-actin disruption         Methods: Contrast sensitivity and grating acuity were measured using
caused reduction in Ca influx through both voltage- and glutamate                the SVEP. Sixteen children with OPGs (OPG group), 14 children with
receptor-activated channels in salamander retinal neurons. The mecha-            NF-1 without OPGs (nOPG) and 16 aged-matched control subjects were
nism whereby the actin cytoskeleton regulates ion channel function is            recruited. All participants had a best-corrected visual acuity of 6/9 or
unclear.                                                                         better. All were tested monocularly.
Methods: Double labeled Immunocytochemistry and patch clamp                      Results: Comparisons between groups using the Tukey B test showed a
technique was used to study the changes in distribution and function of          significant reduction of mean log contrast sensitivity in the OPG group
L-type channel caused by actin depolymerizing agents. Experiments were           (1.55) compared with the nOPG group (1.9, P = .006) and Control group
conducted on retinal slices as well as on dissociated cells.                     (2.10, P < .001). There was no significant difference between the nOPG
Results: In vertical cryostat sections, labeling with anti-α1D antibody          and Control groups (P = .195). Grating acuity was comparable between
revealed strong immunoreactivity in both the outer, and the inner plexi-         groups, and no statistically significant differences were found. Log
form layers. An intense labeling was present also in the ganglion cell           contrast sensitivity was moderately sensitive in identifying patients with
layer (GCL), and nerve fiber layer. The staining for α1D was associated          OPG, and was highly specific in screening out patients with no OPG.
with the margins of cells in the GCL, indicating surface localization.           Conclusions: Children with OPGs have reduced contrast sensitivity when
Comparison of confocal fluorescence images of vertical cryostat sections         assessed using the SVEP. Children with no OPGs display no differences in
double stained with Alexa-Fluor488-phalloidin in normal Ringer solution          visual functioning compared with controls. The findings suggest that the
containing vehicle, and after 1 h exposure to cytochalasin D (CD), or            SVEP can be a useful and non-invasive screening tool for early detection
latrunculin A (LA) revealed an increase in α1D immunoreactivity in the           of visual pathway gliomas in children with NF-1 and normal visual acuity.
cell interior in slices treated with F-actin disruptors, indicating internali-
zation of α1D subunit of L-type Ca channels. Similar redistribution of α1D
immunoreactivity by F-actin disruption was observed in dissociated cells.        Poster Session 2
Exposure of dissociated cells for 30 min to CD or LA resulted in a disrup-       Sunday, 4 March 2007
tion of F-actin, as was apparent from Alexa-Fluor 488 phaloidin staining.
In both cases, disruption of F-actin caused reduction in α1D labeling on
the surface membrane and an increase in the cytoplasm. We measured               360-B1
the intensity of pixel fluorescence in the cytoplasm (Fint) and the surface      SAFETY, CLINICAL AND MICROBIOLOGICAL
(Fext) and used the ratio Fin/Fext to assess the Ca channel internalization.     EFFICACY OF TOPICAL AZITHROMYCIN (AZITH)
Actin depolymerization caused significant increase in Fint/Fext from 0.4±        FOR THE TREATMENT OF ACTIVE TRACHOMA
0.06 to 1.8±4 (n=10, P<0.03). Internalization of Ca channels by cytoskel-
eton disruptors was attenuated in cells pre-exposed for 1 h to endosome-         P. GOLDSCHMIDT1, P. CHE SARRIA1, A. GOéPOGUI2, M. SOW3, T. AFGHANI4,
neutralizing agent bafilomycin A1. In contrast the disruption of microtubules    B. DE BARBEYRAC5, C. CHAUMEIL1
by colchicine, had no effect on Ca channel distribution.                         1
                                                                                  Centre National d’Ophtalmologie des Quinze Vingts, Paris, FRANCE, 2Hôpital Donka,
Conclusions: Provided data indicate that internalization of L-type Ca chan-      Conakry, Guinea, 3Hôpital de Kankan, Kankan, GUINEA, 4Al-Shifa Trust Eye Center,
nels by actin depolymerization could be one of the possible mechanisms           Rawalpindi, PAKISTAN, 5Centre Hospitalier Universitaire de Bordeaux, Bordeaux,
of regulation of voltage-gated Ca currents by the actin cytoskeleton in the      FRANCE
vertebrate retina.
                                                                                 Purpose: Untreated trachoma may lead to blindness. The current anti-
                                                                                 biotic treatments for trachoma are tetracycline 1% ointment x 2d/6weeks
                                                                                 or intermittently for 6 months (reduced compliance) or a single oral dose
                                                                                 of azith (20 mg/kg in children or 1 g in adults). The high cost associated
                                                                                 with the risk of misuse of azith (to treat other systemic infections like
                                                                                 STDs) is a major concern for the programs to eradicate trachoma. The
                                                                                 purpose of the present work was to evaluate safety and efficacy of a
                                                                                 stable solution of azith to treat active trachoma.

140                                                                                                    Asian J Ophthalmol. 2007 Vol 9 No 1 Supplement 1
                                                                                                                                         Poster Abstracts

Methods: Pharmacokinetic profile assessments (healthy volunteers) and                analogs have reduced cytotoxicity to epithelial cells at concentrations of
clinical trials were conducted after topical application of 1.5% azith eye           6-100 µg/ml in comparison with native hBD3.
drops following Good Clinical Procedures (controlled, double-masked,                 Conclusions: The decreased cytotoxicity of the six linear analogs is
double-dummy, non-inferiority trials). A total of 670 children (1-10 y) with         structurally due to the removal of disulfide bridges and the flexible fold
trachoma in Guinea Conakry and Pakistan were included. Conjunctival                  structures of analogs in the absence of stabilization force of disulfide
samples were obtained with a Dacron swab and tested by Cobas                         bridges. The discovery has positive implications for therapeutic
Amplicor® PCR. Controls were carried out to assess the DNA extraction                development.
yields, the retention of DNA by the swabs and the quality of sampling
(number of epithelial cells).
Results: Twice daily topical 1.5% azith for three days to healthy                    362-B3
volunteers achieve long lasting conjunctival levels necessary to control             AQUEOUS CONCENTRATION OF VIGAMOX
trachomatous infection. The conjunctival concentrations at day 7 are higher          FOLLOWING TWO REGIMES OF PREOPERATIVE
than those obtained after a single oral dose of azith (1 g) with no systemic         PROPHYLAXIS
passage. Topical treatment appears safe and well tolerated. After 60 days
of treating with the topical or the oral antibiotic, 95.9% and 95.8% of the          D. GAJJAR, S. RAJ, D. PANDITA, A. VASAVADA
children were free of trachoma symptoms (clinical cure). PCR was posi-               Iladevi Cataract and IOL Research Centre, Ahmedabad, INDIA
tive in 23.2% of children from Guinea and in 21.2% from Pakistan at
inclusion. Negativity was not due to the absence of the cryptic plasmid              Purpose: To measure the aqueous concentration of the topically
targeted by Amplicor® because negative specimens retested with the                   administered moxifloxacin solution (0.5%) following two regimes.
omp1 real-time PCR method produced identical results. Sixty days after               Methods: The study was a prospective, randomized, triple masked
the topical or the oral treatments, 84.2% and 82.1% of the children that             clinical trial of 156 patients undergoing cataract surgery. In Group 1(n=78),
were positive at inclusion became PCR negative. One year after treatment,            one drop of vigamox, 4 times a day on the previous day of surgery and
the topical and the oral azith showed identical levels of clinical efficacy          Group 2 (n=78), one drop of vigamox, 4 times, two hours prior to surgery
(88.1%).                                                                             was administered. Aqueous humor (0.1ml) was collected at the begin-
Conclusions: Topical azithromycin (1 drop twice daily for 3 days) is                 ning of the surgery via paracentesis and stored at -80°C. The antibiotic
safe and its efficacy is equivalent to that obtained with the trachoma’s             concentration in all the aqueous aspirates was determined using high

                                                                                                                                                                         POSTER ABSTRACTS
reference treatment (oral azithromycin).                                             performance liquid chromatography (HPLC). The data was analyzed
                                                                                     using Kolmogorov- Smirnow T -test.
                                                                                     Results: The mean aqueous humor concentrations of moxifloxacin was
361-B2                                                                               1.57±0.80 µg/ml and 2.05 ±0.72 µg/ml for group 1 and group 2
DESIGN OF LINEAR ANALOGS OF HUMAN                                                    respectively. The concentration of moxifloxacin in group 2 was signifi-
β-DEFENSIN 3 TO REDUCE CYTOTOXICITY TO                                               cantly higher compared to group 1 (p<0.0001, CI, 95%).
HOST CELLS                                                                           Conclusions: The findings of this investigation reveal that topically
                                                                                     administered moxifloxacin on the same day 2 hours prior to surgery
S. LIU1, L. ZHOU2, J. LI2, Y. FOO1, A. SURESH3, C. VERMA3, E. YAP4, S. CHEE5,        can achieve significantly high aqueous concentrations. Both the regimes
D. TAN6, R.BEUERMAN2                                                                 show significantly high concentrations when compared to the MIC (Mean
  Singapore Eye Research Institute, Singapore, SINGAPORE, 2Singapore Eye             inhibitory concentration) levels for Staphylococcus epidermidis.
Research Institute; Dept of Ophthalmology, Yong Loo Lin School of Medicine,
National University of Singapore, Singapore, SINGAPORE, 3Bioinformatics Institute,
Singapore, SINGAPORE, 4Defence Medical & Environmental Research Institute,           363-B4
Singapore, SINGAPORE; 5Singapore National Eye Center, Singapore, SINGAPORE,          DISINFECTION EFFICACY AGAINST
  Singapore Eye Research Institute; Singapore National Eye Center; Dept of           PSEUDOMONAS AERUGINOSA ON HUMAN SOILED
Opththalmology, Yong Loo Lin School of Medicine, National University of Singapore,   (WORN) CONTACT LENSES
Singapore, SINGAPORE
                                                                                     C. LAKKIS, M. BOYD
Purpose: To study the relationship between the structural factors and                Clinical Vision Research Australia, University of Melbourne, Carlton, Australia
biological activities of human β-Defensin 3 analogs.
Methods: A series of novel linear analogs of human β-Defensin 3 (hBD3)               Purpose: The antimicrobial activity of contact lens (CL) disinfectants may
[F6, W6, Y6, A6, S6 and C(Acm)6] were synthesized and structurally                   be affected by the presence of organic material. We have shown that
characterized by mass spectra, circular dichroism spectra and molecular              some disinfectants vary in efficacy against P. aeruginosa strains when
hydrophobicity using experimental and theoretical methods. We have                   challenged with laboratory soiled CLs. The aim of this study was to inves-
screened antimicrobial activity, hemolysis to rabbit erythrocytes and                tigate the effect of human soiled (worn) CLs on disinfection efficacy against
cytotoxicity to human conjunctival epithelial cells.                                 cytotoxic and invasive P. aeruginosa strains.
Results: Among these analogs, W6 showed the most potent activity (LD50:              Methods: Susceptibility of 2 clinical P. aeruginosa isolates, 6294 (invasive)
1.5 and 4.8 µg/ml) against Staphylococcus aureus and Escherichia coli,               and 6206 (cytotoxic), was compared using unsoiled (new) and soiled (worn
and strong, comparable killing ability (LD50: 5.1 and 7.4 µg/ml) against             for 8 h) etafilcon A CLs. An initial inoculum of 6x105 CFU/ml was achieved,
Pseudomonas aeruginosa and Bacillus cereus. S6 and F6 also display                   and the number of bacterial survivors in the disinfectant (preserved with
high activity against the four pathogens (almost all LD50 being less than            polyquaternium-1 0.001% (PQ) and myristamidopropyl dimethylamine
10 µg/ml). No significant hemolytic effect was observed in native hBD3               0.0005% (MAPD)) was determined at 4 and 6 h post-inoculation via
and five of the six analogs in concentration of 3-100 µg/ml, W6 showed a             viable counts. Soiled lenses were also screened for potential contaminants.
significant increased hemolytic effect in the tested concentration. All              Results were compared to testing of laboratory soiled CLs using the

Asian J Ophthalmol. 2007 Vol 9 No 1 Supplement 1                                                                                                                   141
Poster Abstracts

FDA/ISO organic soil model.                                                    among lens care regimens can have a measurable impact on patients’
Results: There were no significant differences in disinfection efficacy        lens wearing experience. *CR
between human soiled and unsoiled CLs (p>0.05). Log reductions of 5.8
and 5.9 were achieved for P. aeruginosa 6294 and 6206 respectively,
which compared favorably to the log reductions of 5.5 and 5.7 observed         365-B6
with laboratory soiled CLs. Invasive and cytotoxic strains did not vary        CORNEAL STAINING AND COMFORT OBSERVED
significantly in susceptibility to disinfection (p>0.05); however, greater     WITH VARIOUS CONTACT LENS AND SOLUTION
initial adherence to human soiled lenses was observed for the invasive         COMBINATIONS
strain 6294 when compared to all other lens/bacteria combinations
(p<0.05). There were no contaminants isolated from the human soiled            G.J. ANDRASKO, K. RYEN
CLs.                                                                           Private Research, Columbus, OH, UNITED STATES OF AMERICA
Conclusions: Cytotoxic and invasive P. aeruginosa strains do not vary in
their susceptibility to disinfection with PQ/MAPD preserved solution when      Purpose: To assess the ocular response associated with various combi-
associated with human soiled CLs. Differences in adherence of invasive         nations of lenses and marketed contact lens solutions after 2 and 4 hrs of
and cytotoxic strains to worn CLs require further investigation. Assess-       lens wear.
ment of a wider range of clinical isolates, contact lens materials and         Methods: A series of double-masked, randomized, crossover, clinical
disinfectants will increase our understanding of the effects of organic        studies were conducted at one research site. Asymptomatic contact lens
load on disinfection efficacy. *CR                                             wearers wore soft contact lenses for 2 and 4 hrs. Prior to wear, new
                                                                               lenses were soaked for at least 15 hours using a preconditioned lens
                                                                               case in Alcon OPTI-FREE® EXPRESS® (polyquaternium-1), Alcon OPTI-
364-B5                                                                         FREE® RepleniSH® (polyquaternium-1), B&L ReNu® with MoistureLoc®
CLINICAL PERFORMANCE OF A NEW MULTI-                                           (alexidine), B&L ReNu® MultiPlus® (polyaminopropyl biguanide), CIBA
PURPOSE DISINFECTING SOLUTION                                                  Vision AQuify® (polyhexanide), or AMO Complete® MoisturePLUS™
                                                                               (polyhexamethylene biguanide). In addition, Unisol 4® Preservative Free
D. MEADOWS, R. STONE, L.D. NAPIER, H. KETELSON, D. KEITH, R. GAROFALO,         Saline and Clear Care® Cleaning & Disinfecting Solution were assessed
J.R. KERN, M. CHRISTENSEN                                                      with the lenses. On each study visit day at baseline, 2 hours, and 4 hours,
Alcon Research Ltd., Fort Worth, TX, UNITED STATES OF AMERICA                  subjects rated comfort on a 100-point scale and the investigator
                                                                               examined the cornea using sodium fluorescein and a wratten yellow filter.
Purpose: To clinically evaluate a new multi-purpose disinfecting solution      Corneal staining severity (0-4) and area (0-100%) were recorded for
(MPDS) with a variety of lens materials in both asymptomatic and symp-         five corneal zones per eye.
tomatic subjects.                                                              Results: All observed staining type was micropunctate. PureVision
Methods: Four randomized, double-masked studies conducted at over              lenses in combination with the biguanide-preserved solutions resulted
40 sites assessed the clinical performance of a new MPDS with tradi-           in excessive staining area at 2 hours (ReNu MultiPlus, 73%; Complete
tional soft and silicone hydrogel (SiH) contact lenses. Regimen 1 (OPTI-       MoisturePLUS, 48%; Aquify, 21%). Focus Night & Day lenses, when soaked
FREE® RepleniSH® MPDS) was compared with Regimen 2 (ReNu®                      in ReNu MultiPlus, exhibited an excessive staining area of 24% at 2 hours.
MultiPlus® MPS) and Regimen 3 (Complete® MoisturePLUS™ MPS).                   Similar to the unpreserved saline solution, OPTI-FREE EXPRESS and
Investigators conducted a slit-lamp exam including corneal staining and        OPTI-FREE RepleniSH exhibited a minimal staining area, averaging 7% or
assessed lens cleanliness and visual acuity. Subjects recorded rewetting       less at 2 hrs across all lens brands. Also, reported comfort tended to
drop use and average lens wearing time. Subjective comfort and symp-           decrease with higher levels of corneal staining area. Additional combina-
toms were assessed using visual analog scales and Likert-style                 tions of marketed lenses and solutions are currently being evaluated.
questionnaires. At a subset of sites, lenses were collected for residual       Conclusions: These results demonstrate how some combinations of
lens lysozyme and lens wettability analyses.                                   lenses and solutions may cause clinically meaningful corneal staining
Results: There was significantly less severe corneal staining with             within 2-4 hours. Practitioners who dispense these lens materials
Regimen 1 compared to Regimen 2 in SiH lens wearers (p=0.0019). The            and solutions should be aware of the potential ocular response and
percentage of lenses rated as microscopically clean at Day 90 was greater      consider following up with the patient during the first few hours post
and the mean percent area of crystalline deposits at Days 60 and 90 was        lens insertion. *CR
lower for Group IV lenses treated with Regimen 1 compared to Regimen
2 (p≤ 0.03). Rewetting drop use was significantly higher in SiH lens wearers
using Regimen 3 compared to Regimen 1 (p<0.004). Many indices                  366-B7
of comfort favored Regimen 1, particularly in symptomatic subjects             OVERNIGHT ORTHOKERATOLOGY AND CORNEAL
who reported significantly better comfort on all 12 Likert statements          SUSCEPTIBILITY TO A CYTOTOXIC STRAIN OF
(p<0.05). Residual lysozyme on Group IV lenses was significantly lower         PSEUDOMONAS AERUGINOSA
for Regimen 1 (564.5 µg) versus Regimen 2 (1062.8 µg; p<0.0001). Group
I and IV lenses treated with Regimen 1 had significantly lower contact         J.D. CHOO1, P.J. CAROLINE2, E.B. PAPAS1, M. WILLCOX1, B.A. HOLDEN1
angles (better wettability) than those using Regimen 2 (Group I: Regimen       1
                                                                                Institute for Eye Research, Sydney, AUSTRALIA, 2Pacific University College of
1 = 58.0°, Regimen 2 = 76.2°; Group IV: Regimen 1 = 5.8°, Regimen              Optometry, Portland, OR, UNITED STATES OF AMERICA
2 = 90.5°; p<0.002).
Conclusions: A new MPDS was shown to have clinical benefits including          Purpose: In a previous study we showed that the corneal changes
reduced corneal staining, better lens cleanliness and wettability, and         following two weeks of RGP orthokeratology lens wear in cats did not
improved comfort with traditional and SiH lenses compared with two             predispose the feline cornea to infection when exposed to a large amount
marketed MPS. Eye care professionals should be aware that differences          of a highly invasive strain of Pseudomonas aeruginosa (6294). The

142                                                                                                 Asian J Ophthalmol. 2007 Vol 9 No 1 Supplement 1
                                                                                                                                 Poster Abstracts

purpose of this follow-up study was to determine if the resistance to         branded products showed substantial reduction in activity toward
Pseudomonas infection was a strain specific phenomenon.                       S. marcescens and S. aureus upon partial evaporation, even at the
Methods: Sixteen one-year-old cats (that had been used in a previous          2X level.
study involving P. aeruginosa 6294 exposure) were randomly fitted with        Conclusions: Although incorporating models for every conceivable mis-
an alignment (normal) fitting RGP lens on one eye and an orthokeratology      use of a contact lens MPS is not feasible in the development of these
lens (Paragon CRT) on the contralateral eye. All lenses were custom           products, the recent product failure involving Fusarium keratitis informs
designed and fitted for each individual cat and were manufactured in the      the industry of the potential for partial evaporation to occur in the widescale
same Menicon Z, Dk 160, material. Both lenses were worn for 16 hours          usage of a product. No currently marketed product tested was found to
every night and the topographic changes monitored by Medmont corneal          fail at the level of ReNu(R) with MoistureLoc(TM) in a partial-evaporation
topography at baseline, 1 day, 1 week and 2 weeks. After two weeks            model. However, among the various MPS products tested, there are
of lens wear, all lenses were soaked for 10 minutes in a concentrated         differences in antimicrobial performance as a function of degree of evapo-
suspension of a cytotoxic strain of Pseudomonas aeruginosa (6206). The        ration that may indicate a higher patient risk for some products in this
lenses were re-inserted, with approximately 5.0x107 CFU adhered bacteria,     misuse scenario, particularly for the OPTI-FREE(R) and Opti-One(R) brands.
onto their respective corneas for a wearing period of 16 hours. The ani-      However, PHMB based products are indicated to be quite rugged with
mals were monitored for any adverse responses over 24 hours.                  respect to partial evaporation phenomena. *CR
Results: After two weeks of lens wear, the average treatment effect
with the orthokeratology lenses was approximately -4.75D. None of the
16 animals developed an ocular infection in either the alignment              368-B9
or orthokeratology treated eyes following the 16-hour exposure to the         INDICATIONS FOR THE FLUID VENTILATED
cytotoxic strain of P. aeruginosa.                                            BOSTON SCLERAL LENS PROSTHETIC DEVICE
Conclusions: Orthokeratologic corneal changes following two weeks of          AND OUTCOMES OF LENS WEAR
lens wear do not appear to increase corneal susceptibility to Pseudomonas
infection nor does it appear to be a strain specific phenomenon. The re-      P.K. VADDAVALLI1, S.A. BAIG1, C. CHAWAN1, P.G. REDDY1, P. ROSENTHAL2,
sults of this study also indicate that the topographical corneal changes      V.S. SANGWAN1, G.N. RAO1
following orthokeratology lens wear in cats mimicked those seen in            L V Prasad Eye Institute, Hyderabad, INDIA; 2Boston Foundation for Sight, Boston,

human wearers. *CR                                                            MA, UNITED STATES OF AMERICA

                                                                                                                                                                  POSTER ABSTRACTS
                                                                              Purpose: To analyze the indications for the Boston Scleral Lens and
367-B8                                                                        the outcomes of scleral contact lens wear in a Tertiary Eye care center.
EFFECT OF PARTIAL EVAPORATION OF VARIOUS                                      Methods: A retrospective review of the medical records of patients
CONTACT LENS MULTIPURPOSE SOLUTIONS ON                                        undergoing a Boston Scleral Lens trial between August 2005 and July
ANTIMICROBIAL PERFORMANCE                                                     2006 was undertaken. Data collected included demographic data,
                                                                              UCVA, type of refractive error and degree of astigmatism, BSCVA, visual
C.H. POWELL, S.W. HUTH, L.D. HOONG, K. AMBRUS                                 acuity with previous corneal contact lens, current contact lens being used,
Advanced Medical Optics, Santa Ana, CA, UNITED STATES OF AMERICA              UCVA with Scleral contact lens and current medication. Data on patient’s
                                                                              symptoms was also collected from a questionnaire, at baseline and after
Purpose: Recent adverse events involving Fusarium-induced microbial           wearing the lens.
keratitis implicating a particular commercial multipurpose solution (MPS)     Results: The mean age of the 95 patients (153 eyes) was 29.17+13.52
have been reported as primarily connected to evaporation phenomena            years. The major indications for scleral contact lens trial were ectatic
occurring in the lens cases. Although evaporation phenomena ostensibly        corneal disorders (106 eyes, 69.28%) in corneal RGP-intolerant eyes,
stem from misuse of a MPS regimen by leaving the lens case uncapped,          followed by ocular surface disorders (40 eyes, 26.14%) and spectacle-
manufacturers of MPS products are obliged to ensure that particular likely    uncorrectable refractive error (7 eyes, 4.57%). Among these 95 patients,
misuses will not severely compromise the product with respect to anti-        the Boston Scleral Lens was dispensed to 45 patients. On comparison of
microbial potency or in-eye toxicity. Several marketed MPS products were      visual acuities in patients with ectatic corneal disorders a statistically
compared to assess their relative retention of antimicrobial efficacy in an   significant difference was found between BSCVA (Best spectacle corrected
evaporation model, using stand-alone antimicrobial testing methodology.       Visual acuity) and ScCLVA (Scleral contact lens visual acuity) (p = 0.00001),
Methods: Stand-alone disinfection efficacy testing (per FDA/ISO               CLVA (contact lens visual acuity) and ScCLVA (p= 0.0002). The mean BCVA
Guidelines) was performed on products that had been evaporated to             and CLVA of the 3 eyes with refractive errors dispensed with Scleral lens
various levels. Products were evaporated to a “4X” concentration using a      was 6/15(0.4+0.24) and ScCLVA was 6/12 (0.5+0.25). A statistically
stream of air. Portions of the 4X concentrate were diluted to 2X and 1X       significant difference was found between BCVA and ScCLVA (p=0.0277)
(the original product concentration), and the different evaporation-          in patients with ocular surface disorders dispensed with Scleral lenses.
level solutions were tested for antimicrobial activity against the FDA/ISO    Analysis of the symptoms questionnaire revealed that patients’ symp-
stand-alone panel.                                                            toms decreased significantly with Scleral lens wear (p= 0.0001).
Results: The kill-rate data for various products were plotted against the
degree of evaporation (represented by 1X, 2X and 4X concentrations).
The data for RENU(R) with MoistureLoc(TM) (the positive control, no longer
marketed) showed substantial loss of activity against Fusarium solani
and Candida albicans, even for the 2X concentrate. However, other
products, particularly all the OPTI-FREE(R) brand products tested, also
showed weakness in this model toward some organisms, relative to the
PHMB-containing products. Particularly, the OPTI-FREE(R) and Opti-One(R)

Asian J Ophthalmol. 2007 Vol 9 No 1 Supplement 1                                                                                                          143
Poster Abstracts

369-B10                                                                            astigmatism was found. Visual acuity improved to 20/25 or better in all
INFLUENCE OF ISOTONIC AGENTS ON THE                                                eyes. One patient wore lens one hour every morning and had visual
DISINFECTION EFFICACY OF PHMB                                                      acuity with 20/20. There were no remarkable complications.
                                                                                   Conclusions: The conformed Ortho-K lens is an effective and safe method
R. YANAI1, Y. ISHIDA1, K. UEDA1, T. NISHIDA1, O. MORI2                             for improving visual acuity and reducing surgical complications, such
 Yamaguchi University Graduate School of Medicine, Ube, Japan, 2Menicon, Nagoya,   as irregular corneal surface. Proper contact lenses fitting based on topo-
JAPAN                                                                              graphic data and slit-lamp evaluation allowed good visual rehabilitation
                                                                                   and comfortable extended daily wear in patients with corneal ectasia
Purpose: Polyhexamethylene biguanide (PHMB), is a potent biguanide-                after refractive surgery.
base cationic disinfectant that manifests activity against a wide range
of microorganisms, including bacteria, fungi, and amoebae, but which
has a low toxicity and does not irritate the mucous membrane of the                371-B12
eye. It has therefore been used as a disinfectant in major multipurpose            DEVELOPMENT OF CONTACT LENSES: WHAT ELSE
solutions (MPSs) for contact lenses. PHMB selectively affects the                  DO WE NEED TO KNOW?
negative charge of the lipopolysaccharide layer in the cell membrane of
microorganisms. The osmolality of MPSs is adjusted to ~290 mOsm/kg                 K. TAN
with isotonic agents. Given that the disinfection efficacy of PHMB is influ-       CooperVision, Inc., Singapore, SINGAPORE
enced by ionic substances, we have investigated the possible effects of
such isotonic agents on PHMB efficacy.                                             Purpose: Contact lenses have been available in the market for almost 36
Methods: The osmolality of PHMB (1 ppm in water) was adjusted with                 years. There was no major breakthrough research until the introduction
NaCl or propylene glycol. Antimicrobial activity was evaluated with the            of new designs and new materials of contact lenses in early 2000’s. Prac-
stand-alone contact lens disinfection test (ISO14729, 2001).                       titioners have more options now to offer and prescribe to their patients,
Results: PHMB solution without an isotonic agent showed antimicrobial              and the market is now becoming popular with the new generation of
activity against bacterial (Pseudomonas aeruginosa, Staphylococcus                 contact lenses. However, there are still potential issues with the new
aureus, Serratia marcescens) and fungal (Candida albicans, Fusarium                generation of contact lenses, and the recommendation from practitioners
solani) species. The antimicrobial activity of PHMB against bacterial and          is also influenced by the purchasing behavior of patients through con-
fungal species was reduced by the addition of 0.9% NaCl as an isotonic             sumer-oriented programs by the industry.
agent but was unaffected by the addition of propylene glycol.                      This presentation will provide an overview of the development of contact
Conclusions: The disinfection efficacy of PHMB was affected by ionic               lenses in four main areas:
strength of the solution. Ionic compounds such as NaCl may interfere               • Surface properties
with the electrostatic interaction between PHMB and the microbial                  • Mechanical properties
membrane. It is therefore important to avoid the use of ionic substances           • Material properties
as isotonic agents in order to maximize the antimicrobial activity of MPSs         • Permeability properties
containing PHMB. *CR                                                               Methods: Clinical data available from publications and various confer-
                                                                                   ences were reviewed and compiled for this presentation.
                                                                                   Results: Key elements in the four areas stated above include contact
370-B11                                                                            lens materials (HEMA, silicone hydrogel, and phosphorylcholine), lens edge
SUCCESSFUL TREATMENT FOR CORNEA ECTASIA                                            design, lens dehydration/wettability, contact lens deposits, lens modulus
AFTER REFRACTIVE SURGERY BY CONFORMED                                              and oxygen permeability will be discussed. Silicone hydrogel material
ORTHO-K LENS                                                                       will be reviewed further on the pros and cons as compared to the tradi-
                                                                                   tional HEMA material, and how balance is achieved to satisfy the
L.J. LAI1, H.C. TUNG2, R.A. LIN2                                                   patients’ needs in visual correction, comfort and easy handling.
 Chang Gang Memorial Hospital, Taipei, TAIWAN, 2Tung’s Eye Clinic, Taipei,         Conclusions: There is no single contact lens material or design that is
TAIWAN                                                                             perfectly suited for everyone. Compromise in different aspects such as
                                                                                   oxygen permeability, surface wettability and lens modulus are required
Purpose: The corneal shape is significantly altered after refractive surgery,      in order to provide the best combination to meet the patient’s needs.
necessitating new contact lens designs and fitting techniques for optimal          Further research in contact lens material is thus granted to resolve these
postoperative contact lens performance. Cornea ectasia after Lasik is a            issues.
rare but serious complication. To evaluate the US patented conformed               ** Remark: This will be a generic and non-commercial presentation.
ortho-K lens fitting in eyes with irregular cornea surface induced by com-         No commercial product names to be mentioned in the presentation.
plications after myopic corneal refractive surgery.                                *CR
Methods: Corneal ectasia was diagnosed based on abnormal topographic
findings, progressive myopic changes, and uncorrected visual acuity with
glasses. The conformed ortho-K lenses were fit in ten eyes that under-
went myopic cornea refractive surgery and experienced a reduction in
best spectacle-corrected visual acuity (BSCVA) postoperatively. The
contact lens fitting characteristics and visual acuity were evaluated. Pa-
tients were interviewed about their level of comfort and daily contact lens
wear time.
Results: All the patients reported excellent tolerance and subjective
visual quality with the contact lens. No more cornea ectasia or increasing

144                                                                                                    Asian J Ophthalmol. 2007 Vol 9 No 1 Supplement 1
                                                                                                                                  Poster Abstracts

372-B13                                                                           occludin, p120, N-cadherin and α-catenin. Paracelluar permeability
REGULATION OF THE OCULAR CD36 GENE BY                                             was evaluated by transepithelial electric resistance (TER) and flux of BSA-
HYPOXIA                                                                           FITC. Electric microscopy was also used to evaluate the effect of vanad-
                                                                                  ate on intercellular integrity.
P. HARDY1, B. MWAIKAMBO2, S. SESHADRI3, P. LACHAPELLE4, S. CHEMTOB1               Results: Vanadate induced a time- and concentration- dependent effect
 Research Center Ste-Justine Hospital, University of Montreal, Montreal, PQ,      of protein tyrosine phosphorylation confirmed by Western blot analysis
CANADA, 2Department of Pharmacology and Therapeutics, McGill University,          and ICC. It also induced the disruption of junctional and adherens junctional
Montreal, PQ, CANADA, 3Department of Pharmacology and Therapeutics, McGill        proteins including ZO-1, ZO-2, occludin, p120, E-cadherin and α-catenin
University, Montreal, PQ, CANADA, 4Ophthalmology Department, McGill University,   in ICCs. TER decreased and the flux of BSA-FITC increased after the treat-
Montreal, PQ, CANADA                                                              ment of vanadate. However, the total protein expression level of ZO-1,
                                                                                  ZO-2, occludin, p120, N-cadherin and α-catenin did not change. Electric
Purpose: Hypoxic injury to the ocular surface provokes an inflammatory            microscopy demonstrated the disruption of intercellular integrity by
response, which leads to free radical-induced lipid peroxidation of mem-          vanadate.
brane oxidized phospholipids (oxPLs). CD36, a scavenger receptor, binds           Conclusions: Vanadate can induce protein tyrosine phosphorylation of
to a variety of ligands including oxPLs. CD36 is involved both physiologi-        corneal epithelial cells. Such treatment can disrupt corneal epithelial
cally and pharmacologically in inhibition and regression of inflammatory          junctional integrity and increase paracellular permeability. Protein
corneal neovascularization (CNV), however, little is known regarding the          tyrosine phosphatase plays an important role in regulating the junctional
regulation of CD36 during hypoxia. We therefore examined the expres-              barrier of corneal epithelial cells.
sion of CD36 following hypoxia-induced injury in vitro and in vivo.
Methods: Cultured human microvascular endothelial cells (HMVECs) were
exposed to normoxia (21% O2) or hypoxia (2% O2) for various time points           374-B15
and the CD36 expression was evaluated by real-time PCR, Western blot,             DEVELOPMENT OF A BIOENGINEERED CORNEAL
and immunofluorescence. HMVECs were also pretreated with specific                 SURFACE REPLACEMENT
inhibitors of transcription (actinomycin D), translation (cycloheximide),
reactive oxygen species (ROS) (tempol, U74389), and phosphatidylinositol-         D.P. FRANCIS1, M. DANIELL1, K. ABBERTON2, E. THOMPSON2
3 kinase (PI3K) (wortmannin, LY294002), followed by hypoxic exposure              1
                                                                                   Centre for Eye Research Australia, Victoria, AUSTRALIA, 2Bernard O’Brien

                                                                                                                                                                  POSTER ABSTRACTS
and analysis of CD36 mRNA levels by real-time PCR. The influence of               Institute of Microsurgery, Victoria, AUSTRALIA
hypoxia on CD36 expression was further examined in corneal and retinal
tissue from mice exposed to normoxia or hypoxia (8% O2) for 6 hours.              Purpose: Cell sheets derived from the ex-vivo amplification of limbal stem
Results: Hypoxia strongly induced the expression of CD36 mRNA and                 cells can be used to treat limbal stem cell deficiency. The purpose of
protein levels in a time-dependent manner. Treatment of normoxic or               these experiments is to compare a variety of basement membrane alter-
hypoxic cells with actinomycin D revealed no significant difference in the        natives in the ex-vivo amplification of limbal stem cells, to determine
half-life of CD36 mRNA. Conversely, the hypoxia-induced increase in CD36          which is the most reliable, provides the most rapid growth and which
expression was significantly abolished by pre-treatment of HMVECs with            maintains stemness rather than differentiation in the epithelial cells
cycloheximide, tempol, U74389, wortmannin and LY294002. Analysis of               grown. A secondary aim is to reduce the reliance on animal products in
corneal and retinal tissue from hypoxia exposed mice revealed a 3.5- and          the culturing process.
6-fold increase in CD36 mRNA levels respectively.                                 Methods: Initially explant and cell suspension methods were compared.
Conclusions: The current findings provide unique insight into a                   Subsequently, limbal explants were seeded onto denuded amniotic
previously undisclosed induction of CD36 by hypoxia in both endothelial           membrane, Matrigel, Myogel and a novel basement membrane gel incor-
cells and ocular tissue. Our data suggest that hypoxic induction of CD36          porating corneal stroma proteins. The explants were cultured in media
depends on active protein synthesis, but not mRNA stability. Interestingly,       supplemented with human serum. Growth rate, time to confluence, cell
it also appears to involve production of ROS and activation of the PI3K           sheet transferability and cellular differentiation were measured. The
pathway.                                                                          markers used to determine differentiation included cytokeratins 3 and
                                                                                  19, and G2 member of the ATP binding cassette family (ABCG2).
                                                                                  Results: A confluent sheet of limbal epithelium can be grown over all
373-B14                                                                           four basement membrane alternatives using an explant method (the
EFFECTS OF VANADATE-INDUCED PHOSPHATASE                                           image below shows a H&E stain of stratified epithelium growing over
INHIBITION ON CORNEAL EPITHELIAL                                                  denuded amniotic membrane). Using denuded amniotic membrane and
JUNCTIONAL INTEGRITY                                                              Myogel as a basement membrane gave the most consistent and rapid
                                                                                  growth of a confluent cell layer. The novel basement membrane and
I.H. TU, W.L. CHEN, Y.C. SHEN, M.Y. CHEN, F.R. HU                                 Matrigel were not as consistent and slower at cultivating limbal cells in
National Taiwan University Hospital, Taipei, TAIWAN                               these experiments. The cultured cells demonstrated staining indicative
                                                                                  of stem cells or early transient amplifying cells, where stratification
Purpose: To study the effects of general phosphatase inhibitor, sodium            occurred the superficial cells appear more differentiated. ABCG2 and CK19
orthovanadate (vanadate) on intercellular junctional integrity of corneal         (putative stem cell markers) positive cells were more prevalent around
epithelial cells.                                                                 the explant and at the leading edge of growth outwards from the explant.
Methods: Confluent cultures of bovine corneal epithelial cells were treated       Use of a temperature sensitive culture dish facilitated the transfer of cells
with different concentration of vanadate. Effect of vanadate on protein           grown over gel based basement membranes, making them a clinically
tyrosine phosphorylation was confirmed by Western blot analysis and               suitable alternative to amniotic membranes.
immunocytochemistry (ICC). ICC was also used to evaluate the effect of            Conclusions: Amniotic membrane and Myogel offer great potential for
vanadate on intercellular junctional integrity by staining for ZO-1, ZO-2,        cultivating limbal stem cells in culture. Myogel is a basement membrane

Asian J Ophthalmol. 2007 Vol 9 No 1 Supplement 1                                                                                                          145
Poster Abstracts

gel that can be derived from human muscle and therefore represents a                 376-B17
way of growing autologous cells on an autologous basement membrane                   PHENOTYPIC CHARACTERIZATION AND SIGNAL
using a patient’s own serum.                                                         TRANSDUCTION PATHWAY INVOLVED IN THE
                                                                                     EX-VIVO EXPANSION OF CORNEAL STEM CELLS
                                                                                     OVER VARIOUS SCAFFOLDS
ARE CORNEAL KERATOCYTES SIMILAR TO                                                   S. BALASUBRAMANIAN1, A.K. SUJATHA2, J. SRILATHA1, V. NALINI1,
MESENCHYMAL STEM CELLS?                                                              T.P. SASTRY 2, I.K. GEETHA 1, G.SITALAKSHMI 1, H.N. MADHAVAN 1,
K.Y. THEN1, P.F. CHOONG2, P.L. MOK2, S.K. CHEONG2                                    1
                                                                                       Vision Research Foundation, Chennai, INDIA, 2Central Leather Research Institute,
 Birmingham and Midland Eye Centre, Birmingham, UNITED KINGDOM, 2Hospital            Chennai, INDIA
Universiti Kebangsaan Malaysia, Kuala Lumpur, MALAYSIA
                                                                                     Purpose: To evaluate the growth and the phenotype of limbal epithelial
Purpose: The unique potential of mesenchymal stem cells (MSC) has                    cells grown over various scaffolds [chitosan, chitosan incorporated with
generated much research interest lately, particularly in exploring the               gold and silver, plastic, plastic +3T3 feeder layer and Human Amniotic
regenerative nature of these cells. Previously, MSC were thought to be               membrane (intact and denuded)] and to study the signal transduction
found only in the bone marrow. However, further studies have shown                   pathway involved in the ex-vivo expansion of corneal stem cells on these
that MSC can also be isolated from umbilical cord blood, adipose tissue              scaffolds.
and amniotic fluid. In this study, we explored the possibility of MSC resid-         Methods: Human cadaveric limbal explant cells were cultivated on vari-
ing in the cornea.                                                                   ous scaffolds. The cells were harvested and checked for viability by trypan
Methods: Human cornea tissues were chopped to fine pieces and they                   dye exclusion test and phenotyped by RT PCR for p63 and ABCG2, Connexin
were cultured in DMEM supplemented with 10% FBS. After a few days,                   43 and K3 & K12. Western blot was done on the cells and Akt, FKHRL1,
the crude pieces of cornea were removed. Isolated keratocytes that were              MAPK and JNK pathway was studied.
adherent to tissue culture flask were grown till confluency before being             Results: The limbal epithelial cells grow with ease on all the scaffolds.
passaged further. Immunophenotype was evaluated by flow cytometry.                   Cells started growing from the explant by the end of the 2nd day and
Differentiation assays were performed to differentiate cultured cells into           it formed a monolayer by day 15. The results of the expression of the
adipocytes and osteocytes.                                                           various markers are summarized in Table 1.
Results: We showed that isolated corneal keratocytes exhibit a                       Conclusions: It is interesting to see the differential expression of limbal
fibroblastoid morphology and expressed CD13, CD29, CD44, CD56, CD73,                 phenotype and corneal phenotype in various scaffolds. It is also interest-
CD90, CD105, and CD133, but were negative for HLA-DR, CD34, CD117                    ing to see that the cells on the intact membrane is mediated through the
and CD45. These properties are similar to that of bone marrow-derived                PI3K - Akt signaling pathway and by the mitogenic MAPK pathway
MSC (BM-MSC). In addition, we have shown that corneal keratocytes were               mediated by p44/42 at the expense of p38 and JNK MAPK. The signal
able to differentiate into adipocytes and osteocytes.                                transduction pathway involved in the survival of cells in various scaffolds
Conclusions: Our results indicate that corneal keratocytes have MSC-                 will be discussed.
like properties similar to that of BM-MSC. This study opens up the possi-
bility of using BM-MSC in corneal tissue engineering and regeneration.
Furthermore, discarded corneal tissue can also be used to generate MSC
for tissue engineering purposes.

