2011 memoria by Barraquer

Càtedra de Recerca en Oftalmologia "Joaquim Barraquer" - UAB

MEMÒRIA ANUAL Exercici 2011

Càtedra de Recerca en Oftalmologia "Joaquim Barraquer" - UAB

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

LÍNEAS DE INVESTIGACIÓN.............................................................4 1.1 1.2 1.3 1.4 1.5

Proyecto Phaco Ersatz - Cristalino - Catarata - Acomodación ........................... 4 Calidad óptica del ojo........................................................................................... 6 Diagnóstico y tratamiento del queratocono .......................................................12 Queratoprótesis y superficie ocular ................................................................... 20 Retinopatia diabetica ......................................................................................... 26

2. ACTIVIDADES DOCENTES ...............................................................28 2.1 2.2 2.3 2.4

Tesis de doctorado presentada en 2011.............................................................. 28 Tesis de doctorado en desarrollo ....................................................................... 28 Trabajos de investigación Máster ...................................................................... 30 Formación y cursos ............................................................................................ 35

3. ACTIVIDADES EN ORGANIZACIONES CIENTÍFICAS ................37 3.1 3.2 3.3 3.4

European Association for Vision and Eye Research ......................................... 37 Acta Ophthalmologica ....................................................................................... 37 European Vision Institute - Clincal Trials......................................................... 38 Redes Temáticas de Investigación Cooperativa................................................ 42

4. PUBLICACIONES ................................................................................44 4.1 4.2

Publicaciones en revistas indexadas.................................................................. 44 Presentaciones en congresos internacionales.................................................... 47

Càtedra de Recerca en Oftalmologia "Joaquim Barraquer" - UAB

Presentació Amb la normalitat que donen els anys de treball continuat, podem presentar la memòria d'activitats del 2011 parlant, en primer lloc, l'augment considerable de les publicacions en revistes indexades del Centre d'Oftalmologia Barraquer El 2011 no només hem aconseguit publicar 13 treballs en revistes indexades a Medline, sinó a més 11 de les publicacions han sortit en revistes amb factor d'impacte. Aquests publicacions tenen un factor d'impacte acumulat de 30. A l'àrea d'oftalmologia, les 20 millors revistes tenen com a mitjana un factor d'impacte de 3. Tres publicacions en revistes importants s'han publicat com a fruit de nostre treball en la xarxa espanyola Redes Temáticas de Investigación Cooperativa, integrada per diversos centres i grups d’investigació en biomedicina associats al Instituto de Salud Carlos III. Aquesta memòria també resumeix les nostres presentacions als congressos internacionals més rellevants en oftalmologia, com the European Society of Cataract & Refractive Surgeons, the Association for Research in Vision and Ophthalmology i the European Association for Vision and Eye Research. 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 12. III. 2012

Càtedra de Recerca en Oftalmologia "Joaquim Barraquer" - UAB

1. Líneas de investigación 1.1 Proyecto Phaco Ersatz - Cristalino - Catarata - Acomodación Reemplazamiento del material cristaliniano para recuperar la acomodación tras la cirugía de cataratas En el ámbito del Phaco Ersatz hemos publicado un Review article sobre el cristalino:

Abstract:: Cataract is a visible opacity in the lens substance, which, when located on the visual axis, leads to visual loss. Age-related cataract is a cause of blindness on a global scale involving genetic and environmental influences. With ageing, lens proteins undergo non-enzymatic, post-translational modification and the accumulation of fluorescent chromophores, increasing susceptibility to oxidation and cross-linking and increased light-scatter. Because the human lens grows throughout life, the lens core is exposed for a longer period to such influences and the risk of oxidative damage increases in the fourth decade when a barrier to the transport of glutathione forms around the lens nucleus. Consequently, as the lens ages, its transparency falls and the nucleus becomes more rigid, resisting the change in shape necessary for accommodation. This is the basis of presbyopia. In some individuals, the steady accumulation of chromophores and complex, insoluble crystallin aggregates in the lens nucleus leads to the formation of a brown nuclear cataract. The process is homogeneous and the affected lens fibres retain their gross morphology. Cortical opacities are due to changes in membrane permeability and enzyme function and shear-stress damage to lens fibres with continued accommodative effort. Unlike nuclear cataract, progression is intermittent, stepwise and non-uniform.

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

Michael R, Bron AJ. The ageing lens and cataract: a model of normal and pathological ageing. Philos Trans R Soc Lond B Biol Sci. 2011;366(1568):1278-92. Review. DOI: 10.1098/rstb.2010.0300 / PMID: 21402586 Impact factor: 6.0

Càtedra de Recerca en Oftalmologia "Joaquim Barraquer" - UAB

1.2 Calidad óptica del ojo

Abstract: Purpose: To test the feasibility of calculating neural contrast sensitivity function (neural CSF) from conventionally measured total contrast sensitivity function (total CSF) and measured modulation transfer function (MTF). Neural CSF considers the retina and the brain, whereas total CSF considers the optical eye media, the retina and the brain together. Methods: We studied three groups comprising nine eyes each: one group with normal ocular optics but retinal alterations (mild diabetic retinopathy), one with altered ocular optics and normal retina (keratoconus), and a normal control group. Results: Total CSF in the keratoconus and retinopathy groups was significantly lower compared to the control group. Modulation transfer function for keratoconus was lower, and in the retinopathy group was similar to that of the control group. Calculated neural CSF in the diabetes mellitus group was lower than in the control group whereas in the keratoconus group it was similar to that of the control group, with overestimations for some keratoconus cases. Conclusion: It is possible to calculate a meaningful neural CSF from measured total CSF and MTF data. The neural CSF represents a CSF adjusted for optical aberrations. This would allow comparison of the neural component of visual function in eyes with different optical aberrations.

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

Michael R, Guevara O, de la Paz M, Alvarez de Toledo J, Barraquer RI. Neural contrast sensitivity calculated from measured total contrast sensitivity and modulation transfer function. Acta Ophthalmol. 2011;89(3):278-83. DOI: 10.1111/j.1755-3768.2009.01665.x / PMID: 19909292 Impact factor: 2.4

Càtedra de Recerca en Oftalmologia "Joaquim Barraquer" - UAB

Abstract: Purpose: This study aimed to investigate the prevalence of impairment of visual function amongst European drivers. Methods: A total of 2422 drivers from five European countries underwent a battery of visual function tests, including tests for visual acuity (VA), visual field (VF), contrast sensitivity, straylight (glare sensitivity) and useful field of view (UFOV). Subjects belonged to the following age categories: 45–54 years; 55–64 years; 65–74 years, and ‡ 75 years. A group of subjects aged 20– 30 years served as a reference group. Results were compared with current standards for the visual function of drivers in the EU. Results: Visual acuity in 0.5% of the younger group and 5.3% of the eldest group was below the standard required for driving. Visual acuity after proper refraction adhered to the standard in the majority of cases. Visual field results were below standard or questionable in 2.7% and 2.4%, respectively, of subjects in the eldest group. In this eldest group, impaired contrast sensitivity was present in 6.3%, increased glare sensitivity in 29.5% and impaired UFOV in 21.6% of subjects, but, as there are no standards for these criteria, the exact level of prevalence depends on the definition of impairment. Conclusions: Prevalences of impairment of visual functions that are not included in current standards (particularly contrast sensitivity and glare sensitivity) are much higher than prevalences of functions that are included (VA and VF).

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

van Rijn LJ, Nischler C, Michael R, Heine C, Coeckelbergh T, Wilhelm H, Grabner G, Barraquer RI, van den Berg TJ. Prevalence of impairment of visual function in European drivers. Acta Ophthalmol. 2011;89(2):124-31. DOI: 10.1111/j.1755-3768.2009.01640.x. / PMID: 19832733 Impact factor: 2.4

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

PURPOSE: To report the impact on visual function and corneal aberrations during an epidemic of diffuse lamellar keratitis (DLK). METHODS: A retrospective, comparative, and consecutive case-control study was performed, involving 418 eyes operated between March and October 2007 in the refractive surgery unit of one center. Eyes were separated into groups: group 1 (DLK group) included 209 eyes that presented with DLK after LASIK and group 2 (control group) included 209 unaffected, consecutive eyes operated from the beginning of the outbreak. Refractive variables and corneal aberrations were compared between the two groups. RESULTS: Visual outcomes were signifi cantly different when comparing control eyes and eyes with DLK grades 3 and 4, but not for eyes with DLK grades 1 and 2. Uncorrected distance visual acuity (UDVA) signifi cantly improved from the third month after DLK was diagnosed (Kruskal-Wallis, P=.02). Corrected distance visual acuity (CDVA) did not decrease signifi cantly with DLK grades 1 and 2 (preoperative CDVA vs 1, 3, and 6 months after diagnosis; MannWhitney, P>.05, respectively). At the end of follow-up, UDVA and CDVA were not signifi cantly different between the two groups. Eyes suffering from DLK had signifi cantly increased corneal aberrations, except for spherical and astigmatism aberrations, 3 months after being diagnosed (Kruskal-Wallis, P .05); however, corneal aberrations were not signifi cantly different between the DLK and control groups (Mann-Whitney, P>.05). CONCLUSIONS: The outbreak of DLK did not induce a signifi cant decrease in global visual outcomes, except in severe cases, and postoperative corneal aberrations were not affected.

