2009 memoria

Càtedra de Recerca en Oftalmologia "Joaquim Barraquer" - UAB

MEMÒRIA ANUAL Exercici 2009

Càtedra de Recerca en Oftalmologia "Joaquim Barraquer" - UAB

PRESENTACIÓN.......................................................................................... 3 1.

LÍNEAS DE INVESTIGACIÓN EN DESARROLLO ..........................4 1.1 Proyecto Phaco Ersatz ......................................................................................... 4 1.1.1 Aparato para simular la acomodación ex vivo ................................................................. 4 1.2 Calidad óptica del ojo........................................................................................... 6 1.2.1 Cuantificación de la luz dispersa en pacientes capsulotomía YAG .............................. 6 1.3 Diagnostico y tratamiento del queratocono ........................................................ 7 1.3.1 The new waveform parameters from the Ocular Response Analyzer ......................... 7 1.4 Queratoprótesis y cultivo de células limbales...................................................... 8 1.4.1 Proyecto Europeo: Córnea artificial .................................................................................. 8 1.4.2 Cultivo de células limbales .................................................................................................. 9 1.5 Enfermedades congénitas................................................................................... 11 1.5.1 Catarata congénita.............................................................................................................. 11

2. ACTIVIDADES DOCENTES ............................................................... 13 2.1 Tesis de doctorado en desarrollo ........................................................................13 2.2 Trabajos de investigación Máster .......................................................................14 2.3 Formación y cursos .............................................................................................18 2.3.1 Transparency Club Meetings ............................................................................................ 18

3. ACTIVIDADES EN ORGANIZACIONES CIENTÍFICAS ................ 19 3.1 3.2 3.3 3.4

European Association for Vision and Eye Research ..........................................19 Acta Ophthalmologica ....................................................................................... 20 European Vision Institute - Clincal Trials..........................................................21 Redes Temáticas de Investigación Cooperativa................................................ 25

4. PUBLICACIONES ................................................................................28 4.1 4.2

Publicaciones en revistas ................................................................................... 28 Presentaciones en congresos internacionales.................................................... 29

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Càtedra de Recerca en Oftalmologia "Joaquim Barraquer" - UAB

Presentació És un motiu de satisfacció poder-vos presentar de nou la memòria anual de les activitats de la Càtedra de Recerca en Oftalmologia “Joaquim Barraquer” UAB-IUB durant l’any 2009, destacant les publicacions més rellevants. S’han publicat cinc treballs en les revistes més importants en l’àmbit de l’oftalmologia a nivell internacional, en dues de les quals figurem com a primers autors.

En primer lloc, i en una de les publicacions com a primers autors, voldríem esmentar l’estudi sobre la retinopatia diabètica, que és la causa més comuna de pèrdua visual en la població i un dels motius principals de ceguesa a nivell mundial. L’objectiu de l’estudi era avaluar els canvis de la proteïna en el vitri en pacients amb diabetis mellitus de tipus II i retinopatia diabètica, en comparació a un grup control sense diabetis del mateix sexe i edat similar. Es va arribar a la conclusió que la retinopatia diabètica està associada a un canvi específic en moltes de les proteïnes del vitri, la qual cosa pot ser utilitzada com a diagnòstic precoç de la malaltia.

L’altra publicació en què figurem com a primers autors tracta de com descriure la qualitat visual.

Tradicionalment s’ha fet mitjançant les proves d’agudesa visual i sensibilitat al contrast. L’objectiu de l’estudi era avaluar també l’impacte de l’enlluernament. La conclusió va ser que l’enlluernament tenia un valor afegit en l’avaluació de la funció visual – quan es coneix l’agudesa visual, la sensibilitat al contrast té poc valor afegit.

Dos dels estudis com a co-autors han estat publicats conjuntament amb l'Hospital Universitari d'Oslo i tracten el tema del trasplantament de cèl·lules epitelials, cultivades ex vivo a la superfície cornial. És una nova estratègia terapèutica que consisteix a tractar la deficiència de cèl·lules mare limbals, que és la causa de moltes malalties greus en la superfície ocular. En les publicacions esmentades es comenten els temes següents: d’una banda el control de l’esterilitat i emmagatzematge al banc d’ulls a llarg termini de cèl·lules epitelials limbals humanes cultivades per a trasplantament, i de l’altra la comparació de la histologia, perfil de l’expressió gènica i fenotipus de cèl·lules epitelials limbals humanes cultivades.

No voldríem acabar sense esmentar una altra publicació com a co-autors, on es van exposar els resultats de l’estudi següent: assaig clínic prospectiu per avaluar l’eficàcia de la teràpia fotodinàmica en l’hemangioma coroideu circumscrit simptomàtic. Aquest assaig clínic, prospectiu, no aleatori i multicèntric, es va realitzar en 10 centres a Espanya durant l’any 2005. Es va arribar a la conclusió que combinar la teràpia fotodinàmica amb el protocol estàndard per a la degeneració macular associada a l’edat és un tractament eficaç per a l’hemangioma coroideu circumscrit.

Aquest resum indica que la nostra voluntad d’esforç i progressió en el treball d’investigació va assolint objectius més importants any rere any, com la consecució l’any 2010 d’una sala blanca, classe A i B segons zones, per a la realització de cultius cel·lulars i, entre altres, la preparació dels teixits donants del banc d’ulls, d’acord amb les noves perspectives més exigents de la Unió Europea.

Els presentem aquesta memòria no només amb la satisfacció de l’objectiu assolit sinó amb el repte de plantejar noves metes.

Dr. Rafael I. Barraquer Titular de la Càtedra 21.IV.2010

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Càtedra de Recerca en Oftalmologia "Joaquim Barraquer" - UAB

1. Líneas de investigación en desarrollo 1.1 Proyecto Phaco Ersatz Reemplazamiento del material cristaliniano para recuperar la acomodación tras la cirugía de cataratas 1.1.1 Aparato para simular la acomodación ex vivo Ralph Michael, Marek Mikielewicz, Marta López, Rodolfo Carretié, Rafael I. Barraquer Institut Universitari Barraquer Hemos diseñado un aparato para medir las características mecánicas y ópticas dinámicas del cristalino durante la simulación de la acomodación ex vivo, que se puede utilizar tanto para el cristalino de ojos de donantes como para el cristalino después de la operación de catarata rellenando la cápsula con un polímero.

Ralph Michael, Rodolfo Carretié, Marek Mikielewicz, Boni Extraviz

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Càtedra de Recerca en Oftalmologia "Joaquim Barraquer" - UAB

El globo del donante se secciona dejando el cristalino y el cuerpo ciliar para poner encima de un dispositivo. El dispositivo permite el estiramiento circunferencial del cristalino simulando la acomodación. El estiramiento se crea por un motor de pasos conectado a un micrómetro y a una balanza que permite medir el desplazamiento y la fuerza. La sección corneal del ojo se va a conectar mediante ocho suturas de Prolene al conjunto del micrómetro y de la balanza. El conjunto funciona haciendo pequeños desplazamientos de 1 a 100 µm con una resolución de 2 µm. El micrómetro tiene una salida digital que permite la medición del desplazamiento con una resolución de 1 µm. El núcleo de una balanza digital sirve para la medición de la fuerza de los estiramientos ligeros (1 a 500 mN) con una resolución de 0.1 mN.

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Càtedra de Recerca en Oftalmologia "Joaquim Barraquer" - UAB

1.2 Calidad óptica del ojo 1.2.1 Cuantificación de la luz dispersa en pacientes capsulotomía YAG Ralph Michael, Gustavo A. Montenegro, Conrad Latoche, Juan Carlos Reyes, Rafael I. Barraquer Institut Universitari Barraquer Purpose: To study the correlation of posterior capsule opacification (PCO) with measured intraocular straylight and visual acuity.

Methods: Visual acuity (VA) (logMAR) and intraocular straylight (C-Quant straylight parameter log[s]) were measured under photopic conditions before and 2 weeks after YAG capsulotomy in 53 eyes (41 patients). Photopic pupil diameter was measured. To document the amount of opacification, pupils were dilated and photographs were taken at a slit lamp, using retroillumination and the reflected-light of a wide slit beam at an angle of 45 degrees focused on the posterior capsule. PCO was subjectively graded on a scale from 1 to 10 and using POCOman. A multiple regression analysis was performed to evaluate factors that influence straylight after capsulotomy.

Results: Straylight showed a good correlation with retroillumination and reflected-light PCO grading whereas VA only correlated with retroillumination. Both VA and straylight improved after capsulotomy. Straylight values presented a large variation after capsulotomy. Multiple regression analysis showed that increasing age and ocular axial length, hydrophobic acrylic IOLs, and small capsulotomies are factors that increased intraocular straylight.

Conclusion: Intraocular straylight is a useful tool in the assessment of PCO. It correlates well with PCO severity grading methods. When performing a posterior capsulotomy, factors such as age, IOL material, axial length, and capsulotomy size must be taken into consideration as they have an influence on intraocular straylight.

Retroillumination

Illuminated with a wide slit beam under an angle of about 50 degrees (same eye)

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CĂ tedra de Recerca en Oftalmologia "Joaquim Barraquer" - UAB

1.3 Diagnostico y tratamiento del queratocono 1.3.1 The new waveform parameters from the Ocular Response Analyzer Ralph Michael, Marek Mikielewicz, Konstantin Kotliar, Rafael I. Barraquer Institut Universitari Barraquer, Barcelona, Spain Department of Ophthalmology, Munich University of Technology Purpose: To test the usability of 39 new waveform parameters from ORA to distinguish between normal and keratoconus (KC) eyes, to determine the severity of keratoconus and to evaluate changes after treatment with crosslinking and intrastromal ring segment implantation.

Methods: Forty waveform parameters were derived from ORA's aplanation signal curve. Data of 119 subjects were included in the study. We examined the power of discrimination between control subjects (n=48) and KC patients (stages I & II, n=54) using ROC curves. Subsequently the correlation between KC stages and the waveform parameters was tested. Finally, the changes at 4 months after the treatment with crosslinking (n=22) and intrastromal rings (n=39) were evaluated.

Results: The ROC curves of 11 parameters showed excellent results, 22 moderate and 6 parameters proved to give poor results. Although 15 of the parameters demonstrated statistically significant results (p<0.05) the correlations between KC stages and parameters were only moderate (r<0.5). After crosslinking one parameters and after intrastromal ring implantation three parameters showed significant difference between pre and postoperative values (p<0.05).

Conclusion: Most of the new waveform parameters demonstrated good ability to discriminate between keratoconus and normal eyes. The ability to detect the severity of keratoconus was moderate. The changes in the parameter values after treatment were smaller than expected.

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Càtedra de Recerca en Oftalmologia "Joaquim Barraquer" - UAB

1.4 Queratoprótesis y cultivo de células limbales 1.4.1 Proyecto Europeo: Córnea artificial Development of an Artificial Cornea for the Human Eye CORONIS GMBH, München, Germany Centre of Medical Biotechnology, Regensburg University, Germany Fraunhofer Institute for Applied Polymer Research IAP, Potsdam, Germany Department of Ophthalmology; Halle University Medical Centre, Germany Dr. Schmidt Intraocularlinsen GmbH, St. Augustin, Germany Institut Universitari Barraquer Summary: SME-1 Co-operative Research (all areas of science and technology) Opacification of the cornea of the human eye results in the loss of vision and finally blindness unless corrected by a corneal transplant. In developed countries the standard surgical technology to restore vision is the replacement of the cornea by a human donor cornea in a penetrating keratoplasty.