Table 1 Abstract 376-B17.
    Scaffold                         Days          P63        ABCG2            Cx -43           K3            K12          WB result on signalling pathway
                                                                                                                            (PI3K-Akt-FKHRL1 & MAPK)
    Chitosan                          4th           +            +               -               -             -                    Will be discussed
                                     12th           +            +               +               -             -
                                     21st           +            +               +               +             +
    Chitosan + gold                   4th           +            +               -               -             -                    Will be discussed
                                     12th           +            +               +               -             -
                                     21st           +            +               +               +             +
    Chitosan + Silve                  4th           +            -               +               -             -                    Will be discussed
                                     12th           +            -               +               +             +
                                     21st           +            -               +               +             +
    Plastic                           4th           +            -               -               -             -                    Will be discussed
                                     12th           +            -               +               +             +
                                     21st           +            -               +               +             +
    Plastic + 3T3                     4th           +            -               -               -             -                    Will be discussed
                                     12th           +            +               -               -             -
                                     21st           +            +               -               +             +
    Denunded Amniotic Membrane        4th           +            -               -               -             -                      Akt - negative
                                     12th           +            -               +               +             +                     PAkt - negative
                                     21st           +            -               +               +             +
    Intact Amniotic Membrane         4th            +            +               -               -             -                      Akt -positive
                                     12th           +            +               -               -             -                     PAkt - positive
                                     21st           +            +               -               -             -

146                                                                                                        Asian J Ophthalmol. 2007 Vol 9 No 1 Supplement 1
                                                                                                                                  Poster Abstracts

377-B18                                                                          each variable as judged on photography and histopathology. Two
OUTCOME OF LIVING RELATED CONJUNCTIVAL                                           rabbits (controls) underwent transplantation with Mebiol gel alone
LIMBAL ALLOGRAFT TRANSPLANTATION                                                 without cultured cells.
                                                                                 Results: Reparative surgery was a total success (score, 8-10) in 7
V.S. SANGWAN, B. RAMAMURTHY, H.P. MATALIA, G.N. RAO                              (58.3%), partial success (score, 6-7) in 2 (16.7%) and failure (score, <5)
L.V.Prasad Eye Institute, Hyderabad, INDIA                                       in 3 (25%). Histological and RT PCR study documented successful growth
                                                                                 of corneal epithelium onto the recipient surface. RT PCR studies showed
Purpose: To report outcome of living related conjunctival limbal stem cell       the limbal phenotype in the limbus and cornea phenotype in the central
transplantation (Lr- CLAL) for total limbal stem cell deficiency.                portion. Reparative surgery was a failure in controls.
Methods: In this retrospective, noncomparative case series, the authors          Conclusion: The results of the rabbit model suggest that autologous limbal
reviewed records of 10 patients (11 eyes) with total limbal stem cell            epithelial cells grown in thermo-reversible gel polymer may restore a nearly
deficiency that underwent Lr- CLAL., diffuse flourescein staining and/or         normal ocular epithelial surface in eyes with unilateral LSCD. *CR
presence of persistent epithelial defect.
Results: Lr- CLAL was performed in 11 eyes of 10 patients between
December 2000-May 2004. 1 patient underwent surgery in both eyes.                379-B20
9 were male and 1 was female. Mean age was 27.3 years (range 6-53                IN VITRO MODELLING OF THE RECOVERY
years). Mean follow-up was 23 months with a range from 6-61 months.              POTENTIAL OF HUMAN CORNEAL EPITHELIAL
Mean duration of injury before surgery was 2.5±1.9 months. Surgeries             CELLS
performed before limbal transplantation included amniotic membrane
grafting (AMG), symblepharon release and extracapsular cataract extrac-          C.Y. CHANG, C.R. GREEN, C.N.J. MCGHEE, T. SHERWIN
tion with posterior chamber intraocular lens implantation (ECCE +PC IOL).        The University of Auckland, Auckland, NEW ZEALAND
Six penetrating keratoplasties (PKP) were done following Lr-CLAL. Mean
duration between limbal transplantation and PKP was 8.4 months. In two           Purpose: The limbus of the cornea is a highly specialized area. It is at the
cases simultaneous PKP and Lr-CLAL was done. Success was seen in                 limbus that the corneal stem cells reside within the pallisades of Vogt.
4/11eyes (36.3%) (95%CI 7.9-64.7). Failure was seen in 6/11 eyes                 These stem cells replicate to give rise to one more stem cell and one
(54.5%) (95%CI 25-83.9), partial success (persistent epithelial defect           transient amplifying cell (TAC). The latter replicates, differentiates further

                                                                                                                                                                  POSTER ABSTRACTS
healed following treatment) was seen in 1/11 eye (9.1%).                         and migrates in a centripetal motion to renew the corneal epithelium ac-
Conclusions: Lr- CLAL, along with systemic immunosuppresion seems                cording to the XYZ hypothesis of corneal re-epithelialization. The limbal
to be a viable option for restoration of ocular surface in severe total limbal   stem cells and youngest TACs are thought to form the “side population”
stem cell deficiency, but with limited success.                                  of regenerative cells. These cells have important functions in retention
                                                                                 of normal corneal epithelial integrity, repair following injury and cellular
                                                                                 interactions in corneal dystrophies.
378-B19                                                                          Methods: We have established a human corneal organotypic culture model
A RABBIT MODEL OF EX VIVO CULTIVATION AND                                        within our laboratory, which allows assessment of corneal healing in vitro.
TRANSPLANTATION OF AUTOLOGOUS LIMBAL                                             We have successfully used this model to follow epithelial regrowth in
EPITHELIAL CELLS GROWN ON A THERMO-                                              intact human corneas followed by histological and immunohistochemical
REVERSIBLE POLYMER (MEBIOL GEL)                                                  analyses post fixation. Ten human corneas were analyzed following
                                                                                 ablation using a Bausch & Lomb Zyoptix 100 excimer laser and one of
G. SITALAKSHMI1, H.N. MADHAVAN1, B. SUDHA1, S. KRISHNAKUMAR1,                    two ablation patterns: 1) a 5mm diameter, 200µm depth PTK ablation
V.S. PILLAI1, Y. MORI2, H. YOSHIOKA2, S. ABRAHAM3                                blending out to 8.6mm, 2) a donut ablation of 7mm outer diameter to a
    Sankara Nethralaya, Chennai, INDIA, 2Waseda University, Tokyo, JAPAN,        depth of 80µm with a masked central “island” of 3mm.
    Nichi- In Center for Regenerative Medicine, Chennai, INDIA                   Results: Rates of epithelial recovery were measured at approximately
                                                                                 0.1mm/hour with both types of ablation. Unexpectedly, in the donut
Purpose: To evaluate the efficacy of autologous expanded corneal                 ablations the rate of regrowth was identical in both the centripetal
epithelial cell transplants derived from harvested limbal epithelial stem        direction from the limbus and in the centrifugal direction from the central
cells cultured on a thermo-reversible polymer (mebiol) for the manage-           epithelial island. Limbal stem cell markers, ABCG2 and p63 were analyzed
ment of unilateral limbal stem cell disease (LSCD).                              immunohistochemically to gauge upregulation of the side population
Methods: In 12 rabbits, a limbal biopsy was taken and thereafter, ocular         following ablation. ABCG2 labelling in lasered human corneas was
surface damage was created on the same eye by removal of corneal and             upregulated in the limbal region but p63 labelling was not restricted to
limbal epithelium. The limbal biopsies were cultured on the mebiol Gel as        the limbal region and seemed to be upregulated at the wound edge.
explant cultures for 3 weeks to produce confluent epithelial cells, har-         Conclusion: We conclude that cells capable of epithelial regeneration
vested non-enzymatically by reducing the temperature to 4°C. Three weeks         are also located within the central cornea and that these cells may re-
later, vascularized pannus was removed and expanded autologous limbal            spond to wounding in similar fashion to the limbal population.
epithelial cells were placed in a drop fashion to cover the entire damaged
corneal surface. The rabbits were sacrificed at the end of the study and
the damaged corneas were harvested for histological and RT-PCR study
for the limbal phenotype (p63 & ABCG2), transient amplifying cell mark-
ers (Integrin β 1 & Connexin 43) and corneal phenotype (K3 & K12)
markers. Outcome measures such as corneal vascularization (V), corneal
haze (H), fluorescein staining (F) and histopathology (P) were evaluated
between 6-8 months. Each outcome was scored based on the severity of

Asian J Ophthalmol. 2007 Vol 9 No 1 Supplement 1                                                                                                          147
Poster Abstracts

380-B21                                                                                 Methods: PAVA membranes of varying thickness and pore size and pre-
EX VIVO EXPANSION OF CADAVERIC                                                          served amniotic membrane were used to culture corneal limbal epithelial
KERATOLIMBAL STEM CELL: A PRELIMINARY                                                   cells. PAVA membranes were studied for thickness, tensile strength, pore
REPORT FROM THAILAND                                                                    size and ability to support cell growth. Corneal limbal epithelial cells were
                                                                                        harvested from cadaveric donor corneo-scleral rims in sterile conditions.
S. SINTUWONG 1 , N. KITIYANANT 2 , N. PRAKAIRUNGTHONG 3 ,                               2mm size pieces from the corneo scleral junction were placed over
C. PHOLPRAMOOL4, Y. KITIYANANT5                                                         the biopolymer in six well tissue culture plates along with corneal limbal
 Eye Research and Technology Assessment Center, Mettapracharak Hospital,                epithelial cell culture media and adjuvants. Similar experiments were set
Nakhonpathom, THAILAND, 2Institute of Science and Technology for R&D,                   up simultaneously with preserved AM using the same cell source. The
Nakhonpathom, THAILAND, 3Department of Ophthalmology, Mettapracharak                    plate was incubated at 37°C with 5% CO2 for 21 days.
Hospital, Nakhonpathom, THAILAND, 4Department of Physiology, Faculty of                 Results: Overall 9 different prototype membranes of different thickness
Science, Bangkok, THAILAND, 5Department of Anatomy, Faculty of Science,                 and pore size were tried with and without various supporting materials.
Bangkok, THAILAND                                                                       Very thin PAVA membranes floated in the culture medium and did
                                                                                        not remain stable. Use of fibrin glue to stabilize the membrane was
Purpose: The loss of limbal stem cells leads to invasion of the cornea by               unsuccessful. Thicker membranes were more stable and showed better
vascularized conjunctival epithelium, which causes functional blindness                 potential to support growth of cells. Visible outgrowth was noticed from
that cannot be treated by standard corneal transplantation. Advances                    the edges of explant tissue. After 21 days culture composite membrane
in tissue engineering techniques have offered a viable alternative to                   was subjected to Hematoxylin and Eosin (H&E) staining. Epithelial cells
overcome the limitation of limbal tissue available for transplantation. We              could not be identified by H&E on PAVA membrane while a confluent and
performed a preliminary report to isolate and expand the cadaveric                      multilayered sheet of cells was observed on AM.
keratolimbal stem cells without feeder cell layer.                                      Conclusions: The use of Nanofibers has advantages over conventional
Methods: Human corneal tissue from Thai Red Cross eye bank was used                     AM as the latter amniotic membrane is an allogenic biological material
in this study. Limbal ring was cut into small pieces of 2 X 2 mm2, 100 µm               associated with potential risks. PAVA membrane seems to support the
thick explants. Two to three explants were placed in 60-mm culture plates.              culture of corneal epithelial cells but to a limited extent. These nano-fiber
The culture medium was the mixture of Dulbeco’s modified Eagle me-                      membranes have advantages like high tensile strength, ease of handling
dium and Ham F12 medium (1:1), 10 % FCS, 5 µg/ml insulin, 10 ng/ml                      and initial ability to support cell growth for supporting culture of explants.
EGF and 50 IU/ml penicillin-streptomysin. Cultures were incubated in                    Further efforts are needed especially regarding cell support for longer
5 % CO2 incubator at 37°C for up to 20 days. The medium was changed                     duration and identifying cells growing on the membrane to develop the
every 2 days. At the end of the incubation, the cell sheets were removed                membrane for clinical use.
for expansion and immunocytochemistry testing for the expression of
p63 and keratin 19 markers.
Results: The results showed cell proliferation from the limbal explants by              382-B23
phase contrast microscope as a continuous layer of many small compact                   GENE MICROARRAY RELATED WITH SIGNALING
colonies and flat polygonal epithelial cells. The explant culture method                TRANSDUCTION IN DIABETIC OLETF
without feeder layer in this study produced 2 types of cells in morphology.             KERATOCYTES
The immunocytochemistry indicated the expression of keratinocyte stem
cell marker p63 as well as keratin 19.                                                  J.E. LEE, S. KIM, B. OUM, J. LEE
Conclusions: The expression of keratin 19 is found in many epithelial tis-              Department of Ophthalmology, College of Medicine, Pusan National University,
sues including skin and conjunctiva. Keratin 19 is closely associated with              Pusan, KOREA
the location of progenitor cells in the limbus whereas p63 is associated with
the developmental tissues especially at the basal of the limbus. Therefore,             Purpose: To compare differentially expressed genes concerned
the presence of p63 and cytokeratin in our established cells confirmed the              with signaling transduction between normal and diabetic keratocytes
keratolimbal stem cells derived from limbal tissues. In Thailand, this new              stimulated with and without interleukin-1α (IL-1α) and tumor necrosis
approach is in progress to be validated, targeted at limbal stem cell in vivo,          factor-α (TNF-α).
stem cell niche, and further studies are needed for better understanding the            Methods: Normal and diabetic keratocytes were primarily cultured, and
biochemical, molecular and cellular basis of this process.                              treated with 20 ng/ml of IL-1α and TNF-α for 6 hours. Hybridization with
                                                                                        cDNA from mRNA was carried out using oligonucleotide microarray.
                                                                                        Identified genes were further evaluated by real-time PCR.
381-B22                                                                                 Results: Diabetic keratocytes showed the different signaling pathways
FEASIBILITY OF USING NANO-FIBER MEMBRANE                                                with overexpressed MAPK, and Notch, and underexpressed insulin,
AS A SUBSTRATE FOR CULTURING CORNEAL                                                    calcium, and TGF-β. Cytokine treated diabetic keratocytes demonstrated
LIMBAL EPITHELIAL CELLS                                                                 differentially expressed signaling pathways associated with TGF-β, and
                                                                                        MAPK. Newly and commonly expressed pathways containing all under-
S. SHARMA1, R. TANDON1, S. MOHANTY1, S. SEN1, A.K. AGRAWAL2,                            expressed 9 genes after treatment of IL-1α and TNF-α were Insulin, TGF-β,
M. JASSAL2                                                                              and Toll-like receptor. Real time PCR showed IL-6 and TGF- β2 genes
 All India Institute of Medical Sciences (AIIMS), New Delhi, INDIA, 2Indian Institute   were significantly decreased and Ppm1a gene was significantly increased.
of Technology (IIT), New Delhi, INDIA                                                   Conclusions: There were some differentially expressed genes related
                                                                                        with signaling transduction pathways such as Insulin, MAPK, Calcium,
Purpose: To evaluate the role of nano-fiber Polyacrylic acid polyvinyl                  and TGF-β between normal and diabetic keratocytes. Also IL-1α and
alcohol (PAVA) membrane as an alternative substrate to amniotic                         TNF-α may stimulate to differing effects on Insulin, TGF-β, and Toll-like
membrane for the culture of corneal limbal epithelial cells.                            receptor signaling pathways at diabetic keratocytes.

148                                                                                                          Asian J Ophthalmol. 2007 Vol 9 No 1 Supplement 1
                                                                                                                              Poster Abstracts

383-B24                                                                        presented with ocular irritation and defective vision since 4 years. The
DOWNREGULATION OF PAX6 IS ASSOCIATED WITH                                      younger brother of the patient had similar complaints while the other 2
ABNORMAL DIFFERENTIATION OF CORNEAL AND                                        siblings and parents were asymptomatic. BCVA of proband was 20/50 in
CONJUNCTIVAL EPITHELIAL CELLS IN SEVERE                                        both eyes (RE: -0.75@900; LE: -1.00@900). Corneal examination revealed
OCULAR SURFACE DISEASES                                                        bilateral coarse reticulate subepithelial opacities involving the pupillary
                                                                               axis and a few discrete anterior stromal opacities in the periphery.
W. LI 1, Y.T. CHEN 1, Y. HAYASHIDA 1, H. HE 1, S.Y. CHEN 1, C.Y. LIU 2,        Affected sibling had similar corneal findings while both parents had
S.C.G. TSENG1                                                                  classical bread crumb-like opacities in the mid stroma in both eyes. The
 Ocular Surface Center, Miami, FL, UNITED STATES OF AMERICA, 2Department       proband and the brother’s mutation were homozygous for TGFBI muta-
of Ophthalmology, University of Cincinnati, Cincinnati, OH, UNITED STATES OF   tion while the parents were heterozygous. The child was treated by alco-
AMERICA                                                                        hol (20% ethanol) assisted epitheliectomy followed by scraping of opacities
                                                                               using No. 15 surgical blade in both eyes under general anesthesia.
Purpose: Pax6 is the universal master control gene for eye morphogen-          Postoperatively, BCVA was 20/20p in right eye and 20/30 in left eye. Cor-
esis in metazoan, while little is known about the function of Pax6 in the      nea showed a clear visual axis with removal of all subepithelial opacities.
postnatal stage, this study was conducted to investigate the role of Pax6      There was a minimal anterior stromal haze in the left eye and persistence
in maintaining the phenotype of ocular surface epithelial cells.               of granular deposits in peripheral stroma.
Methods: Normal corneoscleral tissue and ten corneal pannus tissues            Conclusions: Since increased recurrences have been reported in this
from patients with ocular surface diseases such as Stevens-Johnson             variant of granular dystrophy requiring multiple surgeries, procedures like
syndrome (SJS) (n=5), chemical burn (n=3), aniridia (n=1), and recurrent       superficial keratectomy, phototherapeutic keratectomy will result in stro-
pterygium (n=1) were immunostained with keratin 12, keratin 10, kera-          mal loss with thinning. 20% ethanol assisted epitheliectomy with scrap-
tin 16, keratin 19, filaggrin, Ki67, p63, and Pax6 antibodies. Epithelial      ing clears the visual axis and prevents stromal loss.
cells harvested from normal limbus and pannus from patients with SJS
were seeded on 3T3 fibroblast feeder layers, and the colonies were stained
with Pax6. Colonial expanded epithelial cells from SJS were further            385-B26
transfected with EGFP-Pax6 adenovirus for 72 hours and stained with            CORNEAL DECOMPENSATION ASSOCIATED WITH
Pax6 and keratin 12. Protein harvested from in vivo or colonial expanded       LASER IRIDOTOMY - SMALL CASE SERIES

                                                                                                                                                             POSTER ABSTRACTS
normal limbal, pannus, and transfected epithelial cells were objected to
Western blot of Pax6.                                                          S.M. LEE, M.C. HSIEH
Results: Normal corneal, limbal, and conjunctival epithelial cells includ-     Veterans General Hosp Taipei, Taipei, TAIWAN
ing basal cells expressed Pax6. Pannus basal and suprabasal epithelial
cells from patients with ocular surface diseases showed a notable              Purpose: To present three cases of corneal endothelial degeneration
decline or absence of Pax6, and keratin 12 or keratin 19 expression, while     associated with laser iridotomy.
an increase of keratin 10 and filaggrin expression. Basal epithelial cells     Methods: Observational case series.
on pannus maintained p63 expression and showed activated prolifera-            Results: A case of 65-year-old lady who is a case of chronic angle
tion based on Ki67 and keratin 16 staining. Epithelial cells harvested from    closure glaucoma denied ocular operation or trauma. We recorded her
corneal pannus from SJS generated vivid colonies on 3T3 fibroblast feeder      corneal endothelial count before and after peripheral iridotomy of both
layers without Pax6 expression. In contrast, those from normal limbal          eyes, and we found obviously decreased endothelium count and increased
epithelial colonies did express Pax6. Colonial grown epithelial cells gen-     number of guttata lesion at the center of cornea. A 66-year-old lady
erated from SJS pannus transfected with EGFP-Pax6 adenovirus showed            and an 88-year old gentleman who are cases of chronic angle closure
increased Pax6 and keratin 12 expression.                                      glaucoma received peripheral iridotomy of both eyes at local eye clinic.
Conclusions: Pax6 helps maintain the normal phenotype of ocular sur-           And they denied other ocular operation or trauma of both eyes. We
face epithelium in the postnatal stage. Down-regulation of Pax6 is asso-       also found corneal edema with bullous change of the cornea. The corneal
ciated with abnormal epidermal differentiation of ocular surface epithelial    endothelium count of both eyes was obviously decreased.
cells in severe ocular surface diseases. Further studies of such Pax6          Conclusions: YAG or Argon laser for peripheral iridotomy was a good
downregulation might shed light on how squamous metaplasia develops            choice for prevention and treatment of acute attack of angle closure
in these difficult ocular surface disorders.                                   glaucoma. The possible thermal and mechanical injuries to corneal
                                                                               endothelium of this procedure were studied for a long time. In our cases,
                                                                               decreased endothelium count was found. The delayed onset of bullous
384-B25                                                                        keratopathy due to possibilities of damaged endothelia of the cornea
ALCOHOL ASSISTED DEBRIDEMENT IN A CASE OF                                      occurred even 10 years after the procedure and it resulted in visual
SUPERFICIAL VARIANT OF GRANULAR CORNEAL                                        loss. Peripheral iridotomy is a risk for corneal decompensation, so the
DYSTROPHY WITH R555W HOMOZYGOUS                                                frequency and power of the laser should be planned very carefully. We
MUTATION OF TGFBI GENE                                                         presented cases of corneal endothelial degeneration associated with
                                                                               laser iridotomy to remind that we should pay more attention before we
V. MITTAL, A. ZABBAR, P. GARG, M. SAMANT                                       performed this procedure and avoid it during the acute stage of angle
LV Prasad Eye Institute, Hyderabad, AP, INDIA                                  closure glaucoma.

Purpose: To report the use of alcohol assisted debridement in a child
with superficial variant of granular dystrophy having homozygous mutation.
Methods: Interventional case report.
Results: An eight-year-old girl, the offspring of a consanguineous marriage,

Asian J Ophthalmol. 2007 Vol 9 No 1 Supplement 1                                                                                                     149
Poster Abstracts

386-B27                                                                       Transepithelial electrical resistance [TER] was measured with voltohm-
THE ROLE OF PROTEIN TYROSINE                                                  meter to help to understand the change of paracellular permeability. Cell
PHOSPHORYLATION IN THE CELL-CELL                                              morphology was observed with inverted fluorescence microscopy.
INTERACTIONS, JUNCTIONAL PERMEABILITY AND                                     Results: The preserved solutions and BAC with concentration above
CELL CYCLE CONTROL IN POST-CONFLUENT                                          0.005% significantly decreased cell viability by MTS assay. Increased
BOVINE CORNEAL ENDOTHELIAL CELLS                                              paracellular permeability and decreased membrane integrity were also
                                                                              observed by TER measurement and inverted fluorescence microscopy.
W.L. CHEN, I.H. TU, F.R. CHEN                                                 Ofloxacin and Levofloxacin, both contain no preservatives, showed the
National Taiwan University Hospital, Taipei, TAIWAN                           least cytotoxicity to human corneal epithelial cells in commercial
                                                                              fluoroquinolone eye drops.
Purpose: To evaluate whether protein tyrosine phosphorylation is involved     Conclusions: The cytotoxicity observed with fluoroquinolone eye
in the expression of adherens-type junctional proteins, paracellular          drops seems to be caused mainly by the preservative, which induced a
permeability and cell cycle control in post-confluent, contact inhibited      significant decrease in membrane integrity and increase in paracellular
bovine corneal endothelial cells.                                             permeability. To human corneal epithelial cells, the new generation
Methods: Confluent cultures of bovine corneal endothelial cells were          fluoroquinolones (Moxifloxacin and Gatifloxacin) were not less cytotoxic
treated with different concentrations of the general phosphatase              than the old generation fluoroquinolones.
inhibitor, sodium orthovanadate (vanadate) for several different durations.
Protein tyrosine phosphorylation was confirmed by Western blot analysis.
Immunocytochemistry (ICC) was used to evaluate the effect of vanadate         388-B29
on cell-cell contacts by staining for p120, N-cadherin and α-catenin.         IN VIVO CONFOCAL MICROSCOPIC STUDY OF
Paracelluar permeability was evaluated by transepithelial electric            CORNEAL WOUNDING HEALING AFTER EPI-LASIK
resistance (TER). The effect of vanadate on cell cycle progression was
confirmed by immunostaining for Ki67. Western blot analysis was used to       W.L. CHEN, T.H. TSAI, I.H. TU, F.R. HU
evaluate the expression level of PCNA, cycle D1, cyclin E and cyclin A.       National Taiwan University Hospital, Taipei, TAIWAN
Results: Time-dependent effect of vanadate on protein tyrosine phos-
phorylation was confirmed by Western blot analysis. ICC demonstrated          Purpose: To study the corneal wound healing process after Epi-LASIK.
the effect of vanadate on the disruption of p120, N-cadherin and α-catenin.   Methods: From June 2005 to Mar 2006, all patients who underwent
Time- and dose-effects of vanadate on the severity of p120 disruption         Epi-LASIK were included in this study. In vivo confocal microscopic
were also found. TER demonstrated the time- and dose-effect of vanad-         examinations were performed immediately before, 1 day, 3 day, 1 week,
ate on paracellular permeability. Although cell-cell junctions can be         2 week, 1 month, 2 months and 3 months after operation. The corneal
broken through by vanadate, no significant increase of Ki67 positive          epithelial morphology, corneal nerve morphology/density and stromal
cells was found among the control group and groups with different             reaction will be recorded and compared. In addition, slit lamp
concentrations/durations of vanadate treatment. Western blot also             biomicroscopy, bare and best corrected visual acuity, refractive status
showed no change of PCNA, cyclin D1, cyclin E and cyclin A after treat-       and intraocular pressure will also be recorded.
ment with vanadate.                                                           Results: There were totally 24 patients who met the criteria By slit lamp
Conclusions: Protein tyrosine phosphatase inhibition can induce a time        biomicroscopy, the total healing rate of corneal epithelial cells was 5 ±
and dose dependent release of cell-cell contacts and increase                 2.3 days. By in vivo confocal microscopy, the corneal basal epithelial
transepithelial permeability in post-confluent cultures of bovine corneal     cells demonstrated larger nucleus with higher reflectivity during the first
endothelial cells. However, such phenomenon is not enough to promoted         4 weeks after operation. After 4 weeks, the nucleus became as small as
cell cycle progression even the cell-cell contact mechanism is disrupted.     preoperation. The preoperative clear cellular borders became invisible
                                                                              during the first 14 days after the operations. The corneal nerve did
                                                                              not return to preoperative levels three months after the operations.
387-B28                                                                       Conclusions: Corneal epithelial wound healing by in vivo confocal micro-
COMPARISON OF FLUOROQUINOLONES:                                               copy after Epi-LASIK was much longer than expected clinically. In
CYTOTOXICITY ON HUMAN CORNEAL EPITHELIAL                                      our study, 100% of the corneal epithelial cells in the flap were rapidly
CELLS                                                                         replaced by new growing cells after the surgery. No so-called type I
                                                                              healing process was observed.
National Taiwan University Hospital, Taipei, TAIWAN
Purpose: To compare the cytotoxicity of different fluoroquinolones to         EXPERIMENTAL GROUNDS FOR USING 1%
human corneal epithelial cells.                                               SOLUTION OF PILOCARPINE HYDROCHLORIDE
Methods: Human corneal epithelial cell line were incubated with               FOR THE TREATMENT OF RABBIT CORNEA
fluoroquinolones (Moxifloxacin, Gatifloxacin, Norfloxacin, Ciprofloxacin,     EPITHELIAL DEFECTS OF DIFFERENT ETIOLOGY
Ofloxacin, Levofloxacin), in different concentrations both in commercial
ophthalmic formulations (undiluted concentration and 1/10 concentration)      A. ASANOVA1, B. SULEEVA2
and in unpreserved solutions (0.03%, 0.075%, 0.15%, 0.3% and 0.5%)            1
                                                                               National Hospital of Ministry of Health of the Kyrgyz Republic, Bishkek,
for 4 incubation times (1hr, 8hr, 24hr, 48hr). Several concentrations of      KYRGYZSTAN, 2Kazakh Research Eye Institute, Almaty, KAZAKHSTAN
Gentamicin (0.03%, 0.3%, 1.4%), Cefazolin (5%) and Benzalkonium
chloride [BAC] (0.0005%, 0.001%, 0.005% and 0.01%) were also                  Purpose: To study the effect of 1% solution of pilocarpine hydrochloride
tested. MTS assay was used to evaluate the drug effect on cell viability.     on regenerative processes with cornea epithelial defects of different

150                                                                                                Asian J Ophthalmol. 2007 Vol 9 No 1 Supplement 1
                                                                                                                                        Poster Abstracts

etiology in experimental rabbits.                                                     evaluated by digital imaging after propidium iodide staining. Short inter-
Methods: The total number of rabbits was 6 (12 eyes), including 3 (6                  fering (si) RNA against TGM-2 was used to knock-down TGM-2, with
eyes) with experimental cornea ulcer, and 3 (6 eyes) with deep trauma                 fluorescein conjugated non-targeting siRNA as transfection controls.
cornea erosion. Right eyes (experimental) were treated with pilocarpine               Changes in TNF receptor-I staining and caspase-3 activation were evalu-
in addition to standard treatment. Left eyes (control) received only stand-           ated at various times after UVB. Intracellular delivery of exogenous TGM-
ard treatment. Fluorescein, slit-lamp biomicroscopy and histopathology                2 was performed using a peptide carrier (Chariot).
analysis were used to check up the reduction of cornea epithelial defects.            Results: UVB-stimulated corneal epithelial cell death was evident by MTT
Results: Experimental cornea ulcer. In the first (experimental) group epi-            and TUNEL; and features such as blebbing and disintegration of organelles
thelial regeneration (the growth of young epithelium of cornea) was ob-               could be observed. UVB up-regulated the expression of TGM-2 transcript
served on the third day of the standard treatment with the addition of                and protein levels, as well as the transamidation activity of the enzyme.
pilocarpine. The corneal epithelium was composed of stratified squamous               Monodansyl-cadaverine (MDC), a cell permeable competitive inhibitor
epithelial cells. The proliferation of fibrocytes dominates at the bottom of          of TGM, was able to reduce the UVB-induced cell death. Transfection with
the cornea ulcer, with a small number of eosinophilic leucocytes occur-               siRNA significantly reduced basal and UVB-stimulated TGM transcript
ring in the subepithelium. On the 14th day the complete epithelization of             levels. Activation of caspase and the cell surface clustering of TNF
the cornea defect was recorded.                                                       Receptor-I followed by internalization were evident after UVB, and knock-
      In the second (control) group thick yellow-white infiltrate composed            down of TGM-2 or addition of MDC inhibited both of these processes.
of lymphocytes and eosinophils, the thickening of collagenous laminae at              Delivery of exogenous TGM-2 to cells increased caspase activation. Nu-
the bottom of the cornea ulcer was observed on the third day. On the                  clear shapes were more irregular and ovoid after UVB compared to control,
14th day the infiltrate was less expressed, the cornea epithelium defect              and incubation with MDC reduced the UVB-induced changes in nuclear
with new epithelium still remained.                                                   morphology.
      Traumatic cornea erosion. In the first (experimental) group, the                Conclusions: UVB-stimulated corneal epithelial cell death is consistent
complete epithelization of the cornea defect was recorded on the third                with apoptosis, and UVB-stimulated TGM-2 up-regulation is pro-apoptotic.
day from the beginning of treatment, with the absence of leukocyte                    The involvement of TGM-2 is shown in 2 key stages of apoptosis (clustering
infiltration.                                                                         of TNF Receptor-I) and caspase activation. In ocular surface diseases,
      In the second group, moderate regeneration, the desquamation of                 modulation of TGM-2 pathways may be used to target apoptosis.
superficial epithelium and epithelial edema was recorded.

                                                                                                                                                                   POSTER ABSTRACTS
      On the fifth day, there was a complete regeneration of the epithelial
cornea defect. It was shown that in the experimental group of animals                 391-B32
that underwent additional treatment with pilocarpine the healing period               INCREASED EXPRESSION OF INFLAMMATORY
of cornea epithelial defect areas was shorter in comparison with the                  CYTOKINES AND CATHEPSINS IN THE CORNEAL
control group (2-5 days).                                                             EPITHELIUM IN KERATOCONUS
Conclusions: The application of 1% solution of pilocarpine hydrochloride
in the complex treatment of cornea pathology accompanied by an epithe-                A. SOLOMON, Y. IVANIR, F. ORUCOV, J. PE’eR, J. FRUCHT-PERY
lial defect promotes a significant acceleration of the epithelization period,         Hadassah University Hospital, Jerusalem, ISRAEL
closing infection ways and creating conditions for more successful heal-
ing cornea epithelial defects of different etiology.                                  Purpose: To evaluate the expression of inflammatory cytokines and
                                                                                      cathepsins in the corneal epithelium in keratoconus.
                                                                                      Methods: Tissue sections were prepared from paraffin fixed blocks of
390-B31                                                                               corneal buttons removed during penetrating keratoplasty from 29 pa-
THE ROLE OF TRANSGLUTAMINASE-2 IN HUMAN                                               tients who had keratoconus. Tissue sections from 10 age-matched eyes
CORNEAL EPITHELIAL CELL DEATH                                                         enucleated because of uveal melanoma served as a control. Expression
                                                                                      of Interleukin (IL)-1, IL-6, tumor necrosis factor (TNF)-α, and cathepsins
L. TONG1, Z. CHEN2, D.Q. LI2, S.C. PFLUGFELDER2, R. BEUERMAN3                         (Cath) B, S, L and D in the corneal epithelium was evaluated by immuno-
 Singapore National Eye Center, Singapore, SINGAPORE, 2Cullen Eye Institute, Baylor   histochemistry. Digital image analysis using ImagePro-Plus software
College of Medicine, Houston, TX, UNITED STATES OF AMERICA, 3Singapore Eye            (Media Cybernetics, Silver Springs, MD) was performed to quantify the
Research Institute, Singapore, SINGAPORE                                              expression of the various cytokines and cathepsins. A mean intensity stain
                                                                                      index (ISI), based on the staining density and the area stained, was cal-
Purpose: Corneal epithelial cell death plays an important role in human               culated from digital images captured from sequential areas of the cor-
ocular surface inflammation and dry eye. Transglutaminase (TGM) may                   neal epithelium. The mean ISI of sections from patients with keratoconus
facilitate or prevent cell death in various studies but this has not been             was compared to that of controls for each cytokine and cathepsin tested,
evaluated in the cornea. This study evaluates the characteristics of                  using the Mann-Whitney’s test. Clinical parameters were retrospectively
cell death induced by ultraviolet radiation (UVB) and the possible roles of           recorded from the corresponding patients’ charts including the age
TGM-2 in key stages of apoptosis in corneal epithelial cells.                         at diagnosis, years with keratoconus prior to surgery, age at surgery,
Methods: Corneal epithelial cells cultured from human limbal explants                 and maximal central topographic K reading. The correlation between
were exposed to a single dose of UVB radiation (20 mJ/cm2). Electron                  the clinical parameters and the ISI values for each protein was evaluated
microscopy was performed to evaluate subcellular features of apoptosis;               by factor analysis and Spearman’s rank correlation.
immunofluorescence staining and Western blot were performed to evalu-                 Results: A significantly higher mean protein expression in the corneal
ate expression of TGM-2, and fluorescence cadaverine uptake was used                  epithelium of keratoconus corneas was demonstrated for IL-1β (ISI
to evaluate changes in transamidation activity. TGM-2 transcript levels               score in keratoconus 43,086 ± 32,829 compared to 9,354 ± 15,214 in
were evaluated using real time-PCR. Cell death was evaluated by                       normal controls, p=0.00017), IL-6 (31.63 ± 22.4 in keratoconus vs.
MTT and TUNEL assays. Nuclear morphology of UVB-stimulated cells was                  10.76 ± 21.41 in controls, p=0.024), TNF-α (3,402,263 ± 1,516,245 in

Asian J Ophthalmol. 2007 Vol 9 No 1 Supplement 1                                                                                                           151
Poster Abstracts

keratoconus vs. 1,933,844 ± 1,467,971 in controls, p=0.021) and Cath                       which is generally used in the treatment of choroidal neovascularization.
B (11.08 ± 10.30 in keratoconus vs. 3.51 ± 5.87 in controls, p=0.011).                     Method: Corneal neovascularization was first induced in 24 white rabbits
Higher though not significant expression was also demonstrated for                         (48 eyes). Four rabbits were examined histologically before performing
Cath D, Cath L and Cath S, who had 1.3, 2.1, and 1.9 folds higher ISI                      PDT. Ten rabbits were chosen randomly. One eye of the rabbits was treated
values compared to controls, respectively. A highly significant correlation                with PDT at 50J/cm2, and the fellow eye was used as a control. Both eyes
was found between the patient’s age at diagnosis of keratoconus and                        of the remaining 10 rabbits were treated with PDT at 150J/cm2, and one
the ISI values of IL-1β (r=0.8047, p=0.0072) and TNF-α (r=0.8047,                          eye was further retreated with PDT at the same intensity one week later.
p=0.0039).                                                                                 The area of corneal neovascularization was measured and histologically
Conclusions: The corneal epithelium in keratoconus expresses high                          evaluated through light microscopic and electron microscopic examination.
levels of cytokines and enzymes, which are associated with inflamma-                       Results: The neovascularized area was more decreased in the group
tion and tissue degradation. As the expression of these mediators                          treated with PDT at 50J/cm2 (P=0.002) compared to the control group.
increase with the patients’ age, these data may partially explain the                      It was also more decreased in the group treated with PDT at 150J/cm2
continuous progression of corneal thinning which is typical in keratoconus.                (P=0.022) compared to the group treated with PDT at 50J/cm2. Maxi-
                                                                                           mum decrease was observed in the retreated group (P=0.04). The ante-
                                                                                           rior segment was stained with hematoxyline-eosin for histologic
392-B33                                                                                    examination, and the corneal new vessels were observed to be markedly
RETROSPECTIVE STUDY ON CORNEAL                                                             decreased in the retreated group. Corneal epithelium, stroma, endothe-
ENDOTHELIITIS AT KINKI UNIVERSITY HOSPITAL                                                 lium and iris were normal in appearance. Electron microscopic examina-
                                                                                           tion demonstrated thrombi, destruction of the endothelial cells, nuclear
K. SUGIOKA, M. FUKUDA, T. DEAI, M. MAEDA, M. ITAHASHI,                                     fragmentation, and partial loss of endothelial wall.
S. OKUYAMA, S. HIGAKI, Y. SHIMOMURA                                                        Conclusion: PDT was very effective in the regression of corneal new
Kinki Univ Sch of Med, Osaka-sayama, JAPAN                                                 vessels. Retreatment at a regular interval was significantly more effective.

Purpose: Corneal endotheliitis is rare among all corneal diseases and
still little is known about its pathogenesis. Here, we reported 10 eyes                    394-B35
with corneal endotheliitis treated in our clinic.                                          THE RELATIONSHIP BETWEEN THE STROMA
Methods: Ten eyes of 9 patients (3 men, 6 women; age range: 35-                            MICROENVIRONMENT AND
76 y.o., mean: 54 y.o.) were diagnosed as corneal endotheliitis and                        NEOVASCULARIZATION IN CORNEA
treated in the Department of Ophthalmology, Kinki University School of
Medicine between January 1990 and October 2005. We investigated the                        S.Y.W. G. L. LIU MING-NA
clinical findings and courses, retrospectively.                                            Shandong Eye Institute, Qingdao, CHINA
Results: In 9 eyes, corneal edema with precipitate was observed in
the surrounding area at presentation or during the observation. In the                     Purpose: To study the relationship between the stroma microenvironment
remaining 1 eye, endotheliitis occurred after cataract surgery and                         and neovascularization in cornea and further to reveal the mechanism of
corneal edema was detected in the central area. During the observation,                    cornea neovascularization.
8 eyes with anterior chamber inflammation and 2 eyes with herpetic                         Methods: Cornea neovascularization was induced by alkali burn in
epithelial keratitis were seen. For treatment, antibacterial eye drops and                 40 rats. Immunohistochemistry studies on the stroma microenvironment
steroid eye drops were prescribed in all cases, and acyclovir eye oint-                    around corneal neovascularization. Detect transforming growth factor-
ment or oral acyclovir was also added in some cases. The duration needed                   β1 (TGF-β1), a-smooth muscle actin (a-SMA), fibroblast activation pro-
to cure the inflammation was from 4 days to 3 years. Eventually the                        tein (FAP) and PECAM-1 (CD31) to identify angiogenesis on day 3 and 7.
corneas remained clear in 2 eyes while slight corneal opacity was seen in                  And RT-PCR to identify FAP. Picrosirius-polarization to detect the changes
the endothelial side in 7 eyes. Penetrating keratoplasty was performed                     of main collagen in cornea. The ultrastructure of cornea was examined
in 1 eye because of bullous keratopathy. Secondary glaucoma was                            by transmission electron microscopy.
confirmed in 3 eyes and consequently trabeculectomy was performed.                         Results: On day 3 and 7, alkali burn cornea was found the cells which
Conclusions: In most cases of corneal endotheliitis, steroid eye drops,                    expressed both a-SMA and FAP. At the same time, we found the expres-
acyclovir eye ointment or oral acyclovir can achieve good therapeutic                      sion of TGF-ß1 in the cornea. The FAP+ keratocytes was found around the
results. However, the possibility of secondary glaucoma should be taken                    CD31+ endothelium of angiogenesis. RT-PCR: The normal cornea had not
into careful consideration.                                                                FAP expression. The cornea had angiogenesis was FAP+ expression.
                                                                                           Polarization microscopy revealed when the angiogenesis vegetated to
                                                                                           cornea, the collagen I and collagen III arranged again. In electron
393-B34                                                                                    microscopy examination, another kind cell was found around the endothe-
THE EFFECT OF PHOTODYNAMIC THERAPY WITH                                                    lium of angiogenesis.
VERTEPORFIN ON THE CORNEAL                                                                 Conclusions: The stroma microenvironment changed when the cornea
NEOVASCULARIZATION OF RABBIT                                                               showed neovascularization. The stroma microenvironment have FAP+
                                                                                           keratocytes, and this cells went with and went around the endothelium
E. JUN1, S. CHUNG2                                                                         of angiogenesis; the collagen I and collagen III rearranged for the
    The Catholic University of Korea, St. Paul’s Hospital (Ophthalmology), Seoul, KOREA,   angiogenesis.
    The Catholic University of Korea, St. Mary’s Hospital (Ophthalmology), Seoul, KOREA

Purpose: The purpose of this study is to evaluate the effect of photo-
dynamic therapy (PDT) with verteporfin for corneal neovascularization,

152                                                                                                            Asian J Ophthalmol. 2007 Vol 9 No 1 Supplement 1
                                                                                                                               Poster Abstracts

395-B36                                                                        397-B38
                                                                               TOPOGRAPHY VERSUS ANTERIOR SEGMENT
Govt Medical College, Amritsar, INDIA
                                                                               C.E. WHEELDON, C.A. COOKE, C.N.J. MCGHEE
Purpose: To study the effect of topical amiloride on corneal healing and       University of Auckland, Auckland, NEW ZEALAND
neovascularization using a double blind clinical trial.
Methods: 60 patients of established bacterial corneal ulcer with               Purpose: Accurate measurement of corneal thickness and anterior
neovascularization were taken up for the study, divided randomly into          chamber depth has become increasingly important in a variety of oph-
two groups of 30 each.                                                         thalmic practices. This study compares central corneal thickness (CCT)
Results: Group A was given standard antibacterial treatment [(Topical          and anterior chamber depth (ACD) measured using Orbscan II Computer-
fortified cefazoline 50mg/ml) and (fortified gentamycin 14mg/ml)] and          ized Topography, Heidelberg Slit-Lamp Anterior Segment Optical Coher-
Group B was given amiloride 1% in addition to standard antibacterial           ence Tomography (H-OCT) and Zeiss Visante Anterior Segment Optical
treatment. Response to treatment was evaluated on basis of healing of          Coherence Tomography (Z-OCT).
corneal ulcer and regression of neovascularization. Patients were followed     Methods: 20 normal subjects (40 eyes) were included. Sequential
up weekly till four weeks.                                                     measurements of CCT and ACD (anterior surface of the cornea to anterior
Conclusions: Topical amiloride (1%) hastens bacterial corneal healing          surface of the lens) were performed by the same operator with two
and regression of neovascularization.                                          different anterior segment OCT devices (Visante™, Carl Zeiss, Meditec
                                                                               and Heidelberg Engineering™) and Orbscan II Computerized Topography
                                                                               (Bausch and Lomb Inc™).
396-B37                                                                        Results: The mean age was 40.5 ± 12.5 years (mean ± SD), with a male
CONTRAST SENSITIVITY AND ABERRATIONS IN                                        to female ratio of 2:3. Central corneal thickness for right and left eyes
THE EYES WITH SUPER NORMAL VISION                                              respectively was 527.9 ± 41.3µm (mean ± SD) and 525.9 ± 42.1µm
                                                                               with Z-OCT, and 523.1 ± 39.8µm and 526.3 ± 37.1µm with H-OCT. There

                                                                                                                                                            POSTER ABSTRACTS
P.G. REDDY, P.K. VADDAVALLI, R. NUTHETI                                        was no statistically significant difference in the CCT when measured by
L V Prasad Eye Institute, Hyderabad, INDIA                                     either device (p>0.05). The Orbscan II showed statistically significant
                                                                               higher readings for CCT, 557.3 ± 45.1µm right eye and 560.3 ± 43.9µm
Purpose: To quantify ocular aberrations in eyes with super normal vision,      left eye, when compared with both of the anterior segment OCT devices
that is natural uncorrected Pelli-Robson contrast sensitivity ≥ 1.65 log       (p<0.0001). However, with regards to the anterior chamber depth, the
units, to analyze the correlation of aberrations between the right and         Z-OCT repeatedly provided the highest measurement with a mean of
left eyes.                                                                     3.51 ± 0.49 mm right eye and 3.52 ± 0.49 mm left eye, as compared to
Methods: Ocular aberrations were examined across dilated (with 10 %            an average of 3.34 ± 0.42mm and 3.33 ± 0.44mm with the H-OCT, and
phenylephrine) pupil with a diameter ≥ 6.0 mm under mesopic con-               3.31 ± 0.44mm and 3.35 ± 0.44mm with the Orbscan II.
ditions in 80 eyes of 40 subjects with ≥ 1.65 log units contrast sensitivity   Conclusions: Central corneal thickness measurement is reproducible
(mean age 23.68 ± 2.86) using the Zywave aberrometer. Root mean square         when comparing the Visante Zeiss, and Heidelberg slit-lamp OCT. Orbscan
(RMS) values of higher order aberrations, 2nd order, 3rd order, 4th            II tended to provide consistently higher readings for CCT in all subjects.
order, & 5th order were analyzed. Correlation analysis was performed to        In contrast to this, the results for anterior chamber depth differed
assess the association between age, thickness and higher order                 between the two anterior segment OCT devices with the Z-OCT providing
aberrations & the correlation of aberrations between right and left eyes.      a statistically significant greater measured depth (p < 0.05) when
Results: Mean RMS values were 0.38 ± 0.20 µm for total aberrations,            compared to both the H-OCT and Orbscan II.
0.20 ± 0.09 µm for higher order, 0.89 ± 0.62 µm for 2nd order, 0.33 ±
0.17 µm for 3rd order, 0.22 ± 0.12 µm for 4th order, 0.72 ± 0.05 µm for
5th order. There was no significant difference in the mean values of           398-B39
HOA, 2nd, 3rd, 4th, and 5th order aberrations between right and left           KERATOCYTE DEFICITS SEVEN YEARS AFTER
eyes. The Pearson correlation coefficient between right and left eyes for      LASER IN SITU KERATOMILEUSIS
total aberrations was 0.789 (P< 0.0001). No significant correlation
was found between right and left eyes for 2nd, 3rd, 4th, and 5th order         S.V. PATEL, J.C. ERIE, J.W. MCLAREN, W.M. BOURNE
aberrations. No significant correlation was found between each of the          Mayo Clinic College of Medicine, Rochester, MN, UNITED STATES OF AMERICA
aberrations and thickness of the cornea.
Conclusions: The individuals with good contrast sensitivity have an            Purpose: To determine changes in keratocyte density seven years after
amount of HOA’s similar in magnitude to those revealed in refractive           LASIK by using an automated program to identify keratocyte nuclei in
surgery myopic patients.                                                       confocal microscopy images. Previous studies of keratocyte density
                                                                               have required subjective interpretation of low contrast confocal images
                                                                               to identify keratocyte nuclei manually.
                                                                               Methods: Sixteen eyes (11 patients) received LASIK for myopia or
                                                                               myopic astigmatism with the flap created by a mechanical microkeratome.
                                                                               Corneas were examined by a Tandem Scanning confocal microscope
                                                                               (Tandem Scanning Corp., Reston, VA) before and at several intervals to
                                                                               seven years after LASIK. A custom automated program identified bright

Asian J Ophthalmol. 2007 Vol 9 No 1 Supplement 1                                                                                                     153
Poster Abstracts

objects, which were assumed to represent keratocyte nuclei, against           400-B41
a dark background in confocal microscopy images. Cell density was             LASER SCANNING IN VIVO CONFOCAL ANALYSIS
measured in different anterior to posterior stromal layers and mean           OF KERATOCYTE DENSITY IN KERATOCONUS
densities at each interval were compared to mean density before LASIK
by using paired t-tests adjusted for multiple comparisons.                    J.Y.F. KU1, R.L. NIEDERER2, D.V. PATEL1, T. SHERWIN2, C.N.J. MCGHEE1
Results: The unweighted mean keratocyte density through the stroma            1
                                                                              University of Auckland / Auckland District Health Board, Auckland, NEW ZEALAND,
was 31,486 ± 3,671 cells/mm3 (mean ± SD) before LASIK and 24,209 ±            2
                                                                              University of Auckland, Auckland, NEW ZEALAND
3,012 cells/mm3 at seven years after LASIK (P< .001). At seven years,
keratocyte density decreased by 28% in the anterior half of the stromal       Purpose: Keratoconus is a progressive non-inflammatory corneal ectasia.
flap (P< .001), by 36% in the posterior half of the stromal flap (P< .001),   Whilst abnormalities have been documented at every level of the
and by 25% in the anterior retroablation zone (the first 50 µm deep to        keratoconic cornea, the exact underlying pathophysiological process
the ablated surface, P< .001) compared to before surgery. Keratocyte          remains unknown. This study aimed to determine the keratocyte density
density did not change between one and seven years after LASIK.               in human corneas with keratoconus imaged with laser scanning in vivo
Conclusions: Keratocyte loss is greatest in the first year after LASIK,       confocal microscopy.
and does not recover through seven years. The clinical significance of        Methods: Prospective cross-sectional study of 36 eyes of 26 subjects
keratocyte loss is unknown. The custom program eliminates observer            with keratoconus compared with 33 eyes of 33 control subjects. Subjects
bias and confirms previous results, obtained by manual identification         with a history of ocular trauma, ocular surgery, ocular disease (other than
of keratocyte nuclei, of decreased keratocyte density through five years      keratoconus), and systemic diseases which may affect the cornea were
after LASIK.                                                                  excluded from the study. Written informed consent was obtained follow-
                                                                              ing a detailed explanation of the nature of the study. The protocol used
                                                                              in this study received approval from the Auckland Ethics Committee
399-B40                                                                       and adhered to the tenets of the Declaration of Helsinki. Subjects who
AGE-RELATED DIFFERENCES IN THE NORMAL                                         routinely wore contact lenses were requested to temporarily cease
HUMAN CORNEA: AN IN VIVO CONFOCAL                                             contact lens wear for 12 hours prior to examination. Subjects were
MICROSCOPY STUDY                                                              assessed via ophthalmic examination, Orbscan II slit-scanning elevation
                                                                              topography and laser scanning in vivo confocal microscopy using
R.L. NIEDERER, D. PERUMAL, T. SHERWIN, C.N.J. MCGHEE                          the Heidelberg Retina Tomograph II Rostock Corneal Module (RCM)
University of Auckland, Auckland, NEW ZEALAND                                 (Heidelberg Engineering, GmBH, Heidelberg, Germany). Two masked
                                                                              examiners manually counted all distinct particles with clear cell borders
Purpose: To quantify and establish base-line normative data for age-          within the pre-determined area to calculate the keratocyte density. The
related differences in cellular and innervation density in the normal,        GENMOD procedure of SAS (SAS Institute Inc, v 9.2) was used for these
healthy, human cornea using laser scanning in vivo confocal microscopy.       analyses.
Methods: Cross-sectional study of 85 normal subjects assessed via clinical    Results: Mean age was 34.7 ± 12.1 in the control group, 38.4 ± 11.0 in
history, ophthalmic examination, corneal topography and in vivo confocal      keratoconics with no contact lens wear, and 38.5 ± 10.3 in keratoconics
microscopy with a laser scanning in vivo confocal microscope (Heidelberg      with contact lens wear. No significant difference was noted in age or
Retina Tomograph II Rostock Corneal Module).                                  gender between the groups. Mean cell density in the control group was
Results: The mean age was 38 ± 16 years (range 18 to 87 years) and            786 ± 244 cells/mm2 in the anterior stroma and 293 ± 35 cells/mm2
60% of subjects were female. The anterior keratocyte density declined         in the posterior stroma. Anterior keratocyte density was higher than
by 0.9% per year (r=-0.423, p < 0.001), posterior keratocyte density          posterior keratocyte density (p < 0.001). Anterior and posterior keratocyte
declined by 0.3% per year (r=-0.250, p = 0.021) and endothelial cell          density was significantly lower in subjects with keratoconus (p < 0.001).
density declined by 0.5% per year (r=-0.615, p < 0.001). Sub-basal nerve      In subjects with keratoconus, anterior keratocyte density correlated with
fiber density declined by 0.9% per year (r=-0.423, p < 0.001). No             central corneal thickness (r = 0.426, p = 0.012) and steepest keratometry
association was observed between age and epithelial cell density, or          values (r = -0.383, p = 0.028).
between age and central corneal thickness, corneal astigmatism or             Conclusions: Keratocyte density was significantly lower in subjects
horizontal corneal diameter (p > 0.05). No association was observed           with keratoconus and the decline in keratocyte density correlated
between subject gender and corneal cell or innervation density.               with indices of disease severity. In vivo confocal microscopy offers the
Conclusions: Using laser scanning in vivo confocal microscopy, this study     exciting opportunity to study early microstructural changes in the
highlights a significant, and relatively linear reduction in epithelial,      keratoconic cornea.
keratocyte and endothelial cell density with increasing subject age.
Interestingly, corneal sub-basal nerve fiber density also significantly
decreases with increasing age. In vivo laser scanning confocal microscopy     402-B43
provides a safe, non-invasive method for the establishment of normative       FEMTOSECOND LASER ASSISTED POSTERIOR
data and assessment of alterations in human corneal microstructure.           LAMELLAR KERATOPLASTY: FEASIBILITY AND
                                                                              MORPHOLOGICAL ANALYSIS

                                                                              M.P. HOLZER, G.U. AUFFARTH
                                                                              University of Heidelberg, Heidelberg, GERMANY

                                                                              Purpose: To investigate the feasibility of femtosecond laser assisted
                                                                              posterior lamellar keratoplasty and analyze morphological specifications.
                                                                              Methods: Ten fresh porcine cadaver eyes were used in this experimental

154                                                                                               Asian J Ophthalmol. 2007 Vol 9 No 1 Supplement 1
                                                                                                                               Poster Abstracts

study. Prior to laser treatment, the anterior chamber with special focus      404-B45
on the cornea was analyzed and measured using the slit lamp attached          RISK FACTORS FOR CORNEAL GRAFT FAILURE IN
SL-OCT (Heidelberg Engineering, Germany). This was followed by                SOUTH INDIA - A PROSPECTIVE STUDY
femtosecond laser preparation of a posterior lamellar flap with a diam-
eter of 7.0 mm using the Femtec femtosecond laser (20/10 Perfect Vision,      S. RAJAGOPALAN, V. RAJA, M. SRINIVASAN, V. PRAJNA
Germany). The predefined cut depth was set at 600 µm as pig corneas           Aravind Eye Hospital, Madurai, INDIA
show pachymetry values of 800 µm and higher. The eyes and dimension
of the lamellar cuts were measured again with the SL-OCT prior and            Purpose: To evaluate the outcome and possible risk factors for graft
after surgical removal of the posterior flap via a clear cornea tunnel.       failure in patients undergoing penetrating keratoplasty in a tertiary eye
Additionally, the flap and the cornea morphology were histopathologi-         referral centre in South India.
cally analyzed.                                                               Methods: A cohort of 331 subjects who underwent penetrating kerato-
Results: All posterior flaps were cut without any complications. The          plasty were evaluated prospectively and followed up for a mean period of
predefined depth of 600 µm for the cuts as well as the diameter was           1.5 years. The indications for surgery and the strength of association of
verified with the SL-OCT measurements. All measured parameters like           each possible risk factor for graft failure were analyzed.
cut depth, thickness of posterior flap as well as diameter were within the    Results: The commonest indication for penetrating keratoplasty was
SL-OCT metering precision. Histopathological analysis showed smooth           corneal scarring. Graft rejection was the most significant factor leading
and accurate cuts.                                                            to graft failure, majority of which were within the 1st year. Other signifi-
Conclusions: The preparation of posterior lamellar flaps for posterior        cant risk factors for failure included glaucoma, active corneal infection
lamellar keratoplasty can be performed in a safe and accurate fashion         mostly fungal, regrafts, systemic diseases mainly diabetes and hyper-
using the Femtec femtosecond laser. The flap can be cut in a closed           tension, large diameter grafts and trauma. Age, sex and laterality were
system and afterwards removed via a small clear cornea tunnel.                not statistically significant risk factors.
                                                                              Conclusions: The rates of graft failure are slightly higher than studies
                                                                              in the western world because the most common indications in the sub-
403-B44                                                                       continent are corneal scarring and re-grafts as compared to keratoconus
LIMBAL SPARING LAMELLAR KERATOPLASTY - A                                      in the developed world. Our study has shown that systemic conditions
NEW APPROACH TO KERATOGLOBUS                                                  like diabetes and hypertension may also contribute to an increased risk

                                                                                                                                                               POSTER ABSTRACTS
                                                                              of graft failure. Certain modifiable risk factors, as identified in our study,
V.S. PILLAI, G.K. IYER, G. SITALAKSHMI                                        if considered by the surgeon and patient can significantly enhance the
Sankara Nethralaya, Chennai, INDIA                                            rate of graft survival in our population.