Càtedra de Recerca en Oftalmologia "Joaquim Barraquer" - UAB

Javaloy J, Alió JL, El Kady B, Muñoz G, Barraquer RI, Maldonado MJ. Refractive outcomes and quality of vision related to an outbreak of diffuse lamellar keratitis. J Refract Surg. 2011;27(11):804-10. DOI: 10.3928/1081597X-20110411-02. / PMID: 21563731 Impact factor: 2.3

Càtedra de Recerca en Oftalmologia "Joaquim Barraquer" - UAB

1.3 Diagnóstico y tratamiento del queratocono

Abstract: Aims To test the use of parameters obtained from the ocular response analyser (ORA) to distinguish between normal and keratoconic eyes, to determine the severity of keratoconus (KC), and to evaluate changes after treatment with cross-linking (CXL) and intrastromal corneal ring (ICR) implantation. Methods In total, 42 parameters were derived from the ORA’s applanation response curve. Data on 119 subjects were included in the study. We determined the power of discrimination between control subjects (n=48) and KC patients (stages I and II, n=54) using receiver operating characteristic (ROC) curves. We then tested the correlation between all KC stages (n=71) and the ORA parameters. Finally, we evaluated the changes at 4 months after CXL (n=22) and ICR (n=39). Results The ROC curves for 12 parameters showed excellent results; 24 parameters generated moderate results and six parameters generated poor results. The correlations between the KC stages and 14 parameters were significant, with good to moderate results. The corneal resistance factor and the area under the second peak of the signal curve produced the best results in distinguishing between normal and KC eyes. Two parameters after CXL (p2area and time1) and six parameters after ICR implantation (aplhf, uslope11, w11, path11, time1 and deltatime) showed significant differences with respect to the preoperative conditions. Conclusion Most of the new waveform parameters demonstrated good ability to distinguish between KC and normal eyes. The changes in the parameter values after CXL and ICR treatments were smaller than expected.

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

Mikielewicz M, Kotliar K, Barraquer RI, Michael R. Air-pulse corneal applanation signal curve parameters for the characterisation of keratoconus. Br J Ophthalmol. 2011;95(6):793-8. DOI: 10.1136/bjo.2010.188300 /PMID: 21310802 Impact factor: 2.9

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

Abstract: PURPOSE: To evaluate and characterize the clinical features of corneal ectasia after myopic laser in situ keratomileusis (LASIK) considering internal astigmatism and corneal aberrations and their correlation with other clinical data. DESIGN: Retrospective comparative case series. METHODS: In this multicenter study, eyes were divided into 2 groups. The study group comprised eyes that had corneal ectasia after myopic LASIK. The control group comprised eyes that had successful LASIK to correct high myopia. The clinical outcomes were analyzed and compared. Internal astigmatism was calculated using vectorial analysis. RESULTS: The study enrolled 91 eyes (48 study group; 40 control group) of 81 patients (age 18 to 67 years). Uncorrected and corrected (CDVA) distance visual acuities and the refractive status were significantly worse in the study group (P<.01). Corneas in the study group had a significantly higher steepest keratometry (K) reading and a more negative central asphericity (P<.01). Internal astigmatism and corneal aberrations were also significantly higher in the study group (P<.01). The CDVA was significantly correlated with primary spherical aberration (r = 0.561, P=.01) and primary coma root mean square (r = - 0.451, P=.04). Age was significantly correlated with mean K (r = -0.44, P=.01) and internal astigmatism (r = - .34, P=.04). CONCLUSION: Larger levels of internal astigmatism and anterior corneal aberrations leading to a visual deterioration were present in eyes with corneal ectasia after myopic LASIK.

Càtedra de Recerca en Oftalmologia "Joaquim Barraquer" - UAB

Piñero DP, Alió JL, Barraquer RI, Uceda-Montanes A, Murta J. Clinical characterization of corneal ectasia after myopic laser in situ keratomileusis based on anterior corneal aberrations and internal astigmatism. J Cataract Refract Surg. 2011 Jul;37(7):1291-9. DOI: 10.1016/j.jcrs.2010.12.063 / PMID: 21700106 Impact factor: 2.7

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

PURPOSE. To evaluate by vector analysis the corneal astigmatic changes occurring in keratoconic corneas during a 3-year follow- up and to determine the relationship between these changes and other clinical changes. METHODS. Keratoconic eyes (n = 114) of 75 patients ranging in age from 14 to 70 years were retrospectively reviewed in four different centers. In all cases, a 3-year follow-up was completed after the diagnosis of keratoconus. Visual, refractive, keratometric, aberrometric, internal astigmatism (IA), and pachymetric changes were evaluated during the follow-up. In addition, corneal astigmatic changes were evaluated by examining the following parameters, using a modification of the Alpins vectorial method: evolutive astigmatism (EA) and angle of error (AE). RESULTS. An increase in the magnitude of refractive (P = 0.02) and corneal astigmatism (P = 0.05) was found. The mean magnitude of EA was 1.21 +/- 0.97 D at 3 years, with no significant changes at each annual visit (P > 0.52). Mean absolute AE increased significantly by the end of the follow-up (P = 0.01). Absolute AE and the increase in corneal astigmatism were found to correlate at 2 years (r = 0.675, P < 0.01). This correlation became poorer at 3 years (r = 0.352, P = 0.02). The magnitude of the EA was also found to be significantly correlated with central corneal thinning (r = - 0.441, P = 0.02). Multiple regression analysis revealed that the magnitude of EA at 3 years correlated significantly with the baseline sphere and IA (R2 = 0.86, P < 0.01). CONCLUSIONS. Corneal vector astigmatic changes are related to some signs of keratoconus progression and are therefore predictive.

Càtedra de Recerca en Oftalmologia "Joaquim Barraquer" - UAB

Piñero DP, Alio JL, Tomás J, Maldonado MJ, Teus MA, Barraquer RI. Vector analysis of evolutive corneal astigmatic changes in keratoconus. Invest Ophthalmol Vis Sci. 2011;52(7):4054-62. DOI: 10.1167/iovs.10-6856 / PMID: 21372010 Impact factor: 3.4

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

PURPOSE: To evaluate the clinical features of keratoconus taking into consideration anterior corneal aberrations, internal astigmatism, and corneal biomechanical properties and to define a new grading system based on visual limitation. DESIGN: Retrospective case series. METHODS: This multicenter study comprised consecutive keratoconic eyes with no previous ocular surgery or active ocular disease. Visual, refractive, corneal topography, and pachymetry outcomes were analyzed. Internal astigmatism was calculated by vectorial analysis. Corneal aberrations and corneal biomechanics characterized by the Ocular Response Analyzer were evaluated in some eyes. Correlations between clinical data and a linear multiple regression analysis for characterizing the relationship between visual limitation and objective clinical data were performed. RESULTS: This study comprised 776 eyes of 507 patients (age range 11 to 79 years) The mean keratometry (K) correlated significantly with logMAR corrected distance visual acuity (CDVA) (r = 0.591, P<.01), internal astigmatism (r = 0.497, P<.01), corneal asphericity (r =- 0.647, P<.01), and several corneal higher-order aberrometric coefficients (r2 = 0.603, P<.01). Significant correlations were found between some corneal aberrometric parameters and CDVA (rR0.444, P<.01). Multiple regression analysis showed that CDVA was significantly correlated with the mean K, intraocular pressure, corneal resistance factor, and spherical equivalent (r2 = 0.69, P<.01). There were significant differences in mean K, internal astigmatism, and corneal higherorder aberrations between 4 groups differentiated by visual limitation (P<.01). CONCLUSION: The visual limitation in keratoconus could be explained by different alterations that occur in these corneas and allowed development of a new grading system for this condition.

Càtedra de Recerca en Oftalmologia "Joaquim Barraquer" - UAB

Alió JL, Piñero DP, Alesón A, Teus MA, Barraquer RI, Murta J, Maldonado MJ, Castro de Luna G, Gutiérrez R, Villa C, Uceda-Montanes A. Keratoconus-integrated characterization considering anterior corneal aberrations, internal astigmatism, and corneal biomechanics. J Cataract Refract Surg. 2011;37(3):552-568. DOI:10.1016/j.jcrs.2010.10.046 / PMID: 21333878 Impact factor: 2.9

Càtedra de Recerca en Oftalmologia "Joaquim Barraquer" - UAB

1.4 Queratoprótesis y superficie ocular

Abstract: Purpose: To report the long-term functional and anatomical outcomes of osteo-odontokeratoprostheses (OOKP) and tibial osteo-keratoprostheses (tibial bone KPro); to analyze the influence of clinical factors, such as surgical technique, primary diagnosis, age, and postoperative complications, on the final outcome. Design: Retrospective cohort study Methods: Setting: Centro de Oftalmología Barraquer, between 1974 and 2005. Participants: 227 patients Intervention: Biological keratoprosthesis using osteo-odonto-keratoprosthesis (OOKP) or tibial osteo-keratoprosthesis (tibial bone KPro). Main Outcome Measures: Functional survival with success defined as best-corrected visual acuity (BCVA) ≥0.05; anatomical survival with success defined as retention of the keratoprosthesis lamina. Results: OOKP and tibial bone KPro have comparable anatomical survival at 5 and 10 years of follow-up, but OOKP has a significantly better functional success than tibial bone KPro at the same time periods. Among the primary diagnoses, Stevens-Johnson syndrome, chemical burn, and trachoma have generally good functional and anatomical outcomes and the least favorable prognosis is for ocular cicatricial pemphigoid. Younger patients fared better than those in older age groups. The most frequent complications were extrusion (28%), retinal detachment (16%), and uncontrolled glaucoma (11%). The glaucoma group had the best anatomical success but the worst functional results, only exceeded by the retinal detachment group in terms of functional outcome. Conclusion: Clinical factors, such as surgical technique, primary diagnosis, age, and postoperative complications, can affect the long-term anatomical and functional successes of biological keratoprosthesis. Knowledge about the impact of each of these factors on survival can help surgeons determine the best approach in every particular case.