More than 40.000 keratoplasties per year are performed in Europe and the United States each, with a continuous increase in recent years, and with success rates from more than 90 to less than 50 percent. Low success rates are associated with dry eyes, Herpes keratitis, corneal vascularization, recurring uveitis, acid burns, and traumatic anatomic structures of the anterior eye. The lack of donor corneas resulted in long waiting lists of patients in developed countries, and their non-availability in developing countries in millions of treatable blind people. There is a long history of attempts to replace the human cornea by alloplastic material with either disappointing results, or complicated multiple surgeries associated with severe drawbacks for the patient.

The CORNEA project will combine the invention of a novel corneal transplant by one SME partner with novel flexible ophthalmic polymers developed by a second, the manufacturing technology of a third, and the surgical instruments and technology of two more SME partners.

This combined SME know-how will be merged with the surface modification technology to be developed by one RTD partner and the ophthalmo-surgical expertise, and preclinical and clinical research capacities of two more RTD partners. Thus the project CORNEA will combine several cutting-edge technologies in order to achieve a never before available implant design and precision of surgery, and open the chance to regain vision for otherwise blind people. It will give a long-term competitive advantage and profit to the members of the consortium, and secure existing and create new working places.

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CĂ tedra de Recerca en Oftalmologia "Joaquim Barraquer" - UAB

1.4.2 Cultivo de cĂŠlulas limbales Maria Fideliz de la Paz, Juan Ă lvarez de Toledo, Rafael I. Barraquer Institut Universitari Barraquer Collaborative Research Project between Institut Universitari Barraquer, Schepens Eye Research Institute, Harvard Medical School, Boston, and Oslo University Hospital Ulleval, Norway

Introdcution Any process or disease that disturbs the integrity of the limbal stem cells which is located in the periphery of the cornea reduces the ability of the corneal epithelium to repopulate itself.

Inadequate repopulation of the corneal surface may be secondary to a loss in the number of limbal stem cells and/or reduced function of these cells. Limbal stem cell deficiency may occur in a variety of hereditary and acquired corneal diseases. The acquired causes are the most frequent,and includes UV-radiation, acid burns, autoimmune disorders, and infections, including trachoma, which affects about 80 million people worldwide. The clinical symptoms of limbal stem cell deficiency include irritation, epiphora, blepharospasms, photophobia, pain and decreased vision.

Our research team works on various strategies for treating limbal stem cell deficiency. There are many ways to treat limbal stem cell deficiency. The most studied and promising recent technique is the method first described by Pellegrini et al in Lancet in 1997 called ex vivo expansion of limbal epithelial cells. The principle of the method is to transfer human limbal epithelial cells harvested from the patient itself, a living relative, or a cadaver cultured on various substrates in the laboratory onto the eyes of patients suffering from limbal stem cell deficiency.

Current technology Several clinical studies have demonstrated very promising results of ex vivo expansion of limbal epithelial cells for treating limbal stem cell deficiency. However, there are many disadvantages of the current method: Firstly, the extensiveness of the method has been limited as it requires, in addition to adequate cell culture equipment, knowledge and experience of culturing limbal epithelial cells. Secondly, planning of the treatment has been a logistical nightmare as not all cultures succeed, i.e. no or little growth, alternatively get perceptibly infected (yellow medium/increased turbidity). Under these circumstances, the planned operations are cancelled.

An obvious infection may also be noticed as late as on the operation day, which is especially regrettable for patients travelling long distances. Thirdly, lack of sterility control, i.e. the transplants may be infected without any noticeable colour/turbidity change of the medium, resulting in operation of infected tissue.

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CĂ tedra de Recerca en Oftalmologia "Joaquim Barraquer" - UAB

New technology The Department of Ophthalmology at Ulleval University Hospital (Oslo, Norway) is the first to demonstrate the feasibility of storing cultured corneal epithelium. A patent application was filed on April 26, 2007 to protect the method of culture, storage, transportation, and microbiological assessment of human limbal epithelial cells (HLECs). The patent application also includes design of a kit for optimizing the process of culture and storage. The novel method has several benefits: 1) Storage of cultured corneal epithelium enables tissue to be transported from the laboratory to eye banks and eye departments worldwide. Compared to the surgical procedure, which is considered relatively simple, culture of corneal epithelium is resource-demanding accounting for the imbalance between kinds of treatment and treatment demands.

2) The tissue can be preserved at room temperature, which is an asset as the need for a heating cabinet is eliminated, simplifying logistics and reducing costs.

3) The production of cultured corneal epithelium at few centre of expertise is cost effective and may improve the quality of corneal tissues. European Union Directives* (on setting standards of quality and safety for the donation, procurement, testing, processing, preservation, storage, and distribution of human tissues and cells) make strict demands on tissue engineering laboratories and will contribute to the centralisation of tissue production, hence increasing the demand for tissue storage and transportation. (*Directive 2004/23/EC of the European Parliament and of the Council of 31 March 2004, Commission Directive 2006/17/EC of 8 February 2006, and Commission Directive 2006/86/EC of 24 October 2006).

4) The transplants are eventually stored in a closed container, in contrast to the open culture setting where infection may occur at any time. As the tissue can be stored in at least one week, there is sufficient time to perform microbiological testing. Current insecure methods based on changes of the colour and turbidity of the medium are replaced by more polite and exact diagnostics.

5) Tissue storage maintains the original characteristics of the tissue for at least one week, hence offering flexibility in scheduling the transplantation.

6) Possibly reduced need for immunosuppression (reduced nuclear factor kB activity). However, further studies are warranted.

Future perspecitives The advantages of storing limbal epithelial cells, apply equally to other cultured cell types. Hence, we are currently working on storage and transportation of conjunctival epithelial cells based on our experiences from limbal epithelial cells. In the near future we plan to expand to new cell types. Simultaneously, we will work on improving the culture and storage protocols for treating limbal stem cell deficiency.

Merits for the research group Since 2007 the original project, led by Torstein Lyberg, has resulted in 20 publications, two patent applications, extensive funds, publicity (EuroNews, which is the largest news channel in Europe, among others), extensive international collaboration, and three research awards last year.

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Càtedra de Recerca en Oftalmologia "Joaquim Barraquer" - UAB

1.5 Enfermedades congénitas 1.5.1 Catarata congénita Lourdes Ruiz, Maria Fideliz de la Paz, Ralph Michael, Rafael I. Barraquer Institut Universitari Barraquer Objetivo: Estudiar el error refractivo y la agudeza visual post quirúrgica, a lo largo del tiempo, en niños operados de catarata congénita, con implante primario de lente intraocular.

Métodos: Evaluación de la agudeza visual, medido con el optotipo de Snellen para los niños que colaboraban y el test de Teller para los más pequeños. El resultado del equivalente esférico fue obtenido mediante refracción por esquiascopia y autorrefractometria, para dicho estudio se dividió en tres grupos de edad, (6-18 meses, 19-36 meses; mayores a 36 meses) tanto pre quirúrgico, como a los 2 meses, 6 meses, al año, a los 2 años y a los 3 años post cirugía.

Graficamos la agudeza visual y el equivalente esférico en función a la edad. Para mejor estudio también se agruparon los pacientes, relacionando la agudeza visual y el equivalente esférico, con los que no tenían ninguna patología ocular asociada, los que tenían estrabismo, y otras patologías (nistagmus, microftalmía, papila morning glory, persistencia de vítreo primario hiperplásico, vasculosa lentis, lenticono posterior). También agrupamos las cataratas unioculares por un lado y las cataratas binoculares por otra , relacionando con la agudeza visual y el equivalente esférico.

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Càtedra de Recerca en Oftalmologia "Joaquim Barraquer" - UAB

Resultados: La mayoría de los pacientes presentan una notable mejoría de la agudeza visual entre los 2 – 3 años post cirugía, comparado con los primeros años post cirugía, El equivalente esférico alcanzado fue más estable y próximo al objetivo en los pacientes mayores a 20 meses de edad, sin patología de base, o estrabismo (aproximadamente entre + 2 y – 2), a diferencia de los pacientes que tenían otras patologías oculares, que además presentaron agudeza visual muy baja.

Aproximadamente el 40 % de los pacientes lograron una agudeza visual 0.5 o mejor. También hay una notable mejoría de la agudeza visual en pacientes con catarata binocular comparada con la uniocular .

Conclusión: En los pacientes de 20 semanas o menos, con patologías oculares asociadas, no se llegó a la agudeza visual y el equivalente esférico esperado, si fueron más alentadores los resultados en los pacientes mayores a esta edad, sin patología ocular. Los pacientes con estrabismo presentaron un equivalente esférico aceptable, pero pobre agudeza visual. La catarata uniocular, como esta descrito en la literatura resulta más ambliopizante que la binocular.

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Càtedra de Recerca en Oftalmologia "Joaquim Barraquer" - UAB

2. Actividades docentes 2.1 Tesis de doctorado en desarrollo I.

Evolución del astigmatismo a largo plazo tras queratoplastia penetrante en queratocono. Dr. Juan P. Álvarez de Toledo Elizalde. (Tesis en desarrollo).

II.

Resultados funcionales de la fotocoagulación láser mediante rejilla del edema macular diabético difuso. Dr. Jerónimo Nadal Reus. (Tesis en desarrollo).

III.

Lentes precristalianas para la corrección de alta miopía. Dr. Tahsin Martini. Tutor: Prof. Joaquín Barraquer. (Tesis en desarrollo).

IV.

Endoftalmitis de etiología exógena. Revisión de datos clínicos. Dra. Simona Nossa, Bergamo, Italia.

Tutor: Santos Muiños. (Tesis en desarrollo).

V.

Alteraciones intraoculares secundarias a la cirugía de la catarata senil: estudio comparativo entre los ultrasonidos y el sistema Aqualase. Repercusiones en el endotelio corneal, barrera hematoacuosa y mácula.

Dr. Fabiano Brandao M. Araujo, Brasil. Tutor: Rafael I. Barraquer. (Tesis en desarrollo).

VI.

Capsulorhexis posterior: estudio del segmento posterior mediante OCT. Dra. Marcia Toledo. Tutor: Rafael I. Barraquer. (Tesis en desarrollo).

VII.

Tratamiento de la hipermetropía con Fotoqueratomileusis según el frente de ondas. Dra. Ana María Pascual Agúndez. Tutor: Rafael I. Barraquer. (Tesis en desarrollo).

VIII. Predictibilidad en el cálculo de la lente BIG-BAG en pacientes miopes altos. Dra. Julia Sempere Matarredona. Tutor: Rafael. I. Barraquer. (Tesis en desarrollo).

IX.

Estudio comparativo entre la cirugía de pequeña y micro-incisión: repercusiones en la barrera hematoacuosa, endotelio corneal, anatomía macular y calidad visual. Dr. Rodrigo Abreu González. Tutor: Rafael I. Barraquer y Dr. José Augusto Abreu. (Tesis en desarrollo).

X.

Intralase versus Microqueratomo: Estudio de la morfología y variabilidad del colgajo corneal mediante Visante. Estudio retrospectivo. Dra. Elisa Carreras Bertran. Tutor. Rafael I. Barraquer. (Tesis en desarrollo).

XI.

Cambios en el tejido corneal tras crosslinking. Dra. Patricia Pujol Gomis. Tutor: Rafael I. Barraquer. (Tesis en desarrollo).

XII.

Corrección del Astigmatismo con Láser Excimer. Dra. Marta López Fortuny. Tutor: Prof.