Purpose: To report and describe two cases of limbal sparing lamellar
keratoplasty (LSLK) performed for tectonic reconstruction in keratoglobus.    405-B46
Methods: 2 eyes of 2 patients with keratoglobus with advanced corneal         TRAUMATIC WOUND DEHISCENCE AFTER
thinning associated with decrease in visual acuity underwent initial tec-     PENETRATING KERATOPLASTY
tonic reconstruction with the LSLK technique. The pre and postoperative
visual acuity, refraction, pachymetry and corneal topography were             J. VICUNA-KOJCHEN, J. FRUCHT-PERY, D. LANDAU, F. ORUCOV,
compared.                                                                     A. SOLOMON
Results: There was a considerable improvement in all the parameters           Hadassah Medical Center, Jerusalem, ISRAEL
considered postoperatively.
Conclusions: LSLK, by superficial dissection and reflection of the limbal     Purpose: To assess the patient characteristics, incidence, risk factors,
tissue, provides the option of tectonic reconstruction with preservation of   and clinical outcome of traumatic wound dehiscence after penetrating
autologous limbal tissue.                                                     keratoplasty.
                                                                              Methods: Retrospective chart review of 15 eyes (14 patients) with trau-
Table 1 Abstract 403-B44.                                                     matic wound dehiscence after penetrating keratoplasty (PK) between
  Case I                Pre-operative          Post-operative Results         January 1996 and August 2006, who were operated and managed at the
  Visual acuity         3/60, <N36             6/45, N8
                                                                              Cornea Service in Hadassah Medical Center.
  Refraction            -18.00DS/              -0.50DS/                       Results: Of 758 penetrating keratoplasties that were performed between
                        -12.00DCyl@ 165°       -1.00DCyl@ 180°                January 1996 and August 2006, 15 eyes (1.97%) of 14 patients had trau-
  Pachymetry            235µm                  798µm                          matic wound dehiscence. Eleven eyes were operated for keratoconus,
  Topography (Sim K)    60.98@160°/            47.05@108°/                    3 eyes had trachoma, and one had corneal graft for a traumatic scar. The
                        56.81@70°              43.82@18°
                                                                              mean time from PK to trauma was 33 months (range 2 weeks to 16 years).
  Case II               Pre-operative          Post-operative Results         The mean age at time of wound dehiscence was 37 years (range 18-
  Visual acuity         6\18, N6               6\45, N36                      81 years) with a bimodal distribution (12 eyes between years 11 to 40,
  Refraction            -12.00DS/              +2.00 DS/                      and the remaining 3 eyes between years 60 to 90). Falls (46.6%) and
                        -3.00DCyl@ 110°        -5.00 DCyl @ 30°               playing accidents among children (40%) were the most common mecha-
  Pachymetry            320µm                  609µm                          nism of trauma. Home (80%) was the most common place for trauma to
  Topography (Sim K)    58.20@77°/             45.00@113°/
                        54.94@167°             41.53@23°
                                                                              occur. All corneal ruptures occurred at the graft-host interface. There
                                                                              was no particular location preference for wound rupture. Vitreous and
                                                                              lens loss were noted in 11 eyes (73%) and retinal complications occurred
                                                                              in 3 eyes (20%). The first surgical procedure included primary wound
                                                                              closure in all eyes, combined with anterior vitrectomy in 7 eyes, and

Asian J Ophthalmol. 2007 Vol 9 No 1 Supplement 1                                                                                                       155
Poster Abstracts

posterior vitrectomy in one eye. A second surgical intervention for retinal   407-B48
complication was needed in 3 eyes. Eight grafts remained transparent,         THE OUTCOMES OF THERAPEUTIC
2 grafts remained edematous, 4 eyes were re-grafted, and one eye was          KERATOPLASTY FOR SEVERE MICROBIAL
re-grafted twice. One eye went to phthisis. After one year of follow-up,      KERATITIS FROM 1993 TO 2005
the mean loss of BCVA was 5 lines, one patient had light perception, and
2 patients had no light perception.                                           S. ERJONGMANEE, K. PONGSAKORNKUL, V. PUANGSRICHAREON,
Conclusions: Patients with corneal transplants have a life-long risk for      N. KASETSUWAN, L. PARIYAKANOK
wound dehiscence. Traumatic wound dehiscence is more prevalent in             Chulalongkorn University, Bangkok, THAILAND
younger patients, who had penetrating keratoplasty for Keratoconus. The
visual outcome after this occurrence is usually poor. Patients must be        Purpose: To evaluate the surgical results of therapeutic penetrating
continuously educated as to the risk of wound rupture after penetrating       keratoplasty for severe microbial keratitis.
keratoplasty and as to the necessary precautions.                             Methods: We reviewed medical records of 50 patients with severe
                                                                              microbial keratitis and undergone therapeutic penetrating keratoplasty
                                                                              (PKP) at King Chulalongkorn Memorial Hospital from January 1993 to
406-B47                                                                       December 2005. All patients must complete a 1-month follow-up to be
OCULAR HYPERTENSION AFTER PENETRATING                                         eligible for the study. Patients were divided into five groups according to
KERATOPLASTY                                                                  causative organisms: (1) bacterial; (2) fungal; (3) acanthamoeba; (4) viral;
                                                                              and (5) unknown organism. Surgical outcomes were evaluated using 3
J. VICUNA-KOJCHEN, F. ORUCOV, J. FRUCHT-PERY, D. LANDAU,                      major criteria of success: (1) eradication of infection; (2) anatomical
A. SOLOMON                                                                    success; and (3) visual improvement.
Hadassah Medical Center, Jerusalem, ISRAEL                                    Results: There were 44 out of 50 eyes that met the criteria. These were
                                                                              12 bacterial, 18 fungal, 1 acanthameba, 3 viral, and 10 unknown keratitis.
Purpose: To determine the incidence, risk factors, response to anti-          Therapeutic PKP can eradicate the infection without recurrence and
glaucoma therapy and graft outcome associated with elevation of the           maintain their anatomical integrity in 88.64% (39/44) of the patients in-
intraocular pressure after penetrating keratoplasty (PK).                     cluding 10/12 of bacterial keratitis and 15/18 fungal keratitis patients.
Methods: Retrospective chart review of 146 eyes of 143 consecutive            Four of 44 eyes, 1 of bacterial and 3 of fungal group, were eviscerated
patients who underwent PK between June 2001 and June 2003, and                due to uncontrolled infection. At 1 month after PKP, 56.82% (25/44) of
were operated and managed at the Cornea Service, Hadassah Medical             the patients had improved vision as compared to preoperative level.
Center. High intraocular pressure (IOP) was defined as IOP over 20 mmHg       Among all, fungal keratitis had the highest chance to improve vision
measured by Goldmann tonometry. Multivariate analysis was performed           75.22% (13/18).
to evaluate the risk factors for IOP elevation after PK.                      Conclusions: Therapeutic PKP is the most valuable tool in the manage-
Results: Of 146 PK procedures included in the study, 31 eyes (21.1%)          ment of severe microbial keratitis that does not respond to antimicrobial
had history of glaucoma or were on anti-glaucoma medication before            therapy. If performed under appropriate time and settings, it can provide
surgery, and 6 eyes (4.1%) presented with high IOP on the day of surgery.     success including eradication of infection, preservation of globe integrity,
After surgery, 70 eyes (47.9%) had at least one episode of IOP elevation      and visual improvement for the patients.
(mean 27.15 ± 5.66 mmHg; range 21-49 mmHg). The increase in IOP
appeared after a mean post-operative period of 73 ± 135 days, and con-
tinued for an average of 16.4 ± 17.7 days. Although the increased IOP         408-B49
was controlled in most patients, 35 eyes (24%) had a second episode of        IN VIVO CONFOCAL MICROSCOPY OF
IOP elevation 212.2 ± 276.7 days after the surgery. Multivariate analysis     SUBEPITHELIAL INFILTRATES IN CORNEAL
revealed that preexisting glaucoma (p≤0.003) and an additional intraocular    TRANSPLANT REJECTION
surgery combined with PK (p≤0.01) were the main factors predicting high
IOP after PK. Other parameters, such as age, gender, indication for           R.L. NIEDERER, T. SHERWIN, C.N.J. MCGHEE
keratoplasty, graft size, type of sutures, and immediate postoperative        University of Auckland, Auckland, NEW ZEALAND
IOP rise were not found to be significant predictors. In 11 eyes (7.53%)
the topical anti-glaucomatous therapy failed, and 3 of them required glau-    Purpose: Corneal allograft rejection is the leading cause of penetrating
coma filtering surgery. Eight of 11 failed grafts occurred in eyes with       keratoplasty failure in the first year following surgery. We report two cases
postoperative IOP elevation. However, this higher rate was not significant    of subepithelial infiltrates in corneal transplant rejection (Krachmer’s spots)
(p=0.195). Preexisting glaucoma was not associated with an increased          imaged by in vivo confocal microscopy.
risk for graft failure (p=0.219).                                             Methods: Case report and review of relevant literature.
Conclusions: The incidence of ocular hypertension after PK is high, and       Results: Two subjects with subepithelial infiltrates in previously clear
at least one episode of high IOP was noted in almost half of our patients.    penetrating corneal transplants were assessed. In vivo confocal
A history of preexisting glaucoma, and a combined surgery with PK are         microscopy revealed focal accumulations of hyper-reflective dendritic-
significant factors predicting the occurrence of IOP elevation after PK.      like particles, postulated to represent Langerhans’ cells, at the level of
Ocular hypertension did not have an adverse effect on graft survival.         the basal epithelium and Bowman’s membrane. Altered keratocytes with
                                                                              visible cytoplasmic processes were observed posterior to these foci.
                                                                              Conclusions: To our knowledge, this is the first reported case of the in
                                                                              vivo confocal microscopy appearance of corneal allograft rejection in
                                                                              humans. In vivo confocal microscopy may provide a valuable clinical tool
                                                                              to aid in the diagnosis of early corneal transplant rejection and in the
                                                                              differential diagnosis of other inflammatory conditions of the cornea.

156                                                                                                Asian J Ophthalmol. 2007 Vol 9 No 1 Supplement 1
                                                                                                                                  Poster Abstracts

409-B50                                                                         cox-regression model confirmed that, compared to the recent cohort
INFLUENCE OF MASS MEDIA TO DONATION OF                                          (2001-2003), the grafts done in 1991-1997 were 3.94 times (95% CI,
CORNEA                                                                          1.98-7.83, p<0.001) more likely to fail, whereas the grafts between
                                                                                1998-2000 were indicated to be 1.94 times (95% CI, 0.94-3.97, p=0.07)
M.S. KIM, M.H. SONG                                                             more likely to fail.
Kangnam St Mary’s Hospital, Seoul, KOREA                                        Conclusions: Our evaluation of graft survival in eyes with pre-existing
                                                                                glaucoma clearly shows that a cohort effect of improvement in survival
Purpose: To evaluate effect of mass media to people’s thoughts and              rates over the 13 years. It appears unlikely that this improvement in graft
corneal transplantation.                                                        survival is related to changing indications or disease severity in this
Methods: We evaluate the change of people’s thoughts after cornea               subgroup, but to our management of post-keratoplasty glaucoma, and
donation campaign by means of surveying 1036 peoples above 20 years             efforts to maintain graft clarity may instead have changed for the better.
old with telephone and compare 2005 corneal transplantation to 2004 by          Further analysis of changes to our approach to glaucoma patients
distributing questionnaires to 25 hospitals and received it by 18 hospitals.    who have undergone corneal transplantation is currently underway to
Results: 94% of the survey respondents by telephone were aware of               determine the main factors involved in our improved graft survival in
organ transplantation and 86.9% of respondents knew through mass                these eyes.
media. 80.8% of respondents agreed to organ transplantation and 81.3%
of respondents wanted to donate their organ. After watching <open your
eyes> program, 94.9% of the survey respondents realized the require-            411-B52
ment of organ transplantation and 66.2% of respondents consent the              GRAFT CLARITY AND SURVIVABILITY IN RELATION
establishment of law which asking one’s mind to donate organ when               TO DIFFERENT TECHNIQUES OF INTRALAMELLAR
acquire driving license. Number of total corneal transplantation is increased   DISSECTION IN DEEP ANTERIOR LAMELLAR
in 2005 than in 2004. Portion of domestic corneal transportation is more        KERATOPLASTY
increased than imported one. Under 50 years is most abundant in corneal
donor proportion.                                                               P. VARMA, P. VARMA, S. AGARWAL, S. SINGH, M. DATTANI, A. NAYAK,
Conclusions: As result of organ donation campaign, people’s thoughts of         D. MAHESHWARI
organ donation are changed and Domestic corneal transplantation is              M.G.M.M.C & M.Y.H, Indore, Indore, INDIA

                                                                                                                                                                  POSTER ABSTRACTS
increased. However organ donation should be given continuous publicity
and be established as a well-organized system.                                  Purpose: To study the graft clarity, survivability and assess the visual
                                                                                outcome in relation to different techniques of intralamellar dissection in
                                                                                deep anterior lamellar keratoplasty.
410-B51                                                                         Methods: 12 eyes of 11 patients with partial thickness corneal opacity
ENHANCED CORNEAL GRAFT SURVIVAL IN                                              were divided into 2 groups and DALK was performed. In Group I, Archilla-
PATIENTS WITH GLAUCOMA - A COHORT EFFECT                                        Price’s air dissection with basic method and in Group II, air dissection
                                                                                was combined with Tsubota’s divide and conquer method. Corneal graft
H. ZHOU, D. TAN                                                                 of 8mm size was placed with single continuous suture in both groups.
Singapore Eye Research Institute, Singapore, SINGAPORE                          Results: Shorter dissection time and smoother bed preparation was seen
                                                                                with Group II. Descemet’s perforation seen in 3 cases of Group I and 1
Purposes: To investigate the secular trend of corneal graft survival for        case of Group II. Conversion rate to PK was more in Group I than Group II.
eyes with pre-existing glaucoma over a 13-year period (1991-2003) within        On 6 mth -1 yr follow-up, interface scarring was seen in 2 cases of Group
the Singapore Corneal Transplant Study (SCTS).                                  I and none in Group II with just 1 clear graft in Group I and 5 clear grafts in
Methods: A sample of 133 corneal grafts for optical reasons with                Group II with better visual results.
pre-existing/concurrent glaucoma prior to transplantation, was selected         Conclusions: The combined technique of intrastromal air and dissection
from SCTS database. The sample was divided into 3 temporal cohorts              with four quadrant Divide and Conquer method gives better results in
according to their year of operation, 2003-2001, 2000-1998, 1991-1997.          terms of graft clarity and the visual outcome as compared to intrastromal
To minimize the potential bias caused by different follow up periods for        air injection alone in Deep Anterior Lamellar Keratoplasty.
each cohort, only grafts with follow up period of up to 5 years were
recruited, (which accounted for over 80% of all cases). With similar
sample size in each cohort, a closely balanced design was created.              412-B53
Kaplan-Meier analysis and multivariate cox-regression model were                EFFECT OF PUPIL RECONSTRUCTION ON
applied to compare survival experience and evaluate the risk of graft fail-     CORNEAL GRAFT SURVIVAL - A CASE CONTROL
ure between 3 groups.                                                           STUDY
Results: The overall 1-year, 2-year and 3-year Kaplan Meier survival rate
is 74.3%, 53.1% and 36.7% respectively. For cohort 1991-1997 (n=42),            A. ANSHU1, B. ZHOU2, D.T.H. TAN1
survival rates were lowest, at 58.6%, 28.2%, 11.1%, respectively. Sur-          1
                                                                                 Singapore National Eye Centre, Singapore, SINGAPORE; 2Singapore Eye Research
vival rates improved to 74.1%, 59.1% and 39.8% for cohort 1998-2000             Institute, Singapore, SINGAPORE
(n=44), As no graft failed 3-year period in cohort 2001-2003 (n=47), only
1 year and 2 year survival rates were available, which also improved            Purpose: To describe techniques of pupil reconstruction (pupilloplasty)
further to 88.7% and 71.6% respectively. These improved rates of                at the time of penetrating keratoplasty (PKP) for pupil abnormalities, and
survival by Kaplan Meier analysis were highly statistically significant         to evaluate the effect on graft survival.
(p<0.0001). After adjusting for potential confounding effects from              Methods: A case control study involving 35 cases of PKP combined with
other risk factors identified in the SCTS study (n=901), multivariate           pupilloplasty, and 70 matched controls consisting of PKP alone was

Asian J Ophthalmol. 2007 Vol 9 No 1 Supplement 1                                                                                                          157
Poster Abstracts

undertaken at the Singapore National Eye Centre. Case selection was                414-B55
obtained from the Singapore Corneal Transplant Study (SCTS). Various               DESCEMETS STRIPPING AUTOMATED
iris/pupil abnormalities and specific surgical techniques used were                ENDOTHELIAL KERATOPLASTY (DSAEK) - EARLY
analyzed. Chi-square and student t tests to compare risk factors between           RESULTS IN SINGAPORE
treatment and control groups, and Kaplan Meier and Cox’s regression for
graft survival analysis was performed.                                             M. SUSIYANTI, A. PARTHASARATHY, P. YONG MING, J. MEHTA, L. LI, D. TAN
Results: Pupil/iris abnormalities were classified based on size and                Singapore National Eye Centre, Singapore, SINGAPORE
location of the pupil and the degree of iris tissue loss, which included
dilated, distorted, or eccentric pupils, or large iris defects or iridodialysis.   Purpose: Descemets Stripping Automated Endothelial Keratoplasty
     20 patients were male and 15 were female. Age range was from 27               (DSAEK) is a new form of posterior lamellar keratoplasty which has
to 77 years (mean=62.4 years). Indications for PKP included pseudophakic           tectonic and refractive advantages over conventional penetrating kerato-
(n=11) or aphakic (n=6) bullous keratopathy, mechanical trauma (n=5)               plasty (PKP). We evaluated early visual and refractive outcomes following
and regrafts (n=9). Mean follow-up in treatment group was 39.1 months              treatment of corneal DSAEK.
(range=4.4 to 82.3 months) and in control group was 30.3 (range=0.1 to             Methods: Prospective analysis of the first 7 consecutive cases of DSAEK
98.2 months). During follow up, 8 (22.9%) grafts failed in the treatment           performed by the Corneal Service of the Singapore National Eye Centre.
group and 28 (40%) failed in the control group.                                    This procedure first involved microkeratome-assisted Automated Lamel-
     No cases resulted in breakdown of iris sutures or anatomical reversal         lar Therapeutic Keratoplasty (ALTK) unit (Moria, France) to produce a
of the pupilloplasty.                                                              donor thickness of 150-200 microns. Recipient’s Descemets membrane
     Univariate analysis of 10 risk factors affecting graft survival revealed      (DM) was scored circularly to a diameter of 8 mm using reverse Sinskey
that only pupilloplasty and donor source variables were statistically              hook. A 5mm temporal scleral tunnel incision was made and DM was
significant different between study groups. Kaplan Meier analysis showed           stripped and removed. Lamellar donor was trephined to 8 mm, folded in
graft survival to be higher in the pupilloplasty group (p=0.031).                  a “taco” shape, then inserted into the anterior chamber. BSS was used to
     Multivariate analysis by Cox-regression similarly confirmed                   centralize the graft and air was injected beneath the graft, pushing up
pupilloplasty [hazard ratio (HR) 2.52 (95% CI of 1.14-5.57, p=0.022)] and          the donor towards the posterior stromal surface. A complete airfill of AC
donor source [HR 0.34 (95% CI -0.16-0.73, P=0.005)] to be significant.             for 8 minutes secured the graft in position and adherence was confirmed
Conclusions: Iris reconstruction should be performed in eyes with sub-             1-2 hours after surgery.
stantial pupil abnormalities at the time of penetrating keratoplasty.              Results: Seven eyes of 7 patients (4 women and 3 men) were evaluated.
Pupilloplasty significantly improves graft survival and renders the pupil          Mean age was 65 ± 13. 05 yrs (43-80 yrs). Six patients were Chinese
cosmetically acceptable. Analysis of potential visual improvement with             and 1 Indian. Indications for DSAEK surgery were Fuchs’ endothelial
pupilloplasty is ongoing.                                                          dystrophy (n=5), pseudophakic bullous keratopathy (n=1), irido-corneal
                                                                                   endothelial syndrome (n=1). One eye was phakic and 6 eyes were
                                                                                   pseudophakic. Pre-op BCVA was 6/21 in 1 eye, 6/30-6/45 in 3 eyes and
413-B54                                                                            > 6/120 in 3 eyes. Mean post-op follow-up was 6.4 ± 6.02 wks (3-
PSEUDOPTERYGIUM AN INDICATION OF LIMBAL                                            20 wks). Attachment of donor was successfully achieved in all cases with
STEM CELL DEFICIENCY FOLLOWING                                                     no graft dislocation. Rapid reduction in corneal edema with significant
THERAPEUTIC KERATOPLASTY: A NEW                                                    improvement in graft clarity was seen. At 1-month follow-up, all corneas
COMPLICATION                                                                       were optically clear and free of edema. One eye had achieved BCVA of
                                                                                   6/9, 3 eyes had 6/12, the other 3 eyes achieving 6/21, 6/30 and 6/120
A. SHARMA, K. MOHAN                                                                vision, respectively. One case of poor VA was related to pre-existing dia-
Cornea Centre, Chandigarh, INDIA                                                   betic maculopathy. Moreover, DSAEK eyes showed relatively emmetropic
                                                                                   refractive results with mean astigmatism of 1.80 ± 0.65 D and mean
Purpose: Intact vascular arcade in the periphery of the cornea is an               manifest spherical equivalent of +0.75 ± 0.94 D. One complication of
indication of healthy limbal stem cells. Disruption of peripheral vascular         acute IOP rise due to temporary angle closure was noted on the first post-
arcade and development of pseudopterygium is suggestive of localized               op day, but treated successfully with peripheral iridectomy.
limbal stem cell deficiency. The authors present a new complication                Conclusions: Early results of DSAEK surgery in Asian eyes are promising.
of development of pseudopterygium due to limbal stem cell deficiency               This surgery allows rapid resolution of corneal edema, minimal refractive
following therapeutic penetrating keratoplasty.                                    changes, resulting in rapid visual rehabilitation, and recovery. However,
Methods: In a retrospective study, the records of patients having under-           DSAEK remains in evolution, and longer-term follow-up emphasis in
gone therapeutic penetrating keratoplasty were reviewed. Nine eyes                 evaluating endothelial damage is still needed.
(9 patients) were found to have developed pseudopterygium following
therapeutic penetrating keratoplasty. Details on the duration of the disease,
indication of therapeutic penetrating keratoplasty, surgical procedure, size
of the graft and outcome of surgery were recorded and analyzed.
Results: Six eyes had undergone large diameter (> 9.0 mm) therapeutic
PKP, 3 eyes eccentric therapeutic PKP for fungal corneal ulcers. All 9
eyes had severe ocular inflammation before undergoing PKP. Patients
with eccentric grafts developed pseudopterygium in the quadrant closest
to the limbus.
Conclusions: Therapeutic penetrating keratoplasty coupled with severe
ocular surface inflammation of long duration corneal ulcers may pre-
cipitate limbal stem cell deficiency resulting in pseudopterygium formation.

158                                                                                                    Asian J Ophthalmol. 2007 Vol 9 No 1 Supplement 1
                                                                                                                                   Poster Abstracts

415-B56                                                                            1. 27 (+1.24) diopters at last follow up (P<0.05). The surface regularity
DEVELOPMENT OF A SURGICAL WET-BENCH                                                index (SRI) measured 1.88 (+0.48) preop and improved to 0.83 (+0.44)
PLATFORM FOR MORPHOLOGICAL,                                                        at 6 weeks and further to 0.73 (+0.52) at 3 months (p<0.05). The surface
HISTOLOGICAL AND ELECTRON MICROSCOPIC                                              asymmetry index (SAI) averaged 3.11 (+1.36) preop and improved to
EVALUATION OF CORNEAL SURGICAL QUALITY                                             0.94 (+0.73) and 0.8 (+0.23) at 6 weeks and 3 months respectively
WITH THE FEMTEC FEMTOSECOND LASER IN                                               (P<0.05). Corresponding values at last follow up were 1.06+0.66 and
HUMAN DONOR CORNEAS                                                                1.38+1.3 (P<0.05). Pachymetry measured 806 (+171) µm preop, and
                                                                                   corresponding values at 6 weeks, 3 months and last follow up were
A. PARTHASARATHY1, H. CAJUCOM-UY1, Y.M. POR1, M. SUSIYANTI1,                       541 (+86), 567 (+93) and 594 (+142) µm respectively (P<0. 05). En-
R. BEUERMAN2, D. TAN1                                                              dothelial cell densities (donor measurements) preop averaged 1762 (+262)
 Singapore National Eye Center, Singapore, SINGAPORE, 2Singapore Eye Research      cells/mm2 and 1699 (+512)(P>0.4) and 1597 (+616) cells/mm2 (P>0.63)
Institute, Singapore, SINGAPORE                                                    at 6 weeks and 3 months respectively representing a mean cell loss of
                                                                                   3.5% and 9.5% from preoperative donor cell measurements at 6 weeks
Purpose: To develop a laboratory-based surgical platform to evaluate               and 3 months respectively. 3 patients had a disc dislocation on I postop
surgical quality and precision with the FEMTEC (20/10 Perfect Vision)              day which was subsequently repositioned and 5 patients underwent
femtosecond laser in performing penetrating keratoplasty, anterior and             AC reformation for pupillary block. The causes for poor visual recovery
posterior lamellar keratoplasty, and intrastromal ring surgery in human            postop included pre existing stromal scarring, preop posterior capsular
donor corneas.                                                                     opacification, amblyopia, old cystoid macular edema and other macular
Methods: The utility and precision of the femtosecond laser for perform-           pathologies like ARMD and diabetic maculopathy.
ing corneal surgery was appraised in 10 human eye bank corneas in a                Conclusions: The DLEK procedure preserves an intact ocular surface,
model wet-lab platform. This involved the use of artificial chamber                minimizes astigmatism, and provides healthy donor endothelial cell count
maintainers (Hanna, Katena) on research grade human donor corneas                  and function resulting in faster visual rehabilitation for the patient.
to perform a variety of penetrating and lamellar surgical procedures.
Scanning electron microscopy (SEM) and histopathological sectioning were
performed on treated corneas to confirm morphological dimensions and               417-B58
depth of ablation, profile of perpendicular cut geometries, lamellar bed           EFFICACY AND SAFETY OF ETHYL-2-

                                                                                                                                                                  POSTER ABSTRACTS
quality, as well as sectility of lasered tissue, with appropriate alteration       CYANOACRYLATE ADHESIVES FOR CORNEAL
of beam profiles and treatment algorithms for optimal outcomes. These              GLUING IN PERFORATED CORNEA
were compared with tissues cut with a microkeratome.
Results: Establishment of our wet-lab platform allowed for consistency             P. M E E S O U P O N G , N . K A S E T S U WA N , T. K U L K A M T H O R N ,
in evaluating surgical profiles. Vertical trephination cuts with the femto-        V. PUANGSRICHARERN, L. PARIYAKANOK
second laser were seen to be precisely angled with accurate cut margins            Faculty of Medicine, Chulalongkorn University, Bangkok, THAILAND
and minimal adjacent tissue disruption. Lamellar bed quality assessed
by histology and SEM were found to be smooth and uniform in depth of               Purpose: To study the efficacy and safety of ethyl-2-cyanoacrylate
ablation, after appropriate alteration of beam ablation parameters.                adhesive for corneal gluing in impending or perforated cornea at King
This was comparable to what was seen in microkeratome cut corneas.                 Chulalongkorn Memorial Hospital.
Endothelial morphology remained unaltered in deep lamellar ablations,              Methods: This is a retrospective case study series from charts of all
except for expected peripheral cell loss adjacent to cut edges.                    patients who underwent corneal gluing with ethyl-2-cyanoacrylate at
Conclusion: Development of a surgical femtosecond laser wet bench with             King Chulalongkorn Memorial Hospital from 1992-2005. Data collections
appropriate laboratory support for tissue analysis is essential to evaluate        consist of demographic data, indications for treatment, visual acuity
the quality of femtosecond laser assisted corneal surgery. Our prelimi-            before and after gluing, numbers of gluing, contact lens used, definite
nary studies suggest that the femtosecond laser is a precise surgical tool         treatment, success and complication after gluing.
that may be used to develop new corneal surgical procedures and                    Results: This study included 36 eyes treated with ethyl-2-cyanoacrylate
enhance clinical patient outcomes.                                                 adhesive. There were 26 men (72.2%) and 10 women (27.8%), with age
                                                                                   ranging from 11 to 72 years (mean age 42.27 years). The most common
                                                                                   indications were descemetocele (33.3%) and perforated corneal ulcer
416-B57                                                                            (33.3%). The success of the procedure, determined by sealing of corneal
DEEP LAMELLAR ENDOTHELIAL KERATOPLASTY-                                            perforation, was founded in 29 patients (80.5%). Sealing at the first
CLINICAL RESULTS                                                                   procedure was found in 22 patients (61.1%), the second and the fifth
                                                                                   procedures were 7 patients (19.4%) and 1 patient (2.7%) respectively.
A. JOHRI, P. PADMANABHAN, C. RAJA                                                  Definite treatments after gluing were performed in 8 patients with PK/LK
Sankara Nethralaya, Chennai, INDIA                                                 or AMT. In the series, there was neither evisceration nor enucleation.
                                                                                   One patient developed corneal irritation (2.7%; 95%CI:-0.026, 0.082).
Purpose: To report the early clinical results of patients undergoing DLEK for      No serious complications such as corneal decompensation, infection and
the treatment of endothelial dysfunction at a tertiary eye care centre in India.   intraocular complication were found.
Methods: Prospective, noncomparative interventional case series. 60 eyes           Conclusion: Our study shows efficacy of ethyl-2-cyanoacrylate in gluing
of 59 patients with corneal decompensation from Fuch’s dystrophy and               both non-infectious and infectious impending/perforated cornea. Even
pseudophakic bullous keratopathy.                                                  though ethyl-2-cyanoacrylate has not been shown to be used and
Results: At a mean follow up of 4.5 months (range 4 weeks to 15 months),           reported in human ocular tissues, our study shows the efficacy and
BSCVA improved from an average of 1/60 (range HM-6/12) preop to an                 lack of serious complication in the use of this material. Therefore, it may
average of 6/36 (range 6/6-CF) (P<0.05). Average MR astigmatism was                be safely used as an alternative to ocular tissue adhesive glue.

Asian J Ophthalmol. 2007 Vol 9 No 1 Supplement 1                                                                                                          159
Poster Abstracts

418-B59                                                                         chamber and time lapse microscopic video imaging were performed.
FIBRIN GLUE VERSUS CYANOACRYLATES IN                                            Results: Phosphorylation of ERK was found from wound margin to
CORNEAL CYTOTOXICITY, BACTERIOSTATIC                                            submarginal cells after wounding by immunohistochemical analysis.
EFFECTS AND THE ABILITY TO SEAL CORNEAL                                         PD58059 cause dose-dependent inhibition of the wound closing speed.
INCISIONS                                                                       The inhibition of wound healing becomes significant from 48 to 72 hours
                                                                                in cells treated with 10 and 50 uM of PD58059 (p<0.05). ERK inhibition
W.L. CHEN, T.H. TSAI, I.H. TU, F.R. HU                                          suppressed cell proliferation in Ki67 positive cells and MTS assay. Delay
National Taiwan University Hospital, Taipei, TAIWAN                             in migration by Boyden chamber chemotaxis assay and time lapse
                                                                                microscopy were also found when treated with PD98059.
Purpose: To compare the corneal cytotoxicity, bacteriostatic effect,            Conclusions: ERK plays an important role in coordinating corneal
duration of adherence and the ability to seal corneal incisions among           endothelial wound healing process. Cell proliferation and migration were
fibrin glue and two commercially available cyanoacrylate derivatives.           both involved in the ERK related wound healing process.
Methods: Fibrin glue, N-butyl cyanoacrylate and methoxypropyl cyanoacr-
ylate were compared. Corneal cytotoxicity was tested by direct contact
method using bovine corneal epithelial cells, keratocytes and corneal           420-B61
endothelial cells challenged with droplets of adhesives. The bacteriostatic     TEMPORAL AND SPATIAL TGF-β ISOFORMS
activity was verified by measuring the inhibition zones of bacterial growth     EXPRESSION AND SMAD2 AND P38 MAPK
surrounding adhesive droplets on agar plates inoculated with Staphylo-          ACTIVATION DURING CORNEAL REGENERATIVE
coccus aureus, Streptococcus pneumoniae, Pseudomonas aeruginosa,                WOUND REPAIR
Escherichia coli and Mycobacterium chelonae. The duration of adherence
was evaluated based on the morphological changes of adhesive drops              M.I. HUH, Y.H. KIM, M.H. KIM, J.C. JUNG
when applied on cell culture system. The ability to seal corneal incisions      Natural Sciences, Kyungpook National University, Daegu, KOREA
was verified by the maximum resisted intraocular pressures before
leakage of the rabbit corneal stab wounds sealed with tissue adhesives.         Purpose: The present study analyzed the temporal and spatial expres-
Results: Methoxypropyl cyanoacrylate demonstrated the greatest                  sion of TGF-β isoforms and activated pSmad2 and p38 MAPK during chick
corneal cytotoxocity followed by N-butyl cyanoacrylate. Fibrin glue showed      corneal wound repair.
no detectable cytotoxicity (p<0. 01). Methoxypropyl cyanoacrylate and           Methods: The central corneal epithelium in chickens was removed
N-butyl cyanoacrylate showed bacteriostatic effects against Staphyloco-         using an Alger brush within a 4 mm region. Wounds were allowed to
ccus aureus, Streptococcus pneumoniae, and Mycobacterium chelonae               heal for 12 hours, 2 days, 7 days and 14 days, after which corneas were
but not Pseudomonas aeruginosa and Escherichia coli, while fibrin glue          removed and paraffin-embedded sections analyzed using indirect
has no such effect against both Gram-positive and negative bacteria             immunohistochemistry to determine TGF-β1, -2, and -3, pSmad2 and
(p<0. 01). Methoxypropryl cyanoacrylate and N-butyl cyanoacrylate               p38 MAPK expression.
demonstrated greater duration of adherence and ability to seal corneal          Results: Normal corneas showed low level TGF-β staining. Following
incisions than fibrin glue (p<0. 01).                                           wounding, TGF-β1 expression was strong in the Bowman’s membrane.
Conclusions: There are different corneal cytotoxicity, bacteriostatic effect,   TGF-β3 expression was confined to basal cells in the regenerating
duration of adherence and the ability to seal corneal incisions among           and unwounded regions, and was not detected in migrating epithelial,
fibrin glue, N-butyl cyanoacrylate and Methoxypropryl cyanoacrylate.            stromal or endothelial cells. TGF-β2 expression was strong in migrating
These different properties should be considered when used in corneal            and proliferating epithelial cells, active fibroblasts, endothelial cells and
surgeries.                                                                      Descemet’s membrane. pSmad2 and p38 MAPK expression was observed
                                                                                in the nuclei of migrating and proliferating epithelial cells. Very few
                                                                                migrating epithelial cells at the wound edges expressed both nuclear
419-B60                                                                         pSmad2 and cytoplasmic p38 MAPK. pSmad2 and p38 MAPK expression
ERK1/2 IS INVOLVED IN THE CELL PROLIFERATION                                    was also observed in endothelial cells. nterestingly, many active fibroblasts
AND MIGRATION OF RABBIT CORNEAL                                                 expressed nuclear pSmad2 but little if any cytoplasmic p38 MAPK. The
ENDOTHELIAL WOUND HEALING PROCESS                                               pSmad2 staining pattern correlated with the TGF-β2 staining pattern,
                                                                                suggesting that stromal cell transformation into fibroblasts is mediated
W.L. CHEN, I. H. TU, J.W. LI, T.H. TSAI, F.R. HU                                in part by temporal activation of Smad2 following up-regulation TGF-β2
National Taiwan University Hospital, Taipei, TAIWAN                             expression.
                                                                                Conclusions: Temporal and spatial expression of TGF-β isoforms and
Purpose: To evaluate the role of ERK1/2 in the proliferation and migration      active Smad2 and p38 MAPK appears to be a key aspect of regenerative
in the healing rabbit corneal endothelial cells.                                corneal wound healing in the chick.
Methods: Primary culture of rabbit corneal endothelial cells were used in
this study. Cells were treated with different concentrations of MEK inhibi-
tor PD58059. Immunohistochemistry was performed to demonstrate
the phosphorylation of ERK after injury. Confluent cells were treated
with straight line scrape injury at different concentrations of PD98059.
The wound healing rate was evaluating 24, 48 and 72 hours later. For
evaluating the role of proliferation during wound healing, immunohisto-
chemistry with Ki67, MTS assay and cell density analysis after complete
resurface of the scrape wound were performed. For analyzing the role of
cell migration during wound healing, chemotaxis assay by modified Boyden

160                                                                                                 Asian J Ophthalmol. 2007 Vol 9 No 1 Supplement 1
                                                                                                                                   Poster Abstracts

421-B62                                                                             microscope. The expression levels of collagen I, collagen III, fibronectin
HUMAN CORNEAL WOUND HEALING: DOES THE                                               (FN) and transforming growth factor beta-1 (TGF-β1) were investigated
XYZ HYPOTHESIS OF CORNEAL EPITHELIALIZATION                                         by immunohistochemistry and RT-PCR assays.
HOLD TRUE?                                                                          Results: In the group of LASIK with ultra-thin flaps, the corneas were
                                                                                    clear without haze followed by slight wound healing and fast recovery.
T. SHERWIN, C.Y. CHANG, C.N.J. MCGHEE, C.R. GREEN                                   While in the group of LASEK, corneal wound healing was obviously
University of Auckland, Auckland, NEW ZEALAND                                       delayed. There was haze in grade 1 (62.5%) and grade 2 (37.5%) in 1
                                                                                    month, with grade 0.5 (43.75%) and grade 1 (56.25%) in 3 months. 1
Purpose: The human corneal epithelium consists of five to seven layers              month and 3 months after surgery, proteins and mRNA of collagen III, FN
of squamous cells. Unlike the skin, the corneal epithelium is non-                  and TGF-β1 were expressed in the anterior corneal stromal layer in
keratinized. While the basal cells have long been known to undergo cell             each group. But the expression was much higher in the group of LASEK
division, they are now referred to as transient amplifying cells, since they        (P<0.05). The protein and mRNA expression of collagen I had no
are believed to have a definite life span. Transient amplifying cells arise         difference between the two groups (P>0.05). The mRNA expression of
from the stem cells as a result of very slow cell division, and these               collagen I, collagen III, FN and TGF-β1 had no statistical difference
cells undergo repeated active cell division to maintain the cellular layers.        between the groups of control and LASIK with ultra-thin flap in 3 months
According to the widely accepted XYZ theory the cell loss from the                  (P>0.05).
surface (Z) is balanced by the sum of the supply of basal cells (X) and             Conclusions: It was suggested that the corneal wound-healing response
the centripetal movement of peripheral cells towards the centre of the              of LASIK with ultra-thin flaps was much better than that of LASEK.
cornea (Y). The X component is equivalent to the dividing transient
amplifying cells, and the Y component is accounted for by the slow
supply from the stem cells at the limbus. The loss of epithelial cells that         424-B65
composes the Z component has long been attributed to friction between               INHIBITION OF CORNEAL EPITHELIAL CELL
the eyelids. However, at present, programmed cell death or apoptosis is             PRODUCTION OF FIBROTIC MEDIATOR TGF-β2 BY
believed to explain this loss. The thickness of the superficial layer of            BASEMENT MEMBRANE-LIKE EXTRACELLULAR
epithelial cells is kept constant by such a mechanism.                              MATRIX
Methods: We designed a template with which we were able to ablate a

                                                                                                                                                                 POSTER ABSTRACTS
2mm wide ring of tissue to a depth of 80 microns but leave a central                M.E. FINI, A.J. LAGIER, S.H. YOO, E.C. ALFONSO
3mm island of epithelium which was untouched. This template was termed              Univ Miami Sch Med, Miami, FL, UNITED STATES OF AMERICA
“donut” and ensured that the ablation edges were vertical and not
sloped. The recovery of the epithelium was recorded macroscopically using           Purpose: Transforming Growth Factor-β2 (TGF-β2) is a major epithelial
time-lapse photography.                                                             mediator of fibrotic marker expression. Production of TGF-β2 protein is
Results: Five human corneas were analyzed using this ablation technique.            reduced by plating on matrigel, a basement membrane-like extracellular
Surprisingly, the results have cast a doubt over the validity of the XYZ            matrix extract. The goal of the current study was to further understand
hypothesis. Our results have shown that the epithelium is able to recover           the mechanism of matrigel regulation.
in both centripetal and centrifugal directions. Moreover, the centrifugal           Methods: We used a human epithelial cell culture model for these
epithelial recovery was as efficient as the centripetal recovery and with           studies.
no loss of stratification within the central island.                                Results: TGF-β2 production is inhibited by matrigel at the level of mRNA
Conclusions: We conclude that the XYZ hypothesis does not appear to                 accumulation and activity of the TGF-β2 gene transcriptional promoter.
hold true in a human corneal model and this has ramifications for our               The effects of matrigel cannot be explained by growth factor contaminants,
understanding of corneal epithelial wound healing and also for the                  reduction in heparin sulfate proteoglycans has no effect, and pure
commonly held belief that the central corneal TACs are significantly less           forms of the major ECM components laminin and collagen IV cannot alone
potent than those at the limbus.                                                    reproduce the effect. Experiments also failed to implicate inhibition of
                                                                                    a constitutive TGF-β2 autocrine feedback loop. Thus we went on to con-
                                                                                    sider hypotheses that incorporated a requirement for complexity. Matrigel
423-B64                                                                             caused a reduction of ezrin, a member of the ezrin/radixin/moesin (ERM)
THE EFFECTS ON CORNEAL WOUND HEALING OF                                             family, which plays a role in establishing polarity of epithelial cells in
LASIK WITH ULTRA-THIN FLAPS AND LASEK IN                                            tissues through the Rho signaling pathway and the actin cytoskeleton.
RABBITS                                                                             A set of known chemical compounds was screened for the capacity
                                                                                    to inhibit TGF-β2 promoter activity, yielding two hits - one an inhibiter
J. ZOU1, X.T. ZHOU2, R.Y. CHU2                                                      of actin polymerization and another an inhibitor of the PDGF receptor
 Shanghai Sixth People’s Hospital, Shanghai, CHINA, 2Department of Ophthalmology,   tyrosine kinase.
Eye & ENT Hospital, Fu Dan University, Shanghai, CHINA                              Conclusions: These findings indicate that matrigel inhibits TGF-β2
                                                                                    gene expression and point to a mechanism requiring the complexity of
Purpose: To evaluate the corneal wound-healing response of LASIK                    matrigel composition and structure. Ezrin and the actin cytoskeleton,
with ultra-thin corneal flaps and LASEK in rabbits.                                 Rho kinase, and the PDGF receptor tyrosine kinase are implicated in this
Methods: 32 adult New Zealand rabbits were divided into 2 groups with               mechanism. Chemical compounds that affect this pathway might be
16 each. Two surgical procedures, LASIK with ultra-thin flaps and LASEK             used as pharmacologic modulators to improve the quality of wound
were performed on the right eye of each group, with the left eye as control.        healing and refractive surgical outcomes in the cornea.
A myopic ablation of 10 diopters was performed in each group. Corneal
wound-healing and histopathological changes of the ablation zone were
studied through slit lamp, light microscope and transmission electronic

Asian J Ophthalmol. 2007 Vol 9 No 1 Supplement 1                                                                                                         161
Poster Abstracts

425-B66                                                                         Conclusions: The mean Schirmer test I and II observed were 19.93+
A COMPARATIVE STUDY OF 0. 5%                                                    4.48mm and 10.91+3.88mm. The mean BUT test observed was 14.12+
CARBOXYMETHYLCELLULOSE WITH 0. 005%                                             2.96s. There is a relationship between tear secretion and age. BUT is not
STABILIZED OXYCHLOROCOMPLEX (PURITE™)                                           connected with age and sex.
CONTROLLED TRIAL                                                                427-B68
                                                                                DRY EYE IN HORMONE REPLACEMENT THERAPY
Chulalongkorn Hospital, Bangkok, THAILAND                                       Department of Ophthalmology, Universiti Sains Malaysia, MALAYSIA