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

De La Paz MF, De Toledo JA, Charoenrook V, Sel S, Temprano J, Barraquer RI, Michael R. Impact of Clinical Factors on the Long-Term Functional and Anatomic Outcomes of Osteo-odonto-keratoprosthesis and Tibial Bone Keratoprosthesis. Am J Ophthalmol. 2011;151(5):829-839.e1. DOI:10.1016/j.ajo.2010.11.011 / PMID: 21310387 Impact factor: 3.8

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

Purpose: Corneal epithelium is maintained by a population of stem cells (SCs) that have not been identified by specific molecular markers. The objective of this study was to find new putative markers for these SCs and to identify associated molecular pathways. Methods: Real time PCR (rt-PCR) was performed in 24 human limbal and central corneal epithelial samples to evaluate the gene expression profile of known corneal epithelial SCassociated markers. A pool of those samples was further analyzed by a rt-PCR array (RT2-PCRA) for 84 genes related to the identification, growth, maintenance, and differentiation of SCs. Results: Cells from the corneal epithelium SC niche showed significant expression of ATPbinding cassette sub-family G member 2 (ABCG2) and cytokeratin (KRT)15, KRT14, and KRT5 genes. RT2-PCR-A results indicated an increased or decreased expression in 21 and 24 genes, respectively, in cells from the corneal SC niche compared to cells from the central corneal epithelium. Functional analysis by proprietary software found 4 different associated pathways and a novel network with the highest upregulated genes in the corneal SC niche. This led to the identification of specific molecules, chemokine (C-X-C motif) ligand 12 (CXCL12), islet-1 transcription factor LIM/homeodomain (ISL1), collagen-type II alpha 1 (COL2A), neural cell adhesion molecule 1 (NCAM1), aggrecan (ACAN), forkhead box A2 (FOXA2), Gap junction protein beta 1/connexin 32 (GJB1/Cnx32), and Msh homeobox 1 (MSX1), that could be used to recognize putative corneal epithelial SCs grown in culture and intended for transplantation. Other molecules, NCAM1 and GJB1/Cnx32, potentially could be used to positively purify them, and Par-6 partitioning defective 6 homolog alpha (PARD6A) to negatively purify them. Conclusions: Knowledge of these gene and molecular pathways has provided a better understanding of the signaling molecular pathways associated with progenitor-rich limbal epithelium. This knowledge potentially could give support to the design and development of innovative therapies with the potential to reverse corneal blindness arising from ocular surface failure.

Càtedra de Recerca en Oftalmologia "Joaquim Barraquer" - UAB

Nieto-Miguel T, Calonge M, de la Mata A, López-Paniagua M, Galindo S, de la Paz MF, Corrales RM. A comparison of stem cell-related gene expression in the progenitor-rich limbal epithelium and the differentiating central corneal epithelium. Mol Vis. 2011;17:2102-17. DOI: no / PMID: 21850186 Impact factor: 2.5

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

Case report: A 68 year-old male with idiopathic choroidal polypoidal vasculopathy received seven intravitreal injections of bevacizumab in the supero-nasal quadrant. He later developed a localized limbal stem cell deficiency which required limbal transplantation from the same eye. Two months after surgery, a slight improvement of visual acuity was noted, along with an intact ocular surface, clear cornea and decreased inflammation. Discussion: Repeated surgical trauma on the limbus and surrounding areas may damage the limbal stem cells, giving rise to a corneal epitheliopathy due to iatrogenic limbal deficiency. Repeated intravitreal injections may be considered as one of the possible causes.

Capella MJ, Alvarez de Toledo J, de la Paz MF. Limbal stem cell deficiency following multiple intravitreal injections. Arch Soc Esp Oftalmol. 2011;86(3):89-92. DOI: 10.1016/j.oftal.2010.11.018 / PMID: 21511104 Impact factor: -

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

Case report: An 80-year-old woman diagnosed with a recurrent squamous conjuctival carcinomatreated with surgical excision of the lesion, zonal reconstruction and topical Interferon alpha 2-beta. Discussion: Squamous conjunctival carcinoma is the most frequent neoplasm of the ocular surface. Surgical removal of the lesion is the traditional treatment, but this technique has a high recurrence rate. Interferons are glycoproteins that trigger intracellular pathways with antiviral and antitumoral properties. Recent studies have proven their activity against conjunctival carcinoma.

Verdaguer P, Fideliz de la Paz M, Alvarez de Toledo JP, Barraquer RI. Interferon alpha 2Î˛, partial keratectomy and amniotic membrane transplant for the treatment of a recurrent conjunctival squamous carcinoma. Arch Soc Esp Oftalmol. 2011;86(5):154-7. DOI:10.1016/j.oftal.2011.01.010 / PMID: 21624656 Impact factor: -

Càtedra de Recerca en Oftalmologia "Joaquim Barraquer" - UAB

1.5 Retinopatia diabetica

Objective: To simultaneously evaluate tyrosine nitrosylation and phosphorylation levels of vitreous interleukins of patients with diabetic retinopathy, in which abnormal tyrosine phosphorylation has been previously described. Research Design and Methods: Specific immunoprecipitation of interleukins IL-1α, IL-1β, IL-2 and IL-7 was carried out in samples obtained during vitrectomy performed for proliferative diabetic retinopathy in patients (n = 12) and for macular hole in controls (n = 12). Tyrosine nitrosylation and phosphorylation levels of the immunoprecipitated interleukins were analysed by Western blot with the respective specific antibodies and correlated. The results were also correlated with the total amount of immunoprecipitated interleukin protein. The mean phosphorylation/nitrosylation ratios of these proteins in vitreous humour of both the control group and diabetic patients were determined.

Càtedra de Recerca en Oftalmologia "Joaquim Barraquer" - UAB

Results: Diabetes was associated with decreased tyrosine nitrosylation of IL-1α, IL-1β and IL-7 and an increased tyrosine phosphorylation/nitrosylation ratio with respect to controls in IL-1α (1.58 ± 0.22 vs. 2.74 ± 0.39, respectively; p < 0.05) and IL-7 (2.15 ± 0.01 vs. 3.26 ± 0.57, respectively; p < 0.05). No significant changes were observed in nitrotyrosine or in the tyrosine phosphorylation/nitrosylation ratio of IL-2. Conclusions:Proliferative diabetic retinopathy is associated with concomitant and simultaneous changes in both tyrosine phosphorylation and tyrosine nitrosylation status of specific proinflammatory interleukins present in the vitreous fluid such as IL-1α, IL-1β and IL-7. These changes could be related to the increase in pro-inflammatory activity detected in diabetesinduced retinopathy.

Reverter JL, Nadal J, Ballester J, Ramió-Lluch L, Rivera MM, Fernández-Novell JM, Elizalde J, Abengoechea S, Rodriguez J-E Diabetic Retinopathy Is Associated with Decreased Tyrosine Nitrosylation of Vitreous Interleukins IL-1α, IL-1β, and IL-7. Ophthalmic Res 2011;46:169-174 DOI: 10.1159/000323812 / PMID: 21447989 Impact factor: 1.3

Càtedra de Recerca en Oftalmologia "Joaquim Barraquer" - UAB

2. Actividades docentes 2.1 Tesis de doctorado presentada en 2011 día 11 de noviembre 2011 a las 13:00 h en el Auditorium II del Instituto Banaquer lectura de Tesis Doctoral Jerónimo Nadal Reus Aproximación a la fisiopatologiade la retinopatia diabética. estudio de la fosforilación y nitrosilación de tirosinas de proteinas y péptidos inflamatorios y angiogénicos del humor vitreo Dirigida por el Profesor Julio de la Cámara Hermoso y el Doctor Jordi L. Reverter Calatayud

2.2 Tesis de doctorado en desarrollo I.

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

II.

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

III.

Endoftalmitis de etiología exógena. Revisión de datos clínicos. Simona Nossa, Bergamo, Italia. Tutor: Santos Muiños. (Tesis en desarrollo).

IV.

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

Càtedra de Recerca en Oftalmologia "Joaquim Barraquer" - UAB

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

VI.

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

VII.

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

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

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

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

XI.

Corrección del Astigmatismo con Láser Excimer. Marta López Fortuny. Tutor: Prof. Joaquín Barraquer y Andrés Picó. (Tesis en desarrollo)

XII.