Joaquín Barraquer y Dr. Andrés Picó. (Tesis en desarrollo)

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Càtedra de Recerca en Oftalmologia "Joaquim Barraquer" - UAB

2.2 Trabajos de investigación Máster Máster de segmento posterior NOMBRE

TÍTULO

COORDINADOR

DR. ALBAYEROS

Evolución clínica del Síndrome VogtKoyanagi-Harada en la población indígena Maya-Quiché de Guatemala

Dr. Elizalde

DRA. BLANCO

Características clínicas y morfométricas de la macula y del nervio óptico mediante OCT y perimetria automatizada en pacientes con Aniridia congénita

Dra. De la Paz Dr. Michael

DRA. CARRERAS DRA. PUJOL

Toxicitat del Brillante Blue G sobre l’epiteli pigmentari de la retina humana.

Dr. Nadal

DRA. CRAPANZANO

Utilidad de la OCT en el diagnóstico y seguimiento del E. Macular diabético traccional.

Dr. Abengoechea

DR. EL SHARIF

Estudio retrospectivo desde el año 2003 Dr. Abengoechea o antes, de los pacientes de traumatismos oculares acontecidos en el Área de Salud de Badajoz.

DRA. FERNÁNDEZ PÉREZ

Presencia del signo “Silencio Coroideo” Dr. Santos Muiños en pacientes con distrofias retinianas en la clínica Barraquer.

DR. IYO DRA. VÁSQUEZ

Terapia Fotodinámica en Hemangiomas Coroideos Circunscritos.

Dr. Elizalde

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Càtedra de Recerca en Oftalmologia "Joaquim Barraquer" - UAB

Máster de segmento posterior

Valor pronóstico de la autoflorescencia del EPR en resultados postquirúrgicos en el Agujero Macular.

Dr. Nadal

DRA. LUTZ

Predictive value of visual evoked response and electroretinography in keratoprosthesis surgery.

Dr. Charoenrook Dr. Ralph Michael

DR. MARCH

Revisión bibliográfica del Síndrome Vogt-Koyanagi-Harada

Dr. Elizalde

DR. PONCE

Uso de OCT en edema macular.

Dra. Viver

DR. RABELO

Tratamiento del edema macular cistoide tras la cirugía de la catarata.

Dr. Elizalde

DR. RUIZ RODRÍGUEZ DRA. TORRENT

Papel de los corticoides intraoculares y los Anti VEGF en el edema macular diabético.

Dr. Elizalde

DRA. LÓPEZ FORTUNY

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Càtedra de Recerca en Oftalmologia "Joaquim Barraquer" - UAB

Máster de segmento anterior NOMBRE

TÍTULO

COORDINADOR

DR. ABDALLAH

Crosslinking en keratoconos y otras enfermedades corneales.

Dr. Álvarez de Toledo Dr. Barraquer

DRA. BECCO

Cirugía de Pterigión con autoplastia conjuntival: Dr. Charoenrook resultados y complicaciones.

DRA. BLANCO

Características de la cornea y superficie ocular en pacientes con Aniridia congénita

Dra. De la Paz Dr. Michael

DRA. CARRERAS

Propiedades biomecanicas de la cornea en pacientes operados de Lasik

Dr. Lamarca Dr. Michael

DRA. FERNÁNDEZ PÉREZ

Resultados a largo plazo del homoinjerto de limbo en anillo.

Dr. Charoenrook Dr. Álvarez de Toledo

DR. IYO

Evaluación retrospectiva del manejo de pacientes con neoplasias de la superficie ocular en Instituto Oftalmología Barraquer.

Dr. Charoenrook Dra. De la Paz

DRA. LÓPEZ FORTUNY

Astigmatismo con láser excimer.

Dr. Picó

DRA. LUTZ

Lidocaine eye drops at non-anaesthetic concentration as a treatment for ocular discomfort after laser in situ keratomileusis.

Dr. Barraquer Dra. De la Paz

Complicaciones del lasik. Comparación microqueratomo con láser femtosegundos.

Dr. Pesic

DR. MOHAMED ZEBDEH

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Càtedra de Recerca en Oftalmologia "Joaquim Barraquer" - UAB

Máster de segmento anterior

DR. PONCE DR. RABELO

Estudio Piloto: Inyección de Bevacizumab Dr. Barraquer (Avastin) subconjuntival en neovasos corneales. Dra. De la Paz

DRA. PUJOL

Cambios biomecánicos del tejido corneal tras Crosslinking.

Dr. Barraquer Dr. Lamarca

Manejo del queratocono con anillos intraestromales asociado al láser de femtosegundos.

Dr. Barraquer Dr. Michael

La queratoplastia lamelar anterior profunda en el tratamiento de la patología de la superficie ocular.

Dr. Álvarez de Toledo

DRA. SÁNCHEZ JARQUÍN

DRA. TORRENT

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Càtedra de Recerca en Oftalmologia "Joaquim Barraquer" - UAB

2.3 Formación y cursos 2.3.1 Transparency Club Meetings Grupo de Investigación Segmento Anterior: Cada mes se ha organizado una reunión llamada "Transparency Club" o "Club de Transparencia". El nombre es debido a una de las características más importantes de la córnea y del cristalino. Participan en el grupo los oftalmólogos especializados en segmento anterior, los residentes y alumnos máster interesados en el segmento anterior, y también el equipo del departamento de cirugía refractiva. Se tratan temas clínicos y experimentales en forma de discusión, "brain storming" y ponencias.

Meetings 2009: Miércoles, 16 de diciembre, 14:00

Miércoles, 29 de abril 2009, 14:00

- Trabajos de Master, segmento posterior

- Estudio Piloto: Inyección de Bevacizumab (Avastin) subconjuntival en neovasos corneales - primeros resultados

Miércoles, 18 de noviembre 2009, 14:00 - Resumen y novedades de dos congresos: - Presbyopia-International, Barcelona - European Society of Cataract and Refractive Surgery, Barcelona

Miércoles, 14 de octubre 2009, 14:00 - Phaco Ersatz - medición con los primeros cristalinos

- Phacao Ersatz: Aparato para simular la acomodación ex vivo - listo para experimentos - Sala Blanca para cultivo de células - listo para poner en funcionamiento

Miércoles, 18 de marzo 2009, 14:00 - Resumen de "Alicante Refractiva 2009" - Propiedades biomecánicas de la cornea

- Capsulotomia - YAG y calidad visual Miércoles, 18 de febrero 2009, 14:00 Miércoles, 22 de julio 2009, 14:00

- Estudio de anillos intrastromales

- Juan Álvarez de Toledo: Presentación de sus trabajos clínicos

- Estudio catarata congénita

- Gustavo Montenegro: Opacifición de la cápsula del cristalino y la medición del deslumbramiento

Miércoles, 27 de mayo 2009, 14:00 - La biomecánica de la cornea en queratocono y después del tratamiento con anillos o crosslinking medido con el ORA.

- Estudio aniridia congénita

Miércoles, 21 de enero 2009, 14:00 - Investigación juntos con Alicante sobre keratoconus - Estado de creación del Laboratorio de Cultivo de Células - Ejemplos de resultados del estudio del deslumbramiento y capsulotomia YAG

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Càtedra de Recerca en Oftalmologia "Joaquim Barraquer" - UAB

3. Actividades en organizaciones científicas 3.1 European Association for Vision and Eye Research El Dr. Ralph Michael trabaja en la asociación como "Miembro de la Junta" y "Presidente de la sección de Catarata y Lente". En el 2007 fue elegido "Vicepresidente" para el año 2008/2009.

EVER President and Vice-president 2009 Charles Riva and Ralph Michael

EVER Board 2009 with representatives from ARVO

Càtedra de Recerca en Oftalmologia "Joaquim Barraquer" - UAB

3.2 Acta Ophthalmologica El Dr. Ralph Michael trabaja en la junta como "Editorial Board Member" de la revista Acta Ophthalmologica Scandinavica.

Print ISSN: 1395 -3907 Online ISSN: 1600-0420 Chief Editor Einar Stef ánsson, Iceland Board of Directors Anders Heijl, Sweden Gunnar Høvding, Norway Fridbert Jónasson, Iceland Anna Midelfart, Norway Thomas Olsen, Denmark Jan Ulrik Prause, Denmark Einar Stefánsson, Iceland Lotta Salminen, Finland Stefan Seregard, Sweden Hannu Uusitalo, Finland Charlotta Zetterstr öm, Sweden Amanda Churchill, United Kingdom Per S öderberg, Sweden Co-Editors Anders Heijl, Sweden Emilia Kerty, Norway Tero Kivel ä, Finland Morten la Cour, Denmark Per Montan, Sweden Kristina Tornqvist, Sweden Michael Wall, USA Charlotta Zetterstr öm, Sweden

Editorial Board Elisabeth Agardh, Sweden Juhani Airaksinen, Finland Charlotta All-Ericsson, Sweden Albert Alm, Sweden Sten Andr éasson, Sweden Toke Bek, Denmark Harlinder Dua, United Kingdom Niels Ehlers, Denmark Per Fagerholm, Sweden Hans Fledelius, Denmark Thomas W. Gardner, USA Erling Haaskjold, Norway Ivan Haefliger, Switzerland Alon Harris, USA David Henson, United Kingdom Graham Holder, United Kingdom Gunnar Høvding, Norway Jost B. Jonas, Germany Erich Knop, Germany Leila Laatikainen, Finland Michael Larsen, Denmark Lene Martin, Sweden Ralph Michael, Spain Sven Erik Nilsson, Sweden Selim Orgul, Switzerland Uwe Pleyer, Germany Jan Ulrik Prause, Denmark Charles Riva, Italy Eyvind R ødahl, Norway Matti Saari, Finland Stefan Seregard, Sweden Haraldur Sigurdsson, Iceland

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Càtedra de Recerca en Oftalmologia "Joaquim Barraquer" - UAB

3.3 European Vision Institute - Clincal Trials

EVI.CT.SE Clinical Trials.Sites of Excellence European Vision Institute. Clinical Trials. Sites of Excellence (EVI.CT.SE) is a network of European Ophthalmological Clinical Research Sites, dedicated to perform clinical research in ophthalmology with the highest standards of quality, following the European and International Directives for clinical trial research.

The Centro de Oftalmologia Barraquer is part of this network since 2007.

The EVI.CT.SE is a Special Committee of the European Vision Institute, European Economic Interest Grouping (EVIEEIG) legally constituted in 2003 under European law as a not-forprofit, science–driven organisation in Brussels.

The office of EVI.CT.SE is located in Coimbra, Portugal, upon decision of the General Assembly of the EVIEEIG, held in Vilamoura, 2004.

2. Main objectives - Organization of multicentric clinical trials in ophthalmology in Europe - Performance of multicentric clinical trials in ophthalmology with the highest level of quality.

- Assume EVI.CT.SE as a resource for Healthcare Industry.

- Establish rapid and regular communication links between the Healthcare Industry and the EVI.CT.SE members.

- Create synergies between members and promote clinical research programmes in order to establish clinical trial research in Europe.

- Establish programmes for regular educational and training activities for its members.

- Create an alternative to USA to perform Phase 1 and 2 studies - Create groups of experts for Clinical Trial design in specific areas of ophthalmological research.