Purpose: To compare the efficacy, tolerability, and safety of 0.5% carboxy-     Purpose: To compare the occurrence of dry eye in menopausal women in
methylcellulose (CMC) with PURITE™ and 0.5% CMC alone in patients               Hospital Universiti Sains Malaysia (HUSM) between those taking hormone
with moderate to severe dry eye symptoms and/or signs.                          replacement therapy (HRT) and those not on HRT.
Methods: Randomized, self-controlled, clinical equivalence trial. 101 dry       Methods: A comparative cross sectional study was carried out to
eye patients who had equal bilateral dry eye symptoms were enrolled             determine the occurrence of dry eye in control subjects and those
into the study. Each patients was randomly assigned to use 0.5% CMC             on HRT. Schirmer’s test, tear film break up time (BUT) and Rose Bengal
with PURITE™ in one eye and 0.5% CMC in the fellow eye every 2 hours.           staining were performed on all study participants.
Symptoms, visual acuity, tear break-up time, ocular surface staining            Results: Fifty-four women were examined, 30 (55.6%) were on hormone
with fluorescein, Rose Bengal dye, and Schirmer I test were assessed            replacement therapy (Group 2), while the control group consists of 24
at Day 0, Week 1, 4, 8. The adverse effects of both drugs were also             (44.4%) women not on any hormone replacement therapy (Group 1). In
recorded at each visit. At the end of the study, patients were also asked       Group 2 (HRT), 11 patients were on estrogen (Group 2A) and 19 patients
about their preference. Confidence interval approach was used to com-           were on combined estrogen and progesterone (Group 2B). Dry eye was
pare the difference of Rose Bengal and fluorescein staining between eyes,       found in 29.2% of patients in Group 1 (Control) and in 70.0% of patients
with the equivalence range of ±3. Paired t-test was used for other analyses.    in Group 2 (HRT) [p=0.003]. In Group 2 (HRT), dry eye was more common
Results: There were clinical equivalence in total symptoms, fluorescein         in Group 2B, 84.2% compared to Group 2A, 45.5% (p=0.042).
staining, Rose Bengal staining and Schirmer I test between both CMC             Conclusions: Dry eye was found more commonly in menopausal women
with PURITE™ and CMC groups at any time points. However, eyes treated           who took HRT in HUSM. Our finding has negated the previous assumption
with CMC had statistically increased TBUT at week 8, mean difference            that HRT is a protective factor against dry eye.
0.52 seconds (95% CI 0. 09, 0.95). One in CMC with PURITE™ group
exhibited early keratitis whereas one in CMC group had itching sensation.
43% of patients preferred CMC as compared to 34% who preferred CMC              428-B69
with PURITE™.                                                                   CLINICAL EFFICACY OF REFRESH LIQUIGEL
Conclusions: When comparing efficacy, tolerability and safety, CMC with         COMPARED TO SYSTANE - A PROSPECTIVE,
PURITE™ is equivalent to CMC and can be used as frequently as every 2           RANDOMIZED CLINICAL TRIAL
hours in treating dry eye patients.
                                                                                C.S. TAN, L.W. VOON, A.K.H. LAU, O. HEE, C.C. YIP
                                                                                The Eye Institute, Singapore, SINGAPORE
TEST SCHIRMER AND BREAK UP TIME OF TEAR                                         Purpose: To evaluate and compare the efficacy and tolerability of
FILM IN GROUP OF NORMAL VIETNAMESE                                              Refresh Liquigel® (RL), a non-disruptive, purite containing preservative
                                                                                1% carboxy-methylcellulose (CMC) artificial tears to Systane® (SYS),
P. KHANH VAN, H. MINH CHAU, T. TUYET NHUNG                                      a product with hydroxypropyl Guar (HPG) preserved with Polyquaterbium-
Hanoi Medical Univercity, National Íntitute of Ophthalmology, Hanoi, VIET NAM   1 in dry eye patients.
                                                                                Methods: A prospective, randomized, single-masked clinical trial.
Purpose: To evaluate tear film flow and stability in a group of                 Fifty-eight patients (116 eyes) meeting the inclusion criteria were
healthy population by Schirmer test and tear film break up time (BUT)           randomized to receive either RL or SYS to both eyes at a standardized
measurements.                                                                   dosing schedule for 2 months. Three masked investigators evaluated the
Methods: The tests (Schirmer I, II; BUT) were measured in 400 normal            patients’ clinical parameters - Schirmer’s test (ST), tear breakup time
subjects (800 eyes), age from 18 to 60. Among these, there were                 (TBUT), conjunctival hyperemia (CH) and Oxford scoring scheme (OSS) -
208 men and 192 women.                                                          at baseline, 1 week, 1 month and 2 months.
Results: The mean Schirmer test I observed was 19.93+4.48mm (on                 Results: Seventy-six eyes (65.5%) received RL and 40 (34.5%) received
group of age from 18-29: 24.30+6.72mm, age from 30-39: 20.41+                   SYS. At baseline, the two groups were comparable for age (p=0.820),
5.41mm, age from 40-49: 16.51+4.32mm and age from 50-60: 15.31+                 gender (p=0.567), ST (p=0.474), CH (p=0.052) and OSS (p=0.219). Com-
3.00mm). The mean Schirmer test II observed was 10.91+3.88mm                    pared to baseline parameters, the RL group showed an improvement at
(on group of age from 18-29: 14.65+5.24mm, age from 30-39: 12.13+               3 months for ST (p<0.001), TBUT (p<0.001), CH (p<0.001) and OSS
3.30mm, age from 40-49: 9.56+4.11mm and age from 50-60: 7.32+                   (p<0.001); while the SYS group showed an improvement in TBUT
2.90mm). The mean BUT test observed was 14.12s+2.96s (on group of               (p<0.001), CH (p<0.001) and OSS (p<0.001). When evaluating clinical
age from 18-29: 13.92+3.25s, age from 30-39: 14.96+3.25s, age from              parameters after 2 months of treatment, there was no statistically
40-49: 13.54+2.30s and age from 50-60: 13.98+3.10s).                            significant difference between RL and SYS in terms of ST (p=0.902), TBUT

162                                                                                                 Asian J Ophthalmol. 2007 Vol 9 No 1 Supplement 1
                                                                                                                                      Poster Abstracts

(p=0.062), CH (p=0.055), OSS (p=0.906) or tolerability score to the eye               Methods: Arabinogalactan (AG), a natural polysaccharide from the Larch
drops (p=0.513).                                                                      tree, was tested in different experimental conditions (Opocrin Research,
Conclusions: Both Refresh Liquigel and Systane demonstrate an improve-                Italy, 2005). Rheostress RS 150 Viscosimeter® was employed for meas-
ment in dry eye parameters after 2 months of treatment. Both artificial               uring the AG bioadhesion in vitro. Shimadzu RF-551 Fluorimeter® was
tears are comparable in terms of efficacy and tolerability in dry eye                 used for evaluating the precorneal residence time of AG + fluorescein
treatment.                                                                            solution (FITC-AG) in rabbits. The dry eye in the rabbit was induced on
                                                                                      both eyes; then each rabbit received in one eye 50ul of a water solution
                                                                                      of AG (5% w/w) and in the control eye only polymer-free vehicle.
429-B70                                                                               Results: In spite of newtonian non-viscous behavior (n = 1.6 mPa s for
DYSFUNCTIONAL TEAR SYNDROME AMONG                                                     10% w/w solution), AG 5% precorneal residence in rabbits was evident
PATIENTS ON MAINTENANCE TOPICAL                                                       up to 60 minutes after instillation. The re-epithelization speed of rabbit
GLAUCOMA MEDICATION                                                                   ulcers was significantly more rapid with AG treatment in comparison to
                                                                                      the controls.
J.V. BALINGIT, M.B. AGULTO, R. LIM-BON-SIONG                                          Conclusions: None of the so-called “mucomimetic” marketed lachrymal
Philippine General Hospital, Manila, THE PHILIPPINES                                  substitutes has a real resemblance to the natural mucin; in fact, MUC 1
                                                                                      has a branched-chain chemical structure, on the contrary HPMC and HA
Purpose: To determine the prevalence of dysfunctional tear syndrome                   have linear chemical structure. So, we thought it useful to try a new way,
(DTS) among patients on topical glaucoma medication; the association                  using a non-viscoelastic branched-chain compound, the arabinogalactan
of the use, duration, and number of drops of topical medication; and                  (AG). The long residence time of AG 5% solution derives from its high
benzalkonium chloride (BAC) concentration with DTS; and if DTS symp-                  mucoadhesive properties (delta n / n 17. 21) as compared to hyaluronic
toms affect patient compliance to medication.                                         acid (delta n/ n 3. 02). Moreover AG performed favorably in the re-
Methods: 196 glaucoma patients not previously diagnosed to have                       epithelization of experimental corneal ulcers. These preliminary data sug-
DTS nor with any condition or ocular disease that can cause DTS were                  gest a use of AG also in human subjects as artificial tears. In particular,
grouped into two: with topical glaucoma medication (n=94) or without                  AG should be recommended when mucous layer is altered, but not greatly
topical glaucoma medication (n=102). An interview-guided questionnaire                reduced. In these conditions, a “mucoadhesive” lachrymal substitute,
with medical, medication, and ophthalmic history was administered;                    rather than a so-called “mucomimetic” substitute, is preferable as mucin

                                                                                                                                                                      POSTER ABSTRACTS
ophthalmologic examination (tear break up time, corneal and conjuncti-                restorer. The instillation of AG solution is theoretically advisable during
val staining with fluorescein and lissamine green, Schirmer test with                 contact lens wear: the viscoelastic compounds form a cushion on
anesthesia, Ocular Surface Disease Index and Subjective Grading of                    the lens surface with reduced wettability, on the contrary AG permits an
Ocular Discomfort) was done to determine presence of DTS.                             excellent wettability and also a mechanism of adsorption / bond to
Results: 55% of patients had DTS. Patients on topical glaucoma medica-                hydrophilic lens polymer “siti”.
tion had a higher prevalence of DTS and were 2.5 times more likely to
have DTS compared to non-users. Compared to patients who are not
currently on medications, those with present topical glaucoma medica-                 431-B72
tion use of more than 1 year were 2.61 times more likely to have DTS,                 CONFOCAL MICROSCOPY OF INTRACORNEAL
those on a present regimen of 2 drops per day were 3.22 times more                    INLAYS
likely to have DTS, and those who are presently receiving a total BAC
dose of more than 0.100 were at least 2 times more likely to have                     P.K. VADDAVALLI 1 , J. MOILANEN 2, R.P. KALA 1 , D.F. SWEENEY 3,
DTS. Only 2 out of the 94 patients with topical medications discontinued              M. EVANS3, T. HUGHES4, R.Z. XIE3, K. MCCLEAN5, A. VANNAS2
medication due to symptoms.                                                           1
                                                                                        L V Prasad Eye Institute, Hyderabad, INDIA, 2Department of Ophthalmology;
Conclusions: There is a high prevalence of DTS among patients on                      Central Military Hospital, Helsinki, FINLAND, 3Vision CRC, Sydney, AUSTRALIA,
topical glaucoma medication. The ocular effects are ‘dose-dependent’;                 4
                                                                                        CSIRO molecular science, NSW, Sydney, AUSTRALIA, 5CSIRO molecular science,
the risk of DTS increases as the duration of topical medication use, number           Sydney, AUSTRALIA
of drops instilled, and concentration of BAC are increased. The presence
of DTS symptoms does not affect compliance in the study population.                   Purpose: To evaluate the biocompatibility and tissue response on confocal
                                                                                      microscopy following implantation of intracorneal inlays.
                                                                                      Methods: Corneal inlays were implanted in the corneas of 5 eyes of
430-B71                                                                               5 unsighted patients after creating a LASIK flap with a microkeratome.
NEW PROSPECT IN DRY EYE THERAPY:                                                      Patients were followed up on days 1, 3, 15 and monthly thereafter for
ARABINOGALACTAN, A NEWTONIAN NON-                                                     12 months and at 3 monthly intervals for the next 12 months. The inlay
VISCOUS LACHRYMAL SUBSTITUTE                                                          from patient 006 had to be explanted at the 5-month time point due to a
                                                                                      persistent epithelial defect and stromal melt. Apart from slit lamp biomi-
L.L. MANNUCCI 1, E. BOLDRINI 2, G. FALCONE 3, S. BURGALASSI 4,                        croscopy and other routine measurements, confocal microscopy was
D. MONTI4, P. CHETONI4                                                                performed at each visit. Quantitative indices like endothelial cell count,
 University Medical School, Padova, ITALY, 2Opocrin Research, Formigine(MO), ITALY.   polymegathism, pleomorphism and keratocyte density were determined
 Opocrin Research, Formigine (MO), ITALY, 4University Bioorganic Chemistry School,    and tabulated over time. Qualitative indices including epithelial, stromal
Pisa, ITALY                                                                           and lenticular changes were noted.
                                                                                      Results: The subjects included 3 males and 2 females with an average
Purpose: Our research had a completely new conceptual approach to                     age of 51 yrs. Average endothelial cell density and morphological indices
lachrymal substitutes: to find a compound acting not as viscoelastic,                 at baseline were not significantly different from those at 18 months.
but rather as mucin restorer by a mucoadhesion mechanism.                             Keratocytes showed a gradual reduction of density with increased

Asian J Ophthalmol. 2007 Vol 9 No 1 Supplement 1                                                                                                              163
Poster Abstracts

numbers of activated keratocytes in the first 6 months, which tended to           433-B74
show reduced activity with time. High reflective deposits were seen on            A CASE SERIES OF 24 PATIENTS WITH
either surface of the lenticule while the lenticule itself was low reflective.    MICROSPORIDIA KERATITIS - AN EMERGING
The basal epithelial cells showed increased reflectivity of their borders         CORNEAL PATHOGEN?
and enlarged cells, probably indicative of edema. No significant change
was observed in the nerve structures.                                             L.H. LIM, R.S. K. LOH
Conclusions: Confocal microscopy showed a gradual increase of the                 Changi General Hospital and Singapore National Eye Centre, Singapore, SINGAPORE
stromal reflectivity on both sides of the lenticule. Stromal alterations
remained stationary or even decreased over time. Basal epithelial changes         Purpose: To report a recent significant increase in incidence of
suggest cell border or extracellular swelling but these alterations were          microsporidial keratitis and an apparent change in the profile of affected
reversible. Corneal inlays seem to be compatible with human corneal               patients at Changi General Hospital, Singapore. To our knowledge, this
tissue and do not cause any alterations in the endothelium or posterior           is the largest case series reported so far on microsporidial keratitis.
stroma over time.                                                                 Methods: Observational case series of 24 patients with positive corneal
                                                                                  scraping for microsporidia on modified trichrome stain.
                                                                                  Results: This is a case series of 24 patients (26 eyes) with microsporidial
432-B73                                                                           keratitis (2 with bilateral eye involvement) seen in Changi General Hospital,
FACTORS INFLUENCING RAISED INTRAOCULAR                                            Singapore from the period of December 2005 to July 2006. HIV serology
PRESSURE IN CORNEAL ULCERS                                                        was negative in 18 of the patients. In the remaining 6 patients, HIV
                                                                                  serology was either not offered or declined by the patients. From history
E. ZUNAINA, M. NORLAILI, Y. MAIZAN, O. ABDUL MUTALIB, I. SHATRIAH,                taking, these 6 patients did not have high-risk behavior nor were they
S. BAKIAH                                                                         intravenous drug users. Five patients were treated with topical
Universiti Sains Malaysia, Kubang Kerian, Kelantan, MALAYSIA                      corticosteroids by their general practitioners prior to presentation to us.
                                                                                  Two were contact lens users. Clinical features varied from epitheliopathy
Purpose: To determine the factors influencing the rise in IOP in corneal          to stromal infiltrates. All patients were treated with topical ciprofloxacin
ulcers.                                                                           0.3%. Keratitis persisted in 2 eyes requiring oral albendazole treatment.
Methods: Thirty-one corneal ulcer patients were selected for this study.          All had sub-epithelial scarring on resolution with vision ranging from 6/6
All patients were examined under slit-lamp. The ulcers were graded into           to 6/7.5 on Snellen acuity chart except for one patient who had vision of
three stages; mild, moderate and severe based on the size, depth,                 6/18 and is due for further review.
infiltration, anterior chamber reaction and involvement of the sclera by          Conclusions: A total of 24 patients (26 eyes) were diagnosed with
using a modified Ogawa’s grading. Intraocular pressure was measured               microsporidial keratitis over a period of 8 months in our tertiary hospital,
using the Tono-Pen XL. Patients were re-examined at day 7 and day 14 of           representing a significant jump in incidence as compared with previous
admission. Patients with high IOP of 30 mmHg and above were treated               years. This is the largest series reported to date and may represent an
with oral acetazolamide and were discontinued from IOP measurement                emerging corneal pathogen with a change in the profile of affected
at day 7 and day 14. Raised IOP was defined as a pressure of more than            patients. Although the overall outcome is good there remains a small and
21 mmHg in the affected eye, or a difference of more than 4 mmHg                  significant possibility of persisting or recurrent keratitis in some patients.
between the affected and the unaffected eye.
Results: Thirty-one patients with corneal ulcer who fulfilled the study
criteria were studied. Their age ranged between 7 and 73 years old                434-B75
with mean of 44.45 ± 19.86. Twenty-four patients (77.4%) were male                CLINICAL EFFICACY OF MOXIFLOXACIN IN THE
and 7 patients (22.6%) were female. Twelve patients (38.7%) had raised            TREATMENT OF BACTERIAL KERATITIS: A
IOP while 19 patients (61.3%) did not have any rise in IOP. Ten out of 12         RANDOMIZED CLINICAL TRIAL
patients (83.3%) who developed raised IOP were started on oral
acetazolamide 250 mg every six-hourly and were discontinued from fur-             M. CONSTANTINOU, M. DANIELL, G.R. SNIBSON, H.T. VU, H.R. TAYLOR
ther IOP measurement. The results of the univariate analysis showed that          Centre for Eye Research Australia, Melbourne, AUSTRALIA
the severity of ulcer, size, depth, infiltrate and involvement of the sclera
were found to be significantly associated (P < 0.05) with raised IOP.             Purpose: To determine the clinical efficacy and safety of moxifloxacin
However, all of these factors with the exception of scleral involvement           (1.0%) in patients treated with bacterial keratitis compared with
did not remain significant (P > 0.05) after multiple logistic regression          patients treated with ofloxacin (0.3%) or fortified tobramycin (1.33%)/
analysis. There was no statistically significant association (P > 0.05)           cephazolin (5%).
between anterior chamber reaction and raised IOP.                                 Methods: A prospective randomized trial. A total of 229 patients
Conclusions: Involvement of the sclera in corneal ulcer was a significant         diagnosed with bacterial keratitis were enrolled in the study; 78 patients
risk factor for raised IOP. The severity of ulcer, size, depth and infiltration   were randomized to the fortified tobramycin/cephazolin group, 77
were just associated factors. There was no association between anterior           patients to the moxifloxacin group and 74 patients to the ofloxacin group.
chamber reaction and raised IOP.                                                  A total of 225 patients were evaluable for safety and 198 patients were
                                                                                  included in the efficacy analysis. After corneal specimens were obtained,
                                                                                  the assigned study medication was instilled every hour day and night for
                                                                                  48 hours and on the third day every hour by day and every two hours at
                                                                                  night. For days four and five, one drop every two hours by day and every
                                                                                  four hours at night and for days six and seven, one drop every four hours.
                                                                                  After day seven, the antibiotic was tapered to six hourly and stopped
                                                                                  when appropriate.

164                                                                                                    Asian J Ophthalmol. 2007 Vol 9 No 1 Supplement 1
                                                                                                                                 Poster Abstracts

Results: Resolution of the keratitis and healing of the ulcer occurred in      436-B77
175 (94%) non exiting patients. In the 175 non exiting patients that the       AN OUTBREAK OF CONTACT LENS-ASSOCIATED
corneal ulcer was cured, there were no statistically significant differences   FUSARIUM KERATITIS IN SINGAPORE
between the treatment groups for the mean time to cure (p=0.25). There
were no statistically significant differences between the three treatment      W.B. KHOR 1 , D.T. H. TAN 2 , T. AUNG 2 , S.M. SAW 3 , T.Y. WONG 2 ,
groups in the various sign parameters including the sign score. A positive     P.A. TAMBYAH4, A.L. TAN5, L. LIM1, W.K. CHAN1, W.J. HENG6, J. LIM6,
bacterial corneal culture was obtained in 190 (83%) of the 229 enrolled        R.S. K. LOH7, S.B. LEE8, R. BEUERMAN1
patients. The distribution of the species of bacterial organisms was           1
                                                                                 Singapore Eye Research Institute and Singapore National Eye Centre, SINGAPORE,
similar in each treatment group and no significant difference in the           Singapore, 2Singapore Eye Research Institute, Singapore National Eye Centre, and
percentage of isolates between the groups was observed. Twelve (5.2%)          Department of Ophthalmology, Yong Loo Lin School of Medicine, National Univer-
of the patients that were treated had serious complications (perforation       sity of Singapore, Singapore, SINGAPORE, 3Singapore Eye Research Institute and
or enucleation). No serious events attributable to therapy occurred during     Department of Ophthalmology, Yong Loo Lin School of Medicine, National Univer-
the study and all treatments were safe and well tolerated.                     sity of Singapore, Singapore, SINGAPORE, 4Department of Medicine, Yong Loo Lin
Conclusions: No difference in healing rate, cure rate or complications         School of Medicine, National University of Singapore, Singapore, SINGAPORE,
between fortified cephazolin and tobramycin, ofloxacin or moxifloxacin         5
                                                                                 Department of Pathology, Singapore General Hospital, Singapore, SINGAPORE,
was seen in this study.                                                        6
                                                                                 Department of Ophthalmology, Tan Tock Seng Hospital, Singapore, SINGAPORE,
                                                                                 Singapore Eye Research Institute, Singapore National Eye Centre, and Depart-
                                                                               ment of Ophthalmology, Changi General Hospital, Singapore, SINGAPORE,
435-B76                                                                          Department of Ophthalmology, National University of Singapore, Singapore,
CONFOCAL AS A NON INVASIVE DIAGNOSTIC                                          SINGAPORE
INFILTRATES                                                                    Purpose: To describe a nationwide outbreak of fungal keratitis caused by
                                                                               Fusarium species amongst cosmetic contact lens users in Singapore.
M. SAMANT, V. MITTAL, P. GARG, P. KRISHNA, A. ZABBAR                           Methods: We reviewed all cases of fungal keratitis in contact lens users
LV Prasad Eye Institute, Hyderabad, AP, INDIA                                  in all public hospitals in Singapore. The charts of all contact lens users
                                                                               with culture-proven fungal keratitis during the period March 2005 to May

                                                                                                                                                                  POSTER ABSTRACTS
Purpose: To study the role of confocal in diagnosing deep corneal              2006 were reviewed. A standardized telephone interview was conducted
infiltrates of fungal etiology                                                 to obtain additional clinical information.
Methods: Since January 2006 to September 2006, cases which                     Results: Over the study period, there were 66 subjects (68 eyes) with
presented to Cornea Services of LV Prasad Eye Institute as deep stromal        cosmetic contact lens-associated Fusarium keratitis in Singapore. The
infiltrate and/or endoexudates were included in the study. Confocal            mean patient age was 27.1 years, and 32 (48.5%) were men. The vast
microscopy was done to look for fungal filaments. All these cases under-       majority (65 subjects, 98.5%) wore soft, disposable contact lenses, and
went therapeutic keratoplasty and corneal button was subjected to              62 (93.9%) subjects reported using one brand of contact lens cleaning
histopathological and microbiological analysis. Histopathological diagno-      solution (ReNu®, Bausch & Lomb, USA); in particular, 42 (63.6%) pa-
sis was correlated with Confocal finding.                                      tients recalled using ReNu® with MoistureLocTM. Most subjects (81.8%)
Results: 5 cases, presenting as deep infiltrates, had a variable mode of       had poor lens hygiene practices, including overnight use of daily-wear
onset with duration of more than 1 month. Confocal revealed fungal             lenses (19.7%), and use of lenses past the replacement date (43.9%).
filaments in all 5 cases. Histopathological analysis of corneal button         The final best-corrected visual acuity ranged from 20/20 to 20/80, with
confirmed fungal filaments in all 5 cases.                                     5 eyes (7.4%) requiring emergency therapeutic or tectonic corneal
Conclusions: This pilot study points towards confocal as a useful              transplantation.
diagnostic tool in deep infiltrates where it is difficult to take sample for   Conclusions: We document a major outbreak of contact lens-associated
microbiological analysis.                                                      Fusarium keratitis in Singapore. Physicians and eye care practitioners
                                                                               worldwide need to be aware of the likelihood of similar cases emerging
                                                                               in cosmetic contact lens users.

                                                                               MICROBIOLOGICAL PROFILE OF BACTERIAL
                                                                               CORNEAL ULCERS IN NORTHERN INDIA

                                                                               R. TANDON, B. CHAWLA, P. AGARWAL, T. AGARWAL, N. SHARMA,
                                                                               J.S. TITIYAL, N. NAYAK, G. SATPATHY
                                                                               Dr Rajendra Prasad Centre for Ophthalmic Sciences, AIIMS, New Delhi, INDIA

                                                                               Purpose: To study the microbiological profile of bacterial corneal ulcers
                                                                               in Northern India and to report the incidence of resistance towards 4th
                                                                               generation fluoroquinolones.
                                                                               Methods: Records of 401 patients with bacterial corneal ulcers which
                                                                               presented to R P Centre for Ophthalmic Sciences, AIIMS, New Delhi
                                                                               between Apr to Aug 2006 were reviewed. Repeat samples were required
                                                                               in few cases. 417 corneal scrapings were subjected to microbiological

Asian J Ophthalmol. 2007 Vol 9 No 1 Supplement 1                                                                                                          165
Poster Abstracts

analysis. Parameters recorded were age, sex, organism isolated and sen-      eyes presented with perforation. KOH revealed presence of fungal
sitivity mainly to four commonly used antibiotics: cefazolin, tobramycin,    elements in 390 (90.9%) whereas culture positivity was seen in 246
gatifloxacin, and moxifloxacin.                                              (57.3%)eyes. Organisms isolated were Aspergillus 106 (43.1%), Fusarium
Results: A total of 417 samples were studied. The sample was reported        80 (32.5%), Dematiaceous 22 (8.9%) and others 38 (15.4%) eyes. 259
to be sterile in 69 (16.5%), commensals were found in 55 (13.2%) and         (60.4%) eyes were managed with medical treatment alone, out of which
pathogenic organisms were reported in 293 (70.3%). The most commonly         combination therapy of topical Natamycin 5% and topical Amphoterecin-
seen organisms were as follows                                               B 0.15% was instituted in 147 (56.8%) cases. Adjuvant oral antifungals
• Staphylococcus albus               228 (77.8%)                             were administered in 34 (13.1%). 215 (83.01%) responded favorably to
• Pseudomonas                         26 (8.9%)                              medical management. 174 (69.3%) eyes achieved functional success.
• Staphylococcus aureus               22 (7.5%)                              170 (39.6%) eyes underwent therapeutic penetrating keratoplasty. Mean
• Strep. Pneumoniae                    6 (2%)                                duration from the time of presentation to surgery was 10.22 (+/-12.71)
• Other gram negative bacteria        11 (3.8%)                              days. Anatomical success was achieved in 140 (82.35%) whereas
Drug sensitivity revealed that out of the 293 samples with pathogenic        functional success was seen in 27 (15.9%) eyes. Amongst the eyes with
bacteria, 49 (16.73%) samples had organisms resistant to cefazolin           anatomical success, in 86 (50.6%) eyes, a future optical penetrating
(22 S albus, 17 Pseudomonas, 10 other gram neg bact); 29 (9.9%)              keratoplasty was possible whereas in 27 (15.9%) there was no possibility
samples were resistant to tobramycin (17 S albus, 10 Pseudomonas, 2          of future visual rehabilitation. 11 (6.5%) eyes went into phthisis and
other). Out of 228 cases of S. albus, 5 were resistant to both cefazolin     19 (11.2%) eyes were eviscerated.
and tobramycin, and 2 were resistant to all four drugs. Resistance to        Conclusions: Ocular trauma was an important predisposing factor.
gatifloxacin was seen in 10 (3%) samples (5 S albus, 4 Pseudomonas,          Aspergillus was the most common organism isolated. KOH is a highly
one Streptococcus viridans). Resistance to moxifloxacin was found in 16      sensitive and inexpensive test for rapid diagnosis. Prompt clinical and
(5.5%) specimens (6 S. albus, 6 pseudomonas, 1 S. aureus, 3 other).          microbiological diagnosis and appropriate medical and surgical manage-
Nine had organisms, which were resistant to both gatifloxacin and            ment can help in salvaging a large proportion of eyes with fungal keratitis.
moxifloxacin. Out of 26 samples where Pseudomonas was isolated,
4 (15%) were resistant to all the 4 drugs, 13 (50%) were resistant
to cefazoline only, 1 (3%) to moxifloxocin only. Resistant strains of        439-B80
pseudomonas were sensitive to amikacin and polymyxin B. Resistance to        THE EPIDEMIOLOGY OF KERATOCONUS
all four drugs was seen in 7 cases: 4 Pseudomonas, 2 S.albus, 1 Strep.
viridans.                                                                    W.J. KIM, M.S. KIM
Conclusions: The most common pathogen seen in bacterial keratitis in         Kangnam St. Mary’s Hospital, Seoul, KOREA
Northern India is S albus. There is emergence of resistance to cephazolin.
Resistance to Gatifloxacin and Moxifloxacin was seen, especially with        Purpose: To evaluate the epidemiology, clinical aspect and treatment
S albus and Pseudomonas. Multi drug resistance is high in Pseudomonas,       indication of keratoconus patients.
and antibiotics such as amikacin and polymyxin B may be more useful.         Methods: The subjects of this study were 336 (621 eyes) patients at the
                                                                             KangNam St. Mary’s Hospital From May 1995 to April 2006 from May
                                                                             1995 to April 2004. The medical records were reviewed.
438-B79                                                                      Results: The mean BCVA is 0.07±0.08, mean keratometer is 57.35±
FUNGAL KERATITIS- MANAGEMENT AND                                             9.41 D and mean corneal thickness is 443.69±9.41um. Male proportion
OUTCOMES                                                                     is slightly higher than female (M:F = 1.73:1). The proportion of monocular
                                                                             keratoconus patients is 15.18% (51 patients). Mean age is 26.58±
S. BHARTI, B. RAMENDRA, G. SITALAKSHMI, P. PREMA, R. RAMA,                   8.49 years. The proportion of first visit to Hospital at teenager is 17.8%
R.R. SUDHIR, H.N. MADHAVAN, R. BAGYALAKSHMI                                  (60 patients), age under 30 is 60.4% (203 patients). The number of
Medical Research Foundation, 18 College Road, INDIA                          patients receiving penetrating keratoplasty is 94 (38.%).
                                                                             Conclusions: Keratoconus has its onset at puberty and usually occurs
Purpose: To evaluate the predisposing factors, clinical features,            bilaterally. Because most patients visit hospitals over the first decades,
microbiological profile and management details of fungal keratitis at a      continuous publicity and education for early keratoconus diagnosis is
tertiary eye care center during last 7 years.                                essential.
Methods: A retrospective review of 429 cases of fungal keratitis
presenting between January 1998 to December 2005 was done. Cases
with smear or culture proven diagnosis of fungal keratitis were included     440-B81
in the study. The demographic profile, predisposing factors, clinical        RESOLVING KERATOCONUS THROUGH GAP
features, microbiological details, management and final outcome were         JUNCTIONS
analyzed. Functional success was defined as a final BCVA of >6/60.
Anatomical success was defined as preservation of the structural integ-      T.D. DONALD, G. KO, S. XU, C. GREEN, T. SHERWIN, C. MCGHEE
rity of the globe.                                                           University of Auckland, Auckland, NEW ZEALAND
Results: Mean age of the patients was 44.68+/-16.62 years. There were
343 males (80%) and 86 females (20%). Mean follow up period was 9.01         Purpose: Keratoconus is a progressive corneal disease causing visual
(+/-21.06) months. Predisposing factors included ocular trauma 197           impairment, which may require corneal transplantation. Clinically,
(45.9%), topical steroids 72 (16.8%) and diabetes mellitus in 63 (14.7%)     keratoconus can present with conical protrusion, stromal thinning,
cases. Clinical features included satellite lesions 143 (33.3%), pigmenta-   Fleischer’s ring, Vogt’s striae, stromal scarring and thickened corneal
tion 21 (4.9%), immune ring 65 (15.2%) and hypopyon in 187 (43.6%)           nerves. Histological features of this disease include alterations in the
eyes. Associated endophthalmitis was seen in 14 (3.3%) and 33 (7.7%)         structure and composition of the stromal matrix, breaks in Bowman’s

166                                                                                              Asian J Ophthalmol. 2007 Vol 9 No 1 Supplement 1
                                                                                                                                 Poster Abstracts

membrane, activation of keratocytes and disruption of the epithelium.         one had a tractional retinal elevation; later it settled without any surgical
The causation and progression of keratoconus are difficult to interpret       intervention. Mucous membrane related problems occurred in 5 eyes.
because of variations in disease presentation and severity (including         Conclusions: Modified OOKP provides a stable and permanent prosthe-
subclinical forms) at both the clinical and histological levels. A greater    sis with gratifying visual results in challenging end-stage ocular surface
understanding of the pathology of keratoconus is particularly important       diseases that were hitherto considered hopeless and inoperable.
to New Zealand/Aotearoa as it is the indication for 45.6% of corneal trans-
plants in this country. Gap junctions allow direct cell-cell communication
by providing a passage for molecules <1kDa to pass between adjacent           443-B84
cells. Connexin proteins form hexamers in the cell membrane, which are        GLAUCOMA MANAGEMENT IN PATIENTS WITH
able to bind connexin hexamers in adjacent membranes, forming the             OSTEO-ODONTO-KERATOPROSTHESIS (OOKP)
gap junction channel. There are 21 connexins in the human genome,
each with a unique, but overlapping, expression profile. Connexins            R.S. KUMAR1, T. AUNG2, F.T.S. OEN3, S.T. HOH3, A. PARTHASARTHY3,
are known to have crucial roles in the cell cycle, development, wound         D.T.H. TAN4
healing and disease. We hypothesize that gap junctional intercellular         1
                                                                               Singapore Eye Research Institute, Singapore, SINGAPORE, 2Singapore National
communication plays a role in the disease pathogenesis of keratoconus.        Eye Center, National University of Singapore, Singapore, SINGAPORE, 3Singapore
Methods: Our laboratory has extensively analyzed connexin expression          National Eye Center, Singapore, SINGAPORE, 4Singapore Eye Research Institute,
by immunolabelling connexin proteins in cryosections of human                 Singapore National Eye Center, Singapore, SINGAPORE
keratoconic corneas and viewing under confocal laser scanning
microscopy.                                                                   Purpose: The diagnosis and treatment of glaucoma in patients with OOKP
Results: Immunolabelling of connexins 26 and 43 revealed altered              remains a challenge. We report the diagnostic modalities and treatment
expression localization between control and keratoconic corneas. In           options in a small sample of patients with osteo-odonto-keratoprosthesis
pathologic areas connexin 43 expression increased to include the basal 6      (OOKP).
layers of the corneal epithelium compared with only the basal 3 layers in     Methods: Patients who underwent OOKP at the Singapore National
controls. Connexin 26 plaques increased in size in association with some      Eye Centre were evaluated at the time of the first post-operative visit.
pathologic features of keratoconus but decreased in association with          Digital palpation of the buccal mucosal surface superior to the KPro
others.                                                                       device provided some degree of clinical assessment of IOP, but all

                                                                                                                                                                  POSTER ABSTRACTS
Conclusions: This research suggests that connexins may have a role in         patients also underwent repeated stereo-biomicroscopic optic nerve
the disease pathogenesis of keratoconus.                                      head (ONH) assessment, automated static visual field testing (24-2
                                                                              SITA-Standard), ONH photography, imaging using the Heidelberg Retina
                                                                              Tomograph (HRT II), Scanning Laser Polarimeter (GDx VCC) and Optical
442-B83                                                                       Coherence Tomograph (OCT3) at 3 to 6 monthly intervals.
MODIFIED OSTEO-ODONTO-KERATOPROSTHESIS                                        Results: Five of 13 (7 males and 6 females) patients with OOKP had
(OOKP): INDIAN EXPERIENCE                                                     pre-existing glaucoma (diagnosed at first post-operative visit). No pa-
                                                                              tients without pre-existing glaucoma developed glaucoma following OOKP
G. SITALAKSHMI, V.S. PILLAI, G.K. IYER                                        surgery. Average follow-up period was 1. 43 ± 0.57 years. ONH photog-
Sankara Nethralaya, Chennai, INDIA                                            raphy and visual field testing were the most reliable methods to assess
                                                                              status of the disease, while HRT and GDx had problems with reproduc-
Purpose: Patients with end stage ocular surface disease do not benefit        ibility and quality relating to axial alignment along the small optical cylinder.
by penetrating keratoplasty (PK); modified Osteo-Odonto-Keratoprosthesis      All patients were able to perform reliable and repeatable visual fields.
(OOKP) surgery is the procedure of choice in such clinical settings.          All patients with glaucoma were treated with oral acetazolamide 500 mg
The aim of the study is to report the indications and surgical success of     twice a day on a long-term basis. Trans-cyclophotocoagulation (TCP) was
modified OOKP, performed at a tertiary care centre in India.                  performed in 4 patients after progression was noted. Two patients under-
Methods: Eleven patients (11 eyes) underwent modified OOKP proce-             went endo-TCP; one patient received it as a repeat procedure. One of
dure between March 2003 and April 2006. OOKP surgery was carried out          these patients developed post-operative endophthalmitis related to the
in two or three stages. A 3-staged surgery (preparatory procedure prior       endo-TCP procedure. Two patients were noted to have advanced disease
to Stage I) was performed in 6 eyes. Stage I included harvesting the          based on ONH and visual field assessment.
canine to fashion an osteoodonto lamina (buried in a sub muscular pocket      Conclusions: Visual field testing and disc assessment with ONH photos
in the lower lid of the fellow eye) and draping of the buccal mucosa over     appear to be effective methods to monitor patients with OOKP who have
the ocular surface. Stage II surgery done three to four months later in-      co-existing glaucoma, as intraocular pressure (IOP) cannot be accurately
volved implantation of the lamina on to the eye. Preoperative diagnosis       measured. Treatment strategies are limited to oral medications to lower
was Stevens Johnson syndrome (6 patients), chemical injury (3 patients),      IOP and cyclophotocoagulation.
and ocular cicatricial pemphigoid (2 patients). The preoperative visual
acuity was light perception in 9 eyes and finger counting in 2 eyes. The
mean follow up was 13.18 months (range 5-35 months).
Results: At the last follow-up, the visual acuity was 20/60 or better in 8
of the 11 eyes (72.7%). One eye with a visual acuity of 3/60 was
prephthisical. In one the visual acuity decreased from 20/30 to 20/200
due to vitritis and is on steroid therapy. One patient underwent removal
of lamina as he developed endophthalmitis 3 months after surgery.
Keratoprosthesis was retained in 10 (90.9%) out of the 11 eyes. Two
patients developed oro-antral fistula. Two patients developed vitritis and

Asian J Ophthalmol. 2007 Vol 9 No 1 Supplement 1                                                                                                          167
Poster Abstracts

444-B85                                                                      Zaditen® used in the long term to treat allergic conjunctivitis other than
CURRENT MICROBIAL CORRELATES OF THE EYE                                      Patanol®, a particularly toxic effect on conjunctival cells associated with
AND NOSE IN DACRYOCYSTITIS -THEIR CLINICAL                                   Azelan® and Zaditen® should be considered clinically.

R. KUMAR, S. GHOSE, N. NAYAK, G. SATPATHY, M.S. BAJAJ,                       446-B87
N. PUSHKER, R. GUPTA                                                         NON-SEASONAL ALLERGIC CONJUNCTIVITIS IN
DR R P Centre for Ophthalmic Sciences, AIIMS, INDIA                          THE TROPICS: EXPERIENCE IN A TERTIARY CARE

Purpose: In this era of changing antimicrobials, very few systematic

studies exist on flora in dacryocystitis. The present study has been
undertaken to determine the microbiological correlates of both eye and
                                                                             H.K.Y. CHOI, S.B. LEE
                                                                             National University Hospital, Singapore, SINGAPORE
nose in congenital and acquired dacryocystitis and selection of a proper
antibiotic regime to treat them based on microbiological results.            Purpose: To understand the epidemiology, severity, types of pathology,
Methods: Cases with regurgitating sacs only were enrolled and swabs          clinical features, precipitating factors and treatment outcomes of pa-

obtained from 112 eyes of congenital (12 B/L) and 110 eyes of acquired       tients with allergic conjunctivitis in a tropical climate, requiring corneal
dacryocystitis (10 B/L) from conjunctiva OU, both nostrils and finally       sub-specialist intervention.
regurgitant material.                                                        Participants: A total of 33 patients with severe allergic conjunctivitis
Results: Contralateral conjunctiva and both nostrils were sterile in         requiring corneal sub-specialist care in National University hospital,

77.3% and 56.9% in congenital, 80.1% and 55.6% in adults, with pre-          Singapore were studied.
dominance of Staph 17% in congenital, and 13.3% in acquired cases.           Design: retrospective, noncomparative case series Main outcome

Diphtheroids predominated amongst nasal isolates in congenital (20%)         measures: epidemiological data, clinical features, complete ophthalmo-
while Staph. albus in acquired (20%) dacryocystitis and similarly            logic examination and treatment types.
Staph albus were the major isolates from the regurgitations (21.4% and       Methods: Both eyes of 33 patients seen at the cornea sub specialist
17.3%); Gram +ve cocci including S. aureus and Pneumococci were              clinic between May 2005 to July 2006 were examined at baseline, and
cultured in 37.5 and 25.5%, with tobramycin, vancomycin and                  followed up. Clinical features, treatment and outcome variables through
ciprofloxacin, the best (80-100%) in vitro. Compared to regurgitants,        case sheet review were analyzed.
(26.5% and 21.7%) of ipsilateral nose and also (33.8% and 6.5%) con-         Results: 75.8% were male, and 24.2% were female. Ages ranged from
tralateral (unaffected) eyes exhibited similar isolates and sensitivities.   3 to 25 years, mean age of presentation was 10.7 years. 17 (51.51%) had
Conclusions: In this era of changing antimicrobials, and changing            concomitant allergic rhinitis, 16 (48.48%) had asthma, and 17 (51.51%)
patterns of organisms with their sensitivities, this type of study needs     had associated dermatitis. Only 9 (27.27%) had documented precipitating
repetition in various institutions in different areas, from time to time.    factors. None of the patients said that their symptoms were seasonal. 22
                                                                             (66.67%) said their symptoms were perennial. 12 patients were found to
                                                                             have a corneal epithelial defect or shield ulcer (36.36%). Topical steroids
445-B86                                                                      were required in 25 patients (75.8%). 5 of them were steroid responders.
COMPARISON OF THE CONJUNCTIVAL TOXICITY                                      11 out of the 33 patients (33.33%) required topical cyclosporine 0.5%.
OF TOPICAL OCULAR ANTI-ALLERGIC AGENTS                                       Conclusions: Allergic conjunctivitis in a non-temperate non-seasonal
                                                                             climate has different clinical presentations, and varied precipitating
J.S. LEE, J.E. LEE, Y.M. PARK, B.S. O UM                                     factors. The disease in such conditions may respond differently to the
Pusan National University Hospital, Pusan city, KOREA                        usual anti-allergy drug options used in temperate countries.

Purpose: To investigate the cytotoxic effect of topical ocular allergic
agents with H1-receptor antagonism and inhibition of histamine release       447-B88
from mast cells, on the cultured conjunctival cells of rabbit in vitro.      FROM TEAR PROTEOMIC ANALYSIS TO
Methods: Conjunctival cells of rabbit were exposed to topical ocular         UNDERSTAND DEVELOPMENT AND MANAGEMENT
allergic agents; Azelastine hydrochloride 0.05% (Azelan®, Taejoon, Korea),   OF VERNAL KERATOCONJUNCTIVITIS
Ketotifen fumarate 0. 025% (Zaditen®, Novartis, USA), Olopatadine
0. 1% (Patanol®, Alcon, USA) at a concentration of 10, 20 and 30%,           J.C.F. PONG, N.C.Y. CHU, R.C.C. WANG, T.C.W. POON, S.K. RAO,
respectively for a period of 0, 30 min, and 4, 12 and 24 hrs. Cell damage    C.C.P. PANG, D.S.C. LAM
was determined using the lactate dehydrogenase (LDH) leakage assay,          Chinese University of Hong Kong, Hong Kong, HONG KONG
and morphologic findings by the light and transmission electron
microscopy. The osmolarity, pH, and composition of electrolytes in the       Purpose: Vernal keratoconjunctivitis (VKC) is a severe and chronic
topical ocular allergic agents were also evaluated.                          allergic inflammatory disease commonly affecting young children in their
Results: The LDH titers increased after all the allergic agents were         first decade. Its clinical signs of giant papillae on palpebral conjunctiva,
exposed up to 4 hrs, and maintained its level for 12 hrs, and then           Tranta dots on limbus, punctate epitheliopathy and shield ulcers can
decreased until 24 hrs. The greater titer of LDH, the more conjunctival      result in permanent visual complications. In current practice the diagno-
cells became swollen or round. Azelan® and Zaditen® showed greater           sis is clinical and the treatment is mainly symptomatic. Previous studies
LDH titer, edema and cytoplasmic and nuclear degenerations of the con-       have demonstrated VKC as both type I IgE-mediated hypersensitivity
junctival cells than that of Patanol®. The levels of Na+, Cl- and pH were    reaction and T helper 2 cell-mediated reaction. In this study we aimed to
significantly lower with Azelan® and Zaditen® compared with Patanol®.        identify novel molecule(s) to understand the development of this unique
Conclusions: When topical ocular anti-allergic agents, Azelan® and           ocular allergy.

168                                                                                               Asian J Ophthalmol. 2007 Vol 9 No 1 Supplement 1
                                                                                                                                   Poster Abstracts

Methods: Unstimulated tear samples from VKC patients were collected              449-B90
with a sterile blunt-end micropipette from inferior fornices cul-de-sac.         ASSESSMENT OF EFFICACY AND SAFETY OF
No diluted or reflex tears were used for the study. Topical medication was       SUPRA TARSAL TRIAMCINOLONE INJECTION IN
not allowed at least 24 hours before tear collection. Age-matched (± 1yr         THE MANAGEMENT OF REFRACTORY VERNAL
old) tear samples from normal healthy subjects were collected as control.        KERATO-CONJUNCTIVITIS (VKC)
According to severity of presented clinical signs (hyperemia, Tranta dots,
punctate keratitis, papillary hypertrophy) and symptoms (itchiness,              J. BHATIA
discharge, pain, tearing, photophobia), we further divided the VKC               Rustaq General Hospital, Sultanate Of Oman, Rustaq, OMAN
patients into three sub-groups: mild, moderate and severe VKC. Com-
parative proteomic analyses were performed by 2D-PAGE for tear protein           Purpose: To study the efficacy and safety of Supra Tarsal Triamcinolone
separation and differential tear protein display and QSTAR-MS for                acetonide injection in the management of refractory Vernal Kerato-
differential tear protein identification.                                        conjunctivitis (VKC).
Results: We have compared 15 paired tear samples from VKC patients               Methods: Prospective double masked study, so far 64 eyes of 32
and healthy subjects. Age groups were ranged from 8 to 24 yrs old. There         patients with refractory Vernal Kerato-conjunctivitis were selected for
were 4 mild, 10 moderate, and 1 severe VKC patients. As low as 30ug of           the study and both eyes of each patient were given Supra Tarsal
tear protein from about 5-10ul of tears was successfully applied to              Triamcinolone acetonide injection (0. 6 ml).
display differential protein spots. There were at least 7 significantly up-      Results: The initial results are suggesting that dramatic relief of
regulated novel proteins present in tear samples from VKC patients. The          symptoms was seen in all patients by the end of first week after injection.
identified proteins include a novel cytotoxin protein targeting the cellular     Size of giant papillae (Cobble stone papillary hypertrophy) and gelatinous
destruction. Further functional characterization of the identified proteins      thickening of limbus decreased between 4 to 6 weeks. After initial success,
in VKC is undergoing.                                                            recurrence of disease was seen in two patients after two months. So far
Conclusions: The results of this study provide a basis for the develop-          we do not report any complication during follow up report of 5 months.
ment of novel marker for disease diagnosis and also for understanding of         All patients tolerated the treatment well.
disease development and management.                                              Conclusions: Initial result of the study are highly suggesting that
                                                                                 Supra Tarsal Injection of Triamcinolone acetonide is a cheap, safe and
                                                                                 very effective therapy for suppression of severe inflammation associated

                                                                                                                                                                   POSTER ABSTRACTS
448-B89                                                                          with refractory Vernal Kerato-conjunctivitis. Final result and conclusion
POLLENS CAN INCREASE EPITHELIAL                                                  will be discussed and presented at the time of presentation at the
PERMEABILITY AND ALTER TIGHT JUNCTION                                            conference.