Medición de la luz dispersa intraocular como nuevo parámetro para valorar la calidad visual. Gustavo Montenegro. Tutor: Prof. Joaquín Barraquer y Ralph Michael. (Tesis en desarrollo)

Càtedra de Recerca en Oftalmologia "Joaquim Barraquer" - UAB

2.3 Trabajos de investigación Máster Máster de segmento anterior BARREIRO GONZÁLEZ, José Ramón Degeneraciones corneales y queratopatias metabólicas Tutor: Dr. R.I. Barraquer BAUSILI PORTABELLA, Montserrat Estudio comparativo visual de lentes Acrysoft Restor Tutor: Dra. Barraquer CAMPOS POLO, Rafael EL SHARIF AHMED, Hamdy Modificaciones en el grosor corneal a lo largo del día Tutor: Dr. Pico TORRICO DELGADILLO, Mauricio CÁRCAMO MARTÍNEZ, Ana Lilia Queratopatia neurotropfica post ciclofotocoagulación Tutor: Dra. de la Paz CASTILLO VELÁZQUEZ, Javier Calculo de lente intraocular en pacientes pos operados de Lasik Tutor: Dr. Pico COLOMÉ CAMPOS, Jordi Reconstrucción de la superficie ocular a partir de cultivos ex vivo de mucosa oral - Estudio bibliográfico Tutor: Dr. Martínez Osorio DÍAZ ALEMÁN, Valentín Queratitis por Acanthamoeba. Revisión bibliográfica. Tutor: Dr. Alvarez de T., Dra. de la Paz DI SIPIO MANASSERO, Agustina Seguimiento a largo plazo de la Dacriocistorinostomia transcanalicular con laser Tutor Dr. Gorka Martinez Grau, Dr. Martinez Osorio ESPÓSITO, Fernando Augusto Deep Anterior Lamellar Keratoplasty in patients with keratoconus: big-bubble technique with Johns cánula vs needle 30 G Tutor: Dr Alvarez de Toledo y Dra De la Paz FERNÁNDEZ-VEGA CUETO-FELGUEROSO, Luís Queratocono: Orientacion terapeutica y refractiva de las ectasias pericentrales. Tutor: Dr. R.I. Barraquer y Dr. Jose Lamarca

Càtedra de Recerca en Oftalmologia "Joaquim Barraquer" - UAB

Máster de segmento anterior FERNÁNDEZ-VIGO ESCRIBANO, Cristina Cirugía refractiva con lentes intraoculares fáquicas. Estudio clinico y experimental. Tutor: Dr. Milan Pesic GARCÍA OLIVA, Ivanna Queratitis por acanthamoeba, evolución hacia la queratoplastia, dos casos. Tutor: Dr. Alvarez de T., Dra. de la Paz GORDILLO, Carlos Hernán Influence of Injectors on Endothelial Cell Loss after DSAEK Tutor: Dr. Juan P. Álvarez de Toledo, Dr. Ralph Michael MÁRMOL DÍAZ, Marta Comparative study of visual acuity, corneal tomography and macular tomography after phacotrabeculectomy versus phaco-deep sclerectomy Tutor: Dr. F. Ruiz Tolosa MIKIELEWICZ, Marek Elastic properties of human lens zonules in presbyopic donor eyes as a function of age Tutor: Dr. R.I. Barraquer, Dr. Ralph Michael MENDOZA YAYA,Mónica Catherin Manejo de las Alteraciones severas de la Superficie Ocular con Plasma rico en Plaquetas y Suero Autólogo Tutor: Dr. Martínez Osorio MIERS GRANADA, Gloria Rossana Comparación de las mediciones del ORA en ojos de donantes Tutor: Dr. Ralph Michael MIRANDA FERNÁNDEZ, Sara Persistencia de endotelio receptor tras queratoplastia penetrante Tutor: Dr. Juan P. Álvarez de Toledo MONTOYA SANDOVAL, Yanira de Lourdes Calidad visual en pacientes posoperados de facorrefractiva y colocacion de una lente intraocular multifocal Tutor: Dra. Elena Barraquer MUÑOZ GUTIÉRREZ, Gerardo Complicaciones post Queratoprótesis de Boston Tutor: Dra. de la Paz NÚÑEZ SÁNCHEZ, Genry Alex Aspectos clinicos de la queratopatia bullosa Tutor: Dr. R.I. Barraquer

Càtedra de Recerca en Oftalmologia "Joaquim Barraquer" - UAB

Máster de segmento anterior PINILLA CORTÉS, Laura Mª LASIK en pacientes con errores refractivos residuales post cirugía de cataratas con lentes intraoculares Restor Tutor: Dr. R.I. Barraquer, Dr. Ribas PORTORREAL ACOSTA, Judith Eridania Correlación clinica y microbiologica en cultivo bacteriano y fúngico Tutor: Dr. Martínez Osorio QUILENDRINO, Mary Ruth Implante de anillo intraestromal de Krumeich en queratoplastia penetrante de alto riesgo Tutores: Dr. Juan P. Álvarez de Toledo, Dra. María Fideliz de la Paz RAFAT CASAFONT, Laia Cambios en la superficie posterior de la cornea post LASIK Tutor: Dr. Picó RAMOS FERNÁNDEZ, Carlota Eficacia del tratamiento tópico con interferón alfa 2beta para las neoplasias intraepiteliales corneoconjuntivales Tutor: Dr. Charoenrook RIBAS GONZÁLEZ, Verónica Estudio de quistes de iris mediante OCT de segmento anterior y ecografía. Tutor: Dr Santos Muiños - Dra Maria Isabel Canut ROCHA CABRERA, Pedro Uso del bevacizumab en la superficie ocular Tutores: Dra. María Fideliz de la Paz

Càtedra de Recerca en Oftalmologia "Joaquim Barraquer" - UAB

Máster de segmento posterior ALONSO PLASENCIA, Marta RODRÍGUEZ GIL, Ruyman Evaluación de la fiabilidad de la OCT Cirrus en la estimación del espesores y segmentación de capas de la retina en el edema macular secundario a oclusión venosa retiniana Tutor: Dr. S. Abengoechea ALVA FLORES, Víctor Manuel Manejo del edema macular diabético con corticoides Tutor: Dr. Abengoechea BAUSILI PORTABELLA, Montserrat FERNÁNDEZ-VEGA CUETO-FELGUEROSO, Luís Tomas de la Presión intraocular post operatoria tras vitrectomía de 20G y 23G o 25G Tutor: Dr. Jeroni Nadal CASTILLO VELÁZQUEZ, Javier Diagnostico diferencial en el síndrome de puntos blancos. Tutor: Dr. Jeroni Nadal CHARAFEDDIN ABOUL HOSN, Wissam Valoración de la progresión de degeneración macular asociada a la edad en pacientes operados de extracción de catarata por sonofacoaspiración. Tutor deseado: Dr.J.Nadal ESPEJO YEP, Alberto Ultimos alcances en el tratamiento del edema macular diabetico Tutor: Dra. Viver FERNÁNDEZ-VIGO ESCRIBANO, Cristina Eficacia del Lucentis versus fotocoagulación con láser en edema macular diabético Tutor: Dr. Santiago Abengoechea GONZÁLEZ GONZÁLEZ, Fernando Implante de dexametasona intravitrea de liberacion lenta para el tratamieto del edema macular diabético Tutor: Dr. Javier Elizalde Montagut ILKHANY, Baratali Enfermedad de Stargardt - Revisión bibliográfica Tutor: Dr. Javier Santos Muiños KUDSIEH, Bachar RIBAS GONZÁLEZ, Verónica Terapia fotodinámica en el tratamiento de DR sensorial en estafilomas posteriores Tutor: Dr. Abengoechea MÁRMOL DÍAZ, Marta Macroaneurismas arteriales retinianos Tutor: Dr. Javier Elizalde Montagut

Càtedra de Recerca en Oftalmologia "Joaquim Barraquer" - UAB

Máster de segmento posterior MIKIELEWICZ, Marek Valor prognostico de la OCT en la agudeza visual postquirúrgica de las membranas epiretinianas. Tutor: Dr. J. Nadal MACEDO, Kelma Estudio del fenotipo citogenético en los melanomas uveales como índice de factor prognóstico Tutor: Dr. Javier Elizalde MÉNDEZ COTO, Sofía Indicación de antiagregación en la obstrucción vascular venosa en la retina Tutor: Dr. Nadal MENDOZA YAYA, Mónica Catherin Revisión de Coroiditis Serosa Central Tutor: Dr. Javier Santos Muiños MIERS GRANADA, Gloria Rossana Revisión Bibliografica: Retinoblastoma nuevas opciones de tratamiento Tutor: Dr. Javier Elizalde NÚÑEZ SÁNCHEZ, Genry Alex Células madre en retina Tutor: Dr. Javier Santos Muiños PEIRO EMBID, Carlos Complicaciones neovasculares de los procesos inflamatorios e idiopáticos del polo posterior Tutor: Dra. Viver PIÑEIRO FIGUEIRA, Mª Carmen Bases genéticas de la retinosis pigmentaria Tutor: Dr. Javier Santos Muiños RAFAT CASAFONT, Laia Eficacia y seguridad de Lucentis en el tratamiento de la Ploriferacion Angiomatosa Retiniana Tutor: Dr. Abengoechea TORRADO SIERRA, Óscar Retinopatía del prematuro en la provincia de Badajoz. Incidencia y gravedad. Tutor: Dr. Javier Santos Muiños TORRES PEREDA, Juan Pedro Vitrectomía con anestesia tópica subconjuntival Tutor: Dr. Javier Elizalde TORRICO DELGADILLO, Mauricio Adelantos de los anti-VEGF en retinopatía diabética Tutor: Dr. Javier Elizalde VARGAS CALLENDER, Kelia Gardenia Caracterisricas clinicas vasculopatía coroidea polipoidal idiopática Tutor: Dr .Abengoechea