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Càtedra de Recerca en Oftalmologia "Joaquim Barraquer" - UAB

European Vision Institute. Clinical Trials. Sites of Excellence: Clinical Sites with Full Certification: - CS nº 1 - AIBILI, Coimbra, Portugal - CS nº 24 - University of Freiburg, Department of Ophthalmology, Freiburg, Germany Clinical Sites with Conditional Certification: - CS nº 2 - Johannes Gutenberg University, Department of Ophthalmology, Mainz, Germany - CS nº 5 - Faculty of Medicine Mannheim of the RuprechtKarls–University Heidelberg, Department of Ophthalmology, Mannheim, Germany - CS nº 6 - Centre National d’Ophthalmologie des QuinzeVingts, Centre d’Investigation Clinique, Paris, France - CS nº 7 - VISSUM - Instituto Oftalmologico de Alicante, Alicante, Spain - CS nº 8 - Ghent University Hospital, Department of Ophthalmology, Ghent, Belgium - CS nº 9 - Universitäts-Augenklinik Tübingen (UAK), Tuebingen, Germany - CS nº 10 - Moorfields Eye Hospital NHS Foundation Trust, Clinical Trials Unit and Reading Centre, London, United Kingdom - CS nº 11 - University Eye Hospital Munich, Germany - CS nº 12 - University Hospital Antwerp, Department of Ophthalmology, Antwerp, Belgium - CS nº 13 - CHU Gabriel Montpied, Unité de Recherche Clinique, Service d’Ophthalmologie, Clermont-Ferrand, France - CS nº 15 - University of Bonn, Department of Ophthalmology, Bonn, Germany - CS nº 16 - University of Milan, Centre for Clinical Trials at San Paolo Hospital, Milan, Italy - CS nº 17 - University Medical Centre St Radboud, Macula Trial Centre Nijmegen, Netherlands - CS nº 19 - Medical University of Vienna, Department of Ophthalmology, Vienna, Austria - CS nº 20 - G. B. Bietti Foundation - IRCCS, Roma, Italy - CS nº 25 - Academic Medical Center, Department of Ophthalmology, Amsterdam, The Netherlands - CS nº 26 - Centro de Oftalmología Barraquer, Barcelona, Spain - CS nº 27 - University Eye Hospital, Leipzig, Germany

Clinical Sites implementing SOPs and that have had an EvaluationVisit - CS nº 4 - IOBA – Instituto Universitario Oftalmobiologia, Valladolid, Spain - CS nº 14 - Hôpital Lariboisière, Service D’Ophthalmologie, Paris, France - CS nº 21 - University Medical Center Hamburg-Eppendorf, Department of Ophthalmology, Hamburg, Germany - CS nº 30 - Glostrup Hospital, Department of Ophthalmology, Copenhagen University, Glostrup, Denmark - CS nº 36 - Catholic University, Institute of Ophthalmology, Rome, Italy - CS nº 37 - Sezione di Oftalmologia, Dipartimento di Scienze Otorino- Odonto-Oftalmologiche e Cerv. Facc., Parma Clinical Sites implementing SOPs and have not yet had an Evaluation Visit: - CS nº 3 - Centre Hospitalier Creteil, University Eye Clinic, Paris, France - CS nº 18 - University Hospital Leuven, Department of Ophthalmology, Leuven, Belgium - CS nº 22 - Universitäts – Klinik und Poliklinik für Augenheikunde, Bern, Switzerland - CS nº 23 - University Medical Centre of Ljubljana, University Eye Hospital, Ljubljana, Slovenia - CS nº 28 - Instituto de Oftalmologia Dr. Gama Pinto, Lisbon, Portugal - CS nº 29 - Instituto Galego de Oftalmoloxia, Santiago de Compostela, Spain - CS nº 31 - Mater Misericordiae University Hospital, McCauley Education and Research Center, Mater Vision Institute (MVI), Dublin, Ireland - CS nº 32 - Porto Medical School / Hospital S. João, Department of Ophthalmology, Porto, Portugal - CS nº 33 - Poznan University of Medical Sciences, Department of Ophthalmology, Poznan, Poland - CS nº 34 - University of Milan, Luigi Sacco Hospital, Department of Ophthalmology, Milano, Italy - CS nº 35 - Queen’s University, Institute of Clinical Science, Royal Victoria Hospital Ophthalmology And Vision Science Research Center, Belfast, United Kingdom - CS nº 38 - Institut Català de Retina, Barcelona, Spain - CS nº 39 - Clinica Oculistica, Università di Padova, Italy - CS nº 40 - Department of Ophthalmology, Rotterdam Eye Hospital, Rotterdam, The Netherlands CS nº 41 - Institut de la Màcula i de la Retina, Centro Médico Teknon, Barcelona, Spain

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Càtedra de Recerca en Oftalmologia "Joaquim Barraquer" - UAB

European Vision Institute EEIG Clinical Trials. Sites of Excellence EVI.CT.SE EVI.CT.SE Member Certificate N° ECS 26/2008 Valid through the period: 2008/APR - 2010/MAR

CENTRO DE OFTALMOLOGIA BARRAQUER

C/ Muntaner 314 E-08021 Barcelona -Spain

EVI.CT.SE Azinhaga de Santa Comba, Celas 3000-548 Coimbra . Portugal T + 351 239480100 F + 351 239480117

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CĂ tedra de Recerca en Oftalmologia "Joaquim Barraquer" - UAB

4th EVI.CT.SE Members Meeting 16/17 November 2009 Mainz, Germany The 4th EVI.CT.SE Members Meeting was held on 16/17 November 2009 in Mainz (Germany) where a present status of the Network regarding the Steering Committee, the Expert Committees, the certification of the Clinical Site and Clinical Trials through EVI.CT.SE Network was made.

On the first day there were also brief presentations of the new Clinical Site Members, parallel meetings of the Scientific Sections where IDCT were presented and approved, lectures on EU Programmes and Institute of Drugs and Medical Devices and an Open Session on GCP and Quality System. There were meetings of the Industry Advisory Board, the Steering Committee.

The second day started with the Expert Committees meetings and then 3 lectures on: Quality Control, How to prepare for an audit, and Re-Certification of EVI.CT.SE Clinical Sites. At the end of the meeting conclusions and priorities were presented to the members.

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Càtedra de Recerca en Oftalmologia "Joaquim Barraquer" - UAB

3.4 Redes Temáticas de Investigación Cooperativa

El Instituto Universitario Barraquer junto con la Universidad Autónoma de Barcelona presenta su solicitud para participar en la red temática Patología Ocular del Envejecimiento, Calidad Visual y Calidad de Vida, subproyecto Calidad de Vida y Cirugía del Dioptrio Ocular en mayo de 2007. La solicitud es aprobada en noviembre de 2007.

REDES TEMÁTICAS DE INVESTIGACIÓN COOPERATIVA (RETICs) El Instituto de Salud Carlos III es un organismo público de investigación con carácter de organismo autónomo, adscrito al Ministerio de Sanidad y Consumo, cuya misión es desarrollar y ofrecer servicios científico-técnicos de la más alta calidad dirigidos al Sistema Nacional de Salud y al conjunto de la sociedad. En materia de fomento de la investigación en salud, la Ley de Cohesión y Calidad del Sistema Nacional de Salud le encomienda a este Organismo público, en el ámbito de las competencias del Estado, funciones de planificación de la investigación, vertebración de los recursos dedicados a ella, difusión y transferencia de resultados, y desarrollo de programas de investigación, entre otras.

Las RETICs son estructuras organizativas formadas por la asociación al Instituto de Salud «Carlos III» de un conjunto variable de centros y grupos de investigación en biomedicina, de carácter multidisciplinar, dependientes de las diferentes Administraciones públicas o del sector privado y pertenecientes a un mínimo de cuatro Comunidades Autónomas, que tienen como objetivo la realización de proyectos de investigación cooperativa de interés general.

Responden a las prioridades del Plan Nacional de Investigación Científica, Desarrollo e Innovación Tecnológica en el ámbito sanitario e integran los distintos tipos de investigación como estrategia para acortar el intervalo entre la producción de un nuevo conocimiento y su transferencia y aplicabilidad real en la práctica médica.

Hoy en día hay aprobadas 69 Redes Temáticas en campos como la Cirugía, la Geriatría, la Oncología, Farmacología y Terapéutica, Bioquímica y Biología Celular.

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Càtedra de Recerca en Oftalmologia "Joaquim Barraquer" - UAB

Red temática Patología Ocular del Envejecimiento, Calidad Visual y Calidad de Vida, subproyecto Calidad de Vida y Cirugía del Dioptrio Ocular OBJETIVOS Y LÍNEAS DE TRABAJO A DESARROLLAR: La creación de este Nodo pretende implementar las líneas de investigación comunes ya existentes, evitando la duplicación de esfuerzos y de equipamiento, completando las acciones investigadoras, permitiendo su ampliación en base a recursos compartidos y, en la medida de lo posible, la generación de tecnología.

Su objetivo general es la mejora de la calidad de vida mediante la manipulación quirúrgica del dioptrio ocular normal y patológico.

Para conseguir este objetivo se desarrollará una

investigación básica y clínica colaborativa encaminada a la consecución de una mejora en la calidad visual mediante procedimientos quirúrgicos realizados sobre el cristalino, sobre la córnea u otros elementos refractivos del ojo.

Para ello, se propondrá: el desarrollo de 6 líneas de investigación y de una serie de plataformas comunes de investigación, la creación de Biobancos, un plan de trabajo con su correspondiente cronograma de investigación y un plan general de actividades, que incluya un plan de formación del personal investigador

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Càtedra de Recerca en Oftalmologia "Joaquim Barraquer" - UAB

SUBPROYECTO Calidad de Vida y Cirugía del Dioptrio Ocular Coordinador del Nodo: Jorge L Alió Título de la Red: Patologías oculares del envejecimiento y mejora de la calidad de vida.

Subproyecto: Calidad de Vida y Cirugía del Dioptrio Ocular GRUPOS DE INVESTIGACIÓN INVOLUCRADOS EN ESTE NODO

1. Universidad de Alcalá de Henares, Departamento de Cirugía, Área de Oftalmología 2. Fundación Privada Doctor Carlos Vergés, Barcelona 3. Universidad de Murcia. Laboratorio de Óptica 4. Universidad de Navarra, Servicio de Oftalmología, Clínica Universitaria de Navarra.

5. Instituto Gallego de Oftalmología, (Grupo de la Red C03/13) 6. Universidad de Santiago de Compostela, E.U de Óptica y Optometría, 7. Universidad de Santiago de Compostela. Área de Óptica 8. Universidad de Valladolid, Instituto Universitario de OftalmoBiologia Aplicada, (Grupo de la Red C03/13)

9. Consejo Superior de Investigaciones Científicas, Instituto de Óptica Daza de Valdés, Madrid 10. Universidad de Granada, Departamento de Óptica 11. Universidad Miguel Hernández, Departamento Psicología de la Salud 12. Universidad Miguel Hernández, Departamento de Ciencia y Tecnología de Materiales 13. Universidad Politécnica de Valencia, Centro de Biomateriales GRUPOS CLÍNICOS ASOCIADOS

14. Universidad Autónoma de Barcelona, Institut Universitari Barraquer, Barcelona 15. Hospital Clínico Universitario San Carlos, Madrid 16. Conselleria de Sanidad, Comunidad Autónoma de Murcia 17. Fundación ICHUVI, Complejo Hospitalario Universitario de Vigo 18. Fundación Andaluza de Investigación Oftalmológica

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Càtedra de Recerca en Oftalmologia "Joaquim Barraquer" - UAB

4. Publicaciones 4.1 Publicaciones en revistas Reverter JL, Nadal J, Fernández-Novell JM, Ballester J, Ramió-Lluch L, Rivera MM, Elizalde J, Abengoechea S, Guinovart JJ, Rodríguez-Gil JE. Tyrosine phosphorylation of vitreous inflammatory and angiogenic peptides and proteins in diabetic retinopathy.