M.C.H. TAM, P. LACKIE, M.K. CHURCH, J.I. MCGILL                                  450-B91
University of Southampton, Southampton, Hampshire, UNITED KINGDOM                ACCURACY AND SENSITIVITY OF THE DYNAMIC
                                                                                 OCULAR THERMOGRAPHY AND INTER-SUBJECTS
Introduction: Seasonal Allergic Conjunctivitis (SAC) is estimated to             OCULAR SURFACE TEMPERATURE (OST) NORM IN
affect 10 million people in the UK. SAC is allergen driven and pollen            HUMAN YOUNG ADULTS
impacting on the conjunctiva initiates an allergic reaction. We hypoth-
esized that protease activity in pollens disrupts the conjunctival epithelium,   L. TAN1, Z. CAI2
facilitating pollen movement across the epithelial barrier. A better under-      1
                                                                                  Singapore Polytechnic Optometry Centre, School of Chemical & Life Sciences,
standing of the underlying mechanisms in this important disease could            Singapore Polytechnic, Singapore, SINGAPORE, 2School of Electrical & Electronic
open up new targets for therapy.                                                 Engineering, Singapore Polytechnic, Singapore, SINGAPORE
Purpose: To investigate and quantify the extent of changes in morphol-
ogy and permeability in epithelial tight junctions associated with expo-         Purpose: The accuracy and sensitivity of the dynamic ocular thermogra-
sure to pollens.                                                                 phy in monitoring the temperature of the anterior eye were studied and
Methods: Tight junctions (TJs) forming a continuous barrier between              an inter-subjects ocular surface temperature (OST) norm in human young
cultured human epithelial cells were visualized by immunofluorescent             adults was also investigated.
staining of the TJ protein ZO-1 and quantified using computer aided              Methods:
image analysis. A total of 2646 areas from 63 immunofluorescent stain-           1. Accuracy study. A blackbody with fixed temperature was used.
ing were quantified. The permeability and functional integrity of the TJs            The surface temperature was set at 36.1 degree C (97 degree F) and
was assessed using transepithelial electrical resistance (TER).                      measured 34 times using a Thermo-Tracer TH9100MV, NEC San-ei.
Results: Cells incubated with mixed grass pollens showed increased gaps              The mean and SD were then calculated.
in ZO-1 staining as early as 0.5 hours (p<0.05) with maximal effects at 1        2. Sensitivity study. A blackbody was set at 16 different temperatures
hour when compared to controls. The pattern of ZO-1 staining was also                (to 1 decimal point, 32.2, 32.8, 33.3, 33.9, 34.4, 35.0, 35.6, 36.1,
altered and a 4-fold increase of ZO-1 staining not directly associated               36.7, 37.2, 37.8, 38.3, 38.9, 39.4, 40.0, 40.6 degree C, correspond-
with the cell membrane was found from 0.5 hours (p<0.01) compared to                 ing to 90, 91, 92, 93, 94, 95, 96, 97, 98, 99, 100, 101, 102, 103,
controls. A 30% drop in TER at 15 minutes was seen in pollen-incubated               104, 105 degree F). The surface temperature of the blackbody was
samples compared to controls.                                                        then being measured 5 times on each of them. Mean and SD were
Conclusions: Pollen treatment caused structural and functional changes               calculated for each of them and plotted onto a graph.
in TJs, supporting the hypothesis that pollen can cause epithelial               3. Inter-subjects norm in human eyes. 60 healthy young adults were
disruption.                                                                          recruited, ages 17-21 (mean age 19). No ocular pathology/corneal
                                                                                     inflammatory signs nor general ill-health, non-contact lens wearer

Asian J Ophthalmol. 2007 Vol 9 No 1 Supplement 1                                                                                                           169
Poster Abstracts

    (or lenses removed at least 24 hours prior measurement), not taking            (88.23%) with Grade II, 14 eyes (70%) with Grade III and 13 eyes (32.5%)
    topical eye medication, non-dry eyes. Absence of anterior eye                  with Grade IV injury had visual acuity of >6/18.
    disease/corneal inflammatory signs was assessed and certified                  Conclusions: Males were more affected. Alkali injury is more common
    by a qualified optometrist, using a slit-lamp biomicroscopy at the             with lime being the major agent. Grade IV injuries require multiple
    Singapore Polytechnic Optometry Centre. A room with standard room              surgeries and had more grave prognosis than others.
    temperature and humidity was used. A machine was used to meas-
    ure the room temperature and humidity. Subjects were adapted to
    the room conditions for 20 min before measurement (Morgan PB,                  452-B93
    1994). Subjects’ upper eyelid was held to expose the whole cornea              CONJUNCTIVAL RESECTION FOR THE TREATMENT
    using a cotton bulb, after the instrument has been set up. OST was             OF SUPERIOR LIMBIC KERATOCONJUNCTIVITIS
    then measured during 5-6s using infrared thermo-imaging, in a                  AND THE INVOLVEMENT OF MAST CELL IN SLK
    non-invasive manner. Human ethics approval was granted from the
    ethics committee and informed consent was obtained from every                  Y.C. SUN1, P.Y. SU2, C.H. HSIAO3, W.L. CHEN3, I.J. WANG3, Y.C. HOU3,
    subject.                                                                       F.R. HU3
Results: When the surface temperature was set at 36.1 degree C                     1
                                                                                     Taipei Tzu Chi General Hospital, Taipei County, TAIWAN, 2Far Eastern Memorial
using blackbody, the reading given by Thermo-Tracer TH9100MV, NEC                  Hospital, Taipei County, TAIWAN, 3National Taiwan University Hospital, Taipei,
San-ei was 36.5±0.1 degree C. Therefore the accuracy of the machine is             TAIWAN
+0.3 to +0.5 degree C. Sensitivity of the machine falls within the range of
± 0.1 to 0.2 degree C.                                                             Purpose: To evaluate the effectiveness of conjunctival resection in
Conclusions: The dynamic ocular thermography technique used in this                treating superior limbic keratoconjunctivitis (SLK) and the involvement of
study was found to overestimate OST by 0.3 to 0.5 degree C. A factor of            mast cell in SLK.
0.4 is suggested to be added to all OST measurement in the future. On              Methods: From 1996 to 2005, 40 eyes from 30 SLK patients who were
the other hand, it is found that OST can be measured within a sensitivity          unresponsive to medical treatment received superior bulbar conjunctival
range of ± 0.1 to 0.2 degree C. Data for inter-subjects ocular surface             resection. Another 20 patients from cataract and retinal surgery served
temperature (OST) norm in human young adults will be published during              as control group. The conjunctiva specimens were examined by
presentation.                                                                      hematoxylin and eosin (H & E) stain and immunohistochemistry using
                                                                                   antibodies against mast cell tryptase.
                                                                                   Results: In all operated eyes, the clinical symptoms and signs, including
451-B92                                                                            irritation/redness and superior bulbar conjunctival hyperemia / superior
CLINICAL PROFILE AND MANAGEMENT OF ACUTE                                           tarsal conjunctival papillary hypertrophy, subsided significantly one month
CHEMICAL INJURIES - A 6 YEAR ANALYSIS                                              after the operation. Only 2 eyes had recurrence from the margin of con-
                                                                                   junctival resection, which were relieved after re-operation. Keratinized
B. SRINIVASAN, S. PALLAVI, V.S. PILLAI, G.K. IYER, G. SITALAKSHMI                  conjunctival epithelium, loss of goblet cells and increased mast cell
Sankara Nethralaya, Chennai, INDIA                                                 numbers (P<0.05) were found in SLK group.
                                                                                   Conclusions: Our cases demonstrate that superior bulbar conjunctival
Purpose: To review the demographic profile, cause, and results of treat-           resection is an effective treatment modality for SLK. The pathological find-
ment of chemical eye injuries in patients presenting in the acute phase            ings suggested that mast cells may play some roles in the pathogenesis
(within 2 weeks) to a tertiary care center in South India over a six year          of SLK.
Methods: Records of all patients presenting with ocular burns between
Jan 2000 through Dec 2005 were examined retrospectively. Main                      453-B94
outcome measures analyzed were time to corneal epithelialization and               ASSESSMENT OF FIBRIN GLUE (TISSEEL®) IN
final best-corrected visual acuity.                                                PTERYGIUM SURGERY AND OTHER FORMS OF
Results: Out of the 185 patients (234 eyes), men (76.7%) were involved             OCULAR SURFACE RECONSTRUCTION
more than women. The mean age of the patients was 27.152 years ± 14.
76 years. The mean duration between the injury and the presentation to             Y.M. POR1, L.P.K. ANG2, D.T.H. TAN2
the hospital was 2.61 days ± 3.58 days. Alkalis were the most frequent             1
                                                                                    Singapore National Eye Centre, Singapore, SINGAPORE, 2National University of
chemical, implicated in 46.15%, while strong acid caused 33.76% of the             Singapore, Singapore, SINGAPORE
injuries. Hydrochloric acid was the most common causative agent among
the acid group and lime in the alkali group. Rest of the cases were due to         Purpose: To evaluate the efficacy and safety of fibrin glue in pterygium
unknown chemicals (20.09%). The average follow up was 215.77 days ±                and other ocular surface conjunctival and amniotic membrane surgery.
389.59. According to the Roper Hall classification, 59.82% (140 eyes)              Methods: This was a prospective non-comparative case series. Patients
suffered Grade I injury, 14.52% (34 eyes) had Grade II injury, and                 were recruited from the general clinics for pterygium surgery and from
8.5% (20 eyes) had Grade III and 17.09% (40 eyes) had Grade IV injury.             the cornea clinics for ocular surface reconstruction. For pterygium surgery,
Surgical intervention was needed in 17.94% (42 cases) of which majority            autologous conjunctiva was harvested from the superior bulbar conjunc-
were Grade IV injuries (13.24%). 1 eye with Grade IV injury underwent              tiva after pterygium excision. The graft was secured to bare sclera at the
Osteoodonto kerato prosthesis (OOKP) surgery with recovery of 6/6 vision.          site of the pterygium by Tisseel® fibrin adhesive. Patients were followed
The average epithelial healing time was 8.3, 12.67, 35.35 and 71.10                up with a standard form. Key parameters included visual acuity, graft
days in Grade I, II, III & IV (statistically significant p =0.003). There was no   integrity and graft size. The rate of pterygium recurrence was monitored.
correlation between acid or alkali versus time to epithelialization. At            Results: 24 patients were recruited, and 29 pterygia excised with con-
the end of the follow-up period, 121 eyes (86.42%) with Grade I, 30 eyes           junctival grafting. Mean follow-up was 5.7 months. All conjunctival grafts

170                                                                                                     Asian J Ophthalmol. 2007 Vol 9 No 1 Supplement 1
                                                                                                                                     Poster Abstracts

were secured adequately with no cases of dislodgement. Graft                         455-B96
dimensions tended to decrease slightly in the early post-operative period,           THE PREVALENCE OF PTERYGIUM IN A MALAY
followed by stabilization. There were no cases of serious adverse events             POPULATION: THE SINGAPORE MALAY EYE STUDY
and no reduction in visual acuity. 1 pterygium recurrence occurred at                (SIMES)
3 months. 1 spontaneous subgraft hemorrhage occurred with no effect
on graft stability. 3 patients with chemical injuries had secure fixation of         H.Y. CAJUCOM-UY1, S.M. SAW2, W.L. WONG3, T.Y. WONG4
amniotic membrane based conjunctival equivalents to both sclera as well              1
                                                                                      SERI, SNEC, Singapore, SINGAPORE, 2SERI, NUS, Singapore, SINGAPORE, 3SERI,
as corneal stroma.                                                                   Singapore, Singapore, 4SERI, SNEC, NUS, Singapore, SINGAPORE
Conclusions: Tisseel ® fibrin glue provided adequate adhesion of
conjunctival grafts and conjunctival equivalents to the ocular surface.              Purpose: To describe the prevalence rate for pterygium in the urban
Healing was characterized by a comfortable eye, minimal inflammation                 Malay population of Singapore.
and good cosmetic result. There were no significant complications and                Methods: A population-based, cross-sectional study of 3,280 (78. 7%
the results appeared similar to those reported in the literature for sutured         response rate) Malays aged 40-79 years in Singapore. The population
grafts.                                                                              was selected based on an age-stratified random sampling procedure of
                                                                                     Malay people living in the south-western part of Singapore. Participants
                                                                                     had a standardized interview, examination and ocular imaging at a
454-B95                                                                              centralized study clinic. Pterygium was diagnosed and graded clinically
P53 EXPRESSION AND HISTOPATHOLOGICAL                                                 by slit lamp examination as Grade 1 (atrophic), Grade 2 ( intermediate)
CHANGES IN PRIMARY AND RECURRENT                                                     and Grade 3 (fleshy). They were also classified as either unilateral or
PTERYGIA AMONG EGYPTIAN CASES                                                        bilateral.
                                                                                     Results: Data were available on 3266 participants. There were 508
S.R.E.N. NOWEIR1, A. ABDEL MEGEED1, N. ABDEL RAHMAN2                                 people with any pterygia, with 289 having unilateral and 219 bilateral
 Research Institute of ophthalmology, Cairo, EGYPT, 2Faculty of medicine, Al azhar   pterygia. The overall prevalence was 15.6% (95% confidence intervals,
University, Cairo, EGYPT                                                             14.3, 16.8). The prevalence increased with age (7.1%, 15.0%, 19.0%
                                                                                     and 22.0%, among participants aged 40-49, 50-59, 60-69 and 70-
Purpose: The aim of this work is to assess p53 expression and histo-                 79 years, respectively, p trend <0.001) and was higher in men than women

                                                                                                                                                                    POSTER ABSTRACTS
pathologic features in the epithelia of both primary and recurrent ptery-            (20.4% vs 11.1%, p<0.001).
gia cases, searching for the pathogenesis of this very common lesion.                Conclusions: The prevalence of pterygium in Singapore is 15.6% among
Methods: The pterygia specimens from 22 patients (twelve primary and                 Malays aged 40 years and older. This rate is higher than most popula-
ten recurrent cases) were studied by both routine hematoxylin and eosin              tion-based studies.
stain and immunohistochemically using antibodies against p53 protein.
Results: Cases included in this study were 16 males and 6 females. Their
ages ranged from 20 to 55 years. Positive family history was recorded in             456-B97
18.2% of patients and positive parental consanguinity in 9.1% of them.               ULTRA-THIN LIMBAL CONJUNCTIVAL AUTOGRAFTS:
Twenty cases (90.1%) had a history of chronic exposure to solar light i.e.           A NEW INNOVATION IN PTERYGIUM SURGERY
prolonged outdoor exposure time (8-12 hours / day) for more than 5 years.
While eight cases with recurrent pterygium showed hyperplasia, only one              A. SHARMA, K. MOHAN
primary pterygium sample had epithelial hyperplasia and another one                  Cornea Centre, Chandigarh, INDIA
sample showed squamous metaplasia without dysplastic changes.
Also, 10 primary and 2 recurrent pterygium cases showed squamous                     Purpose: The success of pterygium surgery using limbal conjunctival
metaplasia with mild dysplasia. Ten out of twelve studied specimens with             autograft depends on the use of fibrous tissue free graft. However no
primary pterygium (83.4%) were positive for abnormal p53 expression                  surgical technique has been described to obtain an ideal ultra thin limbal
and two specimens (16.6%) were negative, while only 2 specimens                      conjunctival autograft. The authors describe the technique and evaluate
(20%) of recurrent pterygium showed the abnormal positive expression                 the results of primary pterygium surgery using ultra thin limbal conjunc-
and 8 cases (80%) were negative. Cases with marked and moderate                      tival autografts.
immunostaining (12 cases) showed squamous metaplasia with mild                       Methods: Twenty one eyes (21 patients) with primary pterygium with a
dysplastic changes, nine out of ten cases with negative immunostaining               follow-up of 6 months. Our technique was performed under topical
showed epithelial hyperplasia and the remaining sample showed squa-                  and peribulbar anesthesia. The excision of the pterygium was performed
mous metaplasia without dysplasia.                                                   using standard technique. The size of the conjunctiva graft was marked
Conclusions: p53 protein is expressed at a high rate in primary pterygia             with calipers oversized by 1.5 mm in diameter. Hydrodissection was
as compared to cases of recurrence. Hence the possible role of p53 in                performed by injecting subconjunctival injection containing xylocaine with
the original development of pterygium, suggesting that pterygium could               adrenaline in the superotemporal quadrant about 3 mm behind the limbus.
be a result of uncontrolled cell proliferation and unregulated cell apoptosis        The limbal conjunctival graft was dissected up to the limbal insertion of
which can be proposed a type of benign tumor or even a precancerous                  the conjunctiva with blunt scissors after discussion. The conjunctival graft
condition and not as a degenerative lesion. There seems to be no corre-              was everted on to the corneal surface and gently teased with a number
lation between p53 expression and recurrence. Recurrent pterygium was                15 bard parker blade. Once conjunctival tissue was devoid of fibrous
related to hyperplastic changes and this may explain the pathogenesis of             tissue, the details of iris became visible. The inferior margin of the con-
recurrence especially if the pterygium was not excised completely and                junctival graft was trimmed to get rid of the fibrous tissue attached to it.
the remained epithelial cells continued to grow and formed a new                     The conjunctiva graft was spread to cover excision the area of the excised.
pterygium.                                                                           The graft was sutured with interrupted 8-0 viral sutures.
                                                                                     Results: Ultra thin conjunctival grafts were obtained in all 21 eyes

Asian J Ophthalmol. 2007 Vol 9 No 1 Supplement 1                                                                                                            171
Poster Abstracts

successfully. Two grafts developed a buttonhole during preoperative. One      opposite perilimbal area used as a control. The specimens were
eye developed recurrence between the cleavage of union of conjunctival        subjected to the periodic acid schiff and papanicolaou staining. The
graft with host conjunctiva.                                                  morphology of the conjunctival epithelium and goblet cell density (GCD)
Conclusions: Use of ultra thin limbal conjunctival graft prepared using       were recorded.
definite end points reduces the risk of recurrences.                          Results: All patients had successful pterygium removal with no corneal
                                                                              recurrence after a mean follow up of 18.4+/-2.0 months. Impression
                                                                              cytology revealed normal no goblet conjunctival epithelial cells at the
457-B98                                                                       excision area, with a 4-fold decrease in the GCD when compared with the
IDENTIFICATION OF BETA MICROSEMINOPROTEIN                                     contra lateral nonoperated site (p=0.0039).
BINDING PARTNER WITH YEAST TWO HYBRID                                         Conclusions: The conjunctival epithelium retains its normal morphology
SYSTEM                                                                        with a significant decrease in goblet cell density with a single application
                                                                              of intraoperative low dose mitomycin C in pterygium surgery.
Singapore Eye Research Institute, Singapore, SINGAPORE
Purpose: Previously, we have shown beta microseminoprotein (MSMB)             FIRST CONTACT MANAGEMENT OF OCULAR
to be up-regulated in pterygium compared to uninvolved upper bulbar           TRAUMA PATIENT
conjunctiva. MSMB has been shown to be important in prostate cancer,
but in the ocular surface, its role and binding partners are not known.       R. AGRAWAL
To understand the importance of MSMB and its signaling pathway, we            Shri Ganapati Netralaya, Jalna, INDIA
screen for potential binding partners for MSMB.
Methods: MSMB protein was used as the bait in the yeast two hybrid            Purpose: To highlight the importance of emergency assessment of a
(Y2H) system to identify putative binding partners from a cDNA library. In    patient with ocular trauma.
positive clones, PCR amplification was performed and sequencing               Methods: Whenever confronted with ocular trauma patient life threaten-
done to delineate sequences of interest. In vitro translation of the MSMB     ing injuries should be identified and must be addressed first. History about
and putative binding partners were performed to validate these positive       prior surgery, vision prior to the trauma and detailed history of traumatic
binding partners of MSMB.                                                     incident is taken. Visual acuity evaluation, relative afferent pupillary
Results: Seventy five yeast colonies grew on the stringent selection media.   defect evaluation, slit lamp evaluation without much manipulation and
After PCR screening, we successfully amplified and sequenced 44 colonies.     fundus examination if possible is carried out. The initial management of a
However, not all clones contained full open reading frames for the protein    traumatized patient comprises of the steps to minimize further trauma,
coding sequences. Some sequences were probably genomic DNA or                 minimize infectious risks, minimize psychological trauma and most
unknown EST fragments, DNA coding for RNA-binding and ribosomal               importantly minimize legal problems. The designing of subsequent
proteins. There were a total of 11 colonies containing sequences with         management plan is then individualized for the particular patient and injury.
more than 80% of open reading frames. Functions of candidates include         Results: The complete assessment of a patient with ocular trauma
post-translational modification, cell adhesion, cytoskeletal formation and    helps in planning of proper treatment strategy and in proper prognosis of
calcium binding.                                                              a patient with ocular trauma. It also safeguards the treating ophthalmolo-
Conclusions: We have identified several potential binding partners of         gist against medicolegal hurdles and hassles.
MSMB by using yeast two hybrid system. Identification of these MSMB           Conclusions: Proper and complete assessment of any patient with
binding partners enable us to further understand the role of MSMB. After      ocular trauma is the basic prerequisite for anatomical and visual rehabili-
elucidation of the biological function of MSMB and its signaling pathway,     tation of a patient with ocular trauma.
our findings may be used as therapeutic targets to control pterygium.

458-B99                                                                       USE OF FIBRIN GLUE AS TISSUE ADHESIVE FOR
SURGERY                                                                       Sankara Nethralaya, Chennai, INDIA

K.R. BHATNAGAR, M.N. KARANDIKAR                                               Purpose: To report the indications, technique and outcome of use of
Bharati Vidyapeeth Deemed University Medical College, Pune, INDIA             fibrin glue as an adjunct to tectonic procedures.
                                                                              Methods: The case records of 16 patients who underwent tectonic
Purpose: To evaluate effects of intraoperative application of low dose        procedures with fibrin glue as an adjunct was reviewed. Fibrin glue was
mitomycin C on the conjunctival epithelium at the surgical site of ptery-     used with tectonic lamellar keratoplasty in 6 eyes of Stevens Johnson
gium excision with the help of conjunctival impression cytology.              syndrome (SJS) (5 with corneal thinning and 1 with corneal perforation),
Methods: Twenty patients who underwent primary pterygium excision             2 eyes with limbal fistula and 1 eye with diffuse thinning associated with
with intraoperative low dose mitomycin C (0.02% for 30 sec) in our            keratoglobus. Fibrin glue with amniotic membrane transplantation was
hospital during the year 2003 were included in the study. They were           used for persistent epithelial defect with corneal thinning (1 eye), a 2mm
evaluated by slit-lamp biomicroscopy and impression cytology. Impres-         full thickness perforation in a case of chemical injury and in 1 eye
sion cytology was performed by applying a small nitrocellulose filter         of infective keratitis with descemetocele. It was used as an adjunct to
paper for a few seconds at the excision area and for a few seconds at the     scleral patch graft in 4 eyes.

172                                                                                                Asian J Ophthalmol. 2007 Vol 9 No 1 Supplement 1
                                                                                                                                   Poster Abstracts

Results: The procedure resulted in complete healing in 12 out of the 16          462-B103
eyes (75%). Among the eyes with the lamellar graft, 3 were displaced in          EPITHELIAL DENUDATION OF AMNIOTIC
eyes with SJS and 1 with limbal fistula necessitating further conventional       MEMBRANE AS A CARRIER FOR STEM CELL
surgical intervention due probably to the associated severe ocular               TRANSPLANTATION
surface inflammation.
Conclusions: Fibrin glue forms an important adjunct in tectonic proce-           J.S. MEHTA1, R.W. BEUERMAN2, D.T.H. TAN2
dures to secure a lamellar corneal graft, scleral graft and amniotic             1
                                                                                  Singapore Eye Research Institute, Singapore, SINGAPORE, 2Singapore Eye Re-
membrane. Being a sutureless surgery it reduces intra-operative time,            search Institute, Department of Ophthalmology, Yong Loo Lin School of Medicine,
increases post-operative patient comfort and avoids suture related               National University of Singapore, Singapore, SINGAPORE
complications. When used judiciously fibrin glue has an advantage over
conventional methods of tectonic procedures.                                     Purpose: Tissue engineered stem cell transplantation has revolutionized
                                                                                 ocular surface surgery in the last decade. Human amniotic membrane
                                                                                 (HAM) provides an ideal carrier for engineered cells whether corneal limbal,
461-B102                                                                         conjunctival or oral. Growth factors and other molecules that are part of
DENTAL FINDINGS IN OOKP PATIENTS IN SINGAPORE                                    HAM, enhance the adhesion and phenotype of the epithelial cells. The
                                                                                 aim of this study was to examine the effects on these growth promoting
A.B.G. TAY1, D. TAN2, K.W. LYE1, J. THENG2                                       molecules and extracellular matrix of human amniotic membrane after
 National Dental Centre, Singapore, SINGAPORE, 2Singapore National Eye Centre,   treatment with agents to denude the epithelium.
Singapore, SINGAPORE                                                             Methods: Cryopreserved amniotic membrane was subjected to different
                                                                                 treatments to allow subsequent denudation i.e. Dispase for 30min/60
Purpose: The aim of this abstract is to describe the oral findings of            min/120 min, 0.02%EDTA, 5M urea and 20% ethanol. The effect on the
candidate patients for OOKP surgery in Singapore.                                extracellular matrix was examined by light microscopy and immuno-
Methods: Consecutive patients referred to the National Dental Centre             histochemistry examining; collagen I, II, IV, VI, VII, elastin, laminin-5,
(NDC) for pre-OOKP dental evaluation from November 2002 to October               fibronectin and thrombospondin-1.
2005 were included. Patients underwent complete oral examination, with           Results: After treatment with Dispase there was no immuno-recognition
panoramic and periapical radiographs. Patients were graded as being:             of these molecules other than collagen I/II/VI. However, longer duration

                                                                                                                                                                   POSTER ABSTRACTS
(a) suitable for OOKP, (b) at risk for complication or failure, (c) unsuitable   incubation with Dispase also disrupted collagen VI. Incubation with EDTA,
for OOKP. Patients graded as being at risk for complication or failure           urea and alcohol preserved immuno-recognition of these molecules as
had diseased mucosa or compromised teeth due to periodontal bone loss,           well as an intact basement membrane on light microscopy with PAS
gingival recession, root restorations or large coronal restorations. Con-        staining.
traindicating factors included non-vitality, previous root canal therapy,        Conclusions: Conventional use of Dispase for amniotic membrane
inadequate bone investing the root, peri-radicular pathology, and unduly         denudation irreversibly damages the extracellular matrix. Novel alter-
close proximity of adjacent teeth. Every patient underwent routine dental        native agents e.g. Urea and Alcohol allow rapid denudation and are
treatment as indicated prior to first stage OOKP surgery.                        preferable to maintain HAM integrity as a structural matrix for epithelial
Results: Twenty-one patients were evaluated from November 2002 to                cell expansion
October 2005. Of these, 3 had diseased mucosa (1 Sjörgren’s syndrome,
1 submucous fibrosis and SLE, 1 smoker’s keratosis). A third of patients
had complete dentition (7 patients); the rest had partial dentition. Nine-       463-B104
teen patients had canine teeth for OOKP surgery and 1 patient had                INDICATIONS AND OUTCOMES OF
only one curved lower premolar tooth. One patient had no usable teeth.           PHOTOTHERAPEUTIC KERATECTOMY IN
Eight patients were at risk for complication or failure for various reasons      DEVELOPING WORLD
(4 - periodontal bone loss, 1 - smoker’s keratosis, 1 - Sjörgren’s syndrome,
1 - limited mouth opening from severe facial scarring, 1 - poor ophthal-         G. PRAKASH1, N. SHARMA1, T. AGARWAL1, R. MANNAN1, R. TANDON1,
mological risk). Fourteen patients underwent OOKP Stage 1 surgery. Teeth         J.S. TITIYAL1, R.B. VAJPAYEE2
harvested included 12 upper canines, 2 lower canines and 1 lower                 1
                                                                                  All India Institute of Medical Sciences, New Delhi, INDIA, 2Centre for Eye
premolar. One harvested lower right canine could not be used because             Research Australia, Melbourne, AUSTRALIA
the lingual bone was fractured off the tooth. A second upper right canine,
was harvested and used. Optical cylinders of diameters 3.5 mm and                Purpose: To analyze the indications and outcomes of phototherapeutic
4.0 mm were used in equal halves of these 14 cases. Harvested teeth              keratectomy (PTK) in the developing world.
that incorporated 4.0 mm diameter optical cylinders were all upper               Methods: In this retrospective study , the records of 142 consecutive
canines. Other intraoperative complications included oronasal perfora-           eyes of 138 patients undergoing PTK at our tertiary care specialized center
tion (1 case which resolved) and exposure of adjacent roots (5 teeth).           were evaluated. The indication, demographic data, BCVA, pachymetry,
Postoperative complications included scar formation in the cheek                 symptom severity and other preoperative parameters were assessed. PTK
(10 cases) and persistent lower lip paresthesia (2 cases) for more than 6        was done under topical anesthesia after the epithelium was scraped
months; this was most likely from the buccal mucosal graft harvesting.           manually and 193nm ArF Excimer laser (Chiron Technolas Keracor 217 C)
Data was unavailable for 2 patients who had failed dental follow-up.             was used with 6mm treatment zone and ablation depth of 25 - 100µm
Conclusions: The proportion of patients who had sound canine teeth and           (based on clinical assessment). Patients were followed up till 6 months.
healthy buccal mucosa for OOKP was 61.9%. About a third of patients              Results: The most common indication was symptomatic post cataract
(38.1%) had sub-optimal teeth or buccal mucosa. Careful dental exami-            surgery bullous keratopathy (BK) (81 eyes) , 67 eyes had pseudophakic
nation and radiography is essential in determining suitability for OOKP          BK (47.2%) and 14 had aphakic BK (9.9%) . Spheroidal degeneration was
surgery.                                                                         the next most common indication . Baseline parameters of patients with

Asian J Ophthalmol. 2007 Vol 9 No 1 Supplement 1                                                                                                           173
Poster Abstracts

bullous keratopathy (PTK-BK) were significantly different from those              465-B106
with superficial corneal pathologies (PTK-CS): poorer pre PTK BCVA                THE SOLID STATE LASER (213NM) CAUSES LESS
and increased pachymetry was seen in bullous keratopathy patients. The            KERATOCYTE PROLIFERATION FOLLOWING
outcomes were thus analyzed separately. Mean pre and postoperative                LASER REFRACTIVE SURGERY
BCVA were 6/60(0.10) and 6/23(0.25) in PTK-CS, and 6/120(0.05) and
6/67(0.09) in PTK-BK (significant improvement in both groups , p=0.000).          P. VAN SARLOOS1, T. PUJARA1, J. RODGER2, T. SANDERS2
More than 85 % patients in both groups had relief in symptoms. Signifi-           1
                                                                                      CustomVis, Perth, Australia, 2University of Western Australia, Perth, AUSTRALIA
cant reduction in number of patients with severe symptoms was seen in
both PTK-BK (p =0.000) and PTK-CS groups (p=0.004). Mean epitheliza-              Purpose: To compare keratocyte proliferation in and around the
tion time in the PTK CS patients was 3.69 + 1.32 and in PTK BK it was             crater created by laser correction by the Solid State (213nm) and the
6.51 + 3.58 days. No significant correlation was seen between change in           conventional Excimer laser (193nm).
BCVA and ablation depth in either groups. However change in BCVA                  Methods: New Zealand white rabbits in a group of 3 to 5 underwent
was significantly related to both pre PTK BCVA and pachymetry in PTK-             Photo Refractive Keratectomy (PRK). Treatment planned for -5.00 Diopter
BK group, but not in PTK CS group. The epithelization time was signifi-           (D) spherical with 6.5mm optical zone and 7 mm transitional zone. All
cantly related to pre PTK pachymetry in both group, but to ablation depth         rabbits were sacrificed at 1 or 3 days after surgery. Corneas were
in only patients with bullous keratopathy (PTK BK).                               dissected, fixed and stained with Promega Dead End TUNEL labeling
Conclusions: PTK seems to be an efficacious treatment modality for                kit and counterstained with propidium iodide. TUNEL positive and total
symptomatic relief and visual gain for indications in the developing world.       cells were counted. Values were analyzed using Statview and Bonferroni/
                                                                                  Dunn Post Hoc Test.
                                                                                  Results: No difference in the number of apoptotic cells detected at 1 and
464-B105                                                                          3 days. At 3 days greater numbers of keratocytes were detected in the
COMPARISON OF PRE-OPERATIVE                                                       crater of the 193nm lasered corneas compared to the 213 nm lasered
CHARACTERISTICS OF PATIENTS UNDERGOING                                            corneas.
LASIK SURGERY IN 1997 VERSUS 2004 AT A HIGH                                       Conclusions: Results demonstrate that the 213nm Solid State laser
VOLUME SURGICAL EYE CENTER IN CHINA                                               has similar cell death inducing properties, but causes less keratocyte
                                                                                  proliferation/migration, to the currently used 193nm Excimer laser, there-
Y.Y.B. YANG                                                                       fore making it a potentially superior tool for refractive surgery. *CR
The Second Hospital Affiliated to ZheJiang University, Hangzhou, Zhejiang, P.R.
China, CHINA
Purpose: To compare the pre-operative characteristics of LASIK patients           HISTOLOGICAL FINDINGS OF SEPARATED
undergoing surgery in 1997 versus 2004 at one of the principal eye                EPITHELIAL SHEETS AFTER EPILASIK
surgical centers in China.
Methods: Pre-operative data of patients who underwent LASIK in 1997               V. JHANJI 1 , N. SHARMA 1, S. KAUSHAL 1, S. SEN 1, J.S. TITIYAL 1 ,
and 2004 were recorded and retrospectively compared.                              R.B. VAJPAYEE2
Results: In 1997, the mean spherical equivalent of the 824 eyes of 428            1
                                                                                   All India Institute of Medical Sciences, New Delhi, INDIA, 2Centre for Eye Re-
patients undergoing LASIK surgery was -7.30±4.65D, with a mean                    search Australia, Melbourne, AUSTRALIA
patient age of 24.67±6.76 years old. Students represented 45.05 % of
the patients undergoing surgery in 1997. In 2004, the mean spherical              Purpose: To report the histological findings of four eyes of four patients
equivalent of the 8,434 eyes of 4,286 patients undergoing LASIK surgery           who underwent EpiLasik treatment for the correction of myopia.
was -6.66±3.31D, with a mean patient age of 25.20±6.59 years old.                 Methods: The epithelial sheets were harvested from the operated eyes
Students represented over 50% of the patients undergoing surgery                  after performing EpiLasik. All epithelial sheets were subjected to light
in 2004. There were significant differences in the constitution ratio of          microscopy and transmission electron microscopy.
occupation and the spherical equivalent refractions between 1997 and              Results: Histological evaluation showed that the majority of the epithelial
2004 (t=-2.712, =25.117,P<0.05). Need to change                                   cells were morphologically normal in all examined specimens except for
Conclusions: At our center in China, the majority of LASIK patients are           hydropic changes in the epithelial cells close to the basement membrane.
young and have myopia ranging from -3.00D to -10.00D. Students were               No basement membrane was detected in the separated sheets.
much more likely than any other occupation to undergo LASIK. The number           Conclusions: Light microscopic and transmission electron microscopic
of patients undergoing LASIK at our center in China has increased                 examination of specimens from the eyes which underwent EpiLasik
exponentially from 1997 to 2004, with an average annual increase in               showed that the microkeratome separates the epithelial sheet above the
surgical volume of nearly 40%.                                                    epithelial basement membrane and the epithelial cell morphology is near

174                                                                                                        Asian J Ophthalmol. 2007 Vol 9 No 1 Supplement 1
                                                                                                                                        Poster Abstracts

467-B108                                                                               Table 1 Abstract 468-B109. Specimen 2: comparison between confocal and
LASER IN SITU KERATOMILEUSIS TO CORRECT                                                histological measurements of flap and residual
RESIDUAL MYOPIA AFTER RADIAL KERATOTOMY                                                                             Confocal (µm)             Histo; US (µm)
                                                                                         Flap                            187                        153
S. HERYATI1, P.K. VADDAVALLI1, K. RAO1, A. KELAPURE1, A.K. BANSAL2,                      Stromal Bed                     219                        296
M.S. SRIDHAR3                                                                            Total Thickness                 397                        449
    L V Prasad Eye Institute, Hyderabad, INDIA, 2Apollo Hospitals, Hyderabad, INDIA,
    Krishna Institute of Medical Sciences, Hyderabad, INDIA                            measurements. A comparison was made with measurements obtained
                                                                                       by confocal microscopy.
Purpose: To evaluate the safety ,efficacy, predictability and complica-                Results: The IFB was highlighted in all specimens stained for both total
tions of laser in situ keratomileusis (LASIK) to correct residual myopia               and cellular fibronectin. The ratio of distance between the LASIK flap
after radial keratotomy.                                                               interface and the upper epithelial layer to the total corneal thickness was
Methods: Retrospective, non-comparative interventional case series.                    0.2 in the first case and 0.34 in the second where preoperative confocal
Sixteen eyes that had previously undergone radial keratotomy and                       measurements were made (specimen 2). A comparison is presented in
had residual myopia were included. The mean refractive error in spheri-                table 1.
cal equivalents (SE) ,uncorrected visual acuity (UCVA), and best corrected             Conclusions: The thickness of post LASIK flaps and residual beds can be
visual acuity (BCVA) before and after LASIK are reported.                              measured histologically by highlighting the IFB immunohistochemically
Results: The mean age of patients was 25.6 ± 5.2 years. There were 6                   with fibronectin antibodies. The practical and forensic aspects of this find-
(67%) female and 3 (33%) male patients. The mean interval between RK                   ing will be discussed.
and LASIK was 8 ± 3.22 years. Eleven (69%) of the 16 eyes had 8 RK
incisions , and the remaining 5 (31%) eyes had 12 incisions. All the inci-
sions were at a depth of 80 to 90% without evidence of wound dehis-                    469-B110
cence or cysts. At the last follow up the mean spherical equivalent was                COMPARISON OF WAVEFRONT-GUIDED LASIK
reduced from -9.22 ±4.47 D (range -3.5 to 20D ) preoperatively to -2.4 ±               BETWEEN IRIS RECOGNITION AND NON IRIS
3.7 (range 0 to -12 D)(p=0.007). 12 (75%) eyes were within 0.5 D of the                RECOGNITION
target refraction, 13 (81%) eyes were within 1 D of the target refraction,
and 15 eyes (94%) were within ± 2 D of the target refraction. The mean

                                                                                                                                                                        POSTER ABSTRACTS
                                                                                       E. RISMAYANTI, I. SOEKARDI
UCVA improved from 1.13 ± 0.27 (range 0.48 to 1.3) preoperatively to                   University of Indonesia, Jakarta, INDONESIA
0.28 ± 0.45 (range -0.1 to 0.3)(p=0.001). The mean postoperative BCVA

was significantly better than the pre-RK BCVA at the 3 month and 1 year                Purpose: To compare the efficacy, predictability and patients satisfaction
follow up (P=0.02). Efficacy index (ratio of post operative UCVA and
preoperative BCVA) was 1.07. The only intraoperative complication
was incision opening in 3 (18%) eyes while the flap was lifted; there                                                   W
                                                                                       of Wavefront-Guided LASIK between iris recognition (IR) and non iris
                                                                                       recognition (Non IR).
                                                                                       Methods: A prospective study comprised 54 eyes of 27 patients, divided
were no further complications. None of the patients lost any Snellen lines             into 2 groups: group I ( IR ) 27 eyes and group II (non IR) 27 eyes. Bilateral
of BCVA.                                                                               Wavefront-Guided LASIK were performed with technolas 217 Z100TM.
Conclusions: LASIK was safe ,effective, predictable and stable in the                  Efficacy was evaluated on uncorrected visual acuity (UCVA), predictability

treatment of residual myopia after RK.                                                 on spherical equivalent (SEq) and surgical induced astigmatism (SIA),
                                                                                       which described by Olsen method and patients satisfaction on best-
                                                                                       corrected visual acuity (BCVA) using contrast sensitivity test. Follow-up

468-B109                                                                               was done at day 1 and one month post-LASIK.
AN IMMUNOHISTOCHEMICAL METHOD TO                                                       Results: At 1 month, efficacy in group I and group II were 62% and 59%,

HIGHLIGHT THE INTERFACE BETWEEN FLAP AND                                               respectively (p> ,05). Predictability of mean SEq in group I was 0,03±
RESIDUAL BED AFTER LASIK IN POST                                                       0,30 and 0,05±0,45 in group II, while mean SIA in group I was 1,22±1,17
KERATOPLASTY BUTTONS                                                                   and 1,21±1,14 in group II (p> ,05). In patients satisfaction, 70% and
                                                                                       59% in group I and group II were achieved LogMar 0,0 of contrast sensi-
E. MAGUEN, A.V. LJUBIMOV                                                               tivity test.
Cedars Sinai Medical Center, Los Angeles, CA, UNITED STATES OF AMERICA                 Conclusions: Both groups were effective, predictable and satisfied
                                                                                       for correction of myopic astigmatism, although a longer follow up and a
Purpose: To describe a method of highlighting the interface between                    larger study are required.
corneal flap and residual bed (IFB) after LASIK in post keratoplasty
corneal buttons, and to discuss the practical applications and implica-
tions of this finding.
Methods: Two ectatic corneas after penetrating keratoplasty (specimens
1,2) and three postmortem corneas following uneventful LASIK (specimens
3-5) were embedded in OCT within 3 hours after surgery and cryostat
sections were analyzed by immunofluorescence with antibodies to
fibronectin. One antibody (clone 568 to 8th type III repeat) recognized any
fibronectin, whereas the other (clone IST-9), reacted only with cellular
fibronectin (in this case, locally produced and not derived from plasma).
A method was devised to allow calculating the depth of the flap and
residual bed based on preoperative ultrasonic corneal thickness

Asian J Ophthalmol. 2007 Vol 9 No 1 Supplement 1                                                                                                                175
Poster Abstracts

471-B112                                                                           with electrochemical detection. Cataract type was classified using the
CENTRAL CORNEAL THICKNESS AND                                                      ‘Lens Opacities Classification System, Version III’.
INTRAOCULAR PRESSURE IN URBAN MALAY                                                Results: Mean concentrations of ascorbate in the aqueous humor and
POPULATION: THE SINGAPORE MALAY EYE STUDY                                          plasma were 1.42 and 0.039 mmol/L respectively. Uric acid levels in
(SIMES)                                                                            the aqueous were on average 28% of the corresponding blood levels
                                                                                   (0.097mmol/l v. 0.35mmol/l). Patients with mixed type cataracts had
W. WONG1, S. SAW2, T. AUNG1, S. SHEN1, T. WONG3, SIMES STUDY GROUP                 significantly higher plasma uric acid than those with nuclear cataracts
 Singapore Eye Research Institute, Singapore, SINGAPORE, 2Department of            (p=0.004); no other significant correlations with blood levels were seen.
Community, Occupational and Family Medicine, Yong Loo Lin School of Medicine,      Patients with combined posterior subcapsular/nuclear cataracts had
National University of Singapore, Singapore, SINGAPORE, 3Centre for Eye Research   significantly higher aqueous humor uric acid levels than those with pure
Australia, University of Melbourne, Melbourne, AUSTRALIA                           nuclear (p=0.016) or cortical cataracts (p=0.012). Diabetic patients had
                                                                                   significantly higher aqueous levels of uric acid compared with non-
Purpose: To determine the distribution and correlation of central corneal          diabetics (p=0.013) but in this study no differences in plasma levels were
thickness (CCT) and intraocular pressure (IOP) in Malay adults in Singapore.       observed. Surprisingly we were unable to demonstrate any significant
Methods: A population-based, cross-sectional study of 3,280 (78.7%                 differences between cataract type and the concentration of ascorbic
response rate) Malays aged 40-80 years in Singapore. The population                acid in either plasma or aqueous humor.
was selected based on an age-stratified random sampling procedure of               Conclusions: The significant differences that we have observed between
Malay people living in the south-western part of Singapore. Participants           cataract type and aqueous humor uric acid concentration has not, to our
had a standardized interview, examination and ocular imaging at a                  knowledge been previously reported. Given that aqueous levels of ascor-
centralized study clinic. CCT measurements were performed with an                  bic acid have been studied intensively for over 50 years it is interesting
ultrasound pachymeter and IOP were assessed from the Goldmann                      that we have been unable to demonstrate any correlation between
applanation tonometer.                                                             cataract type and plasma or aqueous concentrations; although this does
Results: CCT was recorded for 3240 right eyes and 3258 right eyes                  accord with our previous studies that have shown that in general
for IOP. In this population, CCT and IOP were normally distributed with            relatively low concentrations of vitamin C intake are required to achieve
mean of 541.6 µm (95% confidence interval [CI], 539.6 to 541.9) and                maximal concentrations in the aqueous in many patients.
15.4 mmHg (95% CI, 15.3 to 15.5), respectively. CCT had a significant
negative correlation with age (P < 0.001) but was not associate with
gender. IOP was not associated with age, but was significantly associ-             473-B114
ated with gender, with women having higher mean IOP than men (15.7 vs              ETHNIC VARIATIONS OF ANTIOXIDANT INTAKE IN A
15.0mmHg, p<0.001). IOP was significantly and positive correlated                  SOUTH LONDON CATARACT POPULATION
with CCT (P<0.001). In linear regression models adjusting for age and
gender, IOP increased by 0.21 (95% CI, 0.17 to 0.24) mmHg for each                 G.B. FIRTH1, G. THOMPSON2, A.K. KARIM3, C. COLLINS3, N. SRIKANTHA3,
10 µm increase in CCT.                                                             M. FIRTH3, R. MOSS3
Conclusions: This study shows that IOP is positively correlated to CCT in          1
                                                                                    The Princess Royal Hospital, Haywards Heath, UNITED KINGDOM, 2Moorfields Eye
Malay adults.                                                                      Hospital at St Georges Hospital, London, UNITED KINGDOM, 3St Georges Hospital,
                                                                                   London, UNITED KINGDOM

472-B113                                                                           Purpose: To determine the dietary intake of patients presenting for
CORRELATION OF CATARACT CLASSIFICATION                                             cataract surgery at a South London Hospital.
WITH BLOOD AND AQUEOUS HUMOR LEVELS OF                                             Methods: A dietary survey was carried out on patients attending for
ASCORBATE AND URIC ACID IN PATIENTS                                                cataract surgery at St Georges Hospital, London, UK using a 7 day food
UNDERGOING CATARACT SURGERY                                                        frequency questionnaire. Average daily intake of vitamin C, vitamin E,
                                                                                   carotene and lutein levels were calculated by a scored dietary question-
G.B. FIRTH1, G. THOMPSON2, M. FIRTH1, A.K. KARIM3, C. COLLINS3, R. MOSS3           naire. Data was compared to population intakes from the Foods Stand-
 The Princess Royal Hospital, Haywards heath, UNITED KINGDOM, 2Moorfields Eye      ards Agency NDNS Survey, and guidelines set up by the AREDS study
Hospital at St Georges Hospital, London, UNITED KINGDOM, 3St Georges Hospital,     were made.
London, UNITED KINGDOM                                                             Results: 253 patients were recruited. The median age was 73 years (range
                                                                                   24-98 years). The ethnicity of patients was: European (77.3%), South
Purpose: High levels of ascorbic acid are found in the aqueous humor of            Asian Hindu (11.9%), South Asian Muslim (7.2%), Afro-Caribbean (3.1%)
the eye and these may have antioxidant effects and/or provide protection           and Oriental (0.5%).
against UV damage. Ascorbic acid levels in these patients have been                    31% of the patients took dietary supplements. The mean daily
studied extensively, however published studies attempting to correlate             dietary intake of vitamin C was 119mg (range 0.0-366 mg), vitamin E
the vitamin C levels in the blood and aqueous humor with the cataract              5mg (range 0-45mg), beta carotene 2500ug (range 0-32446ug) and lutein
type are confused and conflicting. Uric acid can also act as an antioxidant        2683ug (range 0.0-27069 ug). Afro-Carribean’s had the largest mean
and is present in relatively high concentrations in the aqueous humor but          intake of all dietary antioxidants evaluated. Conversely South Asian
no studies have attempted to correlate the blood and aqueous levels of             Muslims had the lowest mean intake of antioxidant vitamins, although
uric acid with the cataract type.                                                  the mean intake of no group fell below the EU RDA for the nutrients
Methods: 250 patients undergoing cataract surgery at St Georges                    studied.
Hospital were recruited into the study following informed consent. A food          Conclusions: The average fruit and vegetable intake of the patients
questionnaire was completed prior to surgery and blood and aqueous                 studied appear to provide adequate recommended levels of vitamin C
humor was collected at surgery for measurement of vitamin C by HPLC                and carotenes but not vitamin E. However, difficulties of estimating quantity

176                                                                                                     Asian J Ophthalmol. 2007 Vol 9 No 1 Supplement 1
                                                                                                                                      Poster Abstracts

of polyunsaturated cooking oils consumed meant that this valuable source             equivalents (CRVE) summarized mean arteriolar and venular diameters
of vitamin E was excluded from the analysis. From data collected, it seems           of each eye. Cataract status was graded from lens photos using the
unlikely that dietary vitamin E was compromised. Females consumed                    Wisconsin Cataract grading system. Cortical cataract was defined as opac-
higher antioxidant levels, and age did not seem to influence the quality of          ity ≥5% of the total lens area, posterior subcapsular cataract (PSC) if
dietary intake. In our mixed ethnic population, the typical diet appears to          present, and nuclear cataract as opacity ≥ standard photo 4. Eye-specific
provide adequate antioxidant intake. South Asian Muslim’s appear to con-             data were analyzed using generalized estimating equations, adjusting
sume the least amount of antioxidants, but this is unlikely to compromise            for age, sex, smoking, hypertension, diabetes, education level and use of
general or ocular health.                                                            inhaled steroids.
                                                                                     Results: Of the participants with generalized arteriolar narrowing
                                                                                     (narrowest CRAE quintile) at baseline, 17.7%, 9.3%, 30.3% and 22.2%
474-B115                                                                             developed cortical, PSC, nuclear cataract and had undergone cataract
CLINICAL PROFILE AND CAUSES OF UNILATERAL                                            surgery, respectively, in the right eye, compared to 21.3%, 5.8%, 33.8%
PEDIATRIC TRAUMATIC CATARACT IN A TERTIARY                                           and 9.4%, respectively, in persons with the widest CRAE quintile. Gener-
EYE CARE CENTRE IN INDIA                                                             alized arteriolar narrowing (vs the widest quintile) was associated with
                                                                                     incident PSC (age-sex-adjusted odds ratio, OR, 2.44, 95% confidence
T. DADA, S. MANDAL, A. AGARWAL, S. KHOKAR, V.M, A. PANDA                             interval, CI, 1.43 - 4.18) and cataract surgery (OR 1.84, 95% CI 1.26 -
Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical   2.68), and was inversely associated with nuclear cataract (OR 0.64, 95%
Sciences, Ansari Nagar, New Delhi, INDIA                                             CI, 0.42 - 0.97). These associations persisted after controlling for other
                                                                                     risk factors. In participants with venular dilation (widest CRVE quintile),
Purpose: To evaluate the clinical presentation and causes of unilateral              18.4%, 4.2%, 35.7% and 9.5%, developed cortical, PSC, nuclear
traumatic cataract in pediatric age group.                                           cataract and had undergone cataract surgery, respectively, in the right
Methods: This retrospective review comprised of 101 consecutive cases                eye, compared to 17.1%, 10.3%, 31.2% and 19.7%, respectively, in
of unilateral traumatic cataract in children (age<12years). A detailed               persons with the narrowest CRVE quintile. Venular dilation (vs the
history was taken regarding place and mode of injury. The ocular exami-              narrowest quintile) was negatively associated with incident PSC (OR
nation included best corrected visual acuity, slit lamp biomicroscopy,               0.67, 95% CI 0.20 - 0.70) and cataract surgery (OR 0.58, 95% CI 0.39 -
applanation tonometry and posterior segment ultrasonography.                         0.88), but was positively associated with nuclear cataract (OR 1.54, 95%