Càtedra de Recerca en Oftalmologia "Joaquim Barraquer" - UAB

2.4 Formación y cursos 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 2011: Miércoles, 14 de diciembre 2011, 14:00 - Calidad visual de los LIOs - Medición de la luz dispersa en el COB - Temas para los Transparency Club 2012 Miércoles, 23 de noviembre 2011, 14:00 - Diseño de estudio "IOL glistenings & Visual quality" - Diseño de estudio "IOL material & Visual quality" - Solicitud subvención UE con el Institut de Ciències Fotòniques - Opción para los Masters presentar sus propuestas de estudios Miércoles, 19 de octubre 2011, 14:00 - Presbyopia - resumen de un simposio principal del ESCRS en Viena - KPro - resumen del EUCornea & ESCRS en Viena - KPro - posibles estudios experimentales Miércoles, 28 de septiembre 2011, 14:00 - Laser de femto segundos en la cirugía de catarata - Laser de femto segundos para tratar la presbicia - Nuevo aparato para medir la biomecánica de la cornea

Càtedra de Recerca en Oftalmologia "Joaquim Barraquer" - UAB

Miércoles, 27 de julio 2011, 14:00 - Situación de proyectos actuales y futuros en el dpto. de investigación: Krumeich, Boston Kpro, Aniridia, FIS 2008, FIS 2010, Alzheimer I y II, Lens stretching, Zonules, Lentotomy, IOL opacification, Straylight, ... Miércoles, 22 de junio 2011, 14:00 - Resultados de trabajos de Master - Diseño del estudio sobre cortes con fs-laser en el cristalino Miércoles, 18 de mayo 2011, 14:00 - Resumen y novedades del ARVO 2011 (www.arvo.org) - Preparaciones para el EVER 2011 (www.ever.be) Miércoles, 13 de abril 2011, 14:00 - Resultados del estudio Alzheimer & Cataract - Posibles nuevos estudios sobre la luz dispersa Miércoles, 23 de marzo 2011, 14:00 - Presentación del capitulo "Medición de la luz dispersa como parámetro de calidad visual" - Estudios de queratocono dentro de la Red Temática del Instituto Carlos III - Queratoprótesis: diseño de nuestro estudio sobre el Boston Kpro Martes, 15 de febrero 2011, 14:00 - Phaco Ersatz y cortes en el cristalino con laser de femtosegundos - Institut de Ciències Fotòniques en Castelldefels Miércoles, 12 de enero 2011, 14:00 - Estudio Alzheimer y catarata - Estudio experimental de ORA con ojos de donantes

Càtedra de Recerca en Oftalmologia "Joaquim Barraquer" - UAB

3. Actividades en organizaciones científicas 3.1 European Association for Vision and Eye Research

Organización de un Special Interest Symposium durante el congreso de EVER 2011: RESTORATION OF ACCOMMODATION Moderators: Rafael I. BARRAQUER, Ralph MICHAEL Saturday 8 October 2011 from 13:45 - 15:15

3.2 Acta Ophthalmologica

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

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.

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

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: 2010/MAY - 2012/APRIL

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

Càtedra de Recerca en Oftalmologia "Joaquim Barraquer" - UAB

6th EVICR.net Members Meeting 14 November, 2011 Ghent - Belgium The meeting was attended by 120 participants. In the Scientific Sections meetings that took place in Ghent the Expert Committee Members were elected. At the Expert Committee meetings the following Expert Committee Coordinators were elected for the period of November 2011-2013: - AMD and Retinal Dystrophies – Prof. J. Sahel (CS nº 6) - Diabetic Retinopathy – Prof. J. Cunha-Vaz (CS nº 1) - Glaucoma – Dr. E. Hoffmann (CS nº 2) - Cornea, Cataract and Refractive Surgery – Prof. J. Alió (CS nº 7) - Ocular Surface and Inflammation – Prof. J. Murta (CS nº 70) - Reading Centers – Dr. T. Peto (CS nº 10)

Càtedra de Recerca en Oftalmologia "Joaquim Barraquer" - UAB

3.4 Redes Temáticas de Investigación Cooperativa

El Instituto Universitario Barraquer es miembro de la red temática Patología Ocular del Envejecimiento, Calidad Visual y Calidad de Vida, subproyecto Calidad de Vida y Cirugía del Dioptrio Ocular desde 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.

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

Càtedra de Recerca en Oftalmologia "Joaquim Barraquer" - UAB

4. Publicaciones 4.1 Publicaciones en revistas indexadas Las 10 primeras revistas de oftalmologia tienen un promedio de 3.7 de factor de impacto. Ordenadas por factor de impacto: Michael R, Bron AJ. The ageing lens and cataract: a model of normal and pathological ageing. Philos Trans R Soc Lond B Biol Sci. 2011;366(1568):1278-92. Review. DOI: 10.1098/rstb.2010.0300 / PMID: 21402586 Impact factor: 6.0 De La Paz MF, De Toledo JA, Charoenrook V, Sel S, Temprano J, Barraquer RI, Michael R. Impact of Clinical Factors on the Long-Term Functional and Anatomic Outcomes of Osteo-odonto-keratoprosthesis and Tibial Bone Keratoprosthesis. Am J Ophthalmol. 2011;151(5):829-839.e1. DOI:10.1016/j.ajo.2010.11.011 / PMID: 21310387 Impact factor: 3.8 Piñero DP, Alio JL, Tomás J, Maldonado MJ, Teus MA, Barraquer RI. Vector analysis of evolutive corneal astigmatic changes in keratoconus. Invest Ophthalmol Vis Sci. 2011;52(7):4054-62. DOI: 10.1167/iovs.10-6856 / PMID: 21372010 Impact factor: 3.4 Mikielewicz M, Kotliar K, Barraquer RI, Michael R. Air-pulse corneal applanation signal curve parameters for the characterisation of keratoconus. Br J Ophthalmol. 2011;95(6):793-8. DOI: 10.1136/bjo.2010.188300 /PMID: 21310802 Impact factor: 2.9

Càtedra de Recerca en Oftalmologia "Joaquim Barraquer" - UAB

Publicaciones en revistas indexadas Piñero DP, Alió JL, Barraquer RI, Uceda-Montanes A, Murta J. Clinical characterization of corneal ectasia after myopic laser in situ keratomileusis based on anterior corneal aberrations and internal astigmatism. J Cataract Refract Surg. 2011 Jul;37(7):1291-9. DOI: 10.1016/j.jcrs.2010.12.063 / PMID: 21700106 Impact factor: 2.7 Alió JL, Piñero DP, Alesón A, Teus MA, Barraquer RI, Murta J, Maldonado MJ, Castro de Luna G, Gutiérrez R, Villa C, Uceda-Montanes A. Keratoconus-integrated characterization considering anterior corneal aberrations, internal astigmatism, and corneal biomechanics. J Cataract Refract Surg. 2011;37(3):552-568. DOI:10.1016/j.jcrs.2010.10.046 / PMID: 21333878 Impact factor: 2.7 Nieto-Miguel T, Calonge M, de la Mata A, López-Paniagua M, Galindo S, de la Paz MF, Corrales RM. A comparison of stem cell-related gene expression in the progenitor-rich limbal epithelium and the differentiating central corneal epithelium. Mol Vis. 2011;17:2102-17. DOI: no / PMID: 21850186 Impact factor: 2.5 Michael R, Guevara O, de la Paz M, Alvarez de Toledo J, Barraquer RI. Neural contrast sensitivity calculated from measured total contrast sensitivity and modulation transfer function. Acta Ophthalmol. 2011;89(3):278-83. DOI: 10.1111/j.1755-3768.2009.01665.x / PMID: 19909292 Impact factor: 2.4 van Rijn LJ, Nischler C, Michael R, Heine C, Coeckelbergh T, Wilhelm H, Grabner G, Barraquer RI, van den Berg TJ. Prevalence of impairment of visual function in European drivers. Acta Ophthalmol. 2011;89(2):124-31. DOI: 10.1111/j.1755-3768.2009.01640.x. / PMID: 19832733 Impact factor: 2.4

Càtedra de Recerca en Oftalmologia "Joaquim Barraquer" - UAB

Publicaciones en revistas indexadas Javaloy J, Alió JL, El Kady B, Muñoz G, Barraquer RI, Maldonado MJ. Refractive outcomes and quality of vision related to an outbreak of diffuse lamellar keratitis. J Refract Surg. 2011;27(11):804-10. DOI: 10.3928/1081597X-20110411-02. / PMID: 21563731 Impact factor: 2.3 Reverter JL, Nadal J, Ballester J, Ramió-Lluch L, Rivera MM, Fernández-Novell JM, Elizalde J, Abengoechea S, Rodriguez J-E Diabetic Retinopathy Is Associated with Decreased Tyrosine Nitrosylation of Vitreous Interleukins IL-1α, IL-1β, and IL-7. Ophthalmic Res 2011;46:169-174 DOI: 10.1159/000323812 / PMID: 21447989 Impact factor: 1.3 Capella MJ, Alvarez de Toledo J, de la Paz MF. Limbal stem cell deficiency following multiple intravitreal injections. Arch Soc Esp Oftalmol. 2011;86(3):89-92. DOI: 10.1016/j.oftal.2010.11.018 / PMID: 21511104 Impact factor: Verdaguer P, Fideliz de la Paz M, Alvarez de Toledo JP, Barraquer RI. Interferon alpha 2β, partial keratectomy and amniotic membrane transplant for the treatment of a recurrent conjunctival squamous carcinoma. Arch Soc Esp Oftalmol. 2011;86(5):154-7. DOI:10.1016/j.oftal.2011.01.010 / PMID: 21624656 Impact factor: -

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

4.2 Presentaciones en congresos internacionales

The Association for Research in Vision and Ophthalmology

Presentation Abstract Program#/Poster#:

817/D965

Abstract Title:

Elastic Properties Of Human Lens Zonules In Presbyopic Donor Eyes As A Function Of Age

Presentation Start/End Time:

Sunday, May 01, 2011, 11:15 AM - 1:00 PM

Session Number:

132

Session Title:

Crystalline Lens, Presbyopia, Accommodation and Its Restoration

Location:

Hall B/C

Reviewing Code:

101 accommodation and presbyopia, in vivo and in vitro -VI

Author Block:

Marek Mikielewicz, Carlos H. Gordillo, Gustavo A. Montenegro, Rafael I. Barraquer, Ralph Michael. Instituto Barraquer, Barcelona, Spain.