Invest Ophthalmol Vis Sci. 2009 Mar;50(3):1378-82.

Journal impact factor: 3.582 (2008) - Full / Original article - Contribution: First author Michael R, van Rijn LJ, van den Berg TJ, Barraquer RI, Grabner G, Wilhelm H, Coeckelbergh T, Emesz M, Marvan P, Nischler C. Association of lens opacities, intraocular straylight, contrast sensitivity and visual acuity in European drivers.

Acta Ophthalmol. 2009 Sep;87(6):666-71.

Journal impact factor: 2.138 (2008) - Full / Original article - Contribution: First author Boixadera A, García-Arumí J, Martínez-Castillo V, Encinas JL, Elizalde J, Blanco-Mateos G, Caminal J, Capeans C, Armada F, Navea A, Olea JL. Prospective clinical trial evaluating the efficacy of photodynamic therapy for symptomatic circumscribed choroidal hemangioma.

Ophthalmology. 2009 Jan;116(1):100-105.e1.

Journal impact factor: 5.296 (2008) - Full / Original article - Contribution: Co-author Utheim TP, Raeder S, Utheim ØA, de la Paz M, Roald B, Lyberg T. Sterility control and long-term eye-bank storage of cultured human limbal epithelial cells for transplantation.

Br J Ophthalmol. 2009 Jul;93(7):980-3.

Journal impact factor: 2.859 (2008) - Full / Original article - Contribution: Co-author Utheim TP, Raeder S, Olstad OK, Utheim ØA, de la Paz M, Cheng R, Huynh TT, Messelt E, Roald B, Lyberg T. Comparison of the histology, gene expression profile, and phenotype of cultured human limbal epithelial cells from different limbal regions.

Invest Ophthalmol Vis Sci. 2009 Nov;50(11):5165-72.

Journal impact factor: 3.582 (2008) - Full / Original article - Contribution: Co-author

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Càtedra de Recerca en Oftalmologia "Joaquim Barraquer" - UAB

4.2 Presentaciones en congresos internacionales R. Michael, M.F. de la Paz1, V. Charoenrook, S. Sel, J. Temprano, R.I. Barraquer. Impact of Clinical Factors on the Long-Term Functional and Anatomical Results of Osteo- and Osteoodonto-Keratoprosthesis.

Association for Research in Vision and Ophthalmology 2009, Ft. Lauderdale, USA. Poster presentation. Invest Ophthalmol Vis Sci. 2009;50: E-Abstract 1496.

S. Raeder, T. Paaske Utheim, O. Olstad, M. de la Paz, T. Lyberg. Genome-Wide Transcriptional Analysis of Cultured Human Limbal Epithelial Cells Following Hypothermic Storage in Optisol-GS. Association for Research in Vision and Ophthalmology 2009, Ft. Lauderdale, USA. Poster presentation. Invest Ophthalmol Vis Sci. 2009;50: E-Abstract 1773 T.P. Utheim, S. Raeder, J. Eidet, C. Stormo, M. de la Paz, O.A. Utheim, B. Roald, T. Lyberg. Storage of Cultured Human Limbal Epithelial Cells in Optisol-GS at 23°C versus 5°C. Association for Research in Vision and Ophthalmology 2009, Ft. Lauderdale, USA. Poster presentation. Invest Ophthalmol Vis Sci. 2009;50: E-Abstract 1778.

M. Lopez, A. de la Mata, S. Galindo, V. Sáez, T. Nieto-Miguel, O. Riera, M. de la Paz, J.M. Herreras, M. Calonge, R.M. Corrales. Repeated Expansion of Limbal Stem Cells From a Single Biopsy. Association for Research in Vision and Ophthalmology 2009, Ft. Lauderdale, USA. Poster presentation. Invest Ophthalmol Vis Sci. 2009;50: E-Abstract 1787.

G.A. Montenegro, R. Michael, L. Ruiz, J.C. Reyes, C.E. Latoche, P. Marvan, A. Dexl, R.I. Barraquer.

Correlation of Backward Scattered Light With Intraocular Straylight and Visual Acuity in Patients With Posterior Capsule Opacification. Association for Research in Vision and Ophthalmology 2009, Ft. Lauderdale, USA. Poster presentation. Invest Ophthalmol Vis Sci. 2009;50: E-Abstract 5595 MF de la Paz, Z. Blanco, J. Álvarez. Ocular surface findings in patients with congential aniridia. European Association for Vision and Eye Research 2009, Portoroz, Slovenia. Poster presentation. Acta Ophthalmologica. 2009;87 (s244) E-Abstract 503 R. Michael, C. Sánchez, M. Mikielewicz, M. de la Paz, J. Álvarez de Toledo. Refractive and biomechanical results of intrastromal ring segments for keratoconus. European Association for Vision and Eye Research 2009, Portoroz, Slovenia. Poster presentation. Acta Ophthalmologica. 2009;87 (s244) EAbstract 516 MF de la Paz, F de Sousa, C Ponce, J. Álvarez, R.I. Barraquer. Subconjunctival injection of bevacizumab (Avastin®) for corneal neovascularization. European Association for Vision and Eye Research 2009, Portoroz, Slovenia. Oral presentation. Acta Ophthalmologica. 2009;87 (s244) E-Abstract 2224 R. Michael, R.I. Barraquer. Intraocular straylight screening in medical testing centres for driver licence holders in Spain. European Association for Vision and Eye Research 2009, Portoroz, Slovenia. Oral presentation. Acta Ophthalmologica. 2009;87 (s244) E-Abstract 3245

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CĂ tedra de Recerca en Oftalmologia "Joaquim Barraquer" - UAB

MF de la Paz, J. Barraquer. The first keratoprosthesis implantation 1n 1955. European Association for Vision and Eye Research 2009, Portoroz, Slovenia. Oral presentation. Acta Ophthalmologica.

2009;87 (s244) E-Abstract 4122 J. Temprano. Barcelona OOKP and tibial Kpro. European Association for Vision and Eye Research 2009, Portoroz, Slovenia. Oral presentation. Acta Ophthalmologica. 2009;87 (s244) EAbstract 4126 MF de la Paz, J. Barraquer. Long-term functional and anatomical results of OOKP and tibial OKP: Barcelona experience. European Association for Vision and Eye Research 2009, Portoroz, Slovenia. Oral presentation. Acta Ophthalmologica. 2009;87 (s244) E-Abstract 4224 J. Temprano. Tibial Kpro. European Association for Vision and Eye Research 2009, Portoroz, Slovenia. Oral presentation. Acta Ophthalmologica. 2009;87 (s244) E-Abstract 4225 J. Temprano. Tibial Bone KPro technique and long term results. European Association for Vision and Eye Research 2009, Portoroz, Slovenia. Oral presentation. Acta Ophthalmologica. 2009;87 (s244) EAbstract 4326

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Càtedra de Recerca en Oftalmologia "Joaquim Barraquer" - UAB

Desde el departamento de investigación hemos participado con en total cinco presentaciones.

The Association for Research in Vision and Ophthalmology

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Presentation Abstract Program#/Poster#: 1496/A406 Abstract Title:

Impact of Clinical Factors on the Long-Term Functional and Anatomical Results of Osteo- and Osteoodonto-Keratoprosthesis

Presentation Start/End Time:

Monday, May 04, 2009, 8:30 AM -10:15 AM

Location:

Hall B/C

Reviewing Code:

257 keratoprosthesis - CO

Author Block:

R. Michael1, M.F. de la Paz1,2, V. Charoenrook1,2, S. Sel3, J. Temprano1,2, R.I. Barraquer1,2.

1Institut Universitari Barraquer, Barcelona, Spain; 2Centro de Oftalmología Barraquer, Barcelona, Spain; 3Department of Ophthalmology, Halle University Medical Center, Halle, Germany.

Keywords:

576 keratoprostheses, 463 clinical (human) or epidemiologic studies: outcomes/complications

Abstract Body:

Purpose: To analyze the functional and anatomical results of keratoprosthesis using tooth and tibial autograft.

Methods: We reviewed 227 charts of patients that underwent osteo-keratoprosthesis (OKP) (n=82) or osteoodonto-keratoprosthesis (OOKP) (n=145) at the Centro de Oftalmología Barraquer. Mean follow-up time was 8.4 years for OOKP and 3.5 years for OKP. Multivariate analysis (Cox regression model) was applied to test the impact of clinical factors on functional and anatomical survival. Anatomical success was defined as retention of the keratoprosthesis lamina and functional success as BCVA >0.05. We included surgical technique, six primary diagnosis groups (chemical burn; thermal burn; Steven Johnson and Lyell syndrome; ocular cicatricial pemphigoid [OCP]; trachoma; others), age, sex, retinal potential and the five most common post-operative complications (infection; vitreous hemorrhage; retinal detachment; glaucoma; retroprosthetic membrane).

Results: Overall mean 10 year anatomical survival was 62% and functional survival was 59% after 2 years and 32% after 10 years. OOKP tended to give better results than OKP, but multivariate analysis showed that the surgical technique had no significant impact on anatomical (p=0.06) and functional (p=0.15) results. OCP had the worst prognostic for anatomical and functional survival. Age, retinal potential and post-operative complications had no significant impact on anatomical survival, but on functional survival.

Conclusions: Among the clinical factors studies, only primary diagnosis had significant influence on anatomical results. Functional results were significantly influenced by the retinal potential, age, primary diagnosis and post-op complications.

Commercial Relationships:

R. Michael, None; M.F. de la Paz, None; V. Charoenrook, None; S. Sel, None; J. Temprano, None; R.I. Barraquer, None.

Support:

None

©2009, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to www.iovs.org to access the version of record. For permission to reproduce any abstract, contact the ARVO Office at arvo@arvo.org.

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Presentation Abstract Program#/Poster#: 1773/A441 Abstract Title:

Genome-Wide Transcriptional Analysis of Cultured Human Limbal Epithelial Cells Following Hypothermic Storage in Optisol-GS

Presentation Start/End Time:

Monday, May 04, 2009, 1:45 PM - 3:30 PM

Location:

Hall B/C

Reviewing Code:

159 cornea: stem cell - CO

Author Block:

S. Raeder1,2A, T. Paaske Utheim2A,2B, O. Olstad2C, M. de la Paz3, T. Lyberg2A. 1Department of Ophthalmology, Stavanger University Hospital, Stavanger, Norway; ACenter for Clinical Research, BDepartment of Ophthalmology, CDepartment of Clinical Chemistry, Microarray Core Facility, 2Ulleval University Hospital, Oslo, Norway; 3El centro de Oftalmología Barraquer, Universitari Barraquer/Universitat Autonoma de Barcelona, Barcelona, Spain.

Keywords:

480 cornea: basic science, 483 cornea: epithelium, 484 cornea: storage

Abstract Body:

Purpose: We have previously demonstrated the feasibility of eye bank storage of cultured human limbal epithelial cells (HLEC) in serum based medium. However, storage in serum free media would be advantageous to reduce the risk of transmitting prions or animal viruses. In the present study we therefore investigated the transcriptional pattern in HLEC cultures following 2, 4, and 7 days of conventional hypothermic corneal storage in Optisol-GS (Bausch & Lomb, Irvine, CA).

Methods: 3-week HLEC cultures were transferred to polypropylene containers and stored in Optisol-GS for 2, 4, and 7 days at 4°C. 100 ng RNA was extracted from 5-mm biopsy punch samples using RNeasy Micro Kit (Qiagen, Hilden, Germany) and subjected to the GeneChip HT One-Cycle cDNA Synthesis Kit (Affymetrix, Santa Clara, CA) and GeneChip HT IVT labeling kit (Affymetrix). Labeled and fragmented single stranded DNAs were hybridized to the GeneChip Human Gene 1.0 ST Array (28869 genes, Affymetrix). Gene expression of stored HLEC was compared with 3-week HLEC cultures using the non-paired Student’s t-test and a nominal significance level of 0.001.