                                                                                                                                                                      POSTER ABSTRACTS
Results: Mean age was 7.49±3.81years. Eighteen patients (18%) were                   CI 1.04 - 2.29).
female and 83 patients (82%) were male. Forty five percent suffered in-              Conclusions: After the Beaver Dam Eye Study, ours is the second
juries at school, while 55 % had injuries during outdoor games at home.              population-based study to find an inverse relationship between general-
None of the patients used protective eye glasses during playing. The causes          ized arteriolar narrowing and incident nuclear cataract. Future studies
of injury were: wooden stick (n=28, 28%), sharp object (bow and arrow,               are needed to confirm and understand these associations.
knife, scissors, pencils n=42, 41%), blunt object (cricket ball, stone
n=20, 20%), fire cracker (n=5, 5%), and miscellaneous (n=6, 6%). Open
globe injury was present in 57 eyes (56%) and closed globe in 44 eyes                476-B117
(44%). Associated findings included: raised IOP (16%), ruptured anterior             DETERMINANTS OF PEDIATRIC CATARACT VISUAL
lens capsule (21%), subluxated lens (7%), retinal detachment (4%) and                OUTCOMES AND FOLLOW-UP IN A LARGE
2 eyes each had endophthalmitis (2%), and a retained intraocular foreign             MEXICAN SURGERY PROGRAM
body (2%).
Conclusions: Wooden stick, sharp instruments and cricket balls are the               N. CONGDON1, S. RUIZ2, M. SUZUKI3, N. KOURGIALIS3, D. GILBERT4, V.
major causes for unilateral post traumatic cataract in children. Most of             HERRERA5
these injuries can be prevented if play activities are supervised by an              1
                                                                                      Chinese University of Hong Kong, Kowloon, HONG KONG, 2Hospital Luis Sanchez
elder and use of protective eye gear. Parents and school teachers need to            Bulnes, Mexico City, MEXICO, 3Helen Keller International, New York, NY, UNITED
be educated on this issue.                                                           STATES OF AMERICA, 4Wilmer Eye Institute, Baltimore, MD, UNITED STATES OF
                                                                                     AMERICA, 5Helen Keller Mexico, Chihuahua, MEXICO

475-B116                                                                             Purpose: To report the visual outcomes, follow-up and determinants of
RETINAL VESSEL DIAMETERS AND 10-YEAR                                                 outcomes and follow-up, for a large pediatric cataract surgery project
INCIDENT AGE-RELATED CATARACT: THE BLUE                                              in Mexico.
MOUNTAINS EYE STUDY                                                                  Methods: Data were collected prospectively on the following factors for
                                                                                     participants in a pediatric cataract surgery program at Hospital Luis
A.G. TAN, J.J. WANG, G. BURLUTSKY, E. ROCHTCHINA, G. KANTHAN,                        Sanchez Bulnes supported by Helen Keller International: Pre-operative:
P. MITCHELL                                                                          Age, gender, baseline vision, type of cataract, laterality and presence
Ctr for Vis Res/Univ of Sydney, Sydney, AUSTRALIA                                    of conditions such as amblyopia; Surgical: Vitrectomy, capsulotomy,
                                                                                     complications and use of IOL; Post-operative: Final vision, refraction,
Purpose: To determine whether retinal vessel diameter is a predictor of              number of follow-up visits, program support for follow-up.
incident cataract in an older population-based cohort.                               Results: Among 574 eyes of 415 children, IOLs were placed in 416 (87%)
Methods: The Blue Mountains Eye Study examined 3654 participants at                  of eyes. At least one follow-up was attended by 408 (98.3%) of subjects,
baseline (1992-94), 2335 (75.1% of survivors) 5 years and 1952 (75.6%                with 40% of eyes achieving final vision >= 6/18. Children living further
of survivors) 10 years later. At each visit, participants had retinal and lens       from hospital had fewer post-operative visits (p = 0.04), while children
photography. Retinal vessel diameter was measured using standardized                 receiving program support had more (p = 0.001) visits. Factors predictive
computer-assisted techniques. Central retinal arteriolar (CRAE) and venular          of better vision included receiving an IOL during surgery (p = 0.04) and

Asian J Ophthalmol. 2007 Vol 9 No 1 Supplement 1                                                                                                              177
Poster Abstracts

post-operative spectacles (p = 0.001). Predictive of worse vision were        insequential sub-epithelial scar. There was no recurrence at the end of
strabismus/amblyopia at baseline (p = 0.003), post-operative complica-        the follow-up.
tions (p = 0.0001), unilateral versus bilateral surgery (p = 0.0075) and      Conclusions: Microsporidial keratoconjunctivitis can occur more
female gender (p = 0.045).                                                    commonly than expected in healthy individuals. The outcome of the
Conclusions: This is the largest study of pediatric cataract surgery in the   treatment is often satisfactory.
developing world. Our results underscore the importance of surgical
training to reduce complications and early intervention before amblyo-
pia/strabismus (present in 40% of subjects) can develop. The positive         479-B120
impact of program support on follow-up is encouraging. More work is           PREVALENCE OF CORNEAL ARCUS AND
needed to understand reasons for worse visual outcomes in girls.              RELATIONSHIP TO SERUM LIPIDS: THE
                                                                              SINGAPORE MALAY EYE STUDY (SIMES)

477-B118                                                                      S. MYA1, S. SAW2, W. WONG3, E. TAI4, H. CAJUCOM-UY5, R. MOHAMAD5,
CASES OF AGE-RELATED CATARACTS                                                1
                                                                                Singapore Eye Research Institute, Department of Ophthalmology, Yong Loo Lin
                                                                              School of Medicine, National University of Singapore, Singapore, SINGAPORE,
S. RAMAPANTULA, R.S.S.G.T. PADMA                                              2
                                                                                Singapore Eye Research Institute, Department of Community, Occupational and
Osmania University, Hyderabad, INDIA                                          Family Medicine, Yong Loo Lin School of Medicine, National University of Singapore,
                                                                              Department of Ophthalmology, Yong Loo Lin School of Medicine, National Univer-
Purpose: The present study was made to analyze 1139 cases of                  sity of Singapore, Singapore, SINGAPORE, 3Singapore Eye Research Institute,
Age-related cataracts for epidemiological parameters.                         Singapore, SINGAPORE, 4Department of Endocrinology, Singapore General Hospital,
Methods: About 1139 cases of senile cataract cases were studied using         Singapore, SINGAPORE, 5Singapore Eye Research Institute, Singapore National
a specified proforma from Sarojini Devi Eye Hospital , Hyderabad, India.      Eye Center, Singapore, SINGAPORE, 6Singapore Eye Research Institute, Depart-
Results: The mean age of patients was recorded to be 52-62 years with         ment of Ophthalmology, Yong Loo Lin School of Medicine, NUS, Singapore
age at onset from 51-60 years. Based on the distribution of age at onset,     National Eye Centre, Centre for Eye Research Australia, Singapore, SINGAPORE,
cases below 45 years were considered as pre-senile and above 45 years         7
                                                                                Singapore Eye Research Institute, Department of Ophthalmology, Yong Loo Lin
were considered as senile cataracts. Nuclear cataracts had delayed mean       School of Medicine, National University of Singapore, Singapore National Eye
age at onset 60.6 years followed by cortical-55.2 and PSC with 51.2.          Center, Singapore, SINGAPORE
There was a preponderance of females (56.5%) than males (43.5%).
Conclusions: In this present study, the frequency of Nuclear cataract         Purpose: To describe the prevalence of corneal arcus and its association
were found to be significantly high, with frequency of females compared       with serum lipids in Malay adults in Singapore.
to males.                                                                     Methods: A population-based, cross-sectional study of 3,280 (78.7%
                                                                              response rate) Malays aged 40-79 years in Singapore. The population
                                                                              was selected based on an age-stratified random sampling procedure of
478-B119                                                                      Malay people living in the south-western part of Singapore. Participants
MICROSPORIDIAL KERATOCONJUNCTIVITIS: AN                                       had a standardized interview, examination and ocular imaging at a
EMERGING HEALTH-CARE PROBLEM                                                  centralized study clinic. Corneal arcus was defined from a standardized
                                                                              clinical examination. Non fasting blood samples were collected for meas-
M. RAY, S.B. LEE                                                              urement of total cholesterol, high-density lipoprotein (HDL) cholesterol,
National University Hospital, Singapore, SINGAPORE                            and low-density lipoprotein (LDL) cholesterol.
                                                                              Results: The prevalence of corneal arcus was 58.1% (95% confidence
Purpose: To report epidemiological, clinical and microbiological profile of   intervals [CI], 56.4, 59.8). The prevalence increased with age (P trend
microsporidial keratoconjunctivitis in healthy individuals.                   <0.001) and was higher in men than women (64.1% vs 52.4%,
Methods: In a prospective non-comparative case series 15 cases of             p<0.001). Mean total cholesterol was 5.62 mg/dL, HDL cholesterol
microsporidial keratoconjunctivitis clinically diagnosed between June to      1.35 mg/dL and LDL cholesterol 3.54 mg/dL. Total cholesterol, HDL cho-
August 2006. All cases of suspected microsporidial keratoconjunctivitis       lesterol and LDL cholesterol were not associated with corneal arcus.
underwent relevant history recording, detailed clinical examination and       Conclusions: This study shows a higher prevalence of corneal arcus in
corneal scraping. Corneal scrapings were evaluated by modified trichrome      the adult Malay population. In contrast with clinical perception, corneal
stain. All cases were treated with topical Gatifloxacin (0.3%) and            arcus was not related with serum lipid levels in this population.
systemic Albendazole (400 mg). Topical Fluorometholone was added
when there was stromal involvement. Clinical course, demographic
features, predisposing factors, microbiological profile, treatment and
final outcome were evaluated.
Results: 15 cases of suspected microsporidial keratoconjunctivitis, 8 were
microbiologically positive. All patients were apparently healthy. The mean
age of the patients was 29.86 (±10.81) years (range, 13-52). Topical
steroid was the most common predisposing factor. Slit lamp examination
revealed coarse, multifocal, raised epithelial lesions along with mild to
moderate non-purulent conjunctivitis in all patients. Corneal stroma was
involved in 53.3% cases. All eyes recovered in an average 21.06 (± 7.66)
days after treatment started. Six eyes (40%) developed visually

178                                                                                                 Asian J Ophthalmol. 2007 Vol 9 No 1 Supplement 1
                                                                                                                               Poster Abstracts

480-B121                                                                             Group V (n=1) eye with total epithelial loss within 48 hrs, HBL single
NUTRITIONAL AND IMMUNIZATION PROFILE OF                                         used for four months.
PRE-SCHOOL CHILDREN PRESENTING WITH                                                  Group VI (n=1) eye SJS patient reported with acute inflammation,
SUPPURATIVE INFECTIOUS KERATITIS                                                post IOL surgery, HBL single used till 3 weeks and lens loss?
                                                                                     Group VII (n=2) endophthalmitis eyes, HBL single used for 4 months.
T. AGARWAL 1, P. NATHANI 1, V. JHANJI 1, R. TANDON 1, N. SHARMA 1,              All groups reverted to normal and near normal, except group VII which
R.B. VAJPAYEE2                                                                  could be helped only with psychological relief and ocular comfort.
 All India Institute of Medical Sciences, New Delhi, INDIA, 2Centre for Eye     Conclusions: As advances continue in HBL’s- the scope of treatment has
Research Australia, Melbourne, AUSTRALIA                                        widened. While acting as a protective barrier, immediate pain relief. A
                                                                                reduction of chair time and anxiety was also observed. A possible alter-
Purpose: Identification of preventable, systemic associations of                native to post phaco surgery, causing endophthalmitis, as reported, caused
suppurative infectious keratitis occurring in pre-school children.              during fluid flow, carrying the bacteria through the unsutured wound,
Methods: Nutritional and immunization profile of 44 pre- school children        during the transient IOP drop, causing again monocular blindness over a
presenting with suppurative infectious keratitis without any known              decade as reported. With Ophthalmology and Optometry converging, co-
risk factor was studied.                                                        management is a true success of joint vision research.
Results: Sixty One percent (61%) of children had protein energy
malnutrition (PEM) and immunization for age was incomplete in 25%
cases.                                                                          482-B123
Conclusions: PEM and incomplete immunization may be predisposing                FAMILIARITY OF AGE-RELATED MACULAR
factors for the occurrence of suppurative infectious keratitis in pre-school    DEGENERATION AND ITS RISK FACTORS AMONG
children.                                                                       SINGAPORE RESIDENTS

                                                                                S. SANJAY, H.Y. NEO, J.Y. KU, S.Y.M. CHAU, A.K. ROSTIHAR, K.G. AU
481-B122                                                                        EONG
HYDROPHILIC BANDAGE LENSES- THE NEXT                                            Alexandra Hospital, Singapore, SINGAPORE

                                                                                                                                                              POSTER ABSTRACTS
                                                                                Purpose: To investigate the awareness of age-related macular
S. ROHATGI, V.S. ROHATGI                                                        degeneration (AMD) among Singapore residents.
Rohatgi Eye Center, Kolkata, INDIA                                              Methods: Cross-sectional survey. Households were randomly selected
                                                                                from the Singapore phone book residential listings 2005/2006 and
Purpose: It has been reported that monocular blindness passed unno-             one subject from each household was invited to participate in the survey
ticed but individuals who were bilaterally blind represent only a fraction      using a structured questionnaire.
of the population. Monocular blindness is a result of corneal trauma of         Results: 520 subjects out of the 796 households contacted agreed to
some degree and subsequent development to microbial keratitis. Rate of          participate (response rate = 65.3%). The mean age (range) of the sub-
incidence for monocular blindness in Madurai district, South India was          jects was 41 (18 to 85) years. The awareness of AMD among the partici-
113.0 per 100,000 population, in numbers 50,000 new cases register              pants was 7.3%. There was increased awareness of AMD with higher
every year in the State of Tamil nadu, south India. If generalised all over     education (secondary level and above), age group 31-50 years, and those
India, 840,000 people develop corneal ulcer each year. World wide it is         who had a recent eye examination within the last one-year. Respondents
estimated to be over one and a half million new cases of unilateral             with at least secondary education (n=393) were 18.5 times (95% CI,
blindness. Opaque corneas, is a common sight, witnessed, while travel-          (confidence interval) 2.3-150.8) more likely to be familiar with AMD than
ling in the developing world.                                                   respondents with no or primary education. Respondents in the age group
Methods: Bigger diameter HBL lens used were of spincast material U4             31 to 50 years (n=225) were 18.9 times (95% CI, 11.3-31.8) mores likely
design, -3.0 Diopter, Dia 14.5mm, extending 4 mm to the limbus in most          to be familiar with AMD than respondents aged 18-30 and 51-85. Re-
India eyes with center thickness as low as 0.07mm were used in this             spondents who have had their eyes tested (n=187) within the last one
study. Lenses were soaked in Providone -Iodine 5 % solution, (a microbi-        year were 8.8 times (95% CI, 5.5-14.2) more likely to be familiar with
cidal solution) for 3 to 5 minutes and fitted inside the Operation Theatre      AMD than those who have had their eyes tested more than one year ago,
protocols. Other supportive managements were also considered. The               or never had them tested. Among respondents who had their eyes tested
wearing modalities for each patient was supported via Tele-medicine.            within the last one-year, 106 (57.6%) were with an optician. Among 105
Results: Over 81 patients have come into this unconventional therapeu-          (20.2%) who never had their eyes tested, 35 (33.1%) cited that they did
sis with vision loss > 6/60, with severity of pain varies due to opening of     not have any problem with their eyes. Smoking was considered a risk
nerve ending. They were divided into 7 groups according to the nature of        factor for AMD by 17 (44.7%) of the respondents who were familiar with
injuries.                                                                       AMD. Among respondents who were aware of AMD 9 (23.7%) smoked
     Group I (n=32) eyes, villagers with acuity < 6/60, presented later         and 6 (75.0%) of them would smoke less or stop completely if they were
than 72 Hrs, HBL used for months.                                               told that smoking may cause blindness.
     Group II (n=40) eyes, with home- office injury from nail injury to sharp   Conclusions: The awareness of AMD among Singapore residents is
objects, HBL used for 4 weeks.                                                  low. Subjects who are more educated, with at least secondary education
     Group III (n=3) eyes with severe outdoor injuries, two Post IOLs and       and who had eye examination within a year are more likely to be aware
one with laceration, HBL single used for 4 to 6 months.                         of AMD.
     Group IV (n=2) eyes with corneal erosion post 3 months IOL, one eye
with acute glaucoma, one eye with viral keratitis, HBL single used for 4

Asian J Ophthalmol. 2007 Vol 9 No 1 Supplement 1                                                                                                      179
Poster Abstracts

483-B124                                                                      factors for diabetic retinopathy among a multi-ethnic diabetic patient
SANKARA NETHRALAYA DIABETIC RETINOPATHY                                       group presenting to a diabetic retinopathy clinic in Singapore.
ASSOCIATION OF DIABETIC RETINOPATHY WITH                                      485-B126
                                                                              URBAN AND SEMI-URBAN AREAS IN CANADA
Sankara Nethralaya, Chennai, INDIA                                            M.C. BOUCHER 1 , G. DESROCHES 2 , R. GARCIA 3 , A. KHERANI 4 ,
                                                                              D. MABERLEY 5, M. OH 6, S. OLIVIER 1, M. POTTER 5, F. STOCKL 7,
Purpose: To find out any association of Diabetic Retinopathy with risk of     A. VACHON1
Obstructive sleep apnea (OSA).                                                1
                                                                               Université de Montréal, Montreal, PQ, CANADA, 2University of Ottawa, Ottawa,
Methods: SN-DREAM I*, a population-based study was conducted in the           ON, CANADA, 3University of Saskatchewan, Regina, SK, CANADA, 4University of
urban Chennai, India between 2003 and 2006. Using stratified random           Calgary, Calgary, AB, CANADA, 5University of British Colombia, Vancouver, BC,
sampling, based on socioeconomic status, 5784 individuals above the           CANADA, 6McGill University, Montreal, PQ, CANADA, 7University of Winnipeg,
age 40 years were enrolled. All known and newly diagnosed diabetics           Winnipeg, MB, CANADA
underwent comprehensive ophthalmic evaluation including 45° four field
digital fundus photographs. They underwent anthropometric evaluation          Purpose: Our aim was to measure the health results of a category-
to calculate BMI, physical examination including blood pressure estima-       3 tele-ophthalmology screening project for DR implemented through
tion and Epworth Sleepiness Scale (ESS) questionnaire. Risk of OSA was        mobile screening imaging units located within pharmacies with the goal
determined based on Berlin Questionnaire.                                     of reaching to unscreened diabetics in urban communities by lowering
Results: Out of 1425 diabetics who underwent detailed evaluation at           barriers to screening and saving medical resources.
the base hospital, 17% (243) had high risk for OSA. Risk factors for          Methods: Fundus image capture of 3505 known diabetics was performed
OSA included Hypertension 34.6% (493), Obesity 14.7% (210), History of        in the provinces of Quebec, British Columbia, Alberta, Manitoba and
snoring 46.7 %( 666) and ESS score >10 in 7% (101). Diabetics with high       Saskatchewan through mobile units traveling in urban communities.
risk of OSA had less chances of Diabetic Retinopathy [Odds Ratio: 0.77        Through imaging units located in pharmacies a photographer performed
(CI .49- 1.21) p=.26].                                                        fundus imaging and a nurse provided DR education using pupil dilation
Conclusions: The study shows that diabetics with high risk of OSA             only when necessary. Screening was provided free of cost in the context
have no effect on Diabetic Retinopathy. However polysomnography               of DR health screening days. Through telemedicine ophthalmologists
studies are warranted to prove a definitive association of OSA and            proceeded with data and image interpretation.
Diabetic retinopathy.                                                         Results: 68.8% of non-compliant diabetics to screening guidelines were
                                                                              recuperated to screening. Presence of some level of DR was found in
                                                                              22.5% of the cohort patients and in 1.8% in need of urgent follow-up/
484-B125                                                                      treatment. Insufficient imaging in 0.7% of the cohort highlighted the
DIABETIC RETINOPATHY IN MULTI-ETHNIC                                          effectiveness of this strategy. Incidental findings requiring urgent
PATIENTS IN SINGAPORE                                                         ophthalmologic attention were found in 0.6% of the cohort while 85.6%
                                                                              was exempted of an examination by an ophthalmologist saving medical
M.C.C. LIM, S.Y. LEE, I.Y.S. YEO, B.C.L. CHENG, D.W.K. WONG,                  resources.
K.T. YEO, S.G. ONG, C.L. ANG                                                  Conclusions: This model efficiently reaches under-serviced diabetic
Singapore National Eye Centre, Singapore, SINGAPORE                           populations in urban and semi-urban areas. It creates new screening
                                                                              opportunities and offers timely ophthalmologic follow-up. It favors the
Purpose: To describe the prevalence and risk factors for diabetic             development of multidisciplinary collaborations Significant incidental
retinopathy in a multi-ethnic diabetic patient cohort in Singapore.           findings associated with screening highlight the need for experienced
Methods: 742 patients, aged 21 to 95, referred for suspected diabetic         ophthalmologic competences in exercising diabetic retinopathy screen-
retinopathy from primary care to a hospital-based eye clinic were included.   ing within a teleophthalmology approach. *CR
Patients underwent a standardized interview and examination. Fundi were
examined with indirect ophthalmoscopy by 2 examiners. Presence and
severity of diabetic retinopathy was graded into none, mild, moderate,
severe, very severe non-proliferative diabetic retinopathy (NPDR) and
proliferative diabetic retinopathy (PDR). Macular edema and clinically
significant macular edema was also graded.
Results: 99.5% of patients were type 2 diabetics. The prevalence of
diabetic retinopathy was 38.1%, vision-threatening retinopathy 11.8%
and macular edema 6.9%. There were no racial differences. Significant
predictors of any retinopathy were younger age, longer duration of
diabetes, lower BMI, being on treatment for hypertension, hyper-
cholesterolaemia and use of diabetic medication. Predictors for vision-
threatening retinopathy were younger age, longer duration of diabetes
and lower BMI.
Conclusions: This study provides data on the prevalence of and risk

180                                                                                               Asian J Ophthalmol. 2007 Vol 9 No 1 Supplement 1
                                                                                                                                    Poster Abstracts

487-B128                                                                             India. The interim analysis of the population-based, cross-sectional
THE 3 YEAR INCIDENCE AND CUMULATIVE                                                  cohort study included 603 subjects. Mean age was 49.13 ± 13.49 years
PREVALENCE OF RETINOPATHY: THE                                                       (range, 30 - 95 years), mean refractive error was -0.23 ± 1.78 diopters
ATHEROSCLEROSIS RISK IN COMMUNITIES STUDY                                            (range, -20.0 diopters to +6.00 diopters). IOP was measured by applana-
                                                                                     tion tonometry. Anterior chamber depth was measured by sonography.
F.M.A. ISLAM1, R. KLEIN2, M.F. COTCH3, D.J. COUPER4, B.E.K. KLEIN2,                  Results: Mean anterior chamber depth was 3.22 ± 0.39 mm (median,
L.D. HUBBARD2, A.R. SHARRETT5, T.Y. WONG1,6                                          3.21 mm; range, 2.25 - 5.31 mm). It was statistically independent of age
 University of Melbourne, Melbourne, AUSTRALIA, 2University of Wisconsin, Madison,   (P=0.10; 95%CI: —0.004, 0.000). It increased significantly with axial
WI, UNITED STATES OF AMERICA, 3National Institutes of Health, Bethesda, MD,          length (P<0.001; correlation coefficient r=0.26; equation of the regres-
UNITED STATES OF AMERICA, 4University of North Carolina, Chapel Hill, NC, UNITED     sion line: Anterior chamber depth (mm) = 0.13 * axial length (mm) +0.37
STATES OF AMERICA, 5Johns Hopkins Bloomberg School of Public Health, Baltimore,      mm; 95%CI: 0.09, 0.16) and myopic refractive error (P=0.027; r=0.09).
MD, UNITED STATES OF AMERICA, 6National University of Singapore, Singapore,          Conclusions: In the adult population in Central India, mean anterior cham-
SINGAPORE                                                                            ber depth is 3.22 ± 0.39 mm, which is not markedly different from values
                                                                                     found in Western countries. Anterior chamber depth increases with axial
Purpose: To describe the 3 year incidence and cumulative prevalence                  length and myopic refractive error.
of retinopathy and their relationship to cardiovascular risk factors.
Design and Setting: Population-based, prospective cohort study in four
U.S. communities.                                                                    491-B132
Methods: In the Atherosclerosis Risk in Communities Study, 1,018                     EFFECT OF CORRECTION FORMULA ON
participants had retinal photography of one randomly selected eye at the             INTRAOCULAR PRESSURE BETWEEN URBAN AND
3rd examination (1993-95) and 3 years later at the 4th examination (1996-            RURAL SOUTH INDIAN POPULATION - CHENNAI
98). Photographs were evaluated on both occasions for the presence of                GLAUCOMA STUDY
retinopathy signs (microaneurysms, retinal hemorrhages and cotton wool
spots). Incidence was defined as participants without retinopathy at the             M. BASKARAN, S.V. RAMESH, R. RAM MOHAN KUMAR, R. PREMA,
3rd examination who developed retinopathy at the 4th examination, and                R.J. GEORGE, H. ARVIND, L. VIJAYA
cumulative prevalence was defined as participants who had retinopathy                Sankara Nethralaya, Chennai, INDIA

                                                                                                                                                                  POSTER ABSTRACTS
at both the 3rd and 4th examinations. Main Outcome Measure: Incidence
and cumulative prevalence of any retinopathy in the total cohort (n=981),            Purpose: To analyze the differences in intraocular pressure (IOP) due to
and incidence and cumulative prevalence of retinopathy among partici-                Central Corneal Thickness (CCT) between a subset of Urban and Rural
pants without diabetes (non-diabetic retinopathy, n=836).                            South Indian population using Orssengo and Pye correction formula.
Results: The 3-year incidence of any retinopathy in the whole cohort was             Methods: Nine hundred and ten urban subjects (M:F::369:541) and
3.8% and the 3-year cumulative prevalence of any retinopathy was                     204 rural subjects (M:F::92:112) from the Chennai Glaucoma study were
7.7%. In multivariable analysis, the incidence of any retinopathy was                selected for analysis. The corneal thickness, corneal curvature and
related to higher levels of mean arterial blood pressure (OR 1.5, 95% CI             intraocular pressure data were used to get the corrected intraocular pres-
1.0, 2.3, per standard deviation increase in risk factor levels), fasting            sure using Orssengo and Pye formula. Logistic regression analysis and t
serum glucose (OR 1.6, 95% CI, 1.3, 2.1), serum total cholesterol (OR                test were performed to evaluate the differences between groups in com-
1.4, 95% CI, 1.0, 2.0), and plasma fibrinogen (OR 1.4, 95% CI, 1.1, 1.9).            parison to age, gender, CCT, corrected and uncorrected IOP.
The 3 year incidence of non-diabetic retinopathy was 2.9% and the                    Results: The difference between urban and rural population was signifi-
3- year cumulative prevalence was 4.3. The incidence of non-diabetic                 cant for age, gender, CCT (p=0.00) and uncorrected IOP (Urban - 15.95 ±
retinopathy was related to higher levels of mean arterial blood pressure             3.7 vs Rural - 15.24 ±3.7; 95% C.I. of diff = 0.15, 1.27; p=0.014). The
(OR 1.4, 95% CI, 0.9, 2.3) and fasting serum glucose (OR 1.5, 95% CI,                corrected IOP showed no statistically significant difference between
1.0, 2.3).                                                                           the populations (Urban - 16.99 ± 3.9 vs Rural - 17.17 ± 4.57; 95% C.I. of
Conclusions: Retinopathy signs occur frequently in the general popu-                 diff = - 0.85, 0.51; p = 0.625) or among the genders (p = 0.625). Logistic
lation, even in persons without diabetes. Higher blood pressure and fast-            regression showed larger correction in rural population due to thinner
ing blood sugar levels are risk factors for the development of retinopathy           cornea (518 ± 39 vs 505 ± 30; 95% CI of diff = 7, 17; p=0.00).
signs in non-diabetic persons.                                                       Conclusions: The observed difference in intraocular pressure between a
                                                                                     subset of rural and urban South Indian population was mainly due to
                                                                                     central corneal thickness and its correction using a standard formula
490-B131                                                                             negates the influence. The risk for glaucoma due to the difference in
ANTERIOR CHAMBER DEPTH IN THE ADULT                                                  central corneal thickness between the groups needs to be studied.

 Department of Ophthalmology, Faculty of Clinical Medicine Mannheim, University
of Heidelberg, Mannheim, GERMANY, 2Suray Eye Institute, Nagpur, INDIA

Purpose: To assess the anterior chamber in the adult population in Central
India and to examine its relationship with ocular and general parameters.
Methods: The Central India Eye and Medical Study (CIEMS) is a popula-
tion-based cohort study carried out in Nagpur / Maharashtra / Central

Asian J Ophthalmol. 2007 Vol 9 No 1 Supplement 1                                                                                                          181
Poster Abstracts

492-B133                                                                            years (range, 30 - 95 years), mean refractive error was -0.23 ѱ 1.78
COMPARISON OF SCANNING LASER                                                        diopters (range, -20.0 diopters to +6.00 diopters). Intraocular pressure
POLARIMETRY AND FREQUENCY DOUBLING                                                  ranged between 6 and 34 mm Hg (mean ± S.D.: 13.3 ± 3.6 mm Hg).
PERIMETRY (FDP) PARAMETERS BETWEEN                                                  Results: Neuroretinal rim area (mean ± S.D.: 1.96 ± 0.39 mm2) was
NORMAL AND NON GLAUCOMA PATIENTS WITH                                               highly significantly and negatively correlated with intraocular pressure
PSEUDOEXFOLIATION IN A RURAL SOUTH INDIAN                                           [P=0.003; 95%CI: -0.02, -0.004; equation of the regression line: Rim area
POPULATION                                                                          (mm2) = -0.013 * Intraocular pressure (in mm Hg) + 2.13 mm2]. In a
                                                                                    multivariate analysis, this correlation was associated with age (P<0.001),
S.V. RAMESH, R. GEORGE, R. PREMA, M. BASKARAN, H. ARVIND, L. VIJAYA                 and it was independent of gender (P=0.34), and refractive error (P=0.15).
Sankara Nethralaya, Chennai, INDIA                                                  Conclusions: Neuroretinal rim decreases with intraocular pressure in
                                                                                    an unselected adult population in Central India supporting the role of
Purpose: To compare scanning laser polarimetry (GDx NFA) and FDP                    elevated intraocular pressure for glaucoma.
parameters in non-glaucoma patients with Pseudoexfoliation in a rural
south Indian population.
Methods: Subjects were recruited from the rural arm of the Chennai                  494-B135
Glaucoma Study (CGS), a population based cross sectional study. 3924                CENTRAL CORNEAL THICKNESS IN CENTRAL
subjects over 40 yrs of age underwent a detailed ophthalmic examination             INDIA. THE CENTRAL INDIA EYE AND MEDICAL
including applanation tonometry, slit lamp biomicroscopy, gonioscopy,               STUDY (CIEMS)
lens opacification classification system (LOCS II), dilated optic disc
evaluation, GDx NFA and FDP. 75 eyes of 53 subjects with Pseudoexfoliation          V. NANGIA1, A. MATIN1, K. BHOJWANI1, P. JOSHI2, M. YADAV1, J. JONAS3
without glaucoma were selected. Reliable FDP and single good image                  1
                                                                                     Suraj Eye Institute, Nagpur, INDIA, 2Government Medical College, Nagpur, INDIA,
on GDx were selected. The GDx reports were available for 74 eyes and                3
                                                                                     Department of Ophthalmology at Mannheim, University of Heidelberg, Mannheim,
50 eyes had reliable FDP. 1556 phakic eyes of 778 normal healthy con-               GERMANY
trols were selected for comparison. The GDx parameters like the Number,
average thickness (NFL) and FDP mean deviation (MD) and pattern stand-              Purpose: Since the central corneal thickness (CCT) is of importance
ard deviation (PSD) values were compared using independent t test.                  for intraocular pressure measurement and possibly of importance for
Results: The Pseudoexfoliation patients (60.30 ± 8.37 yrs) were signifi-            the risk of progression of glaucoma, and since CCT data for the Central
cantly (p=0.0001, 95% CI 11.96 to 15.56) older than the control group               Indian population are missing, it was the purpose of the present study to
(46.52 ± 6.32 yrs). The Number was significantly (p=0.0001, 95% CI of               measure the CCT in a population-based study in Central India.
the difference in mean: 7.15 to 15.00) higher among Pseudoexfoliation               Methods: The interim analysis of the population-based, cross-sectional
group (30.04 ± 20.10) as compared to controls (20.49 ± 16.47). The                  cohort study included 603 subjects. Mean age was 49.13±13.49 years
average thickness showed no significant differences (p=0.056).                      (range, 30-95 years), mean refractive error was -0.23±1.78 diopters
Pseudoexfoliation patients had a significantly (p=0.0001, 95% CI of the             (range, -20.0 diopters to +6.00 diopters). Only one randomly selected
difference in mean: -3.20 to -1.59) higher MD (-4.47 ± 2.86 dB) than                eye per subject was included into the statistical analysis. CCT was meas-
control group (-2.07 ± 2.84 dB). The PSD was higher among the                       ured by ultrasound.
Pseudoexfoliation group with the mean difference of 0.55 SE: 0.25 dB                Results: Mean CCT was 517.6±32.12um (median, 519 um; range, 420
and the difference showed a statistical significance (p=0.028, 95% CI of            um- 624 um). It was statistically independent of gender (P=0.10) and
the difference in mean: 0.06 to 1.04).                                              refractive error (P=0.06). CCT was significantly and positively with
Conclusions: Eyes with Pseudoexfoliation had higher mean deviation on               intraocular pressure measurements (P<0.001; 95%CI: 0.91, 2.31)
the FDP and higher Number on the GDX.                                               (Equation of the regression line: Intraocular Pressure (mm Hg) = 0.02 x
                                                                                    CCT (um) + 2.64). CCT was associated with younger age (P=0.001;
                                                                                    correlation coefficient r = -0.14).
493-B134                                                                            Conclusions: Compared with studies on Caucasians, CCT may be
NEURORETINAL RIM AREA CORRELATED WITH                                               thinner in the adult population in Central India. As in Caucasians, CCT is
INTRAOCULAR PRESSURE IN THE CENTRAL INDIA                                           strongly associated with intraocular pressure measurement values.

V. NANGIA1, A. MATIN1, K. BHOJWANI1, S. UGHADE2, M. YADAV1, J. JONAS3               495-B136
  Suraj Eye Institute, Nagpur, INDIA, 2Government Medical College, Nagpur, INDIA,   NORMAL DISTRIBUTION OF RETINAL NERVE
  Department of Ophthalmology at Mannheim, University of Heidelberg, Mannheim,      FIBER LAYER THICKNESS IN INDIAN POPULATION
GERMANY                                                                             USING CONVENTIONAL AND MODIFIED SCAN
                                                                                    DIAMETERS ON THE GDXVCC
Purpose: In hospital-based studies, intraocular pressure has been one of
the major risk factors for glaucomatous optic neuropathy. It was, therefore,        R. GADIA, T. DADA, S. KUMAR, P. GARG, A. AGARWAL, V. GUPTA, R. SIHOTA
the purpose of the present investigation to explore the relationship be-            Glaucoma Research Facility, Dr. Rajendra Prasad Centre for Ophthalmic Sciences,
tween intraocular pressure and optic disc morphology, irrespective of the           All India Institute of Medical Sciences, New Delhi, INDIA
diagnosis of glaucoma.
Methods: The Central India Eye and Medical Study (CIEMS) is a popula-               Purpose: To quantitatively assess the normative data for disc diameters
tion-based cohort study carried out in Nagpur / Maharashtra / Central               and nerve fiber layer measurements as obtained by scanning laser
India. The interim analysis of the population-based, cross-sectional co-            polarimetry with variable corneal compensation (GDxVCC) at 3 different
hort study included 603 subjects. Mean age was 49.13 ⊂∑± 13.49                     observational circles.

182                                                                                                      Asian J Ophthalmol. 2007 Vol 9 No 1 Supplement 1
                                                                                                                                       Poster Abstracts

Methods: The peripapillary retinal nerve fiber layer of 100 normal eyes              497-B138
was evaluated. Retinal Nerve Fiber Layer Thickness (RNFL) was meas-                  PORTABLE OPHTHALMIC MICROSCOPES IN THE
ured on GDxVCC at 3 different observation circles- conventional small                PHILIPPINES: AN OVERVIEW
circle, medium and large circle. Parameters for evaluation included TSNIT
average, superior average, inferior average and NFI. All eyes had normal             A.C.S. TAN1, R. LE MESURIER2, H. NEWLAND3
visual fields (SITA Standard 30-2) and a refractive error within ±3 diopters.        1
                                                                                      Christian Blind Mission Australia, Fitzroy North, AUSTRALIA, 2Victorian Royal
Results: Male : female ratio was 1.86. Mean age of the subjects was                  Eye and Ear Hospital, Melbourne, AUSTRALIA, 3Royal Adelaide Hospital, Adelaide,
40.12 ± 12.0 (range 20-72) years. Average horizontal and vertical disc               AUSTRALIA
diameter was 1770 ± 208 µm and 1862 ± 186 µm respectively. The
mean TSNIT average (µm) in the sample population at small, medium and                Purpose: Demonstrations were held all over the Philippines to teach lo-
large circle was 54.17 ± 4.6, 47.17 ± 4.8 and 41.57 ± 4.6 respectively.              cal microscope operators basic maintenance skills and trouble shooting
Mean NFI at small, medium and large circle was 17.4 ± 7.5, 17.2 ± 8.5                for their portable Scan Optics microscopes. Feedback was obtained from
and 17.4 ± 8.6 respectively. There was significant difference between                operators on the present use and condition of their microscopes.
small vs. medium (p<0.001), medium vs. large (p<0.001) and small vs.                 Methods: 15 microscopes were examined and feedback was obtained
large circle results (p<0.001) for all the parameters except NFI. The mean           from 16 operators on the present use and condition of their microscopes.
value of superior average and inferior average (µm) was 67.1 ± 7.3 and               The adequacy of information provided with the microscope, as well as
62.8 ± 7.2 at small circle, 57.8 ± 7.0 and 55.1 ± 8.2 at medium circle               the availability of support services was assessed. Determining how often
and 51.1 ± 7.0 and 49.8 ± 6.9 at large circle. The superior average                  the microscope was moved, how easy it was to transport and how
was significantly thicker than inferior average at all the three circles             adequate the present packaging was allowed some assessment of
(p<0.001). There was significant positive correlation of RFNL thickness              portability. Frequent problems were identified and suggestions on how to
to the vertical disc diameter at medium (r=0.232, p=0.03) and large                  improve the microscope were explored.
circles (r=0.259, p=0.02). The TSNIT average at small circle was 13%                 Results: It was found that although there was a general satisfaction
more than medium circle and 23% more than large circle in normals.                   among the operators with regard to their microscopes, the lack of techni-
Conclusions: The normative database of RNFL thickness on the GDxVCC                  cal support services was a problem. Most microscopes were moved fre-
is influenced by the vertical disc diameter and the scan radius.                     quently and the original casing was adequate for transport, with a few
                                                                                     exceptions. Most microscopes examined required a certain degree of

                                                                                                                                                                       POSTER ABSTRACTS
                                                                                     maintenance. This made a large improvement to the 3 most common
496-B137                                                                             problems identified: moldy/dirty lenses, expired mold pellets and poor
RISK OF DEVELOPING GLAUCOMA IN FELLOW                                                alignment.
EYES OF CHRONIC PRIMARY ANGLE CLOSURE                                                Conclusions: These demonstrations aimed to improve the knowledge
GLAUCOMA PATIENTS AFTER 5 YEARS FOLLOW UP                                            and technical skills of the present instrument technicians (in addition to
                                                                                     providing surgeons with basic knowledge to troubleshoot and clean their
R. GADIA, V. GUPTA, R. SIHOTA, A. SHARMA, T. DADA                                    microscopes), in order to improve the technical support available. This
Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical   may also be useful to provide an overview on the different aspects of
Sciences, New Delhi, INDIA                                                           the microscopes specified above to provide microscope designers with
                                                                                     feedback for future improvements. Similar demonstrations could be
Purpose: To study the relative risk of developing glaucoma in fellow eyes            considered for other countries with a similar scarcity of technical support
of Asian patients with unilateral chronic primary angle closure glaucoma             services. *CR
who underwent prophylactic laser peripheral iridotomy.
Methods: Fellow eyes of 20 patients of unilateral chronic primary angle
closure glaucoma who underwent prophylactic YAG laser iridotomy of both              498-B139
eyes and had completed at least 5 years of follow up, were evaluated.                “LIFELINE EXPRESS” THE TRAIN: AN
Fellow eyes were divided into two groups - those on one topical                      UNCONVENTIONAL OUT-REACH APPROACH FOR
antiglaucoma medication (group1, n=12) and those without any medica-                 COMMUNITY BASED CATARACT-CARE SERVICES
tion (group2, n=8). All subjects underwent retinal nerve fiber layer thick-          IN DEVELOPING COUNTRIES WITH STATE-OF-ART
ness (RNFL) assessment by scanning laser polarimetry (GDxVCC) at the                 TECHNOLOGY
last follow up.
Results: All patients were followed for a mean period of 6.2 ± 2.2 years             R. SAXENA, S. KHOKHAR, A. SINHA, A. DUBEY, S. SARKAR,
(range from 5 to 10 years). Mean intraocular pressure after 1 month of               V. AGGARWAL
YAG laser iridotomy in the fellow eyes was 15.2 ± 3.2 mm Hg in group 1               AIIMS, New Delhi, INDIA
and 15.8 ± 4.4 mmHg in group 2 (p=0.2). Mean RNFL thickness (TSNIT
Average) of fellow eyes was 54.6 ± 11.4 in group 1 and 48.2 ± 13.2 in                Purpose: To describe results of 3 years of unconventional out-reach
group 2 (p=0.1). These values were not significantly different from healthy          approach using national railway network in underserved areas of the
controls with mean TSNIT average being 54.17 ± 4.6. There were signs                 country. “Lifeline Express” as an ideal mode of delivery of community
of optic disc damage and RNFL thinning in 1 (12.5%) fellow eye in group              cataract-care services with state-of art technology and training program
2 (n= 8) while none in group 1 (n=12) showed RNFL changes.                           for residents and local ophthalmologists.
Conclusions: Long term risk of development of glaucomatous changes                   Methods: Indian Railways is one of the World’s largest railways
in fellow eyes of patients with chronic primary angle closure glaucoma               systems (about 63,028 km. of track). “Lifeline Express” is part of a non-
are rare after prophylactic iridotomy and subsequent medical therapy.                governmental organization “Impact India Foundation”, promoted by
                                                                                     WHO, UNDP, UNICEF and government of India. Train is utilized for uncon-
                                                                                     ventional out-reach camps. Each camp is for 10 days (3 days screening,

Asian J Ophthalmol. 2007 Vol 9 No 1 Supplement 1                                                                                                               183
Poster Abstracts

4 days surgeries, 3 days post-operative care). The train is equipped with      500-B141
operating microscope, phaco-emulsifier, slit lamp, A-scan biometry,            PATTERN OF EYE DISEASES AMONG ORANG ASLI
laminar air flow, keratometry and air-conditioned operating room. Pa-          IN TEMERLOH HOSPITAL
tients are collected, screened and admitted in local hospital or tents and
are operated on the train by the visiting experts.                             H. HANIZASURANA1, C. JEMAIMA2
Results: In last three years, three out-reach camps were done by the           1
                                                                                   Hospital Temerloh, Pahang, MALAYSIA, 2HUKM, Kuala Lumpur, MALAYSIA
authors. Of 1762 patients screened 673 had cataract and 1089 had
other ailments like refractive-error, dry-eyes, etc. Selected cataracts were   Purpose: To characterize the ocular diseases among Orang Asli (OA)
operated on train having controlled sterile environment.                       in Temerloh Hospital.
     Phacoemulsification was done in 16.94% cases, rest underwent              Methods: Retrospective analysis of 56 Orang Asli presented to eye
non-phaco surgery (conventional ECCE /SICS). The IOL coverage was              clinic, Temerloh Hospital between January 2003 to December 2005.
96.88%. Of 673 cases, experts operated 425 (63.15%) and under their            Results: 56 OA consisted of 32 male and 20 female. Mean age 19.5 ±
guidance 248 (36.85%) were operated by trainees/local ophthalmologists.        21.7 years, median age 9.5 years. 14 (25%) cases were related to trauma,
All patients are examined on slit lamp and automated refraction performed      13 (23.2%) due to infective causes, 8 (14.2%) ROP, 5 (8.9%) cataract,
post-operatively, providing gross estimate of surgical outcome. All            3 (5.4%) glaucoma, 3 (5.4%) diabetic retinopathy assessment, 11
patients had successful outcome and satisfactory visual recovery.              (19.6%) non-specific. 17 (30.3%) defaulted during or after treatment.
Conclusions: “Lifeline Express” is an effective mode of utilization of         Conclusions: 1. Most OA presented to hospital for acute eye diseases
national railway network for delivery of cataract care services. Out-reach     i.e. trauma and infective cases. 2. No nutritional-related eye diseases
camps using train are better than conventional camps as, state-of-art          noted. 3. Number of cataract, diabetes and glaucoma cases are lower
equipment and technology including sterile controlled operating room           among these population.
can be used without quality compromise and ensure skill transfer and
training with good surgical outcome.
                                                                               HEALTH RELATED QUALITY OF LIFE AND UTILITY
499-B140                                                                       VALUES ASSOCIATED WITH VITREOUS FLOATERS
WITH A NOVEL TEST IMPROVES VISION                                              A.M. WAGLE1, V.S. TAN1, W.Y. LIM2, K. NEELAM3, K.G. AU EONG1
OUTCOMES AND IS COST-EFFECTIVE                                                 1
                                                                                Alexandra Hospital, Singapore, SINGAPORE, 2Department of Epidemiology and
                                                                               Disease Control, Ministry of Health, Singapore, SINGAPORE, 3Waterford Institute
H.J. TING, M. HAAS, D.K. MARTIN                                                of Technology, Waterford, IRELAND
University of Technology, Sydney, Sydney, NSW, AUSTRALIA
                                                                               Purpose: To ascertain the health-related quality of life (HRQoL) and utility
Purpose: To evaluate the cost effectiveness and improved patient vision        values associated with vitreous floaters.
outcomes of a novel prognostic test that detects Diabetic Retinopathy          Methods: Ophthalmology outpatients (n = 200) aged 16 - 97 years
(DR) before the development of clinical symptoms.                              presenting primarily with vitreous floaters were interviewed using a
Methods: A Markov model was built to emulate the natural progression           standardized questionnaire to ascertain the HRQoL and utility values
of DR, based on data from random clinical trials, specifically the             associated with vitreous floaters. The EQ-5D questionnaire was used
UKPDS1 and Da Qing IGT study2. The cohort was characterized based on           for assessing the HRQoL. Utility values were calculated using the time
Australian prevalence for Diabetes, DR and obesity. This model takes into      trade-off and standard gamble (for death and blindness) techniques.
account the likelihood of compliance with blood glucose level control          Results: Majority of patients did not report significant problems with
as well as NHMRC recommendations for eye examinations and laser                mobility (94.5%), self-care (98.5%) and usual daily activities (93%). How-
treatments for DR. Australian costs and published quality of life data         ever a quarter (24.6%) reported some problems with anxiety or depression.
were used in this model. The main outcome measures are the number of           The mean utility values were 0.88 for time trade-off, 0.89 for standard
life years, sight years, Quality Adjusted Life Years (QALY) and the cost       gamble of death and 0.93 for standard gamble of blindness. Patients with
effectiveness measured as the Incremental Cost Effectiveness Ratio             visual acuity < 6/9 in the better-seeing eye had significantly lower utility
(ICER). This model was used to estimate the cost effectiveness of pre-DR       values for time trade-off compared to patients with visual acuity > 6/9 in
screening; a novel, non-invasive innovation developed in our laboratory        the better-seeing eye (p = 0.01). Patients aged < 55 years had signifi-
(WO03103771), which can detect the damaging effects of high blood              cantly lower utility values for standard gamble of blindness compared
glucose on the retinal microvasculature, before the development of clini-      to individuals aged > 55 years (p = 0.01).
cal symptoms. The operation of this innovation is summarized in.               Conclusions: Patients with vitreous floaters on an average are willing
Results: Pre-DR screening can significantly increase live years, sight         to trade-off 1.2 years/10 years of estimated remaining life, take a 11%
years and QALYs, particularly if there is a high rate of compliance to blood   risk of death and a 7% risk of blindness to get rid of the symptom. Younger
glucose control and NHMRC guidelines to eye examinations. Although             patients are willing to take a higher risk of blindness to restore ocular
screening for pre-DR is more expensive than not screening, the addi-           health.
tional cost per QALY gained reduces over time, as shown in figure 2.
Conclusions: It is cost effective to screen for DR before the development
of clinical symptoms.