Keywords:

404 accommodation; 413 aging; 650 presbyopia

Abstract Body:

Purpose: To measure ex-vivo the stress-strain relationship of the human lens zonules. Methods: Eleven presbyopic human donors eyes were classified by age in three groups (median age 60, 73 and 90 years) and measured in a device consisting of a rigid bench for holding and stretching coronal eye sections including the ciliary-lens zone. Radial stretching was created by a stepper motor coupled to a digital outside micrometer for linear displacement and distance measurement, and a digital balance for load measuring. Results: Zonular elongation by 200 µm produced a mean load of 4.4; 3.3 and 2.8 mN in the different age groups (60, 73 and 90 years respectively). Increased elongation above physiological limits to 650 µm resulted in a mean load of 9.2; 6.9 and 6.2 mN, respectively. (10 mN = 1.02 g) Conclusions: The force needed to stretch the human lens zonules decreases between the age of 60 to 90 years by about 30%.

CommercialRelationships: Marek Mikielewicz, None; Carlos H. Gordillo, None; Gustavo A. Montenegro, None; Rafael I. Barraquer, None; Ralph Michael, None Support:

None

©2011, 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.

Presentation Abstract Program#/Poster#:

3364/D811

Abstract Title:

Comparison Of Fibrin Glue And Sutures For Conjunctival Autograft In primary Pterygium Surgery

Presentation Start/End Time:

Tuesday, May 03, 2011, 1:45 PM - 3:30 PM

Session Number:

356

Session Title:

Pterygium and Corneal Surgery

Location:

Hall B/C

Reviewing Code:

344 pterygium - CO

Author Block:

Hernan Martinez-Osorio1,2, Laia Rafat1,2, Maria De la Paz1, Jose Temprano1, Gustavo A. Montenegro2A, Ralph Michael2, Victor Charoenrook1, Rafael I. Barraquer1,2. 1Centro de Oftalmologia Barraquer, Barcelona, Spain; AResearch, 2Institut Universitari Barraquer, Barcelona, Spain.

Keywords:

662 pterygium; 474 conjunctiva; 549 imaging/image analysis: clinical

Abstract Body:

Purpose: To compare pterygium excision conjunctival autograft surgery using Tissucol fibrin glue versus Nylon sutures. Methods: Retrospective comparative case study. Forty one patients (mean age: 42.15 years) with primary pterygium were operated with sutured graft (n=19) or glued graft (n=21). Patients were operated by two surgeons. Standard conjunctival autograft was sutured with nylon (JT) or the autograft was placed with Tissucol fibrin glue (MP). Outcome measures included visual acuity, refraction, pterigyum area, complications and recurrence rates. Patients were followed up to at least 12 months. Results: There were no differences in skin's colour, iris's colour or pterygium's area among the groups. In both groups, darkest iris were more common (grade 3: n=19 or grade 4: n=14). More females were operated by fibrin glued conjunctival autografting (n=16) than sutured surgery (n=5) (p 0.001). There were no changes in visual acuity or refraction. At week 1, conjunctival hemorrhage was more frequent in the glue's group (n=10) than suture's group (n=0) (p 0.0002), as well as, conjunctival edema in glue's group (n=14) vs suture's group (n=7) (p 0.06). At 12 months, there were no recurrences in the glue's group and one recurrence in the suture's group (not significantly different). Conclusions: Fibrin glued and sutured conjunctival autografting procedures are safe and effective methods for pterygium surgery. Conjunctival autograft with fibrin glue showed more complications than sutured surgery, however autograft recurrence rate at 12 months was not statistically significant between groups.

CommercialRelationships: Hernan Martinez-Osorio, None; Laia Rafat, None; Maria De la Paz, None; Jose Temprano, None; Gustavo A. Montenegro, None; Ralph Michael, None; Victor Charoenrook, None; Rafael I. Barraquer, None Support:

None

ÂŠ2011, 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.

Presentation Abstract Program#/Poster#:

3804/D937

Abstract Title:

Longitudinal Variability Of Biomarkers for Dry Eye Disease - Implications for Clinical Trials

Presentation Start/End Time:

Tuesday, May 03, 2011, 3:45 PM - 5:30 PM

Session Number:

376

Session Title:

Dry Eye Disease I

Location:

Hall B/C

Reviewing Code:

186 dry eye disease - CO

Author Block:

Benjamin D. Sullivan1, Baris Sonmez2, María F. de la Paz3, Michael S. Berg1, Michael A. Lemp4. 1TearLab Corp, San Diego, CA; 2School of Medicine, Ondokuz Mayis University, Samsun, Turkey; 3Centro de Oftalmologia Barraquer, Barcelona, Spain; 4Ophthalmology, Georgetown & George Washington Univ, Lake Wales, FL.

Keywords:

486 cornea: tears/tear film/dry eye; 479 cornea: clinical science; 466 clinical (human) or epidemiologic studies: treatment/prevention assessment/controlled clinical trials

Abstract Body:

Purpose: The purpose of this study was to evaluate normative statistics of biomarkers for dry eye disease over time periods typical of clinical trials. An additional therapeutic arm continued to follow a subset of patients on Restasis therapy to determine the comparative efficacy of signs in measuring treatment effect. Methods: Bilateral tear film breakup time (TBUT), Schirmers, staining, meibomian gland grading, OSDI, and tear osmolarity were measured over three consecutive months. 52 subjects completed the study across two sites (n=16 mild/moderate, n=36 severe dry eye). 10 subjects were prescribed Restasis and signs were recorded for an additional three months. To compare variability, the average observed range (as defined by the difference of maximum and minimum values of the more severe eye across all three visits) was calculated as a percentage of the dynamic range for each marker. Results: Tear osmolarity (16.7±12.2%) was found to have significantly less variability over three months than TBUT (30.2±26.1%, p<0.001), Schirmers (30.6±26.5%, p<0.001), meibomain gland scoring (26.5±16.5%, p<0.001) and OSDI (24.8±18.4%, p<0.01). Across all subjects, there was no difference between osmolarity and corneal (12.6±15.3%, p<0.14) or conjunctival (15.4±17.9%, p<0.67) staining. However, the majority of subjects at one site (20/31) demonstrated zero staining, artificially lowering its average variability. Osmolarity variation was significantly less in mild patients (11±6%) than in severe patients (19±13%, p<0.03). For subjects enrolled in the therapeutic arm, the average pretreatment osmolarity was significantly reduced from 341±18 mOsms/L to 307±8 mOsms/L (p=0.000002), while OSDI was significantly reduced from 51±18 to 38±18 (p=0.04). None of the other signs demonstrated a significant change in response to treatment. Conclusions: The longitudinal variability of tear film osmolarity is significantly less than the other biomarkers of dry eye disease. Changes in osmolarity were paralleled by changes in symptoms during therapy.

CommercialRelationships:

Benjamin D. Sullivan, TearLab, Corp. (I, E), TearLab, Corp., US7017394 (P); Baris Sonmez, None; María F. de la Paz, None; Michael S. Berg, TearLab, Corp. (I, E);

Presentation Abstract Program#/Poster#:

4717/D775

Abstract Title:

Comparison Between Retroillumination And Slitlamp-derived Reflected-light Images In Patients With Posterior Capsule Opacification

Presentation Start/End Time:

Wednesday, May 04, 2011, 1:45 PM - 3:30 PM

Session Number:

460

Session Title:

Cataract Surgery I

Location:

Hall B/C

Reviewing Code:

140 cataract surgery - LE

Author Block:

Ralph Michael1, Gustavo A. Montenegro1, Patrick Marvan2, Alois Dexl2, Günther Grabner2, Rafael I. Barraquer1. 1Institut Universitari Barraquer, Barcelona, Spain; 2University Eye Clinic, Paracelsus Medical University, Salzburg, Austria.

Keywords:

649 posterior capsular opacification (PCO); 549 imaging/image analysis: clinical; 627 optical properties

Abstract Body:

Purpose: To compare retroillumination with slitlamp-derived reflected-light images for posterior capsule opacification grading and determine their correlation with retinal straylight. Methods: Forty-one patients (53 eyes) with PCO prior to YAG capsulotomy treatment at the Centro de Oftalmología Barraquer in Barcelona or the University Eye Clinic, Paracelsus Medical University in Salzburg, were included. Retinal straylight was measured using the C-Quant instrument (Oculus GmbH, Wetzlar, Germany) under photopic condition. Photographs were taken with a digital camera attached to a slit lamp with angles of illumination of 1º (retroillumination) and 45º (reflected-light) to document PCO level. Images were subjectively graded on a scale of 0 to 10 and using the POCOman system. Results: Subjective PCO score on retroillumination images showed a statistically significant correlation with the retinal straylight values (r = 0.414; p = 0.003). A similar correlation was found using the POCOman severity score (r = 0.340; p = 0.013). Subjective PCO score on reflected-light images also correlated with the retinal straylight values (r = 0.403; p = 0.006). Conclusions: The different light scattering pattern in the forward and backward direction may explain the only mild correlation between retinal straylight and PCO scores on retroillumination and reflected-light images. The C-Quant instrument measures light that scatters forward to the retina whereas PCO grading uses light that scatters back from the posterior capsule.