Results: No genes were significantly increased in HLEC cultures following 2-days storage, whereas histone cluster 1 H4d (HIST1H4D), histone cluster 1 H3f (HIST1H3F), histone cluster 1 H4b (HIST1H4B), histone cluster 1 H4k (HIST1H4K), and histone cluster 1 H4j (HIST1H4J), which are involved in internucleosomal linker DNA organization, were significantly increased after four days of storage (> 2 fold). Following seven days of hypothemic storage, HIST1H4D, HIST1H4B, RNA, HIST1H4K, histone cluster 1 H4c (HIST1H4C), histone cluster 1 H4j (HIST1H4J), histone cluster 1 H2bb (HIST1H2BB), RNA U5E small nuclear (RNU5E), and small nucleolar RNA C/D box 3B-1 (SNORD3B-1) were significantly increased in HLEC cultures (> 2 fold).

Conclusions: Our data indicate that gene expression of linker histones, previously reported to be associated with apoptotic DNA fragmentation, is upregulated during hypothermic storage of HLEC cultures in Optisol-GS.

Commercial Relationships:

S. Raeder, Patent application, P; T. Paaske Utheim, Patent application, P; O. Olstad, None; M. de la Paz, None; T. Lyberg, None.

Support:

Southern Eastern Norway Regional Health Authority, Hamar, Norway

©2009, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to www.iovs.org to access the version of record. For permission to reproduce any abstract, contact the ARVO Office at arvo@arvo.org.

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Presentation Abstract Program#/Poster#:

1778/A446

Abstract Title:

Storage of Cultured Human Limbal Epithelial Cells in Optisol-GS at 23°C versus 5°C

Presentation Start/End Time:

Monday, May 04, 2009, 1:45 PM - 3:30 PM

Location:

Hall B/C

Reviewing Code:

159 cornea: stem cell - CO

Author Block:

T.P. Utheim1A,1B, S. Raeder1B,2, J. Eidet1B, C. Stormo1B, M. de la Paz3, O.A. Utheim1A, B. Roald1C, T. Lyberg1B. ADepartment of Ophthalmology, BCenter for Clinical Research, CDepartment of Pathology, 1Ullevaal University Hospital, Oslo, Norway; 2Department of Ophthalmology, Stavanger University Hospital, Stavanger, Norway; 3Institut Universitari Barraquer/Universitat Autonoma de Barcelona, Barcelona, Spain.

Keywords:

484 cornea: storage, 483 cornea: epithelium, 480 cornea: basic science

Abstract Body:

Purpose: Successful storage of cultured human limbal epithelial cells (HLEC) in a serumbased medium for one week at ambient temperature (23°C) has been reported. However, the feasibility of storage in serum-free media has never previously been demonstrated. In the present study, we compared the effect of Optisol-GS storage at 23°C versus conventional hypothermic storage (5°C) on cultured HLEC. Methods: Three-week HLEC cultures were transferred to polypropylene containers and stored in Optisol-GS for 4 days at 23°C and 5°C. Morphology and phenotype were analysed by light microscopy and immunohistochemistry, respectively. A calcein-acetoxymethyl ester/ethidium homodimer 1 assay was used to assess viability, and the Mann-Whitney U test was applied for statistical evaluation.

Results: Storage of cultured HLEC for 4 days at 5°C led to extensive detachment of basal cells from the amniotic membranes in sharp contrast to storage for 4 days at 23°C, where the cells attached well to the amniotic membranes in all the cultures. The phenotype, assessed by p63, ΔNp63α, ABCG2, K19, K3, Cx43, Ki67, and PCNA, was maintained after storage at 23° C. Basal layer viability of cultured HLEC was 93.1% ± 6.1% and 55,0% ± 27.2% after 4 days of storage at 23°C and 5°C, respectively, compared with 98.9% ± 0.7% prior to storage (P=0.12 and P<0.001, respectively).

Conclusions: The present study demonstrates the feasibility of serum-free storage of cultured HLEC. The temperature during storage in Optisol-GS strongly affected the morphology and viability of cultured HLEC, favoring storage at 23°C. Conventional hypothermic use of Optisol-GS for storage of cultured HLEC is clearly unsatisfactory.

Commercial Relationships:

T.P. Utheim, Ullevaal university Hospital, Oslo, Norway and Medinnova, Oslo, Norway, P; S. Raeder, Ullevaal university Hospital, Oslo, Norway and Medinnova, Oslo, Norway, P; J. Eidet, None; C. Stormo, None; M. de la Paz, None; O.A. Utheim, None; B. Roald, None; T. Lyberg, None.

Support:

The Eastern Norway Regional Health authority

©2009, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to www.iovs.org to access the version of record. For permission to reproduce any abstract, contact the ARVO Office at arvo@arvo.org.

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Presentation Abstract Program#/Poster#: 1787/A455 Abstract Title:

Repeated Expansion of Limbal Stem Cells From a Single Biopsy

Presentation Start/End Time:

Monday, May 04, 2009, 1:45 PM - 3:30 PM

Location:

Hall B/C

Reviewing Code:

159 cornea: stem cell - CO

Author Block:

M. Lopez1,2, A. de la Mata2,1, S. Galindo1,2, V. Sáez1,2, T. Nieto-Miguel1,2, O. Riera3, M. de la Paz3, J.M. Herreras2,1, M. Calonge2,1, R.M. Corrales1,2. 1CIBER-BBN, Valladolid, Spain; 2University of Valladolid, Ocular Surface Group-IOBA, Spain; 3Centro de Oftalmología Barraquer, Barcelona, Spain.

Keywords:

483 cornea: epithelium, 599 microscopy: light/fluorescence/immunohistochemistry, 684 regeneration

Abstract Body:

Purpose: Transplantation of autologous ex vivo expanded limbal epithelial stem cells (LESCs) is becoming the method of choice to reconstruct the ocular surface affected by LESC deficiency. This can be hampered by the small amount of tissue available and the possibility of failure in the cell expansion procedure. We investigated the feasibility to obtain more than one expanded sheet of cells from the same limbal biopsy.

Materials and methods: Fresh normal human cadaveric corneo-scleral rings were cut into 1 mm pieces. Each piece was placed on a different culture dish and maintained until a rim of migrating cells surrounded the biopsy. Then, the explant was removed and the limbal primary culture (LPC) was allowed to reach confluence (LPC1). The same explant was then placed again on a new culture dish, following the same procedure, then obtaining a LPC2. This protocol was repeated as many times as possible using 4 different stem cell culture media (CM): 1) CM published by De Paiva et al (2005) with FBS (p-FBS); 2) personal modification with FBS (pm-FBS); 3) pm with human serum (pm-HS); 4) Cnt20 commercial CM. Immunofluorescence staining was performed in all confluent cultures (n=3 for each condition) to evaluate the expression profile of limbal stem cell (K5, K14, K15) and corneal (K3, K7, K19) markers, selected based on our previous results. The percentage of positive cells in 5 different microscopic fields was calculated.

Results: We obtained up to LPC7 with p-FBS and pm-FBS. pm-HS and Cnt20 allowed to obtain up to LPC3. The fastest cell growth was observed with p-FBS. With p-FBS, K3 and K7 expression increased (K3: 73-85%; K 7(48-61%) from LPC1 to LPC3, respectively; K5 (50%) and K19 (46%) did not change and K14 (50-43%) and K15 (48%-13%) decreased until LPC3.

With pm-HS, all markers increased from LPC1 to LPC3 (K5: 4-48%, K14: 3-35%, respectively) except K3 and K15. The profile obtained with pm-FBS was not adequate (0% for K5, K14, K15). With Cnt20 all markers decreased in LPC3, except K3.

Conclusion: It was possible to repeat the expansion of the same 1 mm limbal biopsy maintaining a LESC phenotype up to 3 times, specially when the medium pm-HS was used.

Further studies using biopsies from live donors are then warranted.

Commercial Relationships:

M. Lopez, None; A. de la Mata, None; S. Galindo, None; V. Sáez, None; T. Nieto-Miguel, None; O. Riera, None; M. de la Paz, None; J.M. Herreras, None; M. Calonge, None; R.M. Corrales, None.

Support:

Instituto de Salud Carlos III: CIBER-BBN. Centro en Red de Medicina Regenerativa y Terapia Celular, Castilla y León. Junta de Castilla y León: SAN673/VA/28/08(RMC)

©2009, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to www.iovs.org to access the version of record. For permission to reproduce any abstract, contact the ARVO Office at arvo@arvo.org.

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Presentation Abstract Program#/Poster#:

5595/D836

Abstract Title:

Correlation of Backward Scattered Light With Intraocular Straylight and Visual Acuity in Patients With Posterior Capsule Opacification

Presentation Start/End Time:

Thursday, May 07, 2009, 8:30 AM -10:15 AM

Location:

Hall B/C

Reviewing Code:

263 lens: all topics except epidemiology - LE

Author Block:

G.A. Montenegro1, R. Michael1, L. Ruiz1, J.C. Reyes1, C.E. Latoche1, P. Marvan2, A. Dexl2, R.I. Barraquer1. 1Instut Universitari Barraquer, Universitat Autonoma de Barcelona, Barcelona, Spain; 2Department of Ophthalmology, Paracelsus Medical University, Salzburg, Austria.

Keywords:

649 posterior capsular opacification (PCO), 751 visual acuity, 627 optical properties

Abstract Body:

Purpose: To study the correlation of posterior capsule opacification (PCO) with measured intraocular straylight and visual acuity.

Methods: Visual acuity (logMAR) and intraocular straylight (C-Quant straylight parameter log[s]) were measured under photopic conditions before and 2 weeks after YAG capsulotomy in 20 patients. The eyes with PCO were dilated and photographed at a slit lamp, illuminated with a wide slit beam under an angle of about 50 degrees to document the amount of opacification. Photopic pupil diameter was measured. Three masked observers graded the opacification inside the photopic pupil diameter on the PCO photographs on a scale from 0 to 10.

Results: The photographs at the slit lamp with a wide slit beam allow the visualization of optical imperfections inside the IOL and deposits on it, the light scattering from the posterior capsule opacification and even vitreous imperfections, some of which are missed with the retroillumination. Regression of visual acuity improvement (post-pre YAG) as function of PCO-Slit lamp grading gave a coefficient of determination (R2) of 0.30. Regression of intraocular straylight improvement as function of PCO-slit lamp grading gave an R2 of 0.48.

Conclusions: PCO-Slit lamp grading, which considers backward light scattering, is weakly correlated with visual acuity and moderately correlated with intraocular straylight measured by the C-Quant.

Commercial Relationships:

G.A. Montenegro, None; R. Michael, None; L. Ruiz, None; J.C. Reyes, None; C.E. Latoche, None; P. Marvan, None; A. Dexl, None; R.I. Barraquer, None.

Support:

None

Š2009, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to www.iovs.org to access the version of record. For permission to reproduce any abstract, contact the ARVO Office at arvo@arvo.org.

Càtedra de Recerca en Oftalmologia "Joaquim Barraquer" - UAB

European Association for Vision and Eye Research

Desde el departamento de investigación se han organizado un Especial Interesa Symposium sobre la medición de luz dispersa un total de ocho ponencias y dos posters.