184                                                                                                   Asian J Ophthalmol. 2007 Vol 9 No 1 Supplement 1
                                                                                                                                  Poster Abstracts

502-B143                                                                        This study also highlight the increasing numbers of contact lens wearers
THE GLAUCOMA DO ONCE AND SHARE PROJECT                                          in China, and with the increasing popularity of toric contact lenses, it
- A NATIONAL CONSULTATION PROCESS TO                                            would benefit not only myopic patients, but also patients with astigmatism.
INFORM THE DEVELOPMENT OF A NATIONAL                                            Discussion on the rationale behinds these changes will also be presented.
ELECTRONIC CARE RECORD                                                          This is the first kind of study in China revealing the general paradigm
                                                                                shift in optical retails in key cities in China. *CR
Moorfields Eye Hospital, London, UNITED KINGDOM
Purpose: The Do Once and Share Projects are an opportunity for                  LOW VISION SERVICES FOR CHILDREN IN INDIA,
clinicians to be integral to the content and implementation of the National     NEPAL AND INDONESIA METHODOLOGY OF A
Electronic Care Record system. The purpose was to produce a nationally          RESEARCH PROJECT
agreed care pathway and dataset, to review the specification for an
electronic record for patients with open angle, suspect glaucoma and            K.M. VAN DIJK1, C. GILBERT2
ocular hypertension.                                                            1
                                                                                    London School of Hygiene & Tropical Medicine/ CBM, London, UNITED KINGDOM,
Methods: The best available evidence and guidance on the management             2
                                                                                    London School of Hygiene & Tropical Medicine, London, UNITED KINGDOM
of glaucoma relevant to the NHS, and the experiences of current clinical
IT systems in use, was collated under the direction of a national multi-        Purpose: Evidence of the effectiveness of low vision (LV) care for
disciplinary steering group of stakeholders. This steering group comprised      children is lacking. This paper describes the methods being used in a
of Glaucoma clinicians, representatives from the Royal College of               project the aim of which is to evaluate the effectiveness of low vision
Ophthalmologists, Optometrists, Nurses and General Practitioners,               interventions using two different models of low vision care, and to
representatives from the Association of Optometrists and Royal National         estimate the relative efficiency of these models.
Institute for the Blind (RNIB). An open access website provided the             Methods: The project has two components. In the first, a retrospective
glaucoma community of practice, and patients an opportunity to contrib-         study of the records of 1823 children aged <16 years attending 6 LV
ute to the development process.                                                 programs in 3 Asian countries in 2002/3 were reviewed. The following
Results: FULL approval has been obtained from all the relevant profes-          data were extracted: socio-demographic details; diagnosis; presenting/

                                                                                                                                                                 POSTER ABSTRACTS
sional bodies. The final pathway and dataset can be found on the website        best corrected visual acuities (VA) for near and distance; optical LV                                                           devices prescribed. Data were analyzed for all children, by type of program,
Conclusions: A national care pathway and dataset have been produced,            and according to the amount of additional support regularly received.
which is now being submitted for NHS Information Standards Board (ISB)          Results were used to improve existing services, and to design the second,
approval. Currently, the submission is at the draft phase. If fully approved,   prospective, study, which is ongoing.
the dataset will become an information standard, which will provide a           Results: In the retrospective study, 42.2% children attended hospital LV
vehicle for the implementation of best practice and clinical standards.         clinics and 57.8 % LV centers. The majority (64.4%) had no additional
                                                                                support, and only 42.9 % came back for follow-up. The main causes of LV
                                                                                were aphakia/other disorders of the lens 30.7%; refractive errors/
503-B144                                                                        amblyopia 26.4 %; retinal lesions 16.7%. Two thirds did not have glasses
CONTACT LENS PRACTICE IN CHINA: THE PAST,                                       at first attendance. Among those children who could be tested, 45.1%
PRESENT AND FUTURE                                                              had a presenting distance VA of < 6/60; after refraction it was 31.4%;
                                                                                70.8% were prescribed glasses. 58.7 % had a near VA of ≥1.25 M, which
K. TAN                                                                          improved to 73.8 % after refraction and/or magnification. 22.3 % were
CooperVision, Inc., Singapore, SINGAPORE                                        prescribed magnification, 82.5% of this need being met by locally
                                                                                produced devices. The only difference at baseline was that children
Purpose: With the booming economy and increasing purchasing power               receiving extra support at home/school had lower visual acuities at pres-
in China, the life style and consumer behavior in China have changed            entation than those receiving only clinical low vision care.
significantly. The trends and growth patterns of consumer products and          Conclusions: The two different models are being studied for effective-
even medical prescription products have evolved with different patterns         ness and efficiency as no data are available on the relative benefits of the
compared to other developing countries. These have led to a paradigm            different approaches to service delivery. The findings will be of particular
shift in the optical industry in China. This study aimed to review the trend    value in low-income settings. The retrospective study clearly demonstrates
of contact lens practice in key cities in China from 1988 to 2003.              the need for accurate refraction and prescribing. In the prospective study
Methods: Surveys were conducted on twenty-eight key optical chains in           we are exploring the hypothesis that increased follow-up, and therefore
eighteen cities in China. Areas of survey include the following:                more frequent low vision care, has a significant effect on measurable
• Ratio of spectacles to contact lenses                                         outcomes such as the use of devices, reading speed, and selected
• Ratio of contact lenses vs lens care products                                 vision-related daily activities. For pragmatic and ethical reasons a quasi-
• Percentage of toric contact lenses prescribed                                 experimental design is being used, with 500 children aged 4-18 years
• Trend in contact lens modality and contact lens types                         being enrolled.
• Trend in contact lens drop-out rate
• Average numbers of patients per practice
Results: Results on the above evaluations will be presented to illustrate
the trend and change of contact lens practice in China from 1988 to 2003.
Conclusions: Contact lens practice is moving towards a better and healthy
practice, where dropout rate is declining and compliance is improving.

Asian J Ophthalmol. 2007 Vol 9 No 1 Supplement 1                                                                                                         185
Poster Abstracts

505-B146                                                                           Conclusions: The cut-off points of -0.75D and -0.5D in SE refraction
CHARLES BONNET VISUAL HALLUCINATIONS:                                              are appropriate for the prediction of uncorrected logMAR VA worse than
WHAT WE KNOW AND WHAT WE NEED TO KNOW?                                             0.3, which is the criterion for the US common state adult driver licensing
 Massachusetts Eye and Ear Infirmary, Boston, MA, UNITED STATES OF AMERICA,
 British Columbia Centre for Epidemiologic and International Ophthalmology,        507-B148
University of British Columbia, Vancouver, BC, CANADA, 3LV Prasad Eye Institute,   HAS THE HEALTH-RELATED QUALITY OF LIFE OF
Hyderabad, INDIA, 4Arthritis Research Center of Canada, Department of Statistics   ADOLESCENTS BEEN COMPROMISED DUE TO
and Actuarial Science, Simon Fraser University, Vancouver, BC, CANADA              MYOPIA?

Purpose: To review how many patients experience visual hallucinations,             H.B. WONG1, S.M. SAW2, S.B. TAN1, D. MACHIN1
the association between the report of hallucinations and contrast                  1
                                                                                     Clinical Trials & Epidemiology Research Unit, Singapore, SINGAPORE, 2Depart-
sensitivity and how many patients continue to experience complex visual            ment of Community, Occupational and Family Medicine, National University of
hallucinations after one year.                                                     Singapore, Singapore, SINGAPORE
Methods: Consecutive patients seen over one year in a low vision
rehabilitation clinic were asked if they experienced visual hallucinations.        Purpose: To evaluate the health-related quality of life (HRQoL) reported
Patients were asked the same question one year later. The association              by adolescents with myopia and their parents in Singapore.
with acuity and contrast sensitivity was determined.                               Methods: A cross-sectional study was conducted within the Singapore
Results: 1. Of 225 patients seen initially, 78 (35%) reported hallucinations.      Cohort study Of the Risk factors for Myopia (SCORM) which is a longitudi-
2. Visual acuity and contrast sensitivity were considered in four quartiles.       nal cohort study that commenced in 1999. Cycloplegic autorefraction
Contrast sensitivity in the three poorer quartiles (compared to the best)          measures were made using the Canon RK-5 autokeratorefractometer and
was strongly associated with the report of hallucinations (OR 4.1, CI 1.1,         the measurements were analyzed as spherical equivalent. Myopia was
15.9; OR 10.5 CI 2.6, 42.1; OR 28.1, CI 5.6, 140.9) after controlling for          defined as a negative refractive error of at least -0.5D. Adolescents were
acuity, age, sex, depression and independence. 3. Of the 152 patients              classified into myopes and nonmyopes based on the worst eye. Parents
seen in follow up (76%), 39 were still experiencing hallucinations, 15 had         or proxy and their child completed the PedsQL TM 4.0 generic core
stopped seeing hallucinations and 23 patients (15% of the 152 who were             scales (parent-proxy and child-self reports for 13-18 years) independently.
seen in follow up) who had not reported hallucinations at the first visit          Summary scores for total, physical and psychosocial health of myopes
now reported them.                                                                 and nonmyopes were compared.
Conclusions: Complex visual hallucinations with insight are very                   Results: The data collection is still on-going but the preliminary results
common in this patient population. Future research is required to explain          of 667 adolescents aged 11-14 years are reported here. The majority of
why some patients experience this symptom and others may not.                      adolescents were males (52%) and Chinese (76%). There were 503 (75%)
                                                                                   myopic adolescents. The mean (SD) total, physical and psychosocial health
                                                                                   scores reported by myopes were 84.1(11.8), 90.1(11.2) and 80.9(13.8).
506-B147                                                                           Similar scores were reported by nonmyopes. The differences between
THE EQUIVALANCE OF DIFFERENT CRITERIA FOR                                          myopes and nonmyopes in total scores and associated 95% Confidence
MYOPIA IN SINGAPORE CHILDREN                                                       Intervals were 0.1(95% CI: -1.9 to 2.2), physical -0.4(-1.6 to 2.3) and
                                                                                   psychosocial health -0.01(-2.4 to 2.4). The parent reported mean (SD)
Y. WANG, G. GAZZARD, Y. LIANG, A. SHANKAR, D. TAN, S.M. SAW                        total, physical and psychosocial health scores were 82.6 (13.9), 87.0
Singapore Eye Research Institute, Singapore, SINGAPORE                             (14.0) and 80.3 (15.5). Although the parents of myopes reported worse
                                                                                   HRQOL for their children (i.e. lower HRQOL scores) in all summary scales
Purpose: To determine the association of spherical equivalent (SE)                 compared to the parent of nonmyopes, these were not statistically
with low uncorrected visual acuity (VA) along with a proposed definition           significant differences. There were also no significant difference found in
for myopia using logMAR VA >0.3 as the criteria.                                   the scores reported by adolescents with habitual VA more than 6/6, those
Methods: 1334 Chinese schoolchildren (mean age 7.8; range 7-9 years)               with VA 6/6 and nonmyopes. The results remain unchanged after control-
were enrolled in the study after those who had hyperopia > or =+2.00               ling for the child’s age, gender, race groups and medical conditions.
diopters (D) and astigmatism > = -2.00 D were excluded. Uncorrected                Conclusions: The HRQoL of the myopic adolescents in Singapore has not
logMAR VA was measured for both eyes. Cycloplegia autorefraction was               been compromised. We await further data from all 1,500 adolescents
achieved by the instillation of three drops of 1% cyclopentolate 5 minutes         from the 2006 eye screening visit in SCORM.
apart. The average of five successful consecutive refraction and
keratometry readings were obtained with calibrated Canon RK5
autokeratorefractometers by well trained optometry students, at least 30
minutes after the instillation of the third drop of cyclopentolate. SE cut-off
points (-0.25 D, -0.5D, -0.75 D, -1.0 D) were evaluated.
Results: Using different SE cut-off points, the myopia prevalence rates of
this sample of schoolchildren varied from 45.8% (SE at least -0.25 D) to
30.7% (SE at least -1.0 D). The cut-off point of > or =-0.75 D had a
sensitivity and specificity of 91.8% (95% CI, 89.2 to 94.4) and 93.7%
(95% CI, 92.1 to 95.3), respectively, to predict low vision defined as
uncorrected logMAR VA > 0.3 (either eye). The next best cut-off point of
-0.5D had a higher sensitivity (93.3%), but lower specificity (87.9%).

186                                                                                                     Asian J Ophthalmol. 2007 Vol 9 No 1 Supplement 1
                                                                                                                                      Poster Abstracts

508-B149                                                                           511-B152
TECHNOLOGY                                                                         S. SUGIRTHAMUTHU, P. PARIKUMAR
                                                                                   The Light Eye Hospital, Dharmapuri, INDIA
 Singapore Polytechnic, Singapore, SINGAPORE, 2Singapore Eye Research Institute,   Purpose: To observe and analyze the students diagnosed to have myopia
Singapore, Singapore, 3Neurovision, Singapore, SINGAPORE                           between 13 and 17 years of age which was missed by the parent and the
                                                                                   patient till then due to the place they were made to sit in their class
Purpose: Neural Vision Correction (NVC) technology has been shown to               rooms which render them to be unaware of their visual defect.
enhance the blurry image interpretations by amblyopes and low myopes.              Methods: 72 students (School & College) who reported to the hospital
Our pilot project aims to investigate if NVC would be able to similarly            complaining of headache or whose parents reported that their children
enhance habitual VA of young subjects with vision close to but not better          watch Television from closer range than usual aged between 13 and 17
than 6/6.                                                                          were included in the study. They were asked to fill up a questionnaire.
Methods: Forty-three subjects (21.7 ± 7.0 years) with a habitual VA of             Their visual acuity before and after correction, height etc., were meas-
between 0.00 (6/6) and 0.30 (6/12) logMAR units in either eye partici-             ured and entered .The details in the questionnaire were then analyzed
pated in this study. Visual functions including Photopic High (PHVA) and           and conclusions were drawn based on the unique similarities among
Low Contrast VA (PLVA), Mesopic High Contrast VA (MHVA) and contrast               these patients.
sensitivity were assessed using ETDRS charts and Sine Wave Contrast                Results: 1. 49 out of 72 students (68%) sat in the first two rows of
Test (SWCT). All subjects were given a pre-treatment NVC conditioning              benches in their classrooms. 2. The average height of these students
before embarking on a 30 treatment sessions. Persistence evaluation was            was 125.72 cms, which is less than the expected average height for their
done at 3 months post-treatment.                                                   age group 133 cms. 3. 57 out of 72 students (79%) scored over 80% in
Results: Twenty eyes of the 11 subjects who completed the study were               their last written exams. 4. 66 out of 72 students (91%) were not aware
analyzed. There were statistical significant improvements in VA and                of their vision defect. 5. 53% of the parents of these students reported
contrast sensitivity at post-treatment. The mean habitual PHVA improved            that their children watched television from a closer range. 6. All the
from 0.057 (range 0.00 to 0.28) to -0.048 (range -0.22 to 0.00) logMAR             students had a myopia of -2.00 Diopter or more. 7. All of them had

                                                                                                                                                                     POSTER ABSTRACTS
units, where 70% of the eyes had better than 6/6 PHVA at post-treatment.           amblyopia ranging from 6/18 NIP to 6/9 NIP. 8. 48 out of 72 students
The post-treatment improvements over the initial VA were +0.11                     (63.8%) did not use computers and the other 26 students (36.1%) used
(±0.025), +0.07 (±0.016) and +0.10 (±0.022) logMAR units for PHVA,                 computers for 120 minutes per day on an average. 9. 64 out of 72
PLVA and MHVA respectively. Improvements were also found for the five              students (88.88%) watched television for 110 minutes per day on an
spatial frequencies of the SWCT. There were no significant differences in          average. 10. 35 out of 72 students (48.6%) did not play outside and the
persistence VA and persistence contrast sensitivity.                               other 37 students (51.3%) played for 35 minutes per day on an average.
Conclusions: The NVC technology enhanced the habitual VA and contrast              Conclusions: There is a risk of myopia being missed among students
sensitivity of young subjects. Highly motivated subjects with demand of            aged between 13 and 17 who sat in the first two rows of benches in their
greater clarity of vision could benefit from this treatment. *CR                   classrooms because of their short stature. This position in the classroom
                                                                                   prevented the students from realizing their distant vision defect. These
                                                                                   children watched television from a closer range. The fact that these
509-B150                                                                           children performed well academically precluded any clue of defective
UNILATERAL MYOPIA                                                                  vision.
                                                                                   Discussion: Therefore while doing vision screening among school students,
A. PATTANAYAK, S. CHOWDHURY                                                        utmost care must be given to those who sit in the first two benches and
Bokaro General Hospital, India, Bokaro Steel City, INDIA                           they have to be compulsorily tested for any visual defects. It is advisable
                                                                                   for all children who go to std I to have an eye checkup done because by
Purpose: Clinical and optical parameters associated with this can help in          then, they would usually be able to recognize alphabets and numbers
studying the etiopathogenesis of myopia in general.                                making vision screening easy, so that myopia can be picked up early
Methods: Prospective clinical study of patients with unilateral high               and amblyopia can be prevented. So the school authorities can make an
myopia (difference of 5 D or more) with biometric measurements.                    ophthalmologists’ report mandatory in std I to avoid missing myopia.
Results: During 1998-2005, 156 cases were diagnosed of which 124                   We suggest that a column for visual activity be included in the school
cases (80%) were axial, rest were corneal, lenticular or traumatic. The            admission forms.
mean refractive and biometric difference between paired eyes was 8.8 D
and 3.3 mm respectively. Non-progression in the affected eye and
progression in nonaffected eye was noticed in 60% cases. Poor response             512-B153
to antiamblyopia therapy is a common finding                                       FIREWORKS EYE INJURY: SEASONAL
                                                                                   INTERVENTION MOST IMPORTANT FOR

                                                                                   S. CHOWDHURY
                                                                                   Bokaro General Hospital, India, Bokaro Steel City,Jharkhand, India, INDIA

                                                                                   Purpose: Prospective study of fireworks related eye injuries in India
                                                                                   Methods: Patients admitted during 2000-2005.

Asian J Ophthalmol. 2007 Vol 9 No 1 Supplement 1                                                                                                               187
Poster Abstracts

Results: Total: 82 eyes of 66 patients, 40/66 (60%) by Rockets. Mean          514-B155
age 14 years. Male predominance (47,70%), 50% minors (<16yrs),                EPIDEMIOLOGY OF OCULAR TRAUMA IN CENTRAL
Commonest: lids, corneal erosions and abrasions (25/82, 30%). Severe:         INDIA
8/82 eyes (10%) mostly due to falling rocket stick and unexploded
crackers (UXC). Visual impairment was seen in 25% mainly due to               R. AGRAWAL
secondary glaucoma. Severity index: 1.0 ± 0.8. (minors 1.2 ± 1.0, adults      Shri Ganapati Netralaya, Jalna, INDIA
1.0 ± 0.5 ;p = 0.013). Seasonal intervention reduced ocular morbidity.
Conclusions: Injuries in minors, unexploded crackers, falling rockets         Purpose: To describe the current epidemiology of serious ocular trauma
had poorest visual outcome. Seasonal intervention was most effective .        in central India which necessitates admission to the hospital. The epide-
                                                                              miology study provides the basic data for health and safety strategies for
                                                                              the prevention of ocular injuries and their role within the national health
513-B154                                                                      program i.e., in National Programme for Control of Blindness (NPCB).
INDUSTRIAL-ACCIDENT RELATED OCULAR                                            Methods: Retrospective review of medical record file was done for all
EMERGENCIES IN A TERTIARY HOSPITAL IN                                         489 patients admitted at a tertiary referral eye care center in the period
SINGAPORE                                                                     between 1st October 2004 to 30th June 2006 and analysis for the type
                                                                              and cause of injury, the place where it occurred, time lag between injury
C. NGO, S. LEO                                                                and presentation to ophthalmologist and the risk factors present at the
Tan Tock Seng Hospital, Singapore, SINGAPORE                                  time of injury was carried out.
                                                                              Results: The home was the most common place for serious injury to
Purpose: A retrospective review of industrial-accident related ocular         occur (32.6%), followed by the workplace (21.4%) and industrial acci-
trauma, from the perspective of the emergency setting of a large tertiary     dents (16.8%). The home was the single most frequent place of injury at
hospital in Singapore.                                                        extremes of age i.e., for the pediatric patients (0-16 years of age) and
Methods: A retrospective analysis of patients seen by the ophthalmology       geriatric patients (more than 60 years). In young adults, work place and
department at Tan Tock Seng Hospital’s emergency service (on week-            industrial accidents was the most frequent cause of injury, followed
ends and after office hours on weekdays) over a 6-month period (March         by assault (15.6%) and road traffic accident related injuries (13.6%).
to Sept 2006) was performed. This did not include patients who were           The most frequent type of injury was a blunt injury (64.3%). Only three
seen directly at the Ophthalmology outpatient clinic during office hours.     percent of all injuries were bilateral. Males were more frequently affected
Data on clinical presentation, type of work and cause of injury, use of       (73.2%) as compared to females.
protective eye wear and subsequent losses of days-of-work were                Conclusions: Male are more prone to serious ocular trauma, serious ocular
collected via a standardized telephone interview and review of case-          trauma frequently occurs at home and the young and the elderly are par-
sheets.                                                                       ticularly at risk. This represents a significant change in the epidemiology
Results: A total of 300 persons presented with a diagnosis of industrial      of serious ocular trauma and has important implications for prevention of
accident related ocular trauma, out of the 1460 patients seen during the      ocular trauma. Health and safety strategies specifically aimed at pre-
study period (20.5%). 95.7% were non-residents and average age was            venting eye injury should now include the home as a high-risk environ-
31 years old. These were mainly males (99.3%). 66.0% were provided            ment in addition to the work place and industries. Young adult male group
with protective eyewear while 44.7 % were provided with protective            who are the most productive segment of the society are more prone for
eyewear but were non-compliant. Common reasons cited were: ill-fitting        serious ocular morbidity should be the target group and the national health
protective eyewear and poor vision due to fogging from sweat. The             strategies for accident prevention & emergency management should be
most common types of injuries were superficial foreign body (71.3%),          endorsed in National Programme for Control of Blindness. Pediatric age
chemical injury (10%) and blunt trauma (4%), while severe injury              group should again be targeted for and children should be prevented from
requiring admission and EOT occurred in 15 cases (5 %). Average loss of       serious household injuries and injuries sustained while playing; by proper
days of work was 3.4 days.                                                    school education and through media awareness. Those involved in im-
Conclusions: Industrial accident related ocular trauma comprises a            plementing the national accident prevention strategy should be aware of
relatively large proportion of the patients requiring ophthalmic review at    this, for in this process it is possible that some serious eye injuries may
the emergency service level in Singapore. These patients are mainly young     also be prevented.
non-resident men and were generally minor. These however, are largely
preventable with the use of well fitting protective eyewear and strict com-
pliance on use of eyewear. This would greatly reduce the unnecessary          515-B156
loss of workdays. There is thus a need to review the design and reinforce     THE INFLUENCE OF INJURY CHARACTERISTICS
the strict implementation of occupational eye safety programs, especially     AND TIMING OF PRIMARY SURGICAL REPAIR ON
among non-resident workers.                                                   VISUAL OUTCOME IN OPEN GLOBE INJURY

                                                                              S.M. GEORGE1, G.J. MANAYATH2, B. MAHESHWAR1, K.G. AU EONG1
                                                                               Alexandra Hospital, Singapore, SINGAPORE, 2Aravind eye Hospital, Coimbatore,

                                                                              Purpose: To study the influence of injury characteristics and timing of
                                                                              primary surgical repair on the visual outcome in open globe injury.
                                                                              Methods: Seventy-five consecutive cases of open globe injury repaired
                                                                              surgically over a period of one year at the Aravind Eye Hospital, India,
                                                                              were retrospectively analyzed. Data collected included demographic

188                                                                                                Asian J Ophthalmol. 2007 Vol 9 No 1 Supplement 1
                                                                                                                                    Poster Abstracts

details, nature of injury and the initial and final best-corrected visual acu-   518-B159
ity (VA). All injuries were categorized according to the classification pro-     BODY MASS INDEX AND ITS EFFECTS ON RETINAL
posed by the Ocular Trauma Classification Group. (Am J Ophthalmol 1997;          VESSEL DIAMETER IN A 6-YEAR OLD POPULATION
123:820-31). The VA was graded as 1. >20/40. 2. 20/50 to 20/100.3.
19/100 to 5/200. 4. 4/200 to light perception (PL). 5. No light perception       B.T. TAYLOR1, E. ROCHTCHINA1, J. WANG1, T.Y. WONG2, S. HEIKAL3,
(NPL). The Zone of Injury included. I: Isolated to cornea (including the         S. SAW4, P. MITCHELL1
corneo-scleral limbus). II: Limbus to a point 5 mm posterior to the sclera.      1
                                                                                  University of Sydney, Sydney, AUSTRALIA, 2University of Melbourne, Victoria,
III: Posterior to the anterior 5 mm of sclera. and the cases were grouped        AUSTRALIA, 3University of Sheffield, Sheffield, UNITED KINGDOM, 4National
as. Positive: Relative Afferent Pupillary Defect (RAPD) present in affected      University of Singapore, Singapore, SINGAPORE
eye. Negative: RAPD absent in affected eye In addition, the cases were
categorized into 3 groups based on the time interval from injury to the          Purpose: To examine the relationship between body mass index (BMI),
primary surgical intervention: Group I (<24 hours), Group II (24-36 hours)       weight and other anthropometric measures and retinal vessel diameter
and Group III (> 36 hours). The groups were compared with each other             in 6-year old children.
with respect to the various parameters studied. Chi square test was used         Methods: A cross-sectional study examined a random cluster sample
for the comparison of categorical data. A p value of <0.05 was consid-           of 1740 6-year-old school children residing in the Sydney metropolitan
ered significant.                                                                area, Australia, during 2003-4. Digital retinal photographs were used to
Results: On analysis, statistically significant association were found be-       measure retinal vessel diameter using computer-assisted grading.
tween the presenting VA (p <0.05), zone of injury (p<0.05) and presence          Anthropometric measures including weight, height, waist circumference,
of a relative afferent pupillary defect (p<0.001) with the final visual          BMI and body surface area (BSA) were measured and defined using stand-
outcome. Cases that presented with better VA preoperatively, zone of in-         ardized protocols. Data on confounders including axial length, refraction,
jury grade I and absent relative afferent pupillary defect had a better visual   ethnicity, birth parameters and blood pressure were similarly collected.
outcome. No significant difference in the postoperative VA was found             Results: Of 1740 children examined, 1608 had complete data. Mean
between the early and late repair groups (p>0.05).                               BMI was 16.2 kg/m2 (± 2.1 SD), and mean retinal arteriolar and venular
Conclusions: The presenting VA, zone of injury, and presence of a rela-          diameters were 159.6 mm (± 14.0 SD) and 222.3 mm (± 18.4 SD),
tive afferent pupillary defect were associated with a better final visual        respectively. After controlling for age, sex, ethnicity, axial length, birth
outcome following surgical repair of open globe injury. Timing of inter-         weight and mean arterial blood pressure, children with BMI above the

                                                                                                                                                                     POSTER ABSTRACTS
vention does not significantly alter the visual outcome. Though a larger         cardiovascular risk threshold had mean retinal venular diameter 2.1 mm
case series is warranted for a more definitive conclusion.                       larger than those with BMI values below this threshold (p=0.026).
                                                                                 Increasing weight and BSA were also positively associated with wider
                                                                                 retinal venules. Children with waist circumference above the cardiovas-
517-B158                                                                         cular risk threshold had retinal arteriolar diameter 1.8 mm smaller than
COMPARATIVE EVALUATION OF SINGLE STAGE OR                                        those below the threshold. Children in the highest quartile of BMI
TWO STAGE MANAGEMENT OF CORNEAL TEAR                                             had retinal arteriolar diameter 2.2 mm smaller than those in the lowest
WITH TRAUMATIC CATARACT                                                          quartile. However, children in the highest quartile of height had retinal
                                                                                 arteriolar diameter 3.6 mm larger than those in the lowest quartile.
R.K. CHOWDHURY, K.C. TUDU, D.N. BHUYAN                                           Conclusions: Greater BMI, weight and BSA were associated with wider
V.S.S.Medical College, Burla, Sambalpur, Orissa, 768001, INDIA                   retinal venules, while larger waist circumference was associated with
                                                                                 narrower retinal arterioles in children aged 6 years.
Purpose: To compare the surgical outcome of corneal tear repair with
ECCE and PCIOL implantation done as a single procedure or two stage
procedure.                                                                       519-B160
Results: Of the 16 eyes, 7 underwent single stage procedure (group 1)            10-YEAR CUMULATIVE INCIDENCE AND
and 9 underwent two stage procedure (group 2). The major complica-               PROGRESSION OF EPIRETINAL MEMBRANES AND
tions were corneal edema (71.43%) in group 1 and PCO (55.56 %) in                ASSOCIATED FACTORS: THE BLUE MOUNTAINS
group 2. The BCVA of >6/18 was seen in 85.71% in group 1 and 77.78%              EYE STUDY
in group 2 postoperatively.
Conclusions: The visual outcome in single stage procedure may be                 B. SHAHARUDDIN1, E. ROCHTCHINA2, P. MITCHELL3, J. WANG4
considered as good as two stage procedure in selected cases and single           1
                                                                                  Universiti Sains Malaysia, Kubang Kerian, Kelantan, MALAYSIA, 2Centre for Vision
stage procedure is also cost effective and facilitates early visual              Research, Department of Ophthalmology, University of Sydney, Westmead Hospital,
rehabilitation.                                                                  Westmead, Sydney, AUSTRALIA, 3Centre for Vision Research, Department of
                                                                                 Ophthalmology, University of Sydney, Westmead Hospital., Westmead, Sydney,
                                                                                 AUSTRALIA, 4Centre for Vision Research, Department of Ophthalmology, Univer-
                                                                                 sity of Sydney, Westmead Hospital, Westmead, Sydney, AUSTRALIA

                                                                                 Purpose: To describe the 10-year cumulative incidence and progression
                                                                                 of epiretinal membranes in a defined older population.
                                                                                 Methods: Detailed eye examination including stereoscopic retinal photo-
                                                                                 graphy were conducted. Epiretinal membranes were diagnosed from grad-
                                                                                 ing of baseline, BMES II and BMES III stereoscopic retinal photographs.
                                                                                 Results: Incident epiretinal membranes were found in 192 eyes of 2119
                                                                                 participants, 11.1%; (95% [CI] 9.7-12.7, bilateral in 21.9%. The incidence

Asian J Ophthalmol. 2007 Vol 9 No 1 Supplement 1                                                                                                             189
Poster Abstracts

rates for cellophane macular reflex, CMR and preretinal macular fibrosis,             measured by non-contact tonometry on both eyes.
PMF were 7.3% and 3.8% respectively. The incidence rates increased                    Results: In this population, the mean retinal arteriolar caliber was
significantly with age with p value for trend of 0.009. Incidence rate was            154.5 µm (95% confidence interval [CI], 153.1-155.9) and venular caliber
20.9% for 135 participants who were at 2.5-fold higher risk to develop                was 223.5 µm (95% CI, 221.6, 225.4). The mean IOP was similar across
these lesions in the second eye. Incidence of “secondary” causes                      all quartiles of arteriolar and venular calibers (p for trends >0.05). In
was higher than the “idiopathic group”, with the cumulative incidence of              multivariate analysis adjusted for age, gender, body mass index, axial
17.4%. Epiretinal membranes were found in 26 incident cases in partici-               length, birth weight and mean arterial blood pressure, there was no
pants with previous cataract surgery, OR 2.3; [CI] 1.5-3.7, p <0.001.                 statistically significant change in IOP with each standard deviation
Conclusions: This study provides useful information on the long-term                  increase in retinal vascular caliber.
incidence and the natural history of epiretinal membranes in an older                 Conclusions: Our study provides no evidence of a cross-sectional
Australian population.                                                                association between retinal vascular calibers and IOP in healthy young
                                                                                      Chinese children.

IS RETINAL VASCULAR CALIBER RELATED TO                                                521-B162

K.B. DE HASETH1, N. CHEUNG1, F.M.A. ISLAM1, S.M. SAW2, P. MITCHELL3,                  A.P. GINSBURG
T.Y. WONG1                                                                            Vision Sciences Research Corp, San Ramon, CA, UNITED STATES OF AMERICA
 Centre for Eye Research Australia, Melbourne, AUSTRALIA, 2Singapore Eye
Research Institute, National University of Singapore, SINGAPORE, 3Centre for          Purpose: To determine changes in visual quality from changes in con-
Vision Research, the University of Sydney, NSW, AUSTRALIA                             trast sensitivity. ANSI and ISO standards are emerging for sine-wave
                                                                                      grating contrast sensitivity (CS) based on FDA Device Group Guidelines:
Background: The vascular pathogenesis of glaucoma is incompletely                     3, 6, 12 and 18 cpd for 85 cd/m2 (photopic); 1.5, 3, 6 and 12 cpd for
understood. Variations in retinal vascular caliber have been associated               3 cd/m2 (mesopic). A functionally significant loss in CS is defined as
with glaucoma.                                                                        > -0.3 log units for two or more spatial frequencies. However, there
Purpose: We examined the relation of retinal vascular caliber with intraocular        can be a significant loss of image quality with CS changes less than 0.3
pressure (IOP), an important risk factor for glaucoma, in children.                   log units (1). CS filtered pictures based on these standards are used to
Methods: A school-based, cross-sectional study of 386 Chinese children                explore visual quality.
aged 7 to 9 years who participated in the Singapore Cohort study Of the               Methods: Pictures are spatially filtered using EyeView Vision Analysis
Risk factors for Myopia (SCORM). Retinal vascular caliber was measured                software (VSRC, San Ramon, CA) using average CS data as a control. CS
from retinal photographs using a computer-based program and combined                  data is then increased and decreased from the control CS data in various
to provide average calibers of arterioles and venules in that eye. IOP was            combinations of one or more + 0.15 log units at various spatial frequencies.

Table. 1 Abstract 520-B161. Relationship of intraocular pressure (IOP) and cup-to-disc ratio (CDR) with retinal vascular caliber
                                               N                                                       Intraocular Pressure (mmHg)
                                                                      Mean (95%CI) (adjusted for age and gender)                   P (value for trend)
    Retinal arteriolar caliber (µm)          386
      1st Quartile, <149.9                   117                                      17.6 (17.2, 18.1)                                   0.50
      2nd Quartile, 149.9-155.7               94                                      17.1 (16.6, 17.6)
      3rd Quartile, 155.7-165.7               90                                      17.3 (16.8, 17.9)
      4th Quartile, >=165.7                   85                                      17.3 (16.7, 17.8)
    Retinal venular caliber (µm)             386
      1st Quartile, <213.0                   115                                      17.5 (17.0, 17.9)                                   0.28
      2nd Quartile, 213.0-225.0               88                                      17.6 (17.1, 18.2)
      3rd Quartile, 225.0-236.7               90                                      16.9 (16.4, 17.4)
      4th Quartile, >=236.7                   93                                      17.3 (16.8, 17.8)

Table 2 Abstract 520-B161. Relationship of IOP and cup-to-disc ratio with retinal vessel calibers
                                                                                                            Intraocular Pressure (mmHg)
                                                                                    Mean Difference (95% CI) [Beta coefficient of                    P
                                                                                  intraocular pressure in linear regression models.]
    Retinal arteriolar caliber per SD (13.9 µm) increase
      †Model 1 (Adjusted for age and gender)                                                        -0.11 (-0.37, 0.14)                            0.38
      ‡Model 2 (Adjusted for Model 1 plus BMI, axial length, birth weight)                          -0.14 (-0.44, 0.17)                            0.39
      §Model 3 (Adjusted for Model 2 plus mean arterial blood pressure                              -0.12 (-0.46, 0.21)                            0.48
      [only measured in 259 children])
    Retinal venular caliber per SD (18.7 µm) increase
      †Model 1 (Adjusted for age and gender)                                                        -0.20 (-0.45, 0.05)                            0.44
      ‡Model 2 (Adjusted for Model 1 plus BMI, axial length, birth weight)                          -0.21(-0.55, 0.14)                             0.14
      §Model 3 (Adjusted for Model 2 plus mean arterial blood pressure                              -0.18 (-0.56, 0.20)                            0.34
      [only measured in 259 children])

190                                                                                                         Asian J Ophthalmol. 2007 Vol 9 No 1 Supplement 1
                                                                                                                                    Poster Abstracts

The resulting filtered pictures are visually examined for changes in image          Methods: We conducted a case-control study to compare quality of life
quality. Image quality is defined as change in contrast and sharpness               differences between patients that developed endophthalmitis after cata-
(excluding spatial distortions for this study).                                     ract surgery and those that had uncomplicated surgery. The National Eye
Results: CS gain or loss of > 0.15 log units (+ one patch on the FACT CS            Institute VFQ-25 questionnaire was used to compare quality of life be-
chart (Stereo Optical Co, Chicago, IL) over one or more spatial frequen-            tween cases and control. Linear regression was used to model differ-
cies results in a visually significant gain or loss of image quality: contrast      ences between cases and controls in the scores derived from these
if the change is at the lower spatial frequencies; sharpness if the change          instruments after adjusting for potential confounding by age and gender.
is at the higher spatial frequencies.                                               Results: A total of 19 cases were compared to 29 controls. After adjust-
Conclusions: Spatially filtered images using standard sine-wave CS data             ing for age and gender, the mean composite VFQ-25 score was 11%
can be used to examine changes in visual quality due to changes in CS               lower in patients that developed endophthalmitis than the control group
from visual disease, drugs, lenses and refractive surgery. *CR                      (p=0.01). The general vision (p=0.007), near vision (p=0.005), distance
                                                                                    vision (p=0.04), peripheral vision (p=0.007), mental health (p=0.02) and
                                                                                    role difficulties (p=0.02) subscales were all significantly lower in
522-B163                                                                            endophthalmitis patients. No significant differences were found for the
INTRAINDIVIDUAL COMPARISON OF FUNCTIONAL                                            ocular pain, social functioning, or driving subscales.
VISION AND HIGH-ORDER ABERRATIONS AFTER                                             Conclusions: Endophthalmitis after cataract surgery reduces quality of
IMPLANTATION OF SPHERICAL AND ASPHERICAL                                            life in certain aspects of vision that also impacts upon psychological well-
INTRAOCULAR LENSES                                                                  being and the ability to maintain their role in daily life.

P.Y. SU1, F.R. HU2
 Far-Eastern Memorial Hospital, Taipei, TAIWAN, 2National Taiwan University         524-B165
Hospital, Taipei, TAIWAN                                                            WHY DOES AUSTRALIA NEED A NATIONAL
                                                                                    TRACHOMA SURVEILLANCE UNIT?
Purpose: To compare intraindividually the effects of an aspherical
intraocular lens (IOL) (Tecnis Z9000, AMO Corp.) with conventional                  B. TELLIS, J.E. KEEFFE, H.R. TAYLOR
spherical IOL (Acrysof single-piece SA60AT, Alcon Corp.) on functional              Centre for Eye Research Australia, Department of Ophthalmology, University of

                                                                                                                                                                    POSTER ABSTRACTS
vision and high-order aberrations.                                                  Melbourne, East Melbourne, VIC, AUSTRALIA
Methods: In this prospective study, 17 patients presenting for cataract
surgery were randomly assigned to receive a spherical IOL (Alcon                    Purpose: Trachoma is a public health problem in Australia as it remains
Acrysof one-piece) in one eye and an aspherical IOL (AMO Tecnis) in the             hyper-endemic (>20%) in many remote indigenous populations and
contralateral eye. The patients were followed for three months                      is the leading cause of infectious blindness. It is necessary to review
postoperatively. The results of sine-wave grating contrast sensitivity,             existing data of the prevalence of trachoma in remote areas of Australia
contrast acuity under mesopic and photopic conditions, and high-order               to determine the need for a National Trachoma Surveillance Unit.
aberrations (HOAs)(3rd-, 4th-, 5th-order, primary spherical and total) root-        Methods: We reviewed data collected 30 years ago, from the 1990s, and
mean-square (RMS) were compared intraindividually.                                  recent data to obtain a pattern of active trachoma in children <10 years
Results: The contrast acuity in all eyes was greatly decreased under low            of age in Australia. Active trachoma refers to the presence of ‘follicular’
contrast and mesopic condition, but here was no statistically significant           trachoma (TF). Thirty years ago the National Trachoma Eye Health
difference between two IOL groups. The sine-wave contrast sensitivity               Program (NTEHP) examined over 100,000 children and adults in rural and
test was slightly better in Tecnis group in spatial frequency of 1.5, 3, 6,         remote Australia to record the status of eye health. In 1996 data were
12 cpd, but no statistically significant difference. The postoperative              collected from five rural communities that had been visited by the NTEHP
corneal HOAs were not different significantly between two IOL groups.               to compare prevalence. Between 1989-2002 data collected from the
For ocular wavefront HOAs, the total HOA, coma, 4th-order and primary               Northern Territory (NT), Western Australia (WA) and South Australia (SA)
spherical aberrations were significantly lower in Tecnis group.                     reported prevalence of trachoma in selected communities.
Conclusions: In comparison to spherical IOLs, Tecnis IOLs reduced                   Results: The NTEHP (1976-1979) reported a prevalence of active tra-
total, coma and spherical aberration significantly at pupil diameters of            choma in children ranging from 19% to 64%; children in the driest areas
6 mm. The aspherical lens yielded better contrast sensitivity in all spatial        of the country had the highest levels of active trachoma. Twenty years
frequency, but the difference was not considered statistically significant.         after the NTEHP, a high prevalence of trachoma, ranging from 19% to
Further investigation for relationship between high order aberration and            66% continued to be found in five areas that were previously visited by
visual performance must be done.                                                    that program. In NT, WA and SA active trachoma prevalence in children
                                                                                    continued to be found, ranging from 11% to 55% (1989-2002).
                                                                                    Conclusions: Australia is the only developed country that still has
523-B164                                                                            hyper-endemic trachoma. These data show that little change has occurred
QUALITY OF LIFE AFTER POSTOPERATIVE                                                 in prevalence rates of active trachoma within the last 30 years. A national
ENDOPHTHALMITIS                                                                     trachoma surveillance unit to monitor prevalence and management of
                                                                                    active trachoma in children could assist in eliminating trachoma in
J.B. SEMMENS1, J.Q. NG1, N. MORLET2                                                 Australia.
 The University of Western Australia, Nedlands, AUSTRALIA; 2Royal Perth Hospital,

Purpose: To determine if postoperative endophthalmitis adversely affects
quality of life.