CommercialRelationships: Ralph Michael, None; Gustavo A. Montenegro, None; Patrick Marvan, None; Alois Dexl, None; Günther Grabner, None; Rafael I. Barraquer, None Support:

None

Presentation Abstract Program#/Poster#:

5124/D823

Abstract Title:

Comparison of Storage of Cultured Human Limbal Epithelial Cells in HEPESMEM, Optisol-GS and PAA Quantum 286 for 4 days at 23°C

Presentation Start/End Time:

Wednesday, May 04, 2011, 3:45 PM - 5:30 PM

Session Number:

481

Session Title:

Stem Cell and Bioengineering

Location:

Hall B/C

Reviewing Code:

156 cornea: stem cell - CO

Author Block:

Tor P. Utheim1A, Øygunn A. Utheim1A, Jon R. Eidet1B, Maria de la Paz2, Sten Raeder3, Borghild B. Roald1C, Torstein Lyberg1B. AOphthalmology, BCenter for Clinical Research, CPathology, 1Oslo University Hospital, Oslo, Norway; 2Institut Universitari Barraquer/Universitat Autonoma de Barcelona, Barcelona, Spain; 3Ophthalmology, Stavanger University Hospital, Stavanger, Norway.

Keywords:

482 cornea: epithelium; 483 cornea: storage; 421 anterior segment

Abstract Body:

Purpose: The feasibility of storage of cultured human limbal epithelial cells (HLEC) in serum-free media for as much as 4 days has not been demonstrated. Eye bank storage in a closed container enables important advantages: 1) transportation to eye clinics without culture facilities; 2) quality and microbiological assessment; and 3) increased flexibility in terms of operation time. Methods: 2-week HLEC cultures were stored in serum-free (HEPES-MEM and Optisol GS) or serum-containing (PAA Quantum 286) media for 4 days at 23°C in a closed container. Analyses included light microscopy, immunohistochemistry, and a calceinacetoxymethyl ester/ethidium homodimer 1 viability assay. The Mann-Whitney test was applied for statistical evaluation. Results: Cultured HLEC stored in HEPES-MEM, Optisol-GS and PAA Quantum 286 for 4 days were well-preserved, attaching satisfactorily to the amniotic membranes with occasional intercellular edema. Basal layer viability of cultured HLEC prior to storage (98.1% ± 2.6%) was compared with viability after 4 days of storage in HEPES-MEM (97.3% ± 2.5%; p = 0.22), Optisol GS (91.5% ± 9.7%; p < 0.05), and PAA Quantum 286 (94.6% ± 2.5%; p < 0.01). The epithelial thickness prior to storage (29.0 µm ± 12.1 µm) was compared with the thickness after 4 days of storage in HEPES-MEM (21.2 µm ± 5.8 µm; p = 0.46), Optisol GS (15.4 µm ± 6.6 µm; p < 0.05), and PAA Quantum 286 (22.7 µm ± 16.0 µm; p = 0.32). Conclusions: The present study demonstrates successful storage of cultured HLEC in serum-free HEPES-MEM for 4 days. This may increase the availability of ocular surface stem cell therapy worldwide.

CommercialRelationships:

Tor P. Utheim, Patent applications on storage of epithelial cells have been filed (P); Øygunn A. Utheim, Patent applications on storage of epithelial cells have been filed (P); Jon R. Eidet, None; Maria de la Paz, None; Sten Raeder, Patent applications on storage of epithelial cells have been filed (P); Borghild B. Roald, None; Torstein Lyberg, Patent applications on storage of epithelial cells have been filed (P)

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

European Society of Cataract & Refractive Surgeons

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Anterior Lamellar Keratoplasty

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EuCornea Medal Lecture

Moderators: F. Malecaze FRANCE, R. Nuijts THE NETHERLANDS, L. Laroche FRANCE KEYNOTE: V. Sarnicola ITALY DALK: Management of complications P. Vinciguerra ITALY ALK: Optical and functional considerations

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M. Jancov SERBIA Photoablation and crosslinking M. Muraine FRANCE DALK versus penetrating keratoplasty B. Cochener FRANCE Intracorneal ring segment surgery: Decision tree J. F. Alfonso SPAIN Intracorneal ring segment surgery: Customization F. Hafezi SWITZERLAND Crosslinking in children F. Raiskup GERMANY New developments in crosslinking

Keratoprosthesis

Moderators: C. Liu UK, G. Grabner AUSTRIA KEYNOTE: G. Grabner AUSTRIA Keratoprostheses - why, when and which? S. Hannush USA The nuts and bolts of the Boston Type 1 KPro. A surgical snap shot J. de la Cruz USA The rise and rise of the Boston Type 1 KPro.Innovations, indications and patient selection S. Cortina USA Boston Type 1 KPro complications.Prevention, recognition and management M. Belin USA Boston Type 1 KPro in the developing world.Particular challenges - infection, inflammation, follow up and

economics A. Bussutil UK Psychological assessment and support for KPro patients.The role of the clinical psychologist and patient self help groups K. Hille GERMANY A Tooth for an Eye: Demystification of the Osteo-odonto-keratoprosthesis (OOKP) M. de la Paz SPAIN Strategies for edentulous patients requiring a mucous membrane covered epi-corneal device. Allograft, tibia or Boston Type 2 KPro. F. C. Lam UK OOKP Complications: Highlights of ongoing work on resorption and extrusion, and glaucoma C. Hull UK Optical considerations in artificial cornea D. Tan SINGAPORE The future of keratoprosthesis

Corneal Imaging

Moderators: L. Modis HUNGARY, M. Belin USA KEYNOTE: M. Belin USA 3D corneal topography/tomography in corneal diseases M. Rolando ITALY Diagnostic tools in ocular surface disorders J. Szaflik POLAND Anterior segment OCT in anterior segment disorders O. Stachs GERMANY Confocal microscopy, an inner vision of the cornea Z. Gatziofas GERMANY Ocular response analyser and corneal bio mechanics L. Modis HUNGARY Corneal endothelial imaging

Eye Banking for the Corneal Surgeon

Moderators: J. Hjortdal DENMARK, I. Dekaris CROATIA KEYNOTE: J. Armitage, UK Impact of donor factors on graft survival I. Dekaris CROATIA The European Eye Bank Association D. Tan SINGAPORE Challenges of eye banking in Asia I. Claerhout BELGIUM EU legislation: harvest, testing, quality control P. Maier GERMANY Principles of organ culture and cold storage M. Claesson SWEDEN European quality registers on corneal grafting J. Hjortdal DENMARK Pre-cutting of grafts for posterior lamellar keratoplasty P. Fagerholm SWEDEN Synthetic corneal grafts

Corneal Complications of Refractive Surgery

Moderators: B. Cochener FRANCE, R. Nuijts THE NETHERLANDS KEYNOTE: B. Cochener FRANCE Dry Eye : not to misjudge

J. Colin FRANCE Interface complications : has the femtosecond solved our problem F. Malecaze FRANCE Secondary ectasia : the fear in photoablation R. Nuijts THE NETHERLANDS Endothelial damage : the fear in phakic implantation R. Doyle Stulting USA U.S. long term evaluation of post LASIK ectasia

New Research in Cornea

Moderators: T.A. Fuchsluger GERMANY

KEYNOTE: C. Cursiefen GERMANY Novel translational strategies to promote graft survival by anti(lymph)angiogenic therapy

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SEM Analysis of the interface quality after deep stromal femtolaser cutting in THIN-C

Session Details Session Title: Femtosecond Laser Session Date/Time: Monday 19/09/2011 | 08:00-10:00 Paper Time: 08:06

Opening Ceremony

Venue: Strauss 2

Binkhorst Medal Lecture

First Author: : J.Alvarez de Toledo SPAIN

Gullstrand Lecture

Co Author(s): :

J. D C. Gordillo C. Gatto R. Quilendrino

JCRS Symposium ISRS Symposium

Abstract Details

Video Symposium on Challenging Cases Combined Symposium of Cataract & Refractive Societies

Purpose:

Austrian Ophthalmology Society

To investigate, after a deep stromal femtolaser lamellar cut on previously deswelled human corneas in THIN-C® (Alchimia), the relationship between femtolaser parameters and the quality of the stromal interface, the ease of tissue separation, the predictability of tissue thickness, the interface smoothness and collagen integrity.

Symposium Refractive Surgery Didactic Course

Setting:

Young Ophthalmologists Programme Workshop on Visual Optics ESCRS Industry-Sponsored Surgical Video Symposia Instructional Courses Surgical Skills Training Courses Surgical Skills Course Schedule John Henahan Prize 2011 Practice Development EBO and Accredited Courses EUROTIMES Satellite Education

: Centro de Oftalmologķa Barraquer. Institut Universitari Barraquer. Universitat Autónoma de Barcelona Methods: Twelve human corneas were incubated from 4h to overnight at 4°C in a deswelling solution (THIN-C®) before femtolaser cut. The iFS Advanced Femtosecond Laser (150 kHz) was used at different settings: energy ranging from 0,6 to 0,8 ?J, spot separation ranging from 2 to 5 microns, cutting depth ranging from 350 to 450 micron, and single or double raster passage. Visante OCT (Carl Zeiss Medic Inc.) equipped with FLEB OCT adaptor (Ophthalmic Biophysics Center, Miami) was used to measure central corneal thickness (CCT) before and after THIN-C® storage and for lamellar tissue thickness measurements after the cut. Surgeon scored ease of tissue separation. After the cut, anterior and posterior tissue was fixed in glutaraldehyde 2.5% for scanning electron microscopy (SEM) analysis of surface smoothness and collagen integrity. Results: Corneal thickness measurement showed that overnight incubation in THIN-C® at 4°C permitted to reduce the pre-storage corneal thickness to an average of 26.4%, resulting in mean CCT of 478.5 micron just before the cut. Mean thickness of obtained posterior lamellae for DSAEK was 152 microns. Double laser passage and 2-3 micron spot separation facilitated the tissue separation. SEM analysis of cutting interface showed that higher spot separation increased surface roughness. Increasing energy settings and the double laser passage lead to collagen melting that was more evident on the interface. Conclusions: The femtolaser parameters including energy, spot separation, single or double raster passage can influence the quality of corneal cutting interface. The use of femtolaser on deswelled corneas permitted to optimize the cutting conditions in order to obtain ultrathin tissue for DSAEK with high surface smoothness and preventing the collagen-melting phenomenon. Financial Disclosure: ... is employed by a forNoneprofit company with an interest in the subject of the presentation, ... research is funded, fully or partially, by a company producing, developing or supplying the product or procedure presented

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

SIS: Restoration of accommodation

• 4331 Accommodative IOL’ s and pseudo accommodation

• 4332 Small aperture keratophakia for correction of presbyopia

PALLIKARIS IG Institute of Optics and Vision, Heraklion

RIHA W, GRABNER G University Eye Clinic, Salzburg

Purpose To analyze the existing lenses designs, properties as well as the new intraocular lens technology in the field of accommodative IOLs.Moreover, to distinguish the difference between accommodation and pseudoaccommodation.

Purpose To assess the safety and efficacy of a small-aperture optic device for the treatment of presbyopia in emmetropic presbyopes.

Methods The restoration of near vision in elder individuals that have entered the presbyopic age is considered one of the major challenges in refractive surgery during the last decade.Accommodative IOLs offer to patients satisfactory near vision by restoring to some degree the dynamic component of the ocular ability for near vision. By implementing several designs of the haptic and the optic part of the IOL, the target is to take advantage of the movement of the ciliary muscle and of the vitreous in order to change position and shape. This offers a change of the overall dioptric power of the eye and the facilitation of near vision.

Methods The Kamra Inlay, formerly known as the AcuFocus ACI corneal inlay (AcuFocus, Irvine, CA), is an ultrathin microperforated, opaque artificial aperture (3.8 mm outer diameter and 1.6 mm inner diameter) made of highly biocompatible polyvinylidene flouride (PVDF). A randomized pattern of minute holes allows nutritional flow through the implant to the anterior stroma. Following creation of a superior-hinged flap in the non-dominant eye, a Kamra inlay was centered on the stroma based on the first Purkinje reflex in 32 emmetropic patients with a mean age of 51.20 ± 2.2 years. Manifest refraction and visual acuity at three years postoperative are reported here. Four year data will be presented at the meeting.

Results Pseudophakic patients’ ability for good distance and near visual acuity without correction has been characterized as apparent accommodation, or pseudoaccommodation. It has been attributed to several factors such as the pupil size, total and corneal aberrations, degrees and axis of astigmatism, potential of visual perception and axial movement of the intraocular lens.the i-Trace technology has an important role in the evaluation of accommodation and pseudoaccommodation in pseudophakic eyes not only subjectively but optically.

Results In the implanted eye, mean spherical equivalent shifted from 0.19 ± 0.22 D preop to 0.08 ± 0.68D at 3 years. Mean UNVA improved from J7/J8 to J1 at 3 years. Mean UIVA went from 20/40 preop to 20/25 at 3 years. Mean UDVA decreased slightly from 20/16 to 20/20 at 3 years. At 3 years, all eyes achieved UDVA of 20/32 or better. Mean binocular UDVA was 20/16. There were no explants. Two inlays had to be recentered due to initial misplacement. During the follow up period, no irritation, inflammatory reactions, or changes in corneal appearance were observed.

Conclusion Accommodative IOLs represent the future in the battle for the correction of presbyopia and restoration of near vision.

Conclusion The Kamra corneal inlay improves near and intermediate vision without severe loss of distance visual acuity in emmetropic presbyopes by increasing the depth of field, based on the small aperture optics concept. Commercial interest

• 4333 Lens refilling (Phaco-Ersatz)

• 4334 The use of electro-optical materials to restore accommodation

PAREL JM 1, HOLDEN BA 2 (1) Bascom Palmer Eye Institute, Miami (2) BHVI UNSW, Sydney

MICHAEL R, BARRAQUER RI Institut Universitari Barraquer, Barcelona

Purpose To demonstrate that the content of the crystalline lens can be replaced in vivo by a polymer designed to mimic the properties of the young lens to restore accommodation while maintaining ametropia, that polymer exchange can be performed anytime during follow-up and that Phaco-Ersatz also allows reversibility to IOL implantation in the bag. Methods A safe endolenticular surgical technique was developed to remove relatively hard nucleus via a small capsulorhexis (~1.2mm) by US phacoemulsification (0.7mm titanium tip). The rhexis is closed by a mini-capsulorhexis valve (~2mm), the polymer injected and then cured by low intensity light delivered by a custom made handprobe. Three families of polymers were developed allowing independent adjustment of the elastic modulus and index of refraction. These polymers were tested in 2 ex-vivo accommodation simulators (EVASI and II) on human and primate eyes and their biocompatibility assessed in monkeys and rabbits for periods up to 8 months. Results A safe endolenticular surgical technique was developed to remove relatively hard nucleus via a small capsulorhexis (~1.2mm) by US phacoemulsification (0.7mm titanium tip). The rhexis is closed by a mini-capsulorhexis valve (~2mm), the polymer injected and then cured by low intensity light delivered by a custom made handprobe. Three families of polymers were developed allowing independent adjustment of the elastic modulus and index of refraction. These polymers were tested in 2 ex-vivo accommodation simulators (EVASI and II) on human and primate eyes and their biocompatibility assessed in monkeys and rabbits for periods up to 8 months.

Purpose We present a review of current developments to restore accommodation by means of electro optical materials embedded in glasses, contact lenses or intraocular lenses. Methods Considered electro optical effects include electro active polymers, electro refractive polymers and the electrowetting principle. Possible solutions about how to measure the accommodation demand and to supply electrical energy inside the eye are also discussed. Results Electrowetting uses the ability of a liquid to maintain contact with a surface and having a certain curved shape which can be altered by an electric field. Electro active polymers can change the size and shape under a changing electric field. Electro refractive polymers change the refractive index under an electric field. The electro active and electro refractive polymers can be put into pixelate optics were each pixel can be adjusted independently. Optical properties, energy consumption and dynamic properties of electro optical applications are compared with other accommodation restoration techniques. Conclusion Commercial application of electro optical materials in glasses already exist, the use in contact lenses and intraocular lenses is under development.

Conclusion Phaco-Ersatz can be performed safely and is an effective method to restore accommodation. Commercial interest

EVER 2011 - Abstract book

161

SIS: Restoration of accommodation

• 4335 Experimental femtosecond laser lens surgery BARRAQUER RI 1, LOZAALVAREZ P 2, OLARTE OE 3, MERINO D 3, MONTENEGRO G 1, MICHAEL R 1 (1) Institut Universitari Barraquer, Barcelona (2) ICFO-The Institute of Photonic Sciences, Castelldefels (Barcelona) (3) ICFO-The Institute of Photonic Sciences, Castelldefels Purpose To review the current developments and new experimental applications of femtosecond lasers (FsL) in lens surgery, including cataract and the treatment of presbyopia. FsL lentotomy has been shown effective to soften the lens matter easing cataract extraction. Because the main cause for presbyopia is the stiffening of the lens nucleus with age, FsL lentotomy could be applied to treat it, provided the cuts inside the lens do not induce a significant opacity. Methods Commercial FsL lasers systems for cataract surgery are already available, using repetition rates of 100 kHz at 1041 nm, similar to those of corneal FsL. We have developed a custom build multimodal non-linear microscopy platform modified to work as a nano-surgery scalpel using a FsL with a repetition rate of 80 MHz at 860 nm. This allows cutting inside the lens matter at a much smaller scale than the current lens surgical FsL systems. Results Using a single FsL system, we imprinted complex patterns in 2D and 3D configurations inside human donor lenses. These results were analyzed through transmitted infrared light and Two-Photon Excitation Fluorescence (TPEF) microscopy. We observed an increase of the TPEF signal on the targeted regions. In addition, we found that the caused damage is highly confined without any apparent effect on the surrounding tissue. Conclusion While current FsL lentotomy systems can soften the lens nucleus to ease cataract extraction, optical quality at the optical axis is compromised. Experimental FsL with modified parameters is able to further confine the damage in order to preserve the lens clarity, a requirement for FsL lens presbyopia surgery.

162

EVER 2011 - Abstract book