37

European Association for Vision and Eye Research e503 - Ocular surface findings in patients with congential aniridia Topics Cornea - Clinical sciences - Pathology Additional information Poster only / Rapid fire welcome Session information This abstract has been assigned to sessions Ocular surface and dry eye and Poster Session 2 : Cornea/Ocular Surface Lens/Cataract - Neuro-Ophthalmology - Pathology/Oncology - Vision Sciences/Electrophysiology/Physiological Optics in Europa C. Authors DE LA PAZ MF Centro de Oftalmología Barraquer (Barcelona) BLANCO Z Author 2 Institut Universitari Barraquer (Barcelona) ALVAREZ J Author 3 Centro de Oftalmolgía Barraquer (Barcelona) Abstract to study the Schirmer´s test, tear Break-up time, ocular tear ferning pattern test and impression cytology Purpose results in patients with congenital aniridia 25 eyes of 25 patients with congenital aniridia underwent Schirmer´s test I, tear break-up time, ocular Methods ferning pattern test and impression cytology to study the ocular surface characteristics. Clinical findings were correlated with the results of the aforementioned tests.

Aniridia related keratopathy was Grade 0 in 12%, Grade 1-A in 52%, 1-B in 20% and Grade 2 in 16% of eyes studied. Schirmers Test I was normal in 96% of eyes. Tear break-up time was abnormal in 75% of patients. Ocular ferning pattern tests were as follows: Grade 1 (20%), grade 2 (50%), Grade 3 (20%) and Grade 4 (10%). Conjunctival squamous metaplasia revealed: Grade 0 (23%), Grade 3 (35%), Grade 5 (4%).

Results Conjunctival keratinization was mild in 35% and moderate in 15%. Significant correlation was found between conjunctival keratinization and the degree of Anirida-related keratopathy. Significant correlation was also found between ocular ferning pattern test and conjunctival keratinization.

Aniridia –related keratopathy is a muco-deficient and lipo-deficient, more than an aqueo-deficient dry eye Conclusionsdisease. Simple tests of the ocular surface must be done early on to direct the right kind of dry eye treatment in these difficult cases.

Terms of use - Privacy policy Author 1

EVER Office - European Association for Vision and Eye Research Kapucijnenvoer 33, B-3000 Leuven, Belgium ever@ever.be • tel +32 16 233 849 • fax +32 16 234 097

European Association for Vision and Eye Research e516 - Refractive and biomechanical results of intrastromal ring segments for keratoconus Topics Cornea - Clinical sciences - Optics-refraction Additional information Poster only Session information This abstract has been assigned to session Poster Session 2 : Cornea/Ocular Surface - Lens/Cataract - NeuroOphthalmology - Pathology/Oncology - Vision Sciences/Electrophysiology/Physiological Optics in Europa C. This session will take place on Friday 2 October 2009 from 16:15 till 17:25 in all rooms.

Authors MICHAEL R Institut Universitari Barraquer (Barcelona) SáNCHEZ C Author 2 Institut Universitari Barraquer (Barcelona) MIKIELEWICZ M Author 3 Institut Universitari Barraquer (Barcelona) DE LA PAZ M Author 4 Institut Universitari Barraquer (Barcelona) ALVAREZ DE TOLEDO J Author 5 Institut Universitari Barraquer (Barcelona) BARRAQUER RI Author 6 Institut Universitari Barraquer (Barcelona) Abstract To analyse the refractive and biomechanical changes in the cornea after implantation of intrastromal ring Purpose segments.

The study included 43 eyes of 36 patients (mean age 38 years); 7 eyes had received Intacs® and 36 KeraRings®. Visual acuity, spherical equivalent, K readings, corneal hysteresis (CH) and corneal resistance Methods factor (CRF) were measured pre-op, at 6 and at 12 months post-op. CH and CRF were derived from the Ocular Response Analyser (ORA).

UCVA improved from 1.10 logMAR to 0.65 at 6 months and 0.62 at 12 months post-op. BCVA improved from 0.32 logMAR to 0.25 at 6 months and 0.22 at 12 months post-op. Spherical equivalent improved from -5.28 to -1.30 at 6 months and -1.85 at 12 months post-op. Sim K improved from 5.81 to 3.64 at 6 months Results and 4.10 at 12 months post-op. Mean K improved from 48.9 to 46.3 at 6 months and 46.7 at 12 months postop. All changes between pre-op and 6 months post-op were significant, but between 6 months and 12 months they were not. Pre-op CRF (mean 6.37) and CH (mean 7.34) did not change significantly up to 12 months post-op.

Intrastromal ring segments for keratoconus reduced the spherical equivalent refraction and improved the ConclusionsUCVA and BCVA at 6 months post-op and remained stable up to 12 months. ORA's biomechanical factors CH and CRF did not changed up to 12 months post intrastromal ring segment implantation.

Terms of use - Privacy policy Author 1

EVER Office - European Association for Vision and Eye Research Kapucijnenvoer 33, B-3000 Leuven, Belgium ever@ever.be • tel +32 16 233 849 • fax +32 16 234 097

European Association for Vision and Eye Research e2224 - Subconjunctival injection of bevacizumab (Avastin®) for corneal neovascularization Topics Cornea - Clinical sciences - Pharmacology Additional information Oral presentation Session information This abstract has been assigned to session Physiology-Biochemistry-Pharmacology 1.

This session will take place on Thursday 1 October 2009 from 11:00 till 12:30 in room Europa B. Authors DE LA PAZ MF Centro de Oftalmología Barraquer (Barcelona) DE SOUSA F Author 2 Institut Universitari Barraquer (Barcelona) PONCE C Author 3 Institut Universitari Barraquer (Barcelona) ALVAREZ J Author 4 Centro de Oftalmología Barraquer (Barcelona) BARRAQUER RI Author 5 Centro de Oftalmología Barraquer (Barcelona) Abstract Purpose to study the effects of subconjunctival injection of Bevacizumab on corneal neovascularization.

Prospective interventional case series on 7 eyes of 7 patients who underwent subconjunctival injection with Bevacizumab. The following parameters were studied pre-op, at 1 week, 30, 60 and 90 days post-op: Methods UCVA, BCVA, pachymetry with OCT, slit lamp examination and photographic imaging. Conjunctival impression cytology pre-op at 1 week and 9o days was done and complications were also noted.

Pre-op diagnoses were: herpetic leucoma (4 eyes), chemical burn (2 eyes), neurotrofic keratopathy (1 eye).

An informed off-label consent form prior to procedure was signed. 1.25 mg of subconjunctival Bevacizumab was injected nearest the area affected. Mean preoperative UCVA and BCVA were 0.86 and 0.44 LogMar units, improved to 0.61 and 0.26 LogMar units at 90 days post-op, respectively. Central and peripheral Results pachymetry improved from 532 and 623 microns pre-op, to 529 and 619 microns at 90 days post-op, respectively. All slit lamp findings and photographic imaging showed a clear regression of superficial and deep stromal corneal vascularization, with clearing of lipid deposits around the affected areas. No toxic effects were noted on conjunctival impression cytology.

Subconjunctival injection of Bevacizumab is a safe and effective procedure for the regression of superficial Conclusionsand deep corneal neovascularization. It may be a good alternative for patients prior to performing an optical keratoplasty or for those who are poor candidates for the same.

Author 1

EVER Office - European Association for Vision and Eye Research Kapucijnenvoer 33, B-3000 Leuven, Belgium ever@ever.be • tel +32 16 233 849 • fax +32 16 234 097

European Association for Vision and Eye Research LC: Straylight in the human eye - Small versus large angle domain Often patients complain about halos, glare, hazy vision and blinding at night, but while doing regular tests like visual acuity, contrast sensitivity and slit lamp examination nothing unusual can be found. Most probably, the patient´s complaints are caused by increased light scattering over angles >1degree in the eye media which can not be detected by common tests. The so called straylight degrades the image projected on the retina, thus decreasing the quality of vision.

Usually the only variable for increasing ocular straylight is the crystalline lens and a cataract will cause a significant increase. Sometimes increased ocular straylight may be caused by refractive surgery or other pathology changes. The difference of straylight versus small angle effects as detected with classical means (visual acuity, CS, double pass, etc) will be emphasized.

Session type Special Interest Symposium Moderators for this session Ralph MICHAEL, Harilaos GINIS Time and place of session This session will take place on Friday 2 October 2009 from 11:00 till 12:30 in room Emerald II. Abstracts assigned to this session (6) 11:00

15'

3241

The different domains of the point spread function Small angle vs large angle

VAN DEN BERG TJTP, COPPENS JE, FRANSSEN L

11:15

15'

3242

Challenges in optical measurement of scatter

GINIS H

11:30

15'

3243

Optical simulation of large and small angle scatterers

DE BROUWERE D, GINIS H, PALLIKARIS IG

11:45

15'

3244

Straylight in function of wavelength and refraction

ROZEMA J, TASSIGNON MJ

12:00

15'

3245

Intraocular straylight screening in medical testing centres for driver licence holders in Spain

MICHAEL R, VAN DEN BERG TJTP, BARRAQUER RI

12:15

15'

3246

Quality of life in cataract patients and the role of stray light

ASPINALL P

EVER Office - European Association for Vision and Eye Research Kapucijnenvoer 33, B-3000 Leuven, Belgium ever@ever.be • tel +32 16 233 849 • fax +32 16 234 097

European Association for Vision and Eye Research e3245 - Intraocular straylight screening in medical testing centres for driver licence holders in Spain Topics Whole eye - Clinical sciences - Optics-refraction Additional information Session information This abstract has been assigned to session Straylight in the human eye - Small versus large angle domain.

This session will take place on Friday 2 October 2009 from 11:00 till 12:30 in room Emerald II. Authors MICHAEL R Institut Universitari Barraquer (Barcelona) VAN DEN BERG TJTP Author 2 Netherlands Institute for Neuroscience (Amsterdam) BARRAQUER RI Author 3 Institut Universitari Barraquer (Barcelona) Abstract To test the performance of the C-quant straylight meter during the daily routine work in medical testing Purpose centers for driver license applicants and driver license holders in Spain.

Altogether 914 subjects, of which 376 younger than 35 years, 428 between 35 and 60 years and 110 over 60 years were measured with the C-quant in three medical testing centres (Barcelona, Zaragoza and Palma de Methods Mallorca) in 2006. Technicians were instructed once and the measurements were done during the daily routine work. We recorded: age, BCVA, self-reported subjective blinding at night; and from the C-quant: straylight parameter (log s), measurement quality parameters (ESD, Q) and test duration.

Total C-quant test duration increases slightly with age from a mean of 7 min (<35 years) to a mean of 9 min (>60). At first attempt, 82% of all subjects produced reliable results (ESD < 0.12). The straylight parameter for this group was independent of ESD and ESD was independent of total test duration. The known age dependence of the straylight parameter and the weak correlation with BCVA was confirmed. The Results distribution of subjective blinding at night was very different between test centres. Subjects with "very strong" subjective blinding had significantly higher straylight values than subjects with "no" subjective blinding. Subjects avoiding night driving had significant higher straylight values than subjects driving at night.

The C-quant measure is reasonable fast. Good subject instruction is important to get first attempt reliable Conclusionsresults. Self-reported subjective blinding results depend strongly on the interviewer. The C-quant is an improvement over present methods, because it is objective and cannot be influenced.