Asian J Ophthalmol. 2007 Vol 9 No 1 Supplement 1                                                                                                            191
Poster Abstracts

525-B166                                                                             Methods: 22 eyes of 22 patients were enrolled. 1000 or 5000 centistokes
DIAGNOSIS OF CHLAMYDIA TRACHOMATIS                                                   silicone oil removed with 25-gauge sutureless technique. A new 25-gauge
OCULAR INFECTION IN TRACHOMA-ENDEMIC                                                 microcannula and aspiration line system is designed and used in this
COMMUNITIES BY RRNA AMPLIFICATION                                                    study. The efficacy and safety of the technique is evaluated.
                                                                                     Results: In all eyes, 1000 (n:15), and 5000 (n:7) centistokes silicone oil
J.L. YANG1, J. SCHACHTER2, J. MONCADA2, W. ALEMAYEHU3, T. LEKEW3,                    was removed completely. Mean silicone-oil removal time was 2.53 +/-
J.I. HOUSE1, K.C. HONG1, M.D. NEUWELT1, Z. ZHOU1, T.M. LIETMAN1                      0.78 minutes for 1000 cst and 6.57+/-0.85 minutes for 5000 cst silicone
  F.I. Proctor Foundation, University of California, San Francisco, San Francisco,   oil. Endolaser photocoagulation (n:8) and membrane peeling(n:5) were
CA, UNITED STATES OF AMERICA, 2Department of Laboratory Medicine, University         also performed. The patients were followed-up for a mean period of
of California, San Francisco, San Francisco, CA, UNITED STATES OF AMERICA,           4.2+/-1.32 months. No leakage was observed postoperatively. Best
  ORBIS International, Addis Ababa, ETHIOPIA                                         corrected visual acuity improved in all eyes. A decrease in IOP was
                                                                                     detected on postoperative day one, which did not cause any complication.
Purpose: Trachoma remains the leading infectious cause of blindness                  In one eye, redetachment occurred during follow-up that needed
worldwide, and continues to be the target of a global effort by the World            revitrectomy. There were no other complications.
Health Organization (WHO) to eliminate the disease as a public health                Conclusions: Active aspiration of silicone oil through pars plana using
concern by the year 2020. A major component of trachoma-control pro-                 25-gauge sutureless instruments is an easy, quick and safe technique.
grams is community-wide antibiotic treatment aimed at reducing the                   Any additional vitreoretinal intervention can be performed as needed with
prevalence of active disease. In order to accurately assess the success of           25-gauge equipment. Sutureless surgery reduces trauma and patient
antibiotic distributions it is essential to have a diagnostic test that can          discomfort.
correctly measure the true status of ocular Chlamydia trachomatis infec-
tion in individuals. Currently, DNA-based nucleic acid amplification tests
(NAATs) are used to detect infection. Some believe that newer ribosomal              527-B168
RNA (rRNA) amplification tests may be much more sensitive since bacte-               ROLE OF SCHOOL TEACHERS AS FIRST LINE
rial rRNA is present in amounts up to 10,000 times that of genomic DNA.              INVESTIGATORS OF EYE PROBLEMS IN SCHOOL
Others have suggested that rRNA-based tests are instead less sensitive,              SCREENING PROGRAMME
due to the presence of dead or subviable organisms that the test may not
detect. rRNA-based tests have been shown to possess superior sensitiv-               R. KRISHNA K, B.B N
ity and comparable specificity as compared to polymerase chain reaction              Shree Sharadadevi Eye Hospital & Research Centre, Pavagada, INDIA
(PCR) for detecting genital chlamydial infection. However, they have not
been well-studied for detection of ocular infection. This study compares             Purpose: To study the role of school teachers as first line investigators of
an rRNA amplification test to PCR for the detection of ocular C. trachomatis         eye problems in school screening pogramme in Pavagada and Madhugiri
infection in children living in trachoma-endemic villages.                           Talukas of Tumkur Dist, Karnataka, India.
Methods: An rRNA-based amplification test and PCR were performed                     Methods: An eye screening program being conducted from June 2006
on swab specimens taken from the right upper tarsal conjunctiva of                   and to be continued till October 2006 for a period of five months. Subject
240 children aged 1-5 years living among 16 endemic villages in the                  population being all primary school children of Pavagada and Madhugiri
Gurage Zone, Ethiopia. For each village, 15 children were randomly                   Talukas of Tumkur Dist. 3 teachers of each primary school were trained
selected for inclusion in the study from a census of all children aged 1 to          to collect relevant history, to use Snellen’s chart and torch light examina-
5 years living in the village.                                                       tion to detect Bitot’s spots. These trained teachers were asked to do
Results: The rRNA amplification test detected ocular C. trachomatis                  the school survey and fill the necessary form. An optometrist would visit
infection in 142 (59%) subjects compared with 67 (28%) detected by                   the concerned school and repeat the examination. Referred cases were
PCR (McNemar’s test, p < 0.0001). The rRNA-based test gave positive                  followed up at our hospital with slit lamp examination, refraction, fundus
results for all subjects that were positive by PCR, and also detected                examination, squint work-up as required. Results of optometrist and school
infection in 75 (31%) additional subjects.                                           teachers were compared.
Conclusions: The rRNA-based test may have significantly greater                      Results and Conclusions: Preliminary data suggest that trained teachers
sensitivity than PCR for the detection of ocular C. trachomatis infection in         were able to detect 90-95% of cases that were finally referred to the
children in trachoma-endemic villages. rRNA amplification may allow us               base hospital.
to detect infection that was previously missed with PCR. Past studies
using DNA-based tests to assess prevalence of infectious trachoma could
have underestimated the true prevalence of infection. *CR                            528-B169
                                                                                     AGE RELATED DECLINE OF MITOCHONDRIAL
                                                                                     FUNCTION AND APOPTOSIS IN HUMAN CLEAR LENS
ACTIVE SILICONE OIL REMOVAL WITH 25-GAUGE                                            R.F. SITOMPUL1, N.C. SIREGAR2, T.D. GONDHOWIARJO1, H.A. SUDOYO2,
SUTURELESS VITRECTOMY INSTRUMENTS                                                    S. MARZUKI2
                                                                                         Department of Ophthalmology University of Indonesia, Jakarta, INDONESIA,
N. ACAR, Z. KAPRAN, Y.B. UNVER, T. ALTAN                                             2
                                                                                         Eijkman Institute for Molecular Biology, Jakarta, INDONESIA
Beyoglu Eye Research and Training Hospital, Istanbul, TURKEY
                                                                                     Purpose: To investigate the possibility of age related mitochondrial change
Purpose: To report a new, sutureless technique to remove 1000 and 5000               in the lens epithelial cell which are one of the most exposed group of
centistokes silicone oil by active suction, using newly designed 25-gauge            cells to UV light as part of the normal function of the eye. Human lens
microcannulas.                                                                       epithelial cells were examined for the mitochondrial OXPHOS function,

192                                                                                                        Asian J Ophthalmol. 2007 Vol 9 No 1 Supplement 1
                                                                                                                               Poster Abstracts

mtDNA deletion, ultra-structural changes and frequency of apoptosis.            also prevented aggregation and insolubilization of lens proteins due to
Methods: The cells were obtained from high myopia patients underwent            hyperglycemia.
clear lens extraction without any systemic or other ocular diseases with        Conclusions: The results thus indicate that tannoids of Emblica might be
age range from 10-56 years (n=24). Nicotinamide dinucleotide tetrazolium        helpful in delaying diabetic cataract.
reductase (NADH-TR) activity was examined histochemically and
staining intensity was measured with NIH Image-J. Detection of mtDNA
“common” deletion was carried out by long cycle PCR. In situ cell death         530-B171
detection of lens epithelial cells was performed by TUNEL (terminal             ROLE OF N-TERMINAL DOMAIN IN ALPHA B-
deoxynucleotidyl transferase-mediated d-UPT nick end labeling) and              CRYSTALLIN OLIGOMERIZATION: A CYSTEINE
confirmed by DNA fragmentation assay. Ultra-structural changes of the           MUTAGENESIS STUDY
lens epithelial cells and their mitochondria were studied with electron
microscopy.                                                                     K. SHARMA, S. PUTTUR, R. MURUGESAN
Results: We found no aged related decline of the mitochondrial respira-         University of Missouri, Columbia, MO, UNITED STATES OF AMERICA
tory function but instead the NADH-TR activity was found to be decreased
in higher myopia. Consistent with the respiratory enzymes data, no mtDNA        Purpose: Previous studies have shown that several regions in αB-
deletion was observed in all samples. Surprisingly, a high level of apoptotic   crystallin participate in subunit interaction and oligomerization. The
activity was observed, increases with age ranging from 21.2% to 58.3.           purpose of this study was to confirm the role of residues in N-terminal
However we could not found any DNA fragmentation which indicates                region of the protein in subunit interaction.
endonucleolysis activity. Morphological analysis of the clear lens epithe-      Methods: Site-directed mutagenesis was used to replace I5, S19, L23,
lial cell suggested that those cells undergo early sign of apoptosis. The       S35, T42, S59 and S76 in human αB-crystallin with cysteine to generate
nucleus showed mild condensation, deep invagination of nuclear envelope.        single Cys mutants. Additionally, a double mutant, where S19 and S59
The mitochondria’s size varied from 150-250 nm, elongated with fre-             were replaced with Cys was also prepared. The mutant proteins were
quent intramembranous dilatation and multiple focal intra cristae dilatation.   expressed in E. coliBL21(DE3) pLysS cells, purified and analyzed by
However, sign of late stage apoptosis such as more lobulated chromatin,         SDS-PAGE under reducing and non-reducing conditions. The mutations
apoptotic body and cell fragment was not found.                                 were confirmed by sequencing and mass spectrometry. Of these mutants,
Conclusions: Decrease of mitochondrial function was associated with             oxidized and reduced forms of αB-S19C and αB-S59C were also analyzed

                                                                                                                                                             POSTER ABSTRACTS
the degree of myopia and not of age. High proportion of apoptosis was           by Dynamic Light Scattering (DLS) method. The subunit exchange rate
observed and epithelial cell showed early sign of apoptosis.                    of reduced and oxidized αB-S59C was measured by FRET assay of labeled
                                                                                αB-WT and αB-S59C with Alexa 488 and Alexa 350 respectively.
                                                                                Results: αB- I5C, S19C, L23C. S35C, T42C and S59C readily formed
529-B170                                                                        dimers upon storage due to oxidation of Cys residues whereas <10% of
TANNOIDS OF EMBLICA OFFICINALIS DELAY                                           αB-S76C formed dimer under similar conditions. The average molar mass
STREPTOZOTOCIN-INDUCED DIABETIC CATARACT                                        of αB-S19C and αB-S59C in reduced form were 682 kDa and 755 kDa
IN RATS                                                                         respectively. A marginally increased (10 - 15%) molar mass and decreased
                                                                                polydispersity were observed for oxidized forms of αB-S19C and αB-
P. SURYANARAYANA, A. SATYANARAYANA, G.B. REDDY                                  S59C. The FRET studies with oxidized αB-S59C showed a decreased
National Institute of Nutrition, Hyderabad, INDIA                               subunit exchange rate (1.5x10-4/sec) with wild type αB- compared to the
                                                                                reduced form of αB-S59C (2.6x10-4/sec).
Purpose: Earlier we have reported inhibition of aldose reductase (AR) by        Conclusions: I5, S19, L23, S35, T42, S59 and S76 are located at the
the tannoids of Emblica and also prevention of hyperglycemia-induced            subunit interface in αB-crystallin. A single crosslink at the N-terminal
lens opacification in organ culture (Mol Vis, 12;10:148-54). The purpose        domain affects the dynamic state of crystallin subunits.
of this study was to investigate the effect of Emblica and its tannoids on
streptozotocin induced diabetic cataract rat model.
Methods: Diabetes was induced in Wistar-NIN by streptozotocin (STZ)             531-B172
and divided into 3 groups (G II-IV). The control group received only vehicle    UNILATERAL LENS COLOBOMA IN MOYAMOYA
(G I). While G I and G II animals received AIN93 diet, rats in G III, G IV      DISEASE
groups received 2% of Emblica pericarp and 0.2% of tannoids extracted
from Emblica in AIN93 diet, respectively for a period of 8 weeks.               A. MEHROTRA, S. MANDAL, R.S., N.WADHWA, Z.ABBAS, S.GARG
Cataract progression due to hyperglycemia was monitored by slit lamp            AIIMS, New Delhi, INDIA
biomicroscope. At the end of 8 weeks animals were euthanized and de-
termined the activity of AR and estimated sorbitol. We have also assessed       Purpose: To report a 16 year old girl with developmental anomaly of uni-
protein content and crystalline profile.                                        lateral lens coloboma and ipsilateral optic disk anomaly.
Results: Although, both Emblica and tannoids did not prevent the STZ-           Methods: A full ophthalmic examination, cranial magnetic resonance
induced hyperglycemia, slit lamp microscope observations indicated that         imaging and Digital subtraction angiography were performed.
Emblica delayed onset, progression and maturation of cataract, whereas          Results: The patient had disk anomaly not consistent with the previously
tannoids delayed only progression and maturation. Molecular analysis            reported morning glory disk anomaly in the right eye. She had a lens
suggest that Emblica and tannoids treatment appeared to have coun-              coloboma in the right eye with intact zonules .She had history of seizure
tered the hyperglycemia induced osmotic as well as oxidative stress as          and stroke. Cranial magnetic resonance imaging showed bilateral lateral
there was a reversal of changes with respect to polyol pathway and              ventricles and third ventricle hemorrhage. Digital subtraction angiography
oxidative stress (lipid peroxidation, protein carbonyls, reduced glutathione,   demonstrated a pattern in consistence with Moyamoya disease.
and activities of antioxidant enzymes). Further, Emblica and its tannoids       Conclusions: The patient had a syndrome of optic disk anomaly and lens

Asian J Ophthalmol. 2007 Vol 9 No 1 Supplement 1                                                                                                     193
Poster Abstracts

coloboma with carotid circulation anomaly. The recognition of the previ-     Methods: Retrospective review of medical records of 281 consecutive
ously unreported lens coloboma in association with the vascular anoma-       patients, from a semi urban population in South India, who underwent
lies may help in diagnosis and prevention of complications of general        cataract surgery under local anesthesia, from January 2006 to May 2006
anesthesia in Moyamoya disease.                                              . An anesthetist evaluated all patients preoperatively and investigations
                                                                             were ordered only if warranted by the patient’s history or clinical
                                                                             examination. Intraoperative complications and immediate postoperative
532-B173                                                                     complications were noted.
TO AUDIT THE ACCURACY OF BIOMETRY USING                                      Results: The mean age of the patients was 61.95 years (range 23-94),
SRK/II IN PREDICTING THE TARGET POST-                                        with 54.4% females. Of the 281 patients 36.9% had no systemic illness.
OPERATIVE REFRACTION IN SINGAPORE                                            The most common systemic association was hypertension (41.6%),
NATIONAL EYE CENTRE                                                          followed by diabetes mellitus (31.9%), coronary artery disease (12.9%)
                                                                             and bronchial asthma (4.6). Anesthetist’s intervention was required in
L.H. LIM, S.Y. LEE, C.L. ANG                                                 only 3.7 % (10) patient’s pre or intraoperatively. The intraoperative and
Singapore National Eye Centre, Singapore, SINGAPORE                          immediate postoperative complications were comparable to cataract
                                                                             surgeries done with routine preoperative investigations as mentioned in
Purpose: To assess the accuracy of the biometry assessment and               other studies.
the SRK-II formula in predicting the refractive outcome after uneventful     Conclusions: In the absence of specific indications elimination of
cataract surgery by phacoemulsification for eyes within the normal range     preoperative investigations does not significantly increase the risk and
of axial lengths.                                                            outcome of surgery, results in substantial reduction of time lag and cost.
Methods: A retrospective review of 100 consecutive cases of uncompli-
cated phacoemulsification surgery with in-the-bag intraocular lens
implantation that were performed by two surgeons in SNEC from January        534-B175
to September 2005 with at least 1 month postoperative follow-up. Only        EFFECT OF HONAN BALLOON COMPRESSION ON
eyes with axial length greater than or equal to 22.5mm and less than         RETROBULBAR ANESTHESIA IN
24.5mm were included in the study. Eyes with previous intraocular            PHACOEMULSIFICATION
surgeries or macular pathology and post-operative best corrected visual
acuity of worse than 6/12 on Snellen acuity visual chart were excluded.      T. LUNCHAKONSIRIPAN, N. KASETSUWAN, N. PANJUNYA, P. SAHAPATANA
Analysis of the mean prediction error and standard error of the mean was     Chulalongkorn University, Bangkok, THAILAND
performed using the SPSS PC statistical software.
Results: A total of 336 case notes were reviewed, of which 100 patients      Background: Honan balloons have long been used immediately after
(50 from each of two surgeons) met the inclusion criteria and were           retrobulbar anesthesia to deduct preoperative intraocular pressure (IOP)
analyzed. Mean age was 68.3 (range 38 to 88). Male to female ratio was       for several intraocular procedures. Nevertheless, serious complications,
45:55. Majority of the patients were Chinese (84%), the rest being           such as retinal vascular occlusion, sometimes occur consequently.
Malay (7%), Indian (3%) and others (6%). Mean keratometric reading was       Moreover, it is still controversial whether the Honan balloons reduce
43.94 +/- 1.27D (range 40.5 to 46.5D). Mean axial length by contact A-       IOP preoperatively, and the necessity of its use still remains unclear.
scan ultrasonography was 23.38 +/- 0.51mm (range 22.52 to 24.43 mm).         Purpose: To assess the efficacy of Honan balloon compared with no Honan
The mean IOL power used was 21.77 +/- 1.50D (range 18.5 to 24.5).            balloon, in preoperative IOP reduction, patients’ pain scores, surgeon’s
Post-operative best corrected visual acuity ranged from 6/6 to 6/12, with    satisfaction, and complications in planned cataract surgery by phaco-
73% achieving 6/7.5 or better. The error of prediction was calculated by     emulsification technique.
actual post-operative refractive error minus refractive target. Mean error   Design: A prospective, randomized, controlled, clinical trial (equivalent
was +0.25 +/- 0.67 D (range -1.58D to +1.80D), with the standard error       trial).
of mean 0.669. 45% of the patients were within 0.5D of the predicted         Participants: Sixty patients, 1:1 randomization (block of four) who
refractive error and 83% were within 1.0D.The prediction error between       underwent planned cataract surgery by phacoemulsification technique
the two surgeons were compared using Pearson Chi-square test and was         with intraocular lens (IOL) implantation.
not statistically significant (P=0.452).                                     Methods: After conducting retrobulbar anesthesia with a 30-second-
Conclusions: The accuracy of SRK-II in prediction of refractive outcome      manual pressure, a total of 60 eyes were assigned randomly to either
in normal length axial length eyes in our study is comparable with those     Honan balloon of pressure up to 30 mmHg on the eye or no Honan balloon
found in previous studies.                                                   group. Intraocular pressure was measured at 30 seconds to be baseline
                                                                             IOP before intervention, and reassessed at 10 minutes to report changes.
                                                                             Immediately after cataract surgery, complications, patients’ pain scores,
533-B174                                                                     and surgeon satisfaction were recorded.
TITLE: PREOPERATIVE INVESTIGATIONS IN ALL                                    Results: In all 60 cases, the IOPs decreased after 10 minutes of retrobul-
PATIENTS UNDERGOING CATARACT SURGERY - IS                                    bar block from baseline at 30 seconds, however, the reduction didn’t
IT NECESSARY?                                                                differ significantly between two groups (Honan 2.4 mmHg, no-Honan
                                                                             1.5 mmHg, P= 0.41; Ancova test). Also, complications, patients’ pain
R. GANDHI, M. CHETTINALLI, K. MURALI, S. BARATAN, A. RANGARAJAN,             scores, and surgeon satisfaction were not different (pain score P= 0.18,
S. BHARGAV, I. SUNDARRAJ                                                     satisfaction P= 0.19; Mann-Whitney test). Complications, such as peri-
Sankara Nethralaya, Chennai, INDIA                                           bulbar hemorrhage, in Honan equaled no-Honan group= 6.7%, P= 0.69;
                                                                             chi-square test. One patient, who cancelled operation due to retro-
Purpose: To evaluate whether preoperative lab investigations are neces-      bulbar hemorrhage, was not included in evaluation for pain scores and
sary in all patients undergoing cataract surgery.                            satisfaction.

194                                                                                              Asian J Ophthalmol. 2007 Vol 9 No 1 Supplement 1
                                                                                                                                 Poster Abstracts

Conclusions: Regarding preoperative IOP reduction, complications, and          537-B178
satisfaction of patients and surgeons, Honan balloon pressuring on             COMPARATIVE ANALYTICAL STUDY OF
the eye after retrobulbar anesthesia demonstrated no benefit in planned        SURGICALLY INDUCED ASTIGMATISM IN
cataract surgery by phacoemulsification technique with IOL implantation,       SUPERIOR VERSUS TEMPORAL MANUAL SMALL
and could be useless for other intraocular surgeries.                          INCISION CATARACT SURGERY (MSICS)

                                                                               M. KUMARAN1, R. BABU1, V. GANESH2
535-B176                                                                        Hindu Mission Hospital, Tambaram, Chennai, Chennai, INDIA, 2AIIMS, New Delhi,
CHEVRON INCISION- A BREAKTHROUGH IN                                            New Delhi, INDIA
                                                                               Purpose: To evaluate the amount of surgically induced astigmatism in
S. SACHDEVA, M. RATHI, C.S. DHULL, A. MAM                                      temporal versus superior corneo-scleral tunnels in manual small incision
Regional Institute of Ophthalmology, PGIMS, Rohtak, INDIA                      cataract surgery (MSICS).
                                                                               Method: A prospective analytical case series was conducted on 100 eyes
Purpose: To compare the effect of two types of scleral incisions (frown        with senile cataract. They were randomly divided into two groups; in
and chevron) on surgically induced astigmatism in cataract surgery.            one group (n = 50) all surgeries were performed through a 5.5 to 6mm
Methods: 84 patients with cataract having With The Rule Astigmatism            curvilinear superior corneo-scleral tunnel fashioned 1.5 to 2mm from the
were taken up for study. They were equally divided in two groups A             surgical limbus, whereas in the other group (n = 50) all surgeries were
and B. Manual Small incision cataract surgery was performed by the             performed through a 5.5 to 6mm curvilinear temporal corneo-scleral
same surgeon on both the groups. Patients in group A were operated             tunnel fashioned 1.5 to 2mm from the surgical limbus. The patients were
with superior frown scleral incision and those in group B with superior        followed up on day 1,1 week, 4 weeks and 12 weeks postoperatively.
chevron scleral incision. Preoperative and postoperative astigmatism           Correction in keratometric astigmatism, surgically induced astigmatic
was measured using keratometry readings.                                       changes, magnitude and axis of cylinder, spherical equivalent, with and
Results: There was significant decrease in surgically induced astigma-         against the wound change was evaluated.
tism in group B as compared to group A.                                        Results: Temporal sections in MSICS induce surgically induced astigma-
Conclusions: Chevron incision during manual small incision cataract            tism of <1.5 D in 92% of cases as compared to only 12% in superior SICS

                                                                                                                                                                 POSTER ABSTRACTS
surgery significantly reduces the post operative astigmatism as compared       at the end of 12 weeks follow-up. The difference in surgically induced
to the more commonly used frown incision.                                      astigmatism between the two groups was statistically significant. Only
                                                                               8% of pre-op against the rule astigmatism was corrected in superior
                                                                               sections as compared to 48% through temporal tunnels.
536-B177                                                                       Conclusions: A temporal approach to MSICS is best in minimizing
SURGICALLY INDUCED ASTIGMATISM AFTER                                           surgically induced astigmatism and reducing pre-existing against the rule
PHACOEMULSIFICATION: 5.2MM VERSUS 3.2MM                                        astigmatism and reducing the need for astigmatic keratotomy.

A. SOOD, P. SONY                                                               538-B179
Venu Eye Institute and Research Centre, New Delhi, INDIA                       CHANGES IN CORNEAL ASTIGMATISM IN
                                                                               CORNEAL VERSUS SCLERAL SECTION FOR
Purpose: Clear corneal tunnel phacoemulsification via a 5.2mm clear            IMPLANTATION OF AN ACRYLIC FOLDABLE
corneal tunnel incision with rigid intraocular lens implantation continues     POSTERIOR CHAMBER IOL AFTER
to be a common practice at community ophthalmology centers of devel-           PHACOEMULSIFICATION - AN INDIAN STUDY
oping country like India. This prospective study was conducted to com-
pare the surgically induced astigmatism in phacoemulsification via a           M.Y. DHAR, H. SUJITHRA, R. SHANMUGHAM
5.2mm clear corneal tunnel incision with rigid intraocular lens implanta-      Amrita Institute of Medical Sciences and Research Centre, Cochin, Kerala, INDIA
tion and a 3.2mm clear corneal tunnel incision with implantation of a
foldable intraocular lens implantation.                                        Purpose: To evaluate the surgical outcome of phacoemulsification in
Methods: Sixty eyes of 60 patients were assigned alternately to                clear corneal and scleral section.
phacoemulsification via a 5.2mm clear corneal tunnel (Group I, n=30) or        Methods: A prospective study was done at our institute to compare
3.2mm clear corneal tunnel (group II, n=30). The follow-up period was 6        scleral and corneal incisions in patients undergoing phacoemulsification
weeks. Simple substraction and vector method were used to calculate            with foldable lens implantation. It comprised of 60 eyes. Patients were
the final astigmatism from the preoperative and postoperative keratometric     randomly divided into two groups of 30 each based on the incision types
readings. The unpaired two tailed Students t test was used for significance.   [Group I- Scleral incision and Group II- corneal incision]. All patients un-
Results: There was no statistically significant difference in the baseline     derwent routine preoperative assessment. All surgeries were done under
variables in the two groups. The astigmatism at the last follow-up (6 weeks)   local anesthesia with peribulbar block. Vision was checked on the first
was 1.03+/- 0.51 in group I diopters and 0.87 +/- 0.69 diopters in group       postoperative day after one week, after one month. Keratometry was done
II (p=0.40).                                                                   after one week and one month. Visual recovery, peri and post-operative
Conclusions: The surgically induced astigmatism following phaco-emul-          patient comfort, congestion, eyelid drooping, postoperative astigmatism
sification via a 5.2mm clear corneal tunnel incision with rigid intraocular    and postoperative refraction were compared in the two groups. Against
lens implantation and a 3.2mm clear corneal tunnel incision with implan-       the rule astigmatism was with axis 80-1000. With the rule astigmatism
tation of a foldable intraocular lens are comparable with no statistically     was with axis 10-1700.All other axes were taken as oblique astigmatism.
significant difference.                                                        A difference of 0.5D or more was taken as significant corneal astigmatism.

Asian J Ophthalmol. 2007 Vol 9 No 1 Supplement 1                                                                                                         195
Poster Abstracts

All surgeries were done by the same surgeon under peribulbar anesthesia.     540-B181
Incision site is supero temporal quadrant both for the scleral and corneal   SUTURELESS SINGLE PORT
group.                                                                       TRANSCONJUNCTIVAL LIMITED PARS PLANA
Results: Patients with Corneal incision showed a low induced astigma-        VITRECTOMY COMBINED WITH
tism and faster recovery of vision, as compared to the scleral group,        PHACOEMULSIFICATION FOR MANAGEMENT OF
although ultimate visual gain was comparable .None had lid swelling,         CATARACTS WITH SHALLOW ANTERIOR
subconjunctival suffusion or lid droop. In the scleral group healing was     CHAMBER AND HIGH INTRAOCULAR PRESSURE
slower in the sense of mild swelling of lids, droop of upper lid.
Conclusions: Corneal incision in our study lead to lesser surgically         T. DADA, A. AGARWAL, R. GADIA, S. MOHAN, S. KUMAR, R. SIHOTA, V. GUPTA
induced astigmatism. This may be because our incision site was               Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical
Superotemporal and incision was triplanar, made more gently in control-      Sciences, New Delhi, INDIA
lable manner rather than a uniplanar clear corneal one. The triplanar
incision allowed better wound apposition with healing that altered the       Purpose: To report the use of limited sutureless pars plana vitrectomy
corneal curvature minimum, with hydration of the incisions that enabled      to decrease intraocular pressure (IOP) and deepen the anterior chamber
good apposition of the inner wound on the cornea. Also the small size of     to facilitate phacoemulsification in eyes with shallow anterior chamber
the incision alters the curvature minimum in both the groups. Therefore      and very high IOP.
pre-operative evaluation of keratometric astigmatism is important not        Methods: Fifteen patients (8 with phacomorphic glaucoma, 3 with acute
only for calculating IOL power but also planning the incision site and to    angle closure and 4 with chronic angle closure glaucoma) with a visually
control the amount of post-operative astigmatism.                            significant cataract were included. All patients underwent single port 23G
                                                                             transconjunctival sutureless limited pars plana vitrectomy prior to stand-
                                                                             ard phacoemulsification surgery (Figure 1A. showing entry port being made
539-B180                                                                     with MVR blade, Figure 1B. 23G vitrectomy cutter introduced in the eye
SURGICALLY INDUCED ASTIGMATISM IN                                            with the trocar in place). Parameters recorded included best corrected
PHACOEMULSIFICATION VERSUS CONVENTIONAL                                      visual acuity, intraocular pressure, intraoperative problems, trabecular
SICS                                                                         iris angle (TIA) by ultrasound biomicroscopy (UBM) and indirect
                                                                             ophthalmoscopy in the post-operative period.
V. REDDY AETIGADDA, A. RAJ, V. SINGH                                         Results: Mean age of the patients was 52.6 ± 8.4 years. Preoperative
IMS, BHU, Varanasi, INDIA                                                    BCVA was <20/200 in all cases. Mean preoperative IOP was 41.6 ±
                                                                             7.8 mmHg with a closed superior and inferior TIA on UBM. All eyes
Purpose: High astigmatism is an important cause of poor uncorrected          underwent successful phacoemulsification with no intraoperative com-
visual acuity after cataract surgery. The aim of the study is to compare     plications and implantation of a PMMA intraocular lens in the capsular
the astigmatism induced by a superior and temporal incision in manual        bag. Mean postoperative IOP was 13.3 ± 4.2 mmHg on day 1, 14.2 ±
SICS, and to compare the astigmatism induced by clear corneal incision       3.1 mmHg on day 7 and 14.6 ± 3.4 mmHg after 4 weeks. The mean
versus scleral tunnel in phacoemulsification surgery.                        superior TIA was 28.50 ± 9.60 and the mean inferior TIA was 31.20 ±
Methods: Sixty-four eyes of 64 patients (34 Male / 30 Female) with a         8.20 at 1 week follow up. All eyes achieved a best corrected visual acuity
mean age of years (range 45 - 82 years) were included in the study. The      of 20/40 or better at 4 weeks. Indirect ophthalmoscopic screening of
cases were divided into two groups randomly. One group (Group I) had         retina and the sclerotomy site did not reveal any significant abnormality
undergone Manual SICS and the other group (Group II) had undergone           at 4 weeks.
Phacoemulsification. The Manual SICS group patients were randomly            Conclusions: Small gauge sutureless limited pars plana vitrectomy is
allotted into two subgroups depending on the site of incision. Group Ia      an effective technique to reduce positive vitreous pressure, deepen the
received superior incision while Group Ib received temporal incision. The    anterior chamber and facilitate phacoemulsification in eyes with high
Phacoemulsification group (Group II) patients were randomly divided          IOP and a shallow crowded anterior segment.
into two groups depending on the location of the incision. Group IIa re-
ceived clear corneal incision and group IIb received scleral pocket
incision. Informed consent was obtained from all the patients undergoing     541-B182
study. Surgically induced astigmatism is calculated by the subtraction       PHACOEMULSIFICATION IN COLOBOMA
Results and Conclusion: We found significant against-the-rule shift in       M.Y. DHAR
astigmatism in Phacoemulsification group and manual SICS superior            Amrita Institute of Medical Sciences and Research Centre, Cochin, Kerala, INDIA
incision group. The Manual SICS group with temporal incision (Ib) had
with-the-rule shift in astigmatism.                                          Purpose: To elucidate the challenges in doing phacoemulsification
                                                                             including CTR [Capsular tension ring] in a patient with lens and iris
                                                                             Methods: Phacoemulsification was done for done for cataract in both
                                                                             the eyes of a patient with coloboma of the lens, iris, retina; bilateral
                                                                             myopia, microcornea, convergent squint and amblyopia in left eye. Right
                                                                             eye had no zonular support for >180° and in left eye 30° approx. We
                                                                             describe the surgical management of this case with bilateral coloboma
                                                                             with subluxated cataract phacoemulsification with CTR insertion with
                                                                             intraocular lens implantation in capsular bag was done. There was no
                                                                             zonular support for 180° in right eye and 30° in left eye. The difficulties

196                                                                                                Asian J Ophthalmol. 2007 Vol 9 No 1 Supplement 1
                                                                                                                               Poster Abstracts

encountered were unstable bag, trypan blue entering posterior segment          543-B184
and difficult cortical wash with CTR. We also discussed the various            PROGRESSIVE PEROPERATIVE CONJUNCTIVAL
options amongst the CTRs available and their inserting technique.              CHEMOSIS (AN EARLY SIGN OF OCULAR
yopic left eye and while right eye with 6 times less support had good          PERFORATION)
visual recovery.
Conclusions: With availability of phacoemulsification and Capsular             O. MAKHZOUM, M. ABU AIN, M. HERO
Tension Rings (CTR) the prognosis of such patients is no longer grim,          University Hospitals Coventry & Warwickshire, Coventry, UNITED KINGDOM
provided meticulous, alert, careful surgical maneuvers are done.
                                                                               Purpose: To report a previously unreported sign of ocular perforation due
                                                                               to peribulbar block for cataract surgery in a high myopic vitrectomised
542-B183                                                                       eye.
PHACOEMULSIFICATION IN EYES WITH CATARACT                                      Methods: A 62 year-old female underwent a cataract extraction with
AND UVEAL COLOBOMA                                                             intraocular lens implantation in her right eye. This eye previously under-
                                                                               went a vitrectomy with gas for the management of a macula on retinal
A. RANGARAJAN, S. BHARGAVA, D. KOTHARI, R. GANDHI                              detachment. Axial length of her right eye was 26.99 mm. Peribulbar block
Medical Research Foundation, Chennai, INDIA                                    using Lignocaine 2% was performed using 25 guage sharp needle through
                                                                               medial approach. The block was done by an anesthetist with no recorded
Purpose: Cataract surgery in patients with uveal coloboma is challeng-         difficulties or problems. Soon after the phaco probe was inserted into the
ing because of the inherent risks that one can encounter. The purpose of       eye the surgeon became aware of progressive inferonasal chemosis and
this study is to highlight the intraoperative difficulties and postoperative   noted unusual deepening of anterior chamber. Ocular perforation was
outcome in patients undergoing phacoemulsification in eyes with                suspected however surgery was completed successfully. Indirect
cataract and uveal coloboma.                                                   examination was carried out at the end of surgery and it revealed single
Methods: Retrospective chart analysis of 37 eyes of 35 patients with           perforation site inferonasally corresponding with site of local anesthetic
cataract and uveal coloboma who underwent phacoemulsification                  injection. An indirect laser retinopexy was performed around the per-
between September 1996 and May 2005 at a tertiary eye care center in           foration site and the patient was followed up as an out patient for several
Southern India.                                                                weeks.

                                                                                                                                                              POSTER ABSTRACTS
Results: 37 eyes of 35 patients with mean age of 40.21(range 3 to 79           Results: On the first operative day the visual acuity was 6/15 in the
years) had phacoemulsification. Bilateral iris coloboma alone was present      operated eye and the retina was flat with good laser reaction around the
in 12 patients (34.28%). 14 patients (40%) had only one functional eye         break. The patient was followed for 6 weeks and her vision has improved
that was being operated for cataract. Associated ocular features noted         to 6/12 with new glasses. Her retina remains flat with no sub retinal fluid
were microcornea (7 patients), nystagmus (6 patients), squint ( 6 patients)    or PVR changes.
and glaucoma (3 patients). Atypical iris coloboma was noted in only            Conclusions: Progressive conjunctival chemosis can be an early
one patient. 5 eyes (13.51%) had incomplete iris coloboma and 32 eyes          preoperative sign of ocular perforation. In a vitrectomised eye the fluid
(86.48) had complete iris coloboma of which 10 eyes (27.02%) had               can escape the globe to accumulate in the subtenon space around the
choroidal coloboma involving disc and fovea. 6 eyes (16.21%) had prior         eye and cause progressive chemosis. This should prompt a suspicion of
intraocular surgeries like vitrectomy, scleral buckling and wedge              globe perforation so an immediate action to prevent retinal detachment
resection of cornea. The mean axial length was 25.23mm (range 20.44-           can be taken. The subtenon local anesthesia or topical anesthesia
31.48mm). Only 2 eyes (5.40%) had developmental cataract and rest              are safer options in high myopic eyes.
had varying grades of nuclear sclerosis. Intraocular lens implantation
was done in all except 3 eyes (8.1%). 32 eyes (86.48%) had in the bag
IOL implantation. None of the cases required conversion to extracapsular       544-B185
technique. Endocapsular ring implantation was done in 14 eyes (37.83%).        TAMSULOSIN AND IRIS RELATED COMPLICATIONS
2 eyes (5.40%) needed combined trabeculectomy surgery. Posterior               DURING PHACOEMULSIFICATION
capsular rent with vitreous loss was noted in 3 eyes (8.1%). Vitreous loss
from the zone of zonular weakness was noted in 1 eye (2.70%). The mean         T. UNG, C.Y. KANG, D. FARNWORTH
follow up period was 23.37 months. Postoperatively 34 eyes (91.89%)            Eye Unit, Queen Alexandra Hospital, Portsmouth, UK, UNITED KINGDOM
achieved 2 or more Snellen’s line improvement in the visual acuity.
21 eyes (56.75%) achieved visual acuity of 6/15 or better. Causes of           Purpose: Tamsulosin, an alpha-1A antagonist, inhibits the sympathetic
nonimprovement of vision in 3 eyes were each bullous keratopathy,              autonomic nervous system, resulting in the relaxation of smooth muscles
posterior capsular opacity and old retinal detachment.                         contained within vascular walls, urethra, bladder and iris. Iris related
Conclusions: Phacoemulsification is a safe technique in patients with          complications such as poor dilatation and floppy iris during phaco-emul-
iris coloboma. IOL implantation was achieved in-the-bag in majority of         sification have been observed in patients taking tamsulosin. To report the
the patients which maintained its position in long term follow up. The         incidence of iris related complications in patients on tamsulosin during
visual outcome varies and depends on the coexisting ocular associations.       phacoemulsification and to compare this risk with patients not taking
                                                                               Methods: All phacoemulsifications performed between September
                                                                               2004 and October 2005 at the Eye Unit of Queen Alexandra Hospital,
                                                                               Portsmouth was reviewed retrospectively. Patients were divided into
                                                                               2 groups depending on whether they were on tamsulosin at the time of
                                                                               surgery. The incidences and types of intraoperative complications were

Asian J Ophthalmol. 2007 Vol 9 No 1 Supplement 1                                                                                                        197
Poster Abstracts

Results: In total, 3797 eyes were studied. There were 52 eyes of pa-               Methods: Thirty-six residents in a tertiary care setup participated in this
tients taking tamsulosin at the time of surgery. Seven eyes (13.5%) had            questionnaire-based study. On an explained, eight point grading scale,
intraoperative complications of which 4 were iris-related (7.7%) and               all residents noted comfort levels based on their last 20 routine cases,
2 were zonular dehiscence (3.9%). In comparison, of the 3745 eyes of               2nd and 3rd year students also graded complication management com-
patients not on tamsulosin, 120 eyes (3.2%) experienced intraoperative             fort and the 3rd year also graded their overall comfort in difficulty cases
complications, of which 9 (0.2%) were iris related complications and               at their current training stage.
23 (0.6%) were zonular dehiscence.                                                 Results: The respondents were grouped into group 1 (1st and 2nd
Conclusions: Intraoperative complications occurred more frequently                 years, n= 19) and group 2 (3rd year, n= 17). Most difficult step in routine
in patients taking tamsulosin. By identifying such patients pre-operatively,       case of phacoemulsification for group 1 was loading Foldable IOL
precautionary measures can be taken to prevent potentially sight-                  (score 6.05 ± 1.57), followed by nuclear emulsification (Nucl.Emul.) and
threatening complications.                                                         Irrigation - Aspiration (I&A). For group 2 it was Nucl.Emul. (score 3.59 ±
                                                                                   1.42), followed by foldable IOL insertion. Group 2 were significantly
                                                                                   more comfortable in personalizing machine settings, Hydrodelineation,
545-B186                                                                           Nucl.Emul, I&A and foldable IOL insertion than group 1. Most comfortable
COMPARISON OF INGRESS OF BACTERIAL                                                 techniques were trench divide and conquer in group 1 and primary
INNOCULUM INTO THE ANTERIOR CHAMBER                                                horizontal chop in group 2 (p=0.042). The technique which respondents
FOLLOWING BIMANUAL AND MICRO COAXIAL                                               wish to master next were horizontal (group 1) and vertical chopping
PHACOEMULSIFICATION IN RABBITS                                                     (group 2) (p=0.004). Both 2nd and 3rd years found capsular bag dialysis
                                                                                   the most difficult complication (mean scores 6.0 ± 1.9 and 5.75 ± 2.14
D.U. GAJJAR, D. PANDITA, M.R. PRAVEEN, K.JOHAR, A.R. VASAVADA                      respectively). 2nd years had significantly more difficulty with errant
Iladevi Cataract and IOL Research Centre, Ahmedabad, INDIA                         capsulorrhexis, ACIOL placement and repeated Iris Prolapse compared to
                                                                                   3rd years. 3rd year trainees felt that mature senile cataract most difficult
Purpose: To compare the amount of bacterial ingress into the anterior              to manage (score 6.23 ± 1.56) followed by soft cataract and hypermature
chamber from the ocular surface at the end of either bimanual or coaxial           cataract.
phacoemulsification surgery in rabbits.                                            Conclusions: For the first time, subjective assessment of the comfort
Methods: This prospective, randomized experimental study comprised                 level of residents in difficult cases and during management of specific
20 rabbits. Randomization was split evenly between group 1 comprising              intraoperative complications has been done. This can provide insights for
micro coaxial phacoemulsification (MCP) through 2.2mm single plane                 ophthalmology setups to titrate their training programs.
incision, and group 2 comprising bimanual phacoemulsification through
clear corneal 1.2mm incision for phaco tip access and 1.4 mm incision
for irrigating chopper access. At the end of lens removal, 0.5 ml of               547-B188
culture suspension of Staphylococcus epidermidis was instilled on the              VISUALIZATION OF VITREOUS USING DEPO-
ocular surface and kept for two minutes. Aqueous fluid (0.1 ml )was                MEDRONE FOR POSTERIOR CAPSULE RUPTURES
collected from the anterior chamber and subject to microbial viable
count. Non-parametric Mann Whitney U test was used for statistical                 A. TEY1, V. CHADHA2, P.P. KEARNS3
analysis.                                                                          1
                                                                                     Ninewells Hospital and Medical School, Dundee, UNITED KINGDOM, 2Princess
Results: Group 1 resulted in statistically significantly less ingress of           Alexandra Eye Pavilion, Edinburgh, UNITED KINGDOM, 3Queen Margaret Hospital,
bacteria when compared to group 2 (250.0 and 1538.1 CFU/ml,                        Dunfermline, UNITED KINGDOM
respectively; P<0.002) irrespective of presence or absence of wound
distortion.                                                                        Purpose: To report the usefulness and safety of using intracameral
Conclusions: Bacterial ingress occurred in both groups although statisti-          Depo-Medrone to aid in the visualization of vitreous during cataract
cally significantly higher under the bimanual technique. The results of            surgery complicated by posterior capsule rupture.
this study with rabbit eyes does not specifically infer that all corneal           Methods: Retrospective study of 7 patients who had anterior vitrectomy
incision do no seal but that micro coaxial incisions may prevent the               performed using the above technique.
amount of ingress 5 times better over bimanual technique.                          Results: All patients achieved a final best corrected visual acuity of
                                                                                   6/12 or better. Follow-up period was between 1 and 20 weeks with no
                                                                                   evidence of vitreous in the anterior chamber postoperatively. 1 patient
546-B187                                                                           had elevated intraocular pressure day 1 post operatively which was
ASSESSMENT OF DIFFICULTIES FACED BY                                                controlled by week 3. None of the patients had postoperative retinal
RESIDENTS IN ROUTINE AND DIFFICULT                                                 detachment or endophthalmitis. There was no evidence of optic nerve or
PHACOEMULSIFICATION AND IN INTRAOPERATIVE                                          macular toxicity.
COMPLICATION MANAGEMENT AT A TERTIARY                                              Conclusions: This study shows the use of intracameral Depo-Medrone
CARE SETUP IN DEVELOPING WORLD                                                     as a safe and effective alternative method of staining vitreous in the
                                                                                   anterior chamber with no observable complications.
 All India Institute of Medical Sciences, AIIMS, Ansari Nagar, New Delhi, India,
INDIA, 2Centre for Eye Research Australia, Melbourne, AUSTRALIA

Purpose: To analyze the difficulties perceived by residents during
performing routine & difficult phacoemulsification and in managing
specific intraoperative complications.

198                                                                                                    Asian J Ophthalmol. 2007 Vol 9 No 1 Supplement 1
                                                                                                                                    Poster Abstracts

548-B189                                                                         550-B191
Kangnam St Mary’s Hospital, Seoul, KOREA                                         K. JOHAR1, A.R. VASAVADA1, M.R. PRAVEEN1, O. NISHI2
                                                                                  Iladevi Cataract and IOL Research Centre, Ahmedabad, INDIA, 2Nishi Eye Hospital,
Purpose: To evaluate influence of Effective Phacoemulsification Time             Osaka, JAPAN
(EPT) to corneal edema and endothelium in mature cataract.
Methods: We reviewed medical records and divided patients                        Purpose: To detect the presence of live lens epithelial cells in the anterior
(72 eyes) into four groups according to EPT (Group 1: under 1000, Group          chamber of the eye at the end of phacoemulsification.
2:1000~1500, Group 3:1500~2000, Group 4:over 2000). We checked                   Methods: The fluid of anterior chamber was collected from 50 con-
corneal endothelial density and hexagonality change pre and                      secutive cataract patients underwent phacoemulsification at the end of
postoperatively through specular microscopy in each group. We also               intra-ocular lens (IOL) implantation. 30 samples were processed for the
divided patients into two groups according to use of prechopper and              detection of viability of cells by calcein AM - propidium iodide method.
compared endothelial density change in each group.                               Remaining samples were processed for immunofluorescence detection
Results: The mean EPT in each group is respectively 613.4, 1258.65,              of αA-crystallin and vimentin.
2297.62, 3541.69. Corneal endothelial density is significantly decreased         Results: Out of 30 samples collected at the end of surgery, 27 samples
in postoperative period, as EPT increased. Change of hexagonality is             (90%) showed presence of cells either individually or in group. 8 samples
not statistically significant in each group. The decrease of corneal             (26.6%) showed presence of nucleated fiber cells. Total cells observed
endothelial density is lower in prechopping group.                               were 64.70 ± 58.49. Out of these 22.97 ± 18.70 were viable cells and
Conclusions: To decrease damage of corneal endothelium in mature                 41.73 ± 43.19 were dead. Remaining 20 samples which were subjected
cataract phacoemulsification, we should decrease EPT, and use of                 for the immunofluorescence detection of αA-crystallin and vimentin,
prechopper is helpful.                                                           87.75 ± 13.46 cells were positive to αA-crystallin and 90.49 ± 6.87 cells
                                                                                 were positive to vimentin.
                                                                                 Conclusions: Live lens epithelial cells were present in the anterior

                                                                                                                                                                     POSTER ABSTRACTS
549-B190                                                                         chamber at the end of phacoemulsification surgery and IOL implantation.
THE SURGICAL RESULT OF                                                           These LECs may contribute in the development of posterior capsular
PHACOEMULSIFICATION IN EYES WITH SMALL                                           opacification (PCO).

M.H. SONG, M.S. KIM                                                              551-B192
Kangnam St Mary’s Hospital, Seoul, KOREA                                         OUTCOMES IN EYES WITH POSTERIOR CAPSULE
                                                                                 RUPTURE DURING ROUTINE CATARACT SURGERY
Purpose: To evaluate surgical result of phacoemulsification technique
using iris retractor in eyes with a small pupil and to compare surgical          J. NG1, M. ATIF1, B. CHANG1, Y. SUN2, B. HENG2, K.G. AU EONG1
results between small pupil group and control group and also evaluate            1
                                                                                  Alexandra Hospital, Singapore, SINGAPORE, 2Health Services & Outcomes
surgical result according to pupil size.                                         Research, Singapore, SINGAPORE
Methods: This retrospective study included 90 eyes with a maximally
dilated pupil size of 7.0mm or smaller and 90 eyes control group with            Purpose: To determine the short-term outcomes in eyes which sustained
fully dilated pupil in phacoemulsification cataract surgery. We compared         posterior capsule rupture (PCR) during routine cataract surgery.
phacoemulsification time and power, frequency of intra, postoperative            Methods: As part of a clinical audit program, all eyes which had
complication, anterior chamber cell reaction, change of best corrected           PCR during routine cataract surgery were coded and entered into a
visual acuity(BCVA), decrease of corneal endothelial cell density (CD)           database. The case notes of these patients operated from January 2004
according to pupil size between surgical methods with iris retractor             to September 2005 were retrospectively reviewed. Complicated cataracts
and without iris retractor and compared surgical results between small           such as traumatic and subluxated cataracts were excluded.
pupil group and control group.                                                   Results: Out of 1525 cataract surgeries performed by phacoemulsification
Results: There was no difference in BCVA, phaco power x time according           or extracapsular cataract extraction, 28 (1.8%) were complicated by
to pupil size between surgical method with iris retractor and without iris       PCR. Two eyes were excluded from analysis due to incomplete data.
retractor. The surgical results of small pupil group is worse than control       Among the remaining 26 eyes all eyes except one had an anterior
group in use of phaco power x time and decrease of endothelial cell              vitrectomy. 14 (54%) achieved a best-corrected visual acuity (BCVA) of
density and increase of BCVA. And the decrease of endothelial cell den-          6/12 or better between 6 weeks to 3 months postoperatively. Seven
sity with surgical method with iris retractor is statistically significantly     eyes with a postoperative BCVA worse than 6/12 had significant pre-
smaller in groups with pupil size is 3mm or smaller than without iris            existing ocular pathology, which contributed to the poor vision. Upon
retractor(p<0.05).                                                               the exclusion of these 7 eyes, a good visual outcome was attained in
Conclusions: In this study, iris retractor is a useful tool for dilating small   73.7% of patients. Of those with BCVA worse than 6/12, 1 eye had
pupil and also useful for protecting corneal endothelial cell when the           vitreous hemorrhage and 4 eyes were of an indeterminate cause.
pupil size is smaller than 3mm, but the important factor to affect surgical      Conclusions: The majority of eyes that had routine cataract surgery
results such as endothelial cell density and BCVA is preoperative pupil          complicated by PCR had good BCVA in the early postoperative period.
size irrespective of using iris retractor or not.

Asian J Ophthalmol. 2007 Vol 9 No 1 Supplement 1                                                                                                             199
Poster Abstracts

552-B193                                                                            implantation had visual results in terms of BCVA for near and distance
DOCUMENTATION OF POSTERIOR CAPSULAR                                                 that were similar to foldable intraocular lens implantation. The contrast
OPACIFICATION AND INCOMPLETE CELL                                                   acuities that were achieved were better with rollable intraocular lenses,
MIGRATION BARRIER FORMATION BY THINOPYX®                                            probably due to their ultrathin properties.

S. KAUSHAL, G. PRAKASH, S. SEN, R. TANDON                                           554-B195
Dr. RP Centre for Ophthalmic Sciences, New Delhi, INDIA                             INCIDENCE OF CATARACT SURGERY IN A DEFINED
                                                                                    UNITED STATES POPULATION, 1980-2004
Purpose: To report for the first time, documentation in a cadaveric donor
eye of posterior capsular opacification (PCO) and incomplete barrier                J.C. ERIE, S. PATEL, K. BARATZ
effect following implantation of a rollable ThinOptx® intraocular lens (IOL).       Mayo Clinic College of Medicine, Rochester, MN, UNITED STATES OF AMERICA
Methods: Slit lamp evaluation of a cadaveric donor eye received at
our National Eye Bank revealed that the eye had been implanted with a               Purpose: To estimate population-based temporal changes in the
ThinOptX® IOL and was associated with significant PCO. After retrieving             incidence of cataract surgery in a defined United States population.
the corneoscleral button for keratoplasty the globe was fixed in 10%                Methods: Rochester Epidemiology Project databases were used to
formalin. Equatorial cuts were made in the globe and pictures were                  retrospectively identify all primary cataract extractions in Olmsted
taken from the posterior (Miyake Apple) view. Complete iridectomy was               County, Minnesota residents during the 25-year period 1980 through 2004.
then performed exposing the IOL from the anterior (surgeon’s) view and              Cataract surgery incidence rates for each gender and 10-year age
pictures were taken.                                                                group were adjusted to the age and gender distribution of the Olmsted
Results: The IOL was well centered in the bag. A thick (Grade 4) Som-               County population for each year. Trends in incidence rates over time were
mering ring was seen all around the IOL. Centripetal extension of the               estimated by using Poisson regression.
peripheral Sommering ring across the IOL edge margin was also noted.                Results: The 10,245 cataract extractions performed on 7,141 Olmsted
The IOL edge formed only an incomplete barrier against migration of cells           County residents of all ages represented an overall age- and gender-
and PCO formation, as the PCO streaks were seen extending in continuity             adjusted annual incident rate of 511 surgeries per 100,000 residents.
across the IOL edge towards the pupillary axis. The anterior capsule also           The annual age- and gender-adjusted incidence rate of cataract surgery
showed significant fibrosis and distortion of the capsulorhexis margin.             increased from 145 to 838 per 100,000 residents during the study
Conclusions: The edge of the ThinOptX ® IOL seems to be less than                   period, representing an increase of 478%. The average annual incident
satisfactory as a barrier to epithelial cell migration and PCO formation as         rate was greatest in residents 70 years of age and older (3,538 surgeries
demonstrated in this case for the first time. This could have implications          per 100,000 residents). Second eye surgeries nearly doubled in the
of clinical relevance pertaining to long term functional and anatomical             last decade when compared to the previous 15 years.
outcome. Manufacturers of IOLs could consider addressing this issue                 Conclusions: Incident cataract surgery has steadily and substantially
to further improve long term clinical results.                                      increased in our geographically circumscribed United States population
                                                                                    during the 25-year period 1980 through 2004.

COMPARATIVE ANALYSIS OF VISUAL RESULTS                                              555-B196
FOLDABLE INTRAOCULAR LENSES                                                         IN CATARACT SURGERY: APODIZED IOLS VS
                                                                                    MONOFOCAL IOLS
Tirupati Eye Centre, Noida, India, Tirupati Eye Centre, Noida, U.P., India, INDIA   E.M. VINGOLO, P. GRENGA, L. IACOBELLI, D. DOMANICO
                                                                                    University of Rome La Sapienza, Rome, ITALY
Purpose: This study was conducted to compare the visual results in
cases of microphaco with rollable intraocular lens implantation versus              Purpose: Evaluate quality of vision in patients after cataract surgery
phacoemulsification with foldable lens implantation.                                considering that in actual world elderly patients may have requests for
Methods: Patients with Grade 2 or 3 cataract undergoing cataract                    full range sight without spectacles.
surgery were divided into 2 groups which were age and sex matched. In               Methods: 40 patients were selected and randomly divided in two
group A microphacoemulsification with rollable lens (ThinOptX/ Micriol)             groups, apodized or monofocal hydrophobic acrylic IOLs were implanted
implantation was performed in 22 eyes. In Group B phacoemulsification               bilaterally in 20 subjects. Far and near UCVA, contrast sensitivity, glare
with foldable lens (Bausch & Lomb, Akreos) implantation was performed               test, pupillometry, and adattometry were performed 3 months after.
in 22 eyes. The patients’ uncorrected and best corrected distance and               Results: In both groups we reached far UCVA of 20/20 in more than 95%
near visual acuity was measured preoperatively and at 1 week, 3 weeks,              of patients, in the apodized mean near UCVA was 6.38 cp (SD 2.12),
6 weeks, 3 months and 6 months after surgery. Contrast visual acuities              while in monofocal was 36.25 cp (SD 18.77), contrast sensitivity test,
were measured and compa