Author 1

EVER Office - European Association for Vision and Eye Research Kapucijnenvoer 33, B-3000 Leuven, Belgium ever@ever.be â&#x20AC;˘ tel +32 16 233 849 â&#x20AC;˘ fax +32 16 234 097

European Association for Vision and Eye Research e4122 - The first keratoprosthesis implantation 1n 1955 Topics Other - Clinical sciences - Other Additional information Session information This abstract has been assigned to session KPro 1 session: design surgical techniques and complications.

This session will take place on Saturday 3 October 2009 from 08:15 till 09:45 in room Europa B. Authors DE LA PAZ MF Centro de Oftalmología Barraquer (Barcelona) BARRAQUER J Author 2 Centro de Oftalmología Barraquer (Barcelona) Abstract to describe the Barcelona experience with the different types of keratoprosthesis for end-stage cicatricial Purpose corneal disease.

We present 6 cases showing various types of keratoprosthesis which we have used at the Barraquer Eye Methods Center from the 1950´s up to the present.

We describe the first keratoprosthesis ever implanted in Spain, on a case of severe chemical burn on a young lady. We implanted a Dorzee acrylic keratoprosthesis in 1955. 5 years later she had extrusion of the prosthesis and superior retinal detachment. The second case describes the Dorzee-Barraquer-Cardona acrylic implant implanted in 1958 on a patient with end-stage glaucoma. Patient had good anatomical retention until his death in 1970. The third case describes the use of the Cardona keratoprosthesis in 1960. Patient had good Results anatomical and functional results for 8 years until suffering from an acute endophthalmitis. The fourth case demonstrates the expulsion of a Teflon-supported keratoprosthesis designed by Girard. The fifth case describes the first implantation of an osteo-odontokeratoprosthesis designed by Strampelli on a blast injury showing good results for 10 years. The last case shows our experience on the Boston keratoprosthesis which we started using in 2006. Finally, we present our technique of the osteo-odontokeratoprosthesis and a summary of our clinical results from 1970´s to the present.

Our clinical experience for more than 50 years on the use of keratoprosthesis shows that while the surgical Conclusionstechnique, design and post-operative treatment of both biological and non-biological keratoprosthesis have improved thru the years, the anatomical and functional success remains a challenge for the KPro surgeon.

Author 1

EVER Office - European Association for Vision and Eye Research Kapucijnenvoer 33, B-3000 Leuven, Belgium ever@ever.be • tel +32 16 233 849 • fax +32 16 234 097

European Association for Vision and Eye Research e4126 - Barcelona OOKP and tibial KPro Additional information Session information This abstract has been assigned to session KPro 1 session: design surgical techniques and complications.

This session will take place on Saturday 3 October 2009 from 08:15 till 09:45 in room Europa B. Authors Author 1

TEMPRANO J Barcelona

Abstract

Purpose

We are using the second technique of the Strampelli OOKP since 1971.Preferably we use a tooth from the superior mandible to prepare the haptic part of the keratoprosthesis. The optic cylinder of 9 mm length, 0.4 mm diameter in the wider part and 3.5 mm in the narrow part is introduced into the prosthesis through the central opening previously prepared for this.

In 1988, trying to find a solution for patients without teeth, we decided to use another heterologous autotransplant, from the tibia. We obtained from the upper part of the medial area of the tibia a disk, 10 mm in diameter and 3 mm thick, and we performed in the center of the same an opening through which we introduced the optic cylinder similar to the one used in OOKP and fixed it to the bone.

The technique is similar for both techniques of keratoprosthesis, excepting the shaping of the support.

The first stage consists in cleaning the anterior portion of the eye, up to the muscle insertions and performing a superficial keratectomy to eliminate the epithelium. Subsequently we obtain from the lower lip of the same patient an oval fragment with a surface of 3 x 2 cm and total thickness including mucous and submucous tissue. This is sutured to the muscle insertations to cover the entire anterior pole of the eye. It is expected to revitalize the surface and will serve later to cover the keratoprosthesis.

The second stage consists in preparing the keratoprosthesis and once it has been completed it is introduced into a palpebral pocket in the inferior lid, so the prothesis will be covered by soft newly formed tissue which will later facilitate facilitate fixation with sutures. The prosthesis is left “in situ” for three months to make sure that it develops neither infection nor immune reaction.

The third stage is performed after three months. The mucosa is separated all over the cornea and an opening of 4.5 mm is performed in the center of the cornea. Previously the prosthesis has been taken out of the palpebral pocket, the wider portion of the optic cylinder is introduced in the anterior chamber, leaving the haptic part on the cornea anteriorly, which means we have a mesoprosthesis, which is then sutured to the eye and covered with the buccal mucosa.

Complications: During the first three months necrosis of the mucosa may develop, which means that a new mucosal graft must be applied or the third stage must be carried out as a transpalpebral procedure. Infection or resorption of the bone support of the prosthesis may also occur, in which case a new prosthesis must be constructed.

Late complications may include by order of frequency: Glaucoma, vitritis, retinal detachment, incipient extrusion of the prosthesis with intraocular infection and, finally, endophthalmitis with total expulsion of the prosthesis and phthisis bulbi.

Methods Results Conclusions EVER Office - European Association for Vision and Eye Research Kapucijnenvoer 33, B-3000 Leuven, Belgium ever@ever.be • tel +32 16 233 849 • fax +32 16 234 097

European Association for Vision and Eye Research e4224 - Long-term functional and anatomical results of OOKP and tibial OKP: Barcelona experience Additional information Session information This abstract has been assigned to session KPro 2 session: Clinical results and indications.

This session will take place on Saturday 3 October 2009 from 11:00 till 12:30 in room Europa B. Authors DE LA PAZ MF Barcelona BARRAQUER J Author 2 Barcelona Abstract To report the long-term functional and anatomical results of OOKP and Tibial OKP performed at the Purpose Barraquer Eye Center from 1974-2006. Different factors like surgical technique, clinical diagnosis, age and post-operative complications are also analyzed and reported.

A retrospective study on 330 eyes of 227 patients who underwent OOKP or tibia OKP was performed.

Methods Kaplan Meier survival curves and multivariate analysis using Cox regression model of the different variables mentioned are presented.

OOKP and Tibia OKP have comparable functional and anatomical results in the long-term. Best long-term functional and anatomical results are for patients with chemical burns, cicatricial trachoma and StevensJohnsons/Lyell syndrome. Thermal burns have a higher anatomical retention than other diagnostic Results categories. Younger patients have better visual prognosis and anatomical retention than older patients.

Patients must be warned of the possibility of sight-threatening complications like extrusion of the prosthesis, retinal detachment and glaucoma.

Our more than 35 years experience with biological keratoprosthesis using the OOKP and the tibia OKP Conclusionsshows that the two techniques are comparable. Certain variables like clinical diagnosis, age and postoperative complications affect the anatomical and functional results in the long-term.

Author 1

EVER Office - European Association for Vision and Eye Research Kapucijnenvoer 33, B-3000 Leuven, Belgium ever@ever.be â&#x20AC;˘ tel +32 16 233 849 â&#x20AC;˘ fax +32 16 234 097

European Association for Vision and Eye Research e4225 - Tibial KPro Additional information Session information This abstract has been assigned to session KPro 2 session: Clinical results and indications.

This session will take place on Saturday 3 October 2009 from 11:00 till 12:30 in room Europa B. Authors Author 1

TEMPRANO J Barcelona

Abstract The clinical results, from the anatomical point of view, are very good, although in the cases of mucosynechial syndromes, which also affect the buccal mucosa, pemphigoids or necrolysing epidermosis (Lyell), the mucosa may retract or necrolyse. In these cases we use the transtarsal method.

In elderly patients with osteoporosis the bone may be resorbed and it would be necessary to repeat the procedure using bone from a more favorable area of the tibia, which should be determined with local densitometry.

As far as the functional results are concerned, these depend on the conditions of the retina and the optic nerve. If both are in good conditions and the ocular pressure is normal, 20/20 vision may be achieved, although the visual field will never be more then 30º maximum.

Purpose

Indications: We perform this type of keratoprosthesis in patients without suitable teeth, affected with: Physical caustications (metal burns, bomb explosions, fire burns, etc.)

Chemical caustications, no matter whether the origin be alkali (worse prognosis because of the glaucoma which usually develops in these cases) or acids (lime, sulphuric acid, sodium hydroxide, etc).

Important trauma where the eye had to be covered with skin because of extensive lid destruction.

Advanced trachoma with total leucoma and extensive vascularization.

Pemphigus and all mucosynechial syndromes which lead to total xerosis Lyell’s syndrome, epidermizing necrolysis Cases of repeated failure of corneal transplantations Anterior segment alterations due to complicated aphakia, bullous keratopathy affecting the entire cornea after previous failure of keratoplasty.

Generally, total leucoma with important alterations of the limbus which would not permit survival of a corneal homotransplant.

Methods Results Conclusions EVER Office - European Association for Vision and Eye Research Kapucijnenvoer 33, B-3000 Leuven, Belgium ever@ever.be • tel +32 16 233 849 • fax +32 16 234 097

European Association for Vision and Eye Research e4326 - Tibial Bone KPro technique and long term results Additional information Session information This abstract has been assigned to session KPro 3 session.

This session will take place on Saturday 3 October 2009 from 13:45 till 15:15 in room Europa B. Authors Author 1

TEMPRANO J Barcelona

Abstract The operation is performed in three stages.

The first stage consists in preparing the eye to receive and maintain the keratoprosthesis. For this purpose the anterior surface of the eye is cleaned and regularized, eliminating fibrous tissue and the entire epithelium. Subsequently we obtain a 2 x 3 cm graft of buccal mucosa from the inferior lip comprising the entire mucosal and submucosal thickness. The graft is sutured to cover the anterior pole of the eye to promote revitalization.

The second stage consists in preparing the keratoprosthesis.

A 10 mm disk of tibial bone from the superior part of the medial face of the tibia is obtained using a crown drill. The posterior part of the piece of bone obtained is then cut with a chisel to obtain a thickness of 3 mm.

Subsequently the obtained disk of bone is cleaned and a central opening of 3.5 mm is performed to introduce in this opening a PMMA optic cylinder, 9 mm in length, 3.5 mm in diameter in its narrow portion, 4 mm in the wider portion. Fixation is achieved with cyanoacrylate. This is left to dry and then it is introduced into a palpebral pocket of the inferior lid of the patient. The pocket is closed with sutures and the piece is left in place for three months.

Purpose

For the third stage we remove the keratoprosthesis device from the palpebral pocket and if it is found to be in perfect conditions we dissect the buccal mucous membrane which is covering the cornea and perform a central window with a 4.5 mm trephine to remove the transparent or cataractous lens and perform a total iridectomy. The posterior portion of the optic cylinder is introduced into the anterior chamber. The prosthesis is sutured to the anterior pole of the eye with non-absorbible sutures. Finally the buccal mucosa is replaced, covering the entire area. One point of blepharorraphy is applied.

Long term results.

We started to use this technique in 1988 and after 21 years of experience we have 80% of anatomically perfect results. In 20 % of the cases the prosthesis extruded due to total or partial resorption of the bone. It has to be emphasized that these were cases without any other possibility of treatment.

We did 143 cases during these years.

The longest follow-up of a prosthesis “in situ” is 19 years. The earliest extrusion was after one year.

The complications are the same as for OOKP (glaucoma, retinal detachment, vitritis, extrusion) The functional results depend on the conditions of the retina and the optic nerve. There were many cases with 20/20 vision.

The mean value of retention of the prosthesis is 15 years.

Methods Results Conclusions EVER Office - European Association for Vision and Eye Research Kapucijnenvoer 33, B-3000 Leuven, Belgium ever@ever.be • tel +32 16 233 849 • fax +32 16 234